In vitro field facing slowdown

The ''test-tube baby" industry seems to have grown up.

For more than two decades, the field expanded explosively, revolutionizing a whole generation's concept of babymaking and producing more than 1 million children worldwide who would otherwise never have been conceived.

But now, fertility doctors in Boston and across the country say they are seeing a slowdown in the growth of in vitro fertilization, or IVF. At Brigham and Women's Hospital, for instance, long renowned for its reproductive care, infertility patient volume failed to grow in the last year for the first time in recent memory.

''Nothing just goes up and up and up forever," said Dr. David Adamson, former president of the Society for Assisted Reproductive Technology.

The number of infertile people is still growing, said Joseph C. Isaacs, president of Resolve, the national infertility association. Soon-to-be-released federal figures show that there were more than 6 million infertile people in 1995, compared with 7.3 million at last count in 2002.

But the growth rates of IVF are falling in part, specialists say, because of the aging of baby boomers: The youngest members of that great demographic wave are now in their 40s and starting to think more about their 401(k) than IVF.

Also, because IVF is getting more efficient, patients more often become parents after just one or two cycles now, rather than trying again and again. The better the clinics do, the faster they lose their patients.

And the cost of IVF, which can run more than $10,000 per cycle and is not covered by insurance in most states, is driving people away during uncertain economic times, Isaacs said.

Lack of means is a constant theme among callers to Resolve's infertility help line, said its coordinator, Davina Fankhauser. She can relate: She is now 17 weeks pregnant through IVF, but she and her husband went through eight years of infertility treatments -- stopping short of IVF because they could not afford it -- before moving to Massachusetts, where they found that insurance would cover it.

''I have to say the economy made me not try, actually, until I moved to Massachusetts," she said.

In 1987, Massachusetts became the first state to mandate that insurance companies cover some infertility treatments. But Isaacs and others worry that current efforts on Beacon Hill to overhaul the health insurance system may end up stripping infertile couples of that guarantee. Infertility coverage is one of the mandates in play in the debate over how to get more people insured.

''If there's a mandated program with a bull's-eye on its forehead, it's IVF," said John McDonough, executive director of Health Care for All, an advocacy group.

Currently, about 1 percent of births in the United States, more than 45,000 babies each year, were conceived by ''Assisted Reproductive Technology," mainly IVF, according to federal figures.

The IVF procedure, mating egg and sperm in a dish for later implantation in the womb, can help with several types of fertility problems.

The slowdown in IVF growth undermines dire predictions that reproduction is becoming so high-tech that it will soon enter an era of ''designer babies," in which parents routinely select embryos or alter their genes to get lots of tall, blond, blue-eyed geniuses. The current slowdown suggests that even when a great many people might benefit from high-tech intervention in conceiving a baby, most do not, or cannot, avail themselves of it.

''Why would one voluntarily undertake that kind of expense, the modest but clearly present risks, and all that's involved -- why would you do that unless you had to?" asked Dr. Marc A. Fritz, chairman of the practice committee of the American Society for Reproductive Medicine.

The lull has not shown up yet in federal figures, which generally lag by two or three years, but several clinic directors said they were aware of it from speaking with colleagues and from recent reports of drug company sales.

''Throughout the country there definitely is a little stagnation and many people are complaining that there is a slight decrease," said Dr. Vito Cardone, medical director of the Fertility Centers of New England. His own centers are still doing fine, he said, but he has even heard from a doctor in Paris that Europe is seeing the same kind of decrease.

Word among the pharmaceutical companies that supply IVF drugs is that the overall market may be down as much as 10 percent compared with last year, said Dr. Michael Alper, medical director of Boston IVF, the nation's largest fertility clinic.

Prescriptions written for gonadotropins, the type of drugs used in fertility treatments, appeared stable early this decade, but seem to be dipping this year, according to data from IMS Health, which tracks drug prescriptions.

Erica Whittaker, a Merrill Lynch analyst, projects annual growth rates for sales of Gonal-F, one of the main IVF drugs, of about 5 percent in the near future. But that growth is likely to stem mainly from price increases and improved delivery systems that will help Gonal-F capture more of the IVF market, rather than from rising volume, she said.

In the past, the growth rate of IVF has stayed strong in part due to the advent of techniques powerful enough to bring in new patients who previously could not be helped.

For example, Cardone said, the early 1990s brought the introduction of Intracytoplasmic Sperm Injection, or ICSI, a method of injecting a single sperm into an egg using a glass needle. Suddenly, men who had few or poor-quality sperm could become fathers relatively easily. And these days, he said, up to 40 percent of the IVF work that the Fertility Centers do follows such sperm injection.

Since then, the most touted advance in fertility treatments is Preimplantation Genetic Diagnosis, or PGD, in which doctors can check the genetic makeup of embryos created for IVF. It is used mainly to avoid implanting embryos carrying serious genetic diseases.

The last great infertility hurdle remains, however: poor egg quality among older women or those with other egg problems. IVF technology can do little beyond spurring a woman to overproduce eggs in hopes of getting a good one, or allowing the implantation of a good egg from a donor.

Perhaps egg-freezing will eventually help solve that problem, perhaps another method will. But somehow or other, ''You hope that the field will grow in a different way," said Elizabeth S. Ginsburg, director of the IVF service at Brigham and Women's, ''because it's so nice to get people pregnant."

Carey Goldberg is reachable at goldberg@globe.com