PREGNANT PAUSES INCREASING NUMBERS OF WOMEN ARE PUTTING OFF MOTHERHOOD - AND TURNING TO SPECIALISTS TO DEFY FERTILITY STATISTICS.

Byline: Mariko Thompson Staff Writer

TECHNOLOGY CAN CREATE LIFE in a petri dish, allow postmenopausal women to experience birth and give parents the ability to select the sex of their child. All amazing feats, yet science still can't do one thing: It can't make a woman's eggs young again.

So when news stories issued warnings to women in their 30s about declining fertility rates following a recent study by the National Institute of Environmental Health Sciences, Robin Roberts was relieved to see attention shifting from technological feats to biological reality.

``Not one of us can take fertility for granted,'' said Roberts, president of the support group Resolve of Greater Los Angeles. ``In hearing about the technology, people assume there will be an answer. Hollywood actresses and other successful women over 40 - who are likely using donor eggs - give the illusion that our fertility can be extended, and it can't.''

Able to weed out behavior from biology, the NIEHS study was considered significant for adjusting for such variables as timing and frequency of intercourse. What researchers found came as no surprise to top infertility specialists, but might dismay women who have delayed childbearing into their 30s.

Disappointing statistics

The study saw a 50 percent drop in the probability of pregnancy between women in their early 20s and women in their late 30s, when having intercourse at the most optimal time in their menstrual cycle.

The data came from seven European medical centers engaged in a large- scale fertility study. When couples had intercourse at the most fertile peak of the woman's cycle, those ages 19 to 26 had a 50/50 chance of conceiving. Between ages 27 and 34, the percentage fell to 40 percent in a given cycle. The conception rate dropped below 30 percent for couples ages 35 to 39.

The findings mirror what several top infertility specialists have concluded from their work with couples. For women over the age of 35, particularly those looking to have their first child, pregnancy can be difficult to achieve.

``I don't want to make women too paranoid,'' said Dr. Richard Paulson, chief of reproductive endocrinology at USC's Keck School of Medicine. ``It's important to be informed. Between 30 and 35, the pregnancy rates are almost the same as for women in their 20s. The only caution is you might not get pregnant right away. After 35, it's risky. And after 40, you're really flipping a coin.''

Statistics show that more women are challenging the odds. According to the Centers for Disease Control and Prevention's National Vital Statistics Report for 2001, the number of women over 30 giving birth reached the highest mark in three decades.

Whether more women are wrestling with age-related infertility as a result of delaying childbearing or are simply more aware of the alternatives is open to debate. Depending on the source, the chance a couple will be infertile runs as high as one in six. But Paulson doesn't put much stock in such figures. The first in-vitro baby was born in 1981, making infertility a relatively young field.

``Fifty years ago, you didn't go see the doctor,'' Paulson said. ``You adopted or gave up. Infertility is out of the closet now.''

Paulson, who directs USC's in-vitro fertilization program and pioneered the use of donor eggs in postmenopausal women, discovered that a woman has two biological clocks - one for her eggs, the other for her uterus. Eggs deteriorate. But the uterus, even as late as age 63, can still nurture life.

That may be small comfort for women who yearn to get pregnant with their own eggs. Though male infertility, possibly due to environmental factors, is on the rise, female egg quality still represents the largest factor in the equation.

``It's not individual at all,'' said Dr. Joyce Vargyas, a reproductive endocrinologist at Santa Monica-UCLA Medical Center who helped launch UCLA's in-vitro fertilization program in 1980. ``What we're talking about with age-related infertility is the number of years that our ovaries have been on this earth.''

Egg freezing might one day extend the first biological clock for women. Worldwide, an estimated 40 babies have been born using frozen eggs. Though some clinics do offer the service, top experts say paying to store eggs is the financial equivalent of junk bonds.

``Right now, there's little evidence that you can do it,'' said Dr. Alan DeCherney, chairman of obstetrics and gynecology at UCLA Medical School and editor of the journal Fertility and Sterility. ``Until something is published and confirmed, you have to be skeptical.''

Staggering expenses

Health insurance covered preliminary tests for 36-year-old Kris Rivera. Then the former broadcast journalist and Studio City resident was on her own. Over the past 16 months, she and her husband have spent an estimated $30,000 on infertility treatments, including ovary stimulation drugs and in-vitro fertilization.

``It's very easy to go into debt,'' Rivera said. ``It's a long road and you have to decide when to get off.''

Only a few states, such as Massachusetts, require that insurance companies cover infertility procedures. And the procedures don't come cheap. These days, there are two forms of treatment with variations: artificial insemination often in conjunction with fertility drugs, and in-vitro fertilization. One cycle of fertility drugs alone costs about $1,500. One IVF cycle runs about $8,000.

With high out-of-pocket costs and more than 300 clinics in the United States, how do couples ensure they're investing in the right doctor? The International Council on Infertility Information Dissemination, a nonprofit advocacy group, provides a wealth of online information for that very reason.

``The single biggest thing is to move couples to specialized care,'' said Theresa Venet Grant, president of INCIID. ``If you've been trying for more than a year, your (obstetrician) isn't going to get you pregnant. Move to someone who does this all day every day, who has the training and experience to help you find a diagnosis and the best course of building your family.''

The CDC has an online posting of data for live birth rates from U.S. fertility clinics. But Grant says the information isn't very useful. A clinic may boast a high birth rate because it turns away older women.

At Paulson's USC clinic, patients using insemination and IVF with their own eggs have a live birth rate ranging from 50 percent for women under 35 to 20 percent for women over 40. For patients using donor eggs, the clinic has a 60 percent live birth rate.

In Vargyas' practice, California Fertility Partners, the live birth rate over the past four years using IVF was 34 percent for women under 40 and 14 percent for women over 40. With donor eggs, the success rate was 42 percent.

To narrow the choices, local couples can turn to Resolve of Greater Los Angeles for guidance. Resolve offers symposia on infertility and adoption, therapist-led and peer-led support groups, a medical helpline and physician referrals. Besides providing a forum to compare notes, Resolve serves as an emotional outlet for the pain and anger that many couples feel.

``There's a tremendous stigma associated with infertility,'' Resolve president Roberts said. ``Many couples experience shock and a sense of shame because they aren't able to accomplish one of the basic human functions - reproducing.''

An emotional process

Depressed after the first attempt to harvest her eggs failed, Rivera joined Resolve last November. She thought her research skills from years as a news reporter had prepared her for the ordeal. But she underestimated the emotional stress, the physical reactions to the fertility drugs, and the constant doctor's appointments that treatment would bring. Unable to juggle motherhood, infertility treatments and a career, she quit her job.

``It's such a difficult process,'' said Rivera, who has a 5-year-old son. ``I don't wish this on anyone.''

After having her son, Rivera tried to get pregnant again. Her OB kept telling her to give it time. After two years, she finally went to an infertility specialist, who discovered that her uterus was heavily scarred.

A year ago, she had laser surgery to remove the scar tissue. Then she started IVF treatments. Rivera had to experiment with different doses of the stimulation drugs. Because the drugs initially induce a menopausal state, she struggled with night sweats, hot flashes, insomnia and mood swings.

Since November, she's made three more IVF attempts. In one, she had four embryos implanted but didn't get pregnant. The other two cycles had to be canceled, the most recent in July.

Still, she plans to give IVF one more try. So she waits for the next time and gains solace from other women who also live by the calendar.

``My life is spent waiting for my period now,'' Rivera said. ``I've met all these women going through it. You're in this secret club and you don't want to be in it.''

CONCEIVE A GAME PLAN TO BEAT INFERTILITY

Q: What is infertility?

A: The inability to conceive or to carry a pregnancy to term.

Q:When should couples seek help?

A: Women under 35 should seek an initial consultation after one year of unprotected intercourse. Those with other risk factors, such as prior pelvic surgery or a ruptured appendix, might want to get preliminary tests after six months.

Women older than 35 should seek an initial consultation after no longer than six months.

Q: What should a couple look for when selecting a specialist?

A: Make sure your doctor is a board-certified reproductive endocrinologist (unless he or she is a pioneer in the field).

Meet other couples in local support groups and learn from their experiences.

Q: What steps will couples seeking treatment take?

A: Preliminary tests: Examine ovaries, fallopian tubes, uterus, cervix and sperm.

Artificial insemination: Concentrated sperm is placed high in the uterus, either with or without the aid of drugs to stimulate the ovaries. Insemination costs about $500 per cycle. Fertility drugs cost about $1,500 per cycle.

In vitro fertilization: Sperm is injected into the egg in the laboratory and then planted in the uterus. One cycle of IVF costs about $8,000.

IVF with donor eggs: If a woman is unable to use her own eggs, she can use donor eggs. Egg donor and agency fees vary, but expect to pay about $8,000 in addition to IVF costs.

Surrogate mother: In gestational surrogacy, the carrier receives an embryo from the intended parents, or from donor eggs or sperm. In traditional surrogacy, the carrier also provides the egg. Costs vary by agency, but typically include agency, surrogate, legal and counseling fees. A conservative estimate, based on surveying surrogate parenting service Web sites, starts at about $32,000, excluding egg donation, medical treatment and delivery costs. Total cost is likely to exceed $50,000.

Seek legal counsel when pursuing donor egg, donor sperm or surrogate services.

Q: What about the stories about women taking fertility drugs and giving birth to five, six and seven babies?

A: Reproductive endocrinologists and consumer advocates say this is more likely to happen with an OB-GYN who is not an infertility specialist than at a reputable fertility clinic, where women taking ovary stimulation drugs are properly monitored.

FOR MORE INFORMATION:

Visit the International Council on Infertility Information Dissemination Web site at www.inciid.org.

Contact Resolve of Greater Los Angeles online at www.resolvela.org or by phone at [phone].

Review assisted reproductive technology success rates at the Centers for Disease Control and Prevention Web site, www.cdc.gov/nccdphp/drh/art.htm.

CAPTION(S):

7 photos, box

Photo:

(1 -- 4 -- cover -- color) Infertility

Couples' questions. Medical experts' answers.

(5) no caption (book: ``Making a Baby: Everything you need to know to get pregnant'' and calendar)

(6 -- 7) Ovary-stimulating fertility injections, left, which cost about $1,500 per cycle, and a variety of over-the-counter monitoring products are parts of the arsenal for women attempting pregnancy.

Charlotte Schmid-Maybach/Staff Photographer

Box:

CONCEIVE A GAME PLAN TO BEAT INFERTILITY (see text)