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
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
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
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.