Advances in fertility at the
Emory Reproductive Center
Three years ago, Catherine O’Neal and her husband William Chris O’Neal 04MBA decided they were ready to welcome a new member into their family. At twenty-eight, Catherine O’Neal never really believed she would have trouble conceiving a baby, although she had been told that having polycystic ovaries—ovaries that produce eggs sporadically rather than regularly—could present a challenge.
When months went by with no positive pregnancy test, they began to get worried. After going through a few routine steps with O’Neal’s regular OB-GYN, the couple turned to Emory Reproductive Center for more specialized treatment.
Established in 2003 on a top floor of Emory Crawford Long Hospital, the Reproductive Center was envisioned as a full-service fertility clinic with the most up-to-date technologies and treatments. From the stunning window views of Midtown Atlanta to the attractive artwork, soothing lighting, and friendly staff, the clinic is designed to offer a positive experience to patients who are likely to arrive anxious, frustrated, and even embarrassed by their inability to become pregnant.
“It’s hard, especially when you are young,” O’Neal says. “I have a lot of friends who have had children very easily. People don’t understand that it affects how you think of yourself as a person when you can’t get pregnant. You feel like something is wrong with you.”
One of the most remarkable features of the center, according to medical director Donna Session, associate professor of gynecology and obstetrics, is that the clinic itself encompasses virtually every service a couple may require—from having blood drawn to procedures that require anesthesia. This allows the center’s one-hundred-plus patients per week the comfort and convenience of visiting just one place.
“We have a great deal of control over all the factors that might increase one’s chances of becoming pregnant, particularly through in vitro fertilization,” Session says. “For instance, we are completely removed from gas anesthesia, and we don’t permit any scents or perfumes. Embryos are very sensitive to things like light, pH, temperature, cleaning agents—here we can manage these factors.”
Session tends to begin treatment fairly quickly, since age is one of the more important factors in a woman’s ability to conceive. As women approach their mid to late thirties, the chances for pregnancy decline significantly. This is a challenge in a culture of women that increasingly have waited until relationships and careers are firmly established before having children—often in the late thirties and even early forties.
“There are so many news articles about older women having children,” Session says, “but that can be misleading. Patients should not think it’s easy to get pregnant late in life.”
O’Neal began the complex process of fertility treatment: first oral medication—typically chlomiphene citrate, commonly used to induce ovulation, and hormones including estrogen and progesterone—then injectable medication, often followed by artificial insemination. Such treatments carry about a 15 to 18 percent success rate, although they also bring an increased chance of multiple babies, considered a less desirable outcome because multiples place both babies and mother at increased risk for a range of complications.
“Our aim is always to use the least technology necessary to achieve the desired result,” says Sarah Berga, professor and chair of Emory’s Department of Gynecology and Obstetrics. “We have all the highest technology, but we use it only when it is absolutely necessary.”
But in O’Neal’s case, early treatments were unsuccessful. She did become pregnant twice over the course of several months, but miscarried both fetuses due to chromosomal abnormalities. Often, such pregnancies go undetected or the cause of miscarriage remains unknown. But because she was being closely monitored at the Reproductive Center, she and Chris took advantage of the opportunity to conduct chromosomal testing on the fetuses in order to get the clearest possible picture.
“Dr. Session and her staff were wonderful during those really painful losses,” O’Neal says. “They never made us think we were not going to be able to have a baby. It’s difficult to stay hopeful, but they were great about saying, ‘Don’t worry, if this doesn’t work we can always try this.’ ”
For the O’Neals, as for many couples, the final “this” turned out to be in vitro fertilization (IVF)—the delicate process of fertilizing the egg outside the womb, then re-implanting it in the uterus. Medication is first administered to stimulate the ovaries to produce more eggs than occur in a natural cycle, Session explains. Some ten days later, when the eggs are mature, they are retrieved from the ovaries, cushioned in follicle fluid, via a long needle that the physician maneuvers using an ultrasound screen. Ideally, some ten to twenty eggs are transferred to incubator cups, where they are fertilized with sperm the same day. The fertilization rate is about 70 percent.
A few days later, one to two fertilized embryos are transferred back into the woman’s uterus through a thin tube, where one or both have every chance of developing normally; the rest may be frozen for future use. In women under thirty-five, in vitro fertilization offers about a 59 percent success rate, with some 20 percent resulting in twins, according to Session.
Patients also can choose to conduct preimplantation genetic diagnosis (PGD), in which embryos are tested for specific disorders including chromosomal abnormalities such as Down syndrome. Because there is a genetics department at Emory, patients who opt for genetic testing are able to get results the same day. Soon, Emory researchers hope to be able to offer microarray testing, a technique that would allow for thousands of factors to be tested on one microchip.
For many couples, just deciding to try to have a baby can be stressful as well as exciting; participating in infertility treatment is likely to multiply their anxiety a hundredfold, as O’Neal can attest. Ironically, such stress can further inhibit their ability to conceive.
The connection between stress and fertility is a research specialty for Berga, who has studied its effects for more than two decades. “A long time ago, I noticed that a group of patients was having trouble ovulating. I was told that we really didn’t understand why, and it didn’t matter,” she says. “I thought, that’s weird, why wouldn’t we want to know why?”
Berga began to study what happens to the body when the stress system is activated. Among other things, she found that in some cases, the stressed-out brain can actually “go silent” to the ovaries, failing to send the signal to ovulate. She worked with patients on using cognitive behavior therapy to change problematic attitudes and habits and reduce stress levels. “Basically, we were the first to show that stress reduction affected ovulation in a direct way,” she says.
Patients at the Emory Reproductive Center receive a packet of information about coping with stress, including a coupon for a series of visits to a spa.
Other areas of research for the four physicians at the center include human uterine biology, endometriosis, polycystic ovary syndrome, and hormone action, Berga says.
For the O’Neals, IVF was the final phase in a long journey to pregnancy: the first time that embryos were transferred, they got the news they had awaited for so long. This time, O’Neal’s pregnancy progressed without incident.
“It was a very intense process,” she says. “It is uncomfortable. But I would do it again.”
Indeed, it is likely she will. The O’Neals have a number of embryos still frozen at the Emory Reproductive Center, which they hope will become the joyful news of a future day.—P.P.P.