Health Care and Insurance and Technology

Clinic predicts Hamilton County will be fertile ground: Doctors relocate reproductive practice to growing area

June 27, 2005

Surgery centers and a heart hospital are among a host of health care facilities that have risen in burgeoning north-suburban Hamilton County in recent years. Now, a new fertility clinic could contribute to the population surge by helping couples conceive children.

The 6,400-square-foot Follas Center for Reproductive Medicine opened late last month on East 146th Street in Noblesville in a collaboration between several Indianapolis reproductive medicine innovators.

The center is a partnership between Dr. David McLaughlin, a local pioneer of in vitro fertilization, and Dan and Evan Follas, brothers who in 1979 opened the first independent laboratory in Indianapolis to provide same-day test results in the fields of infertility, endocrinology, obstetrics and gynecology.

Follas Laboratories Inc., on Indianapolis' northwest side, has since grown to become the largest independent lab in the Midwest, Evan Follas said.

Demand growing

About 1 million children have been born via the in vitro method, which originated in England in 1978. The first infant delivered by the method was dubbed the world's first test-tube baby.

Climbing success rates and dropping costs-normally ranging from $7,000 to $10,000 per treatment cycle-are driving more women who are having trouble getting pregnant to seek fertility treatment.

The Follas brothers and McLaughlin became well-acquainted while working under the same roof. The Follas Center laboratory is on the campus of Community Hospital North, in the same building as McLaughlin's general practice, Women's Specialty Health Centers PC, until his recent move to Noblesville.

McLaughlin's decision to move the fertility clinic and start anew rested on a desire to be independent from the hospital, where he shared its fertility laboratory, and more favorable demographics.

"It is the hot spot," he said of the State Road 37 corridor near 146th Street that is nearly fully developed. The location near Interstate 69 also remains convenient for patients traveling from outside the metropolitan area.

Hamilton County's population swelled 67 percent, to 180,861, between the 1990 and 2000 censuses, according to statistics from Health Evolutions Inc. of Indianapolis. The county had 204,838 residents in 2003 and projections forecast 300,000 in a few years.

Dr. William Gentry, medical director for Methodist Hospital's Advanced Fertility Group clinic, which borders Hamilton and Marion counties near North Meridian Street, said McLaughlin's move makes sense.

"My guess would be is that [medical providers] are trying to go where there are more demographically favorable payers," Gentry said.

Success rates improve

In vitro fertilization is the process in which eggs are extracted from the ovaries and fertilized with male sperm in a laboratory dish. If the eggs fertilize and begin cell division, the best embryos are transferred into the uterus where it is hoped one or more will implant in the uterine lining and further develop.

IVF bypasses the fallopian tubes and often is the treatment of choice for women who have damaged, or absent, tubes.

Extracting the eggs takes only about 20 minutes. They can be placed into the uterus in even less time. Once the eggs are combined with the sperm, it can take three to five days for the embryo to begin to grow.

The advancement of assisted reproductive technology resulted in 33,141 births-about a 29-percent success rate-in the United States in 2002, according to the most recent statistics available from the U.S. Department of Health and Human Services. The rate is much better-41 percent-for women younger than 35 years old. Just 10 years ago, the rate for the younger age group was about 30 percent.

McLaughlin's success rate of 50 percent for women younger than 35 years old is higher than the national average, according to the statistics. Success rates for Indiana clinics range from as low as 20 percent to as high as 60 percent, although the number of procedures done at each varies widely.

Stem cell debate

What are known as genetic markers locate defective embryos, to give patients the opportunity to determine which embryos should be transferred into the uterus. Unused embryos are stored in a freezer for later use. McLaughlin ships unused embryos to Minnesota-based ReproTech Ltd., a long-term storage bank, which does not discard them.

The embryos can be used later or donated by couples who no longer need them. But during the past two decades, an estimated 400,000 frozen embryos have accumulated in more than 400 fertility clinics around the country. What to do with those frozen embryos has become a matter of intense debate.

Advocates of stem cell research want the excess embryos donated for research. Embryonic stem cells are master cells that form during the early days after conception and can turn into any tissue in the body. Many scientists hope one day to harness them to grow replacement tissue to treat diabetes, Parkinson's disease, spinal cord injuries and other diseases. Cultivating those stem cells, however, kills the embryo.

Two Indianapolis physicians are at the forefront of a method of egg freezing that occurs before the eggs are fertilized to form embryos. Dr. Jeffrey Boldt, scientific director for assisted fertility services at Community Health Network, and Dr. Donald Cline, founder of the local Endocrinology Associates clinic, developed the process in 1999.

Until they perfected their method, attempts at freezing eggs and thawing them for fertilization failed because the eggs could not survive the freeze-thaw process. Freezing eggs for later use benefits women who are diagnosed with cancers that might cause sterility, or who want to delay having children.

Fertility programs in California and New York are replicating the procedure, said Boldt, who since 2001 has delivered 11 babies born from frozen eggs.

"We're essentially stopping the clock," he said.

And that is one of the reasons fertility clinics are thriving, Boldt said. Couples are waiting longer to start families and, at the same time, diminishing the ability of the female to get pregnant.

"When I started [in 1990], patients had scar tissue or a medical problem," Gentry said. "Now, you're seeing more aging patients who want children. That has been the driver for the past five years."

Affordability a factor

The 6,400-square-foot Follas center, equipped with $400,000 in the latest reproductive technology, is one of about eight fertility clinics in central Indiana. Some are independently operated, such as the Follas center, while Clarian Health Partners, Women's Hospital and Community Hospital Network house others.

Dr. Jim Donahue directs two independent Family Beginnings fertility clinics, one on Shadeland Avenue and the other at St. Francis Hospital and Health Centers' south campus. He opened the sites in 2002, after leaving Community Hospital, and saw his clientele grow from 50 to 150 in one year. Cutting the cost of in vitro to about $7,000 was a huge factor for the increase in interest, he said.

"People don't do it because of the cost," Donahue said. "Three years ago, [the cost] was easily $10,000 to $12,000. That could be a down payment on a house."

Couples finance the expense from their own pockets because most health insurance providers do not cover the procedure. Payment plans are available in some cases.

McLaughlin and Donahue contend they can offer the services cheaper than hospital-based clinics, because they do not have the extra overhead a hospital carries. Hospitals are beginning to drop their fees, however, to stay competitive. Community Health Network, for instance, now charges $4,000 not counting a physician fee.

McLaughlin is an independent physician at Community Hospital North and directs its office of reproductive surgery and medicine. In 1981, he pioneered the application of lasers in gynecological surgery and developed the in vitro fertilization technique known as tubal ovum transfer.

The Follases have a similar clinic in Evansville and welcomed the chance to partner with McLaughlin at the Noblesville location.

"When Dr. McLaughlin approached us," said Evan Follas, "we didn't have any qualms. We've worked together for 10 years. We already know the chemistry works."

Dr. Andrew Weston, laboratory director, and Kassi Stroble, embryologist, assist McLaughlin at the clinic, which also offers numerous other reproductive services.

A career in a profession in which one is unsuccessful half the time can be daunting.

"It's really hard to say we tried and it didn't work," McLaughlin said. "Sometimes we fail in spite of our best efforts."
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