Medicine: A Revolution in Making Babies

For hundreds of thousands of years, there was only one way to make a baby, at least for humans. Either it worked or it didn't, and if it didn't, there was little anyone could do about it. All that has changed dramatically. The growing problem of infertility -- exacerbated by a generation of would-be parents who put off having babies until their 30s and 40s -- and the early successes of in-vitro ("test tube") fertilization have laid the groundwork for a revolution in reproductive technology. Hardly a week goes by without news of a breakthrough to help nature take its course. Last week produced two such announcements: one offers new hope to women with blocked Fallopian tubes; the other promises to extend women's fertility beyond their prime childbearing years -- even past menopause.

Of all the barriers to pregnancy, menopause, which shuts down the release of eggs from the ovaries, was long considered the most insurmountable. But though the ovaries may shrivel like raisins, the other reproductive organs of postmenopausal women are still viable. These women can now become pregnant using someone else's eggs, according to a remarkable report in last week's New England Journal of Medicine. A team led by Dr. Mark Sauer of the University of Southern California impregnated six of seven postmenopausal women, ages 40 to 44, using eggs that were taken from younger women and fertilized with sperm from the older women's husbands. Four of these prematurely menopausal women gave birth to healthy offspring, one miscarried, and one had a stillborn baby -- an outcome that Sauer said would have been considered normal with six younger women.

"The limits on the childbearing years are now anyone's guess," wrote Dr. Marcia Angell in an accompanying editorial. Theoretically, donor eggs could allow women whose ovaries have stopped functioning to bear children into their late 40s and 50s. Researchers believe that the new technique will have the biggest impact on women in their 40s who have not yet reached menopause but have failed to conceive. The new findings suggest that these women may be infertile not because their uteruses are too old but because their ovaries . are, and that with eggs donated by younger women their chances of getting pregnant may be as good as those of the young women themselves. The hitch is, of course, that the children developing from such eggs have the genes of the female donor and are genetically unrelated to the mother who bears them -- a fact that presents both legal and ethical problems as yet unresolved.

The other report issued last week focuses attention on the Fallopian tubes, the narrow passages that carry eggs from the ovaries to the uterus. Women whose tubes are clogged with scar tissue or other obstructions cannot conceive by natural means because their eggs have no way of getting to the womb. In the past, such women had to undergo surgery to have their tubes cleared. Now the problem can be overcome in a doctor's office, according to an article in the Journal of the American Medical Association. With a tiny balloon similar to those used to clear blocked arteries, scientists were able to unclog the Fallopian tubes in 64 of 77 women, 22 became pregnant within a year. Dr. Edmond Confino, who pioneered the technique at Mount Sinai Hospital Medical Center in Chicago, estimates that it could help nearly one-third of the 1 million American women who suffer from blocked tubes.