Life support: Fertility Center of Las Vegas still giving couples hope

Wednesday, July 25, 2001 | 8:32 a.m.

More than 15 percent of the women in America of child-bearing age have received infertility services from one of the almost 400 reproductive clinics around the nation, according to a report published last year by the Society of Assisted Reproductive Technologies (SART).

Recently, the Fertility Center of Las Vegas, one of Southern Nevada's oldest reproductive clinics, celebrated 12 years of creating families for people who might otherwise not have one.

"We are a family builder," Dr. Bruce Shapiro, founder of the clinic, said. "We bring life."

Approximately 1,200 lives since the clinic opened.

"A lot of the kids live in Southern Nevada," office manager Shelley Kreutzer said. "But a lot have moved. They are all over the world now."

Shapiro said fertility problems are about equally divided between men and women.

"About 35 percent of the time it's a male problem, 35 percent of the time its female and the rest is a combined package," he said.

Shapiro said any number of problems can occur that prevent normal reproduction.

"We've seen an increase in the number of women who have started to have sexual relations at an earlier age and have problems later because of tubal damage from sexual diseases," he said. "Also, more younger women are becoming overweight, which interferes with the reproductive system."

Short of direct exposure to radiation, Shapiro said he hasn't seen any links between infertility and environmental issues.

Whatever the cause of infertility, Shapiro said his center probably will have a treatment available, whether it be medication, surgery or simply advice on the best time to have intercourse.

"We can take the sperm, wash the sperm and put it past the cervix and into the uterus, a process called artificial insemination," Shapiro said. If artificial insemination and timing don't work, there is always the test tube, or in-vitro fertilization.

"About 40 percent (of our work) is in vitro," Shapiro said.

Reproductive technology is constantly changing.

"We're on the cutting edge," Shapiro said. "Each year is better than the previous year. We are able to address the problems of more and more people.

"In-vitro fertilization began in 1978, 23 years ago. The pregnancy rate in the early '80s (using the test-tube method) was on the order of 10 to 12 percent ... now, in some sub-groups, it's as high as 70 percent."

The rate is higher and the number of attempts required for fertilization to occur is lower.

"The chance for some sub-groups is high for the first cycle, and for others it takes two or three cycles," Shapiro said.

Multiple births are a major problem in test-tube fertilization. According to SART, about 39 percent of those who use the in-vitro method have two or more babies.

Because of increased risks in multiple births, Shapiro said efforts continue to reduce the number of multiples. Technology, he said, has helped address the problem.

"Now we can allow the embryo to grow an extra two or three days in the lab, cull out the ones with the best qualities and those most likely to result in successful implantation. The result is, fewer embryos are needed, there is a higher pregnancy rate and less multiples."

Before technological advancements, Shapiro said it was difficult to identify the good embryos and therefore large numbers of them were implanted to assure at least one success. However, the large numbers also increased the instances of multiple fertilizations.

"In our center here, singletons outnumber multiples," Shapiro said. "However, some people do request multiple births. We council these patients. One is what humans were designed to carry. More than two and morbidity takes hold. It decreases the likelihood that all the babies will be born in a very healthy state."

Genetic advancements

Genetic engineering is playing an increasingly important role in the field of infertility medicine.

"We are invovled in a multicenter trial right now," Shapiro said. "We're together with a whole group of clinics on the West Coast."

The consortium of clinics are working on a research project in which they perform an embryo biopsy on the third day after fertilization.

"We take out one cell from the embryo to test the genetics to make sure it has all the appropriate chromosomes present and then, if it's abnormal, we don't put the (embryo) back in because it would not result in a viable gestation."

The research will allow doctors to determine if there are pre-existing genetic problems.

"We are particularly interested to see whether or not the embryos we are putting back in that look perfectly normal are actually chromosomally abnormal," Shapiro said.

He said some embryos that look normal are not, and some that don't look normal are in fact normal.

The goal, he said, is to identify the good ones and only implant those.

Infertility, Shapiro said, is directly proportionate to the age of the patient.

"We know that in the general population the fertility rate declines after age 30," he said. "There is a steep decline at 35 and then again at 38 and an even steeper decline after 40.

"Some people proceed along the biological timetable faster than others. What we've tried to do is to detect who is in what group. The women who are biologically young tend to have higher success (reproductive) success rates, 50 to 60 percent in some subsets."

Most women who come to the center are in their mid-30s, Shapiro said.

"By then most women have already tried to get pregnant or they have put off childbearing until their career is on track," he said.

It is still uncommon for a single woman to ask for help. "Uncommon, but becoming a little bit more common," Shapiro said.

Dr. Said Daneshmand joined Shapiro at the center two years ago.

"When I met (Shapiro) I had no doubt who I wanted to work with," Daneshmand said. "Dr. Shapiro and this center have a national reputation."

One of the factors in his decision to come to Las Vegas from Los Angeles was the research aspect of Shapiro's clinic.

"In an effort to improve pregnancy rates, we conduct ongoing research here," Daneshmand said.

All in the family

Jill and Michael Andersen, both 42, are among the center's most satisfied customers. They have four children -- three of them thanks to the local clinic.

Having children was very important to the couple, who are members of the Mormon Church. "All the important things we learn in life, we learn in families," Jill Andersen said.

Their children include Nathan, 13, Sara, 10, Jenna, 7 and Ellie, 3.

Nathan was conceived through the work of the University of California at San Diego because Shapiro had not arrived in Las Vegas when the couple decided to try artificial fertilization.

Conception of the three youngest children was through Shapiro's clinic.

"My problem is a hormone," Jill Andersen said. "My body doesn't produce gonadotropin."

Technically, in most women, the hypothalamus produces Gonadotropin Releasing Hormone (GnRH), which stimulates the pituitary to release gonadotropes, which prepares the body for reproduction.

"I don't ovulate," she said. "It was apparent when I was a teenager. Even before we got married we knew something was wrong and we would have a hard time getting pregnant."

After seven years of trying everything they knew to try, the Andersens were referred to the university hospital in San Diego.

"When we started the process, it only took two months," Jill said.

Most insurance companies won't pay for fertilization services, Michael Andersen said.

But the Andersens were fortunate the first time. The university had a grant that paid for the procedure, which involved inserting a syringe attached to a small pump into her arm. She wore the pump 24 hours a day for more than two months. Every three days she refilled the syringe, which pumped the hormone through an intravenous line into a vein every 90 minutes.

"The doctors in San Diego said out of 2,000 to 3,000 women they see there a year, maybe one might have my particular problem," Jill said.

Two years after Nathan was born, the Andersens decided to have another child. When they married they had wanted a large family, even though they knew at the time it would be difficult to have even one child. Jill Andersen is the eldest of 10 children; Michael the youngest of nine.

"We called the doctors in San Diego when we were ready for baby No. 2 and they told me Dr. Shapiro was in Las Vegas," Jill said. "He had just moved to town. We were thrilled there was finally someone here."

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