美国国家公共电台 NPR Seeking Fertility Treatment Means Facing High Costs And Low S（在线收听）

DAVID GREENE, HOST:

Fertility treatment is a multibillion dollar industry, and it is growing. People spend thousands of dollars on procedures. And there's no guarantee of success. One Indianapolis woman found out just how tricky this is to navigate.

Lauren Bavis and Jake Harper from the podcast "Sick" have the story.

LAUREN BAVIS: Heather Woock always imagined she'd struggle to get pregnant because her parents did.

JAKE HARPER: A couple years ago, she and her husband tried to start their family.

HEATHER WOOCK: We were doing, like, all of the calendaring and special whatevers. Like, everything that is out there to help you get pregnant, we were doing that. And nothing was working.

BAVIS: Six months later, Heather still wasn't pregnant. So she went to a fertility clinic for some tests.

WOOCK: And I had to fill out all of this paperwork. And there's a slot that says kind of, like, is there anything else you'd like to share?

HARPER: There was something. When Heather's mom went through fertility treatment in 1985, her doctor told her he would perform artificial insemination using anonymous donor sperm. The doctor's name was Donald Cline.

WOOCK: We now know Cline used his own sample and squirted it into my mom.

BAVIS: In the '70s and '80s, Cline deceived dozens of patients that way. He used his own sperm to impregnate them. He has more than 60 biological children and counting. Heather found out in 2017 she's one of them.

WOOCK: I went through an identity crisis. I mean, I couldn't look in the mirror and think about where did my eyes come from? Where did my hair color come from? I didn't even want to think about any of that.

HARPER: Cline's deception was, understandably, on Heather's mind when she went to a fertility clinic. New allegations of doctors using their own sperm keep coming to light in states like Ohio, Colorado and Arkansas. But those inseminations happened decades ago. Could it happen today?

BOB COLVER: It's a very fair question.

BAVIS: That's Bob Colver. He's a fertility doctor in Indiana. He says it's unlikely because there are more people involved, and in vitro fertilization happens in a lab, not an exam room.

COLVER: You know, unless you're in a small clinic where there's absolutely no checks and balances, I can't even imagine that today.

BAVIS: It's now illegal in Indiana, Texas and California for a doctor to use his own sperm. But there's no national law.

HARPER: And there are other gaps in regulation. For example, sperm banks may not get accurate medical histories from their donors. And there's no limit on how many times a donor's sperm can be used.

BAVIS: Another major issue - maybe the biggest one - is that fertility treatment can be really expensive. And patients may start treatment with unrealistic expectations. That's because success rates are complicated. And some clinics only use the best numbers in their advertising. When Heather's doctors told her she needed IVF, she felt pretty optimistic.

WOOCK: I'm thinking, going into this, that our chances of success are 70, 75%.

BAVIS: Clinics advertise fertilization rates that high. But 70% doesn't mean 70% of eggs turn into babies. Plenty can go wrong after the lab combines egg and sperm.

HARPER: Success depends on your age, your clinic and the type of procedure you need. But most of the time, assisted reproduction, like IVF, doesn't work. The Centers for Disease Control and Prevention says only about 24%, a quarter of attempts result in a baby.

BAVIS: Heather gave herself shots, a couple of day. They stimulated her ovaries to get multiple eggs ready at once so doctors could surgically retrieve them. Multiple eggs means more chances for fertilization. The drugs gave her headaches, made her moody, less patient.

WOOCK: I was actually allergic to one of the medications, which means you keep taking it and deal with the itching and rash.

BAVIS: But Heather hung on until it was time for egg retrieval when patients can face even more choices. For example, the clinic offered to use a special device to help pick the best sperm.

WOOCK: We were kind of like, yeah, why wouldn't you? Like, if it's going to give us a better chance, do it.

HARPER: That's called an add-on. Add-ons are often new, described as cutting edge, which can appeal to patients. Jack Wilkinson is a biostatistician at the University of Manchester. His research shows add-ons can increase costs and they may not work.

JACK WILKINSON: Really, we quite often see there's no benefit at all, but possibly even worse, that there's a disadvantage of using that treatment.

HARPER: That device Heather's clinic offered, Wilkinson says it could work, but the evidence is thin.

How long did it take to find out?

WOOCK: They call you the next morning.

HARPER: Oh, OK. So it's really quick.

WOOCK: Yeah. It's really quick. They immediately saw that there was something wrong with my eggs. So my eggs are just total crap.

BAVIS: None of Heather's eggs fertilized. They tried again, same result.

WOOCK: Getting that news the second time, that there was, again, complete fertilization failure, felt even more set in stone that this was going to be a very long, challenging road.

HARPER: How much does all this cost?

WOOCK: (Laughter) A lot.

HARPER: Most states, including Indiana, don't require insurers to cover fertility treatment. Without insurance, a round of IVF can cost more than $10,000 - even more than 20,000. Heather was lucky. Her insurance covered a lot, but it still wasn't cheap. She had to pay for some drugs.

WOOCK: Plus you have to pay lab and facility fees that insurance doesn't pay.

HARPER: Donor sperm and eggs aren't generally covered either. Those can be tens of thousands of dollars. Heather had a hard choice. After two failed attempts, did she want a kid enough to go through IVF again?

BAVIS: She did, so she did a third round and then a fourth. When that didn't work, she gave up on using her own eggs.

WOOCK: What I expected as I was growing up and picturing my children is not what I will see.

BAVIS: Heather and her husband decided to try donor eggs. If all goes according to plan, she could still carry a child.

For NPR News, I'm Lauren Bavis.

HARPER: And I'm Jake Harper.

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