Small Miracles
The Center for Infertility and Reproductive Medicine uses the latest therapies to make mommies' and daddies' dreams come true.
“Our center strives to offer the most successful
infertility care available, while remembering that this is a highly personal
issue to all our patients.”
—Randall R. Odem, MD
SOMEHOW, KATHY KULIG JUST KNEW that she would one day have a baby. Even a bout with breast cancer at age 29 did not discourage her. Neither did four surgical procedures, followed by a failed attempt at in vitro fertilization (IVF). Finally, a second IVF try yielded two tiny embryos, which doctors implanted in her uterus. Then Kathy and her husband, Matthew, sat back and held their breath.
The outcome of that attempt is visible throughout their Millstadt IL home: in the diapers and baby carriers, in the changing table and cheerful play area. Today, Kathy is the mother of picture-book twin daughters, 11-month-old Kelly and Melanie—a double miracle made possible by Kathy’s persistence and the medical skill of the School of Medicine’s Center for Infertility and Reproductive Medicine.
The center treats couples who are struggling with infertility or recurrent miscarriage due to various underlying problems: polycystic ovary syndrome, endometriosis, pelvic adhesions or tubal disease in women; varicoceles, blocked vas deferens or low sperm count in men. To all of them, the center offers the latest therapies, some still in clinical trial, delivered with sensitivity to their emotional needs.
Playtime at home with twins Melanie, left, and Kelly, and mom Kathy Kulig.
“In this hectic time, it is rare for busy medical personnel to sit down to listen and construct an individualized treatment plan. Our center strives to offer the most successful infertility care available, while remembering that this is a highly personal issue to all our patients,” says Randall R. Odem, MD, associate professor of obstetrics and gynecology and director of the division of reproductive endocrinology and infertility.
In 1995, Kathy Kulig needed that kind of personal attention. Diagnosed with early-stage breast cancer, she had just undergone surgery at Barnes-Jewish Hospital when doctors discovered a pelvic problem. It was not ovarian cancer as they had feared but a bad case of endometriosis—abnormal tissue growth in the pelvic area—a fertility-impairing condition that would worsen as she took post-cancer hormone therapy.
“In the midst of all this, Matt asked me to marry him,” says Kathy, who was then a school drug-prevention coordinator. “We knew we wanted children, and I even suggested forgoing the cancer treatment so I could have them right away—but I also wanted to be around to raise them.”
Referred to the center, she had a series of procedures to remove the adhesions, but they always grew back. Before the third surgery, her endometrial mass had grown to the size of a grapefruit. Then Valerie S. Ratts, MD, assistant professor of obstetrics and gynecology and one of four reproductive endocrinologists on staff, advised Kulig that IVF—the retrieval of her eggs and their fertilization in the laboratory with her husband’s sperm—was her best hope for achieving pregnancy.
IVF is a burgeoning area of therapy at the center. In the mid-1990s, its physicians performed 100 to 120 retrievals a year; in 1999, they did 292, plus 37 frozen embryo transfers. By the end of 2000, they expect the year’s total to exceed 370.
Success rates have followed suit. In 1999, the center achieved clinical pregnancy rates—52 percent in women under 35, 27 percent in the 35 to 39 age group, and 21 percent in women over 39—that placed them in the top group of U.S. fertility programs. In women over 45, the center recommends the use of donor eggs for successful conception. The center’s oldest patient to date has been a 52-year-old woman who just had her second child.
“I can sum up the reason for our success in two words: our lab,"” says Daniel B. Williams, MD, associate professor of obstetrics and gynecology and director of the IVF program since 1995. “The embryology lab is the cornerstone of any IVF program, and ours is especially adept at handling embryos and doing micro- manipulation procedures. We also use blastocyst transfer—culturing embryos for five days instead of the usual two or three—to observe them longer and select the hardiest for implantation.”
While the center’s rates are impressive, a few infertility centers publish statistics that look, on paper, even higher. But patients may wish to take a closer look, cautions Williams. Some programs can potentially increase success rates by screening out those who are not ideal candidates—while the center here treats even the most challenging patient cases.
Kulig, herself an avid Internet researcher, shopped around and found two programs with sky-high IVF success rates. She even sent her blood work to one, which quickly turned her down. “The doctor called and said, ‘You can’t come into our program and, quite frankly, I don’t think you will ever have children of your own,’” she says.
So Kulig returned to the School of Medicine, where she had her first in vitro cycle in July 1998. The treatment did not succeed: She produced just two eggs, and only one achieved fertilization. She and her husband decided to gamble and have the embryo implanted—but no pregnancy resulted.
There are many reasons for IVF failure, including poor egg quality. Severe sperm problems can sometimes be overcome through a procedure called intracytoplasmic sperm injection (ICSI), in which doctors inject the sperm into the egg and force fertilization to take place. But sometimes, the reasons for the failure are mysterious.
“We get eggs that look fine, we get sperm that looks fine, we get fertilization and an embryo that begins to grow and looks pretty good,” Ratts says. “Then we place it in the uterus and it just doesn’t take. Are there uterine or implantation factors at work? Some of this is still unknown.”
For couples undergoing IVF, the two-week waiting period following implantation is filled with roller-coaster emotions. Will the procedure work or will the woman’s menstrual period begin as usual, signaling failure to conceive? Despite every medical effort, some couples never achieve pregnancy—a devastating blow. The center’s physicians and its infertility counselor, Gail Gordon, work with these patients to help them achieve closure.
In May 1999, the Kuligs decided to try again. While they had paid out-of-pocket for the first cycle, their financial decision was easier this time; their insurance company had agreed to provide partial coverage, on the grounds that Kathy’s cancer therapy had impeded her fertility—constituting a disability under the Americans with Disabilities Act. But there was still no shortage of anxiety.
On the day after Mother’s Day, Ratts retrieved two eggs from Kathy and sent them to the lab. Soon the fertilized cells were dividing and the eggs looked strong, so the implantation procedure took place; then the waiting period began. One night, discouraged, Kathy told her husband that she thought the cycle had failed, but Matt, an optimist, still held out hope. Kathy decided to take a home pregnancy test just to show him. That test came back positive; the next day, a second did too. So Kathy went in early for her blood test, which showed surprisingly strong hormone levels. “Do you think it could be twins?” she ventured. Two weeks later, ultrasound revealed two fuzzy forms growing comfortably in her uterus. “It was wonderful. We were so thrilled, crying,” she recalls, crying even now at the memory of it.
Twins and triplets are “doable pregnancies,” says Ratts, but the center works hard to avoid multiple gestations by limiting embryo placements to two for patients under age 33, three for those up to age 39. “For medical reasons, we don’t want multiple gestations, we want one good healthy baby,” she says.
The Kuligs’ twin daughters were born on January 18, 2000, weighing 7 pounds and 6 pounds, 7 ounces, after an uncomplicated pregnancy. Melanie’s middle name is “Elizabeth” for the biblical figure—long past childbearing age—who gave birth to John the Baptist. Now Kathy, more than five years free of cancer, is planning a trip back to the center for another IVF cycle—and just maybe another child.
With luck, she will someday be showing off a third baby in the center, where the staff loves to pose for pictures with the children of grateful patients. Birth announcements and newborn photos also arrive frequently by mail.
“At the end of a hard day, it is wonderful to find
one of those little-bitty envelopes in the mail. You just know what is
in it,” says Ratts. “And you say to yourself: ‘OK, today
was a hard day, but look what happened when I had a hard day nine months
ago—this is the result.’” 
The Center for Infertility and Reproductive Medicine has an active egg donor program that is currently seeking women ages 18 to 32 who are willing to donate eggs to help infertile couples. A rigorous screening process is involved; donors are compensated for their time. For more information, contact the center at (314) 286-2419.
