RAISING EXPECTATIONS Science has discovered new ways to reset the biological clock

THE BALTIMORE SUN

The fertility research that was announced last week gave new hope to many women who have been unable to have children, but infertile men also have cause for more optimism these days. And new fertility techniques for both men and women are available locally.

In what seemed the most startling breakthrough, doctors at the University of Southern California reported successful pregnancies in five women past menopause. The women, all of them in their 40s, were given hormones that provided TC hospitable uterine environment, and were then implanted with fertilized eggs from younger women.

"There's no age limit," says Dr. Eugene Katz, director of assisted reproductive technology at the University of Maryland Medical Center. "All you need to get pregnant is a uterus. You don't even need ovaries. The uterus is like a house: If you have the house, we can provide the heating, plumbing, electricity from the outside."

In fact, the eggs themselves were among the outside elements. So was the fertilization process; it occurred "in vitro," meaning in a glass dish.

The morning after the report was released, phones started ringing in the office of Dr. Marian Damewood, associate professor of gynecology and obstetrics and director of the in vitro program at the Johns Hopkins Medical Institutions.

"Some women think the hormone treatments will make them fertile, but that's not what happens," she says. The hormones do not make old ovaries produce viable eggs; they act on the uterine lining, where fertilized eggs -- provided by a younger, more fertile woman -- are implanted. The husband of the pregnant woman might, however, provide the sperm.

The technique has already been used at Greater Baltimore Medical Center for women in their 30s who have stopped ovulating, in a condition known as "premature menopause."

And, says Dr. Jairo Garcia, director of the Women's Hospital Fertility Center at GBMC, "We are also doing something similar for women aged 40 to 45 who are still ovulating, though the quality of their eggs is not good."

Donor eggs are available, Dr. Garcia says, from women in the in vitro program who produce more ova than they wish to have fertilized. Of the 12 patients impregnated with donated eggs at GBMC, two have had babies. One woman was 45, and the other 46 at the time of birth.

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Bright and beautiful, 7-month-old Bliss Bohuslav is everything her parents could have wanted.

She is also everything they feared they would never have. Years of trying for a pregnancy, even with the help of fertility drugs that made Brenda Bohuslav produce several eggs at one time, yielded nothing.

So she asked her HMO to refer her to a high tech fertility specialist.

And in this age of laboratory-dish fertilizations and embryo implantations, 27-year-old Brenda Bohuslav eventually conceived in the ordinary way, after a procedure her high tech specialist describes as "very simple."

Known as "transcervical balloon tuboplasty," this new method -- described in last week's Journal of the American Medical Association -- uses an inflatable device, introduced through the vagina and uterus, to eliminate obstruction in the Fallopian tubes at the point where tubes and uterus join.

Blocked tubes, a frequent cause of infertility, can occur after pelvic infection, because of dried-up plugs of internal secretions, or for no discernible reason.

Although the majority of obstructions are farther up in the tubes, where the balloon device doesn't reach, this method seems to work quite well for women with blockage at the uterine juncture.

"You do the procedure like a plumber," says Dr. Katz, who is also professor of obstetrics and gynecology at the University of Maryland Medical Center.

"Instead of a big operation that takes three to four hours, you do thisin 20 to 30 minutes," he says.

"Eighty to 90 percent of patients go home with the tubes open, and 33 percent get pregnant within six months," according to Dr. Katz.

For Mrs. Bohuslav, the outcome was 100 percent; one month after having her tuboplasty, she was pregnant with Bliss.

* In vitro fertilization (IVF) was the major breakthrough ireproductive technology. Women take fertility drugs that make them produce extra eggs; eggs are taken from the ovaries and placed in a laboratory dish, along with the partner's sperm. Those that fertilize are then incubated for 72 hours, and when they've formed into eight-celled embryos, they're placed in the mother's uterus.

Variants of the technique have since been developed, along with a wide range of treatments aimed at correcting dysfunctions and malformations that lead to female infertility.

Most of the breakthroughs in reproductive technology have helped women. But a couple of new procedures have extended the possibilities for men as well.

According to Dr. Brad Lerner, a urologist and infertility specialist in Towson, 2 percent of infertile men are thought to have a congenital absence of the vas deferens, the tube that carries sperm from the testes up and through the prostate to the urethra. Like men who have had a vasectomy -- a sterilization procedure in which the vas is cut -- these men ejaculate normally, but have no sperm in the fluid.

With a recently developed kind of microsurgery, Dr. Lerner says, the scrotum can be opened and sperm can be suctioned out of the epididymis, where they mature before their journey up the vas.

Sperm retrieved from the epididymis tend to be scanty; their bestchance of fertilizing an egg occurs when they are manipulated by experts in IVF.

Another new procedure, known as "electro-ejaculation," provides the possibility of fatherhood for men who cannot ejaculate because nerves have been severed in surgery or in spinal cord injury. Most of these men can still have erections, which are governed by a different kind of nerve.

Most of the 10,000 new spinal cord patients in this country every year are men under 25, who may still yearn for children.

Using semen expelled after an electric-shock treatment, 50 pregnancies have reportedly been achieved in the past three years, according to Dr. Lerner.

"A probe is passed into the rectum and pressed up against the prostate, to stimulate the nerves that cause ejaculation," he says. "The man passes ejaculate [sperm-carrying semen] into the urethra, from which it is milked out manually."

Chuck Lamoreaux, 31, of Reisterstown, has hopes that the new procedure will enable him to father a child. After a 1976 auto accident left him paralyzed from the chest down, he was told it would never happen.

Mr. Lamoreaux and his wife, Maureen, had begun the adoption process when they learned of a West Coast physician who was doing electro-ejaculation therapy.

Though two artificial insemination attempts failed, the Lamoreaux were still hopeful when they returned to Baltimore. They are about to start the process again with Dr. Lerner.

"It's expensive and emotionally wearing," he says. "But we have a real love for kids."

To learn more, read . . .

*"Conquering Infertility," By Stephen Corson (Prentice Hall, 1983, revised in 1990.

*"The Baby Makers," By Diana Frank and Marta Vogel (Carroll & Graf, 1988).

*"The Couple's Guide to Fertility," by Gary Berger, Marc Goldstein and Mark Fuerst.

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