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Switched at Conception

'I question everything'

Medical miracles or mad science?

Developed in 1978, IVF is a technique in which an egg is fertilized with sperm in a laboratory setting and then implanted in a woman's uterus. It has given new hope to thousands of infertile couples for whom sperm and egg for some reason cannot meet on their own. For example, women with blocked or missing fallopian tubes, and men whose sperm are not vigorous or plentiful enough to make the trip to the egg, now have a chance to become parents.

After suffering two episodes of ectopic pregnancy (an embryo developing in the wrong place, commonly the fallopian tube instead of the uterus) by the age of 25, Gora had lost one of her tubes and found that her other was too badly scarred to allow passage of a fertilized egg to her uterus. "I worked in a hospital at the time, and all the doctors said to me, 'Ectopic pregnancies are dangerous. You should really consider having your eggs fertilized outside your body and just bypass your tubes so you don't have to worry about that happening,' " she says. "And I was told I could store the embryos and have children whenever I wanted."

On the advice of a friend, she made an appointment at the Irvine clinic with Asch, at the time considered one of the leading IVF doctors in the nation. Gora's first impression: "He was very busy. All over his desk there were piles of books and papers. You could tell there was a lot going on."

Gora says Asch suggested she could cut the cost of the procedure in half by participating in a clinical trial studying the effectiveness of a drug used to induce ovulation (egg maturation and release). She thought it over for a few months and agreed.

Ripening, retrieving, fertilizing, implanting

IVF is a complex and highly controlled process involving a team of more than 10 nurses, doctors, lab technicians, and embryologists, says Anthony Luciano, MD, a professor of obstetrics and gynecology at the Center for Fertility and Reproductive Endocrinology in New Britain, Conn. Today, the procedure typically involves the woman getting daily injections of drugs, beginning a few days into her cycle, that stimulate the development of many eggs at once. Doctors monitor the process through blood tests and ultrasound.

About 12 days later, when the developing egg follicles (structures containing the egg and supportive fluid) reach a diameter of 17 millimeters or more, another drug is given to trigger the final stage of egg development. But before the follicles have a chance to release them, the doctor harvests the eggs with a laparoscope (a long tube with a camera and retrieving device on the end), which reaches the ovary by passing through the vagina, uterus, and fallopian tube on that side. Monitoring the laparoscope's journey by ultrasound, the doctor targets the maturing follicles, inserts a fine needle into them, and withdraws their contents. "We look to get at least four eggs, but 12 or more would not be bad either," Luciano says.

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