By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Dara Torres has it all - talent, a bushel of Olympic swimming medals and stunning looks. But while Torres has smashed records and stood atop the pinnacle of competitive swimming, there is one event Torres hasn't been able to win yet - getting pregnant.

This Mother's Day is bittersweet for Torres and her husband.

"I try not to think about it but it's there - especially on Mother's Day," says Torres, 37. "For me it's hard because I have five siblings and 18 nieces and nephews. Everyone in my family is fertile and having no problem. Everyone has a bunch of kids - at least three or more. I'm so happy for them, but it is hard."

And Torres knows it is hard for a lot of couples.

More than 6 million Americans experience infertility issues, with males and females affected equally. An estimated 20% of couples have fertility issues that involve both partners. The American Infertility Association defines infertility as a disease that prevents the reproductive system from functioning properly.

"My ovaries are fine and my hormone levels are fine," Torres says. "There is actually no reason why I can't get pregnant. But it's just not happening. If there was something wrong with me it would almost be easier because I would have a reason why I couldn't get pregnant."

Infertility is on the rise principally because people are delaying their child-bearing.

But for about 20% of infertile couples the cause remains a mystery. Among the many reasons for infertility are:

• Irregular ovulation
• Endometriosis
• Poor egg quality
• Untreated STDs
• Male fertility problems

"It's very frustrating because here I am this healthy woman who's been to the Olympics and never had any health problems, and I can't get pregnant," says Torres, who became the first American to medal in four Olympiads. "I thought if I could share my story it might really illustrate that this can happen to anyone and that you're not alone."

But talking about her infertility was hard for Torres.  When asked by the AIA to be their spokesperson, she initially balked.

"It's a personal matter to the point that when I first began infertility treatments I told my husband not to tell anyone," Torres notes. "It's not like it's something to be ashamed of, but I never heard anyone talk about it so I was just going with the flow."

Infertility treatments

But Torres realized that her story needed to be shared with infertile couples and agreed to speak out so she could help people find accurate information and resources at a time when many are confused, angry and even ashamed.

"I only know of people who have spoken about their problems getting pregnant after they succeeded," Torres states. "That's great but I felt that people who are struggling with this need to hear from someone going through it just like they are."

Torres suggests people find out more about infertility from either the AIA or Fertility LifeLines, a toll-free service that helps educate patients about the whole spectrum of choices. From May 10-12, Fertility Lifelines and the AIA will hold three teleconferences with experts to answer pre-registered questions from the public. Lifelines is sponsored by Serono, makers of several fertility treatments, but Torres is not financially compensated by the company.

While one in six couples will need medical intervention to help them conceive, approximately two-thirds will in fact have a successful pregnancy.

Typically fertility treatments begin with various forms of ovulation induction using injectible gonadotropins, also called follicle stimulating hormone. FSH allows more than one follicle which contains the egg to mature at a time. Artificial insemination is then performed using a small catheter to place a sample of the male's semen in the woman's uterus.

"This process allows us better control of timing and a numerically better chance by having the semen and one or more eggs available in the right place," says Richard Scott, a reproductive specialist and medical director of Reproductive Medical Associates in Morristown, New Jersey.

After failing to get pregnant, Torres underwent in vitro fertilization. The purpose of IVF is to bypass the majority of the reproductive process. 

First the woman is induced to produce several eggs using FSH. Then doctors retrieve the eggs using a needle under ultrasound guidance. Retrieval is performed under light sedation so patients do not feel anything.

On the day of egg retrieval, a semen sample is taken from the male and the sperm washed and placed around the egg in a very highly refined culture system. Sometimes if the couple has very few sperm doctors can perform intracystoplasmic sperm injection where an individual sperm is injected directly into the egg.

"By the next day we'll know how many eggs fertilized and by the next day after that we will know how many are dividing," Scott says. "After three days - sometimes five or six-we will do the embryo transfer. Typically we implant between two and four embryos depending on the patient's age and their history. The younger the patient the fewer embryos we put back."

False starts

While infertility struggles can strain a marriage, Torres says the IVF was also taxing.

"Going through IVF was difficult because you're on a lot of hormones so for me it was like PMS all the time," Torres says. "I wasn't too bad really, but I did completely lose it one time when I was getting a speeding ticket and I never cry."

But Torres had cause to be happy when her doctor was able to harvest 16 eggs, far more than normal.

"I was lucky I had about 16 eggs that fertilized so I was able to freeze eight and use eight for the procedure where they would transfer the embryos into my uterus," Torres explains. "That was really good news, and I thought it was finally going to happen."

But before doctors transfer embryos they are graded for implantation quality from 1 to 5.

"A grade of 4 or 5 does not mean a pregnancy won't result," Scott explains. "It only means the probability of implanting is lower. The vast majority of people have some good embryos and some less good ones. Our job is to put the best ones back so the patient has the best chance of conceiving."

Torres learned that all of her embryos were less than optimal - all were 4s.

"I was incredibly upset," Torres says. "I did everything you could possibly do and it was still out of my hands. When I swam, I trained hard and did everything my coach asked and I got results. But I had no control over this. It was mind boggling."

Despite the "huge emotional rollercoaster," Torres hoped for the best after four embryos were implanted.

"You have to wait 12 days after the embryos are implanted to take the pregnancy test," Torres explains. "It was the longest 12 days of my life. When the test came back positive, I was so excited."

But three weeks later her ultrasound crushed her hopes.

"My ultrasound revealed there was one embryo, but it did not have a heart beat," Torres says. "It was horrible -- just awful."

After a second cycle of IVF failed, Torres tried three rounds of artificial insemination. But nothing worked.

While Torres is now taking break from getting pregnant to concentrate on covering the Olympics, she is not giving up. She's passionate about helping others and is hopeful about her own chances of becoming a mom.

"I look at it now as whatever is going to happen is going to happen," Torres says. "I think that attitude comes from when I made my comeback after taking seven years off from swimming. I'm just going to have to leave it up to the guy upstairs."

• American Infertility Association

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 5/22/2004  -  Donnica Moore, M.D.