From Publishers Weekly
Marrs, the head of the Institute for Fertility Research in California and editor of Assisted Reproductive Technologies (Blackwell Science, 1993), offers an up-to-date, no-nonsense look at infertility. Enhanced by detailed illustrations, his text reviews both causes and treatment. Marrs does not gloss over the pitfalls of treatment and the likelihood of a cure. In outlining the avenues to take, he discusses assisted reproductive technologies, including current embryology lab techniques. Thankfully, he does not limit his discussion of the emerging field of reproductive immunology to antiphospholipid antibodies, which is just one immune disorder, but broadly considers immunological problems, a topic not discussed in other infertility books. Emotional and financial issues are given equal weight (the unique contribution of coauthor and former patient Lisa Friedman Bloch). Handy glossaries are found at the end of each chapter, and vital resources (including infertility and adoption groups) are also listed. A necessary primer for any couple faced with infertility, this is essential for public libraries. (Index not seen).Lisa A. Errico-Cox, Nassau Community Coll. Lib., Garden City, N.Y.Copyright 1996 Reed Business Information, Inc.


From Library Journal
Marrs, the head of the Institute for Fertility Research in California and editor of Assisted Reproductive Technologies (Blackwell Science, 1993), offers an up-to-date, no-nonsense look at infertility. Enhanced by detailed illustrations, his text reviews both causes and treatment. Marrs does not gloss over the pitfalls of treatment and the likelihood of a cure. In outlining the avenues to take, he discusses assisted reproductive technologies, including current embryology lab techniques. Thankfully, he does not limit his discussion of the emerging field of reproductive immunology to antiphospholipid antibodies, which is just one immune disorder, but broadly considers immunological problems, a topic not discussed in other infertility books. Emotional and financial issues are given equal weight (the unique contribution of coauthor and former patient Lisa Friedman Bloch). Handy glossaries are found at the end of each chapter, and vital resources (including infertility and adoption groups) are also listed. A necessary primer for any couple faced with infertility, this is essential for public libraries. (Index not seen).Lisa A. Errico-Cox, Nassau Community Coll. Lib., Garden City, N.Y.Copyright 1996 Reed Business Information, Inc.


Book Description
A pioneer in the field of assisted reproduction, Dr. Richard Marrs has spent his life counseling couples who struggle with the pain of infertility, developing new treatments, and helping thousands to experience the wonder of birth. Now Dr. Marrs shares his knowledge and expertise in a groundbreaking book that answers all your questions, understands your concerns, and covers every aspect of fertility problems, including infertility's emotional price as well as its financial one. Based on the latest research and technologies--and the real-life experiences of thousands of couples--Dr. Marrs tells you everything you need to know about getting pregnant, including: Which cutting-edge advances in reproductive technology--including in vitro, gift, zift, sperm manipulation, and immunological therapy--are right for you
Is it your nerves? How emotions can delay or stop ovulation
The biggest mistake doctors make when a man's sperm count is borderline or subnormal
Which fertility drugs work best...and the side effects you should expect
Your chances of multiple births...twins, triplets, or more
When to change doctors or see a specialist
The good news about using a partner's sperm and not a donor's...even if your partner's count is very low
Your insurance coverage--what you can and cannot do
And much more


From the Publisher
Contains new information on the latest advances not available in the hardcover edition! Cutting-edge information and compassionate advice from the head of one of America's most prominent fertility institutes"Comprehensive...a virtual encyclopedia of infertility."
"Couples struggling with fertility problems will find comfort in Dr. Marrs' book."
(N.Y.) "A necessary primer for any couple faced with infertility."



From the Inside Flap
A pioneer in the field of assisted reproduction, Dr. Richard Marrs has spent his life counseling couples who struggle with the pain of infertility, developing new treatments, and helping thousands to experience the wonder of birth. Now Dr. Marrs shares his knowledge and expertise in a groundbreaking book that answers all your questions, understands your concerns, and covers every aspect of fertility problems, including infertility's emotional price as well as its financial one. Based on the latest research and technologies--and the real-life experiences of thousands of couples--Dr. Marrs tells you everything you need to know about getting pregnant, including:

Which cutting-edge advances in reproductive technology--including in vitro, gift, zift, sperm manipulation, and immunological therapy--are right for you
Is it your nerves? How emotions can delay or stop ovulation
The biggest mistake doctors make when a man's sperm count is borderline or subnormal
Which fertility drugs work best...and the side effects you should expect
Your chances of multiple births...twins, triplets, or more
When to change doctors or see a specialist
The good news about using a partner's sperm and not a donor's...even if your partner's count is very low
Your insurance coverage--what you can and cannot do
And much more


About the Author
Richard Marrs, M.D., was the second doctor in the United States to achieve the birth of a baby from in vitro fertilization; the birth of the first frozen-embryo baby in the country, as well as the world's first pregnancy using a combination of ZIFT and surrogate gestational carriers. He founded and was the first president of the Society for Assisted Reproductive Technology. He was a member of the National Ethics Committee, which produced the first document in the United States on the morals and ethics of human reproduction. And more recently he headed Advocates for Fertility Treatment, which lobbied both the White House and Congress to increase health insurance coverage so that all infertile couples would have the chance to have a child.

Kathy Kirtland Silverman and Lisa Friedman Bloch are a television writing and producing team with numerous television movies to their credit. Lisa Bloch, the mother of twins, is also a former patient of Dr. Marrs'.


Excerpt. © Reprinted by permission. All rights reserved.
WHY YOU'RE LONGING FOR A BABY

It's a Small World After All

It's around 8 o'clock.  Your hostess, Sidney, a woman who seems to radiate confidence and a sense of accomplishment, carries the salad plates to her festive dining room table.  Her husband, Gary, carefully refills the wineglasses and takes the drink orders of the dozen or so guests.  The conversations shift between ballplayer trades and sneaky politicians, between irresponsible baby-sitters and finding the right preschool.  Sitting there, quietly, you try to focus on one of them, but you can't.  Why?  Is it because they're not interesting to you?  Is it because you can't relate to them?  Or is it because you feel premenstrual symptoms, and you dread the thought of getting your period--proof that, once again, you're not pregnant?br>
Sara rattles on about the violence in the cartoons her four-year-old watches on television.  She should only know how lucky she is to have a child.  Mike, Evelyn's husband, argues about last Sunday's football game.  Pamela and Steve arrive late; Sidney rushes over to greet them, and Pamela quietly nods to her with a hopeful glow.  Isabelle, who's to your right, whispers something to Pamela.  You overhear that Pamela arrived late because of an hCG shot, whatever that is.  Suddenly you feel a wetness between your legs.  It's like a knife through your heart.  You sit there, numb.  Then, in a daze, you excuse yourself and go to the bathroom.

It's a fait accompli once again.  You stare in the mirror, not believing it, not understanding it.  "Why me?" you ask, as tears well up.  You reach for a tissue, but you're all out.  You look around and finally discover some under the sink, next to a pregnancy tester and an Ovukit.  Sidney and Gary?  You thought they were totally absorbed in their successful careers and not at all interested in raising a family.  The knowledge that you and your husband aren't alone brings a small moment of solace.

You're Not Alone

It's not just you, your relatives, and your friends.  Everyone can be affected by infertility...all races, religions, and socio-economic levels.  In the United States today it is estimated that approximately five million individuals are considered infertile.  What exactly does infertile mean?  Clinically, the term is applied if a couple has difficulty getting pregnant after trying for six months.  Approximately 40% of such infertility problems are attributable to the female.  Another 40% are caused by the male.  And the remaining 20% involve either a failure in the coupling, or remain unexplained.

You finish with your tissue.  You pull yourself together by repeating what you've said so many times before: "There's always next month."  You take a deep breath and walk back to the table with feigned confidence.  Your eyes meet your husband's.  He knows.  And his poorly camouflaged look of disappointment makes your pain even worse.  Then, to your dismay, the conversation at the table shifts to pregnancy.  Should you remain detached?  Or should you confide that you and your husband are trying, and risk completely coming apart at the seams, given that you just got your period, you're not pregnant, and you fear you may never be?

It's about now that you decide this is the worst party you've ever attended.  The roast chicken tastes like cardboard.  You gulp down wine, which suddenly has no taste.  Then you notice Gary refilling your glass.

Alcohol and Infertility

Maybe that's the problem!  You've read somewhere that alcohol isn't recommended if you're trying to get pregnant.  Still, what's the difference at this point?  You've already begun your period.  It will be another 12 to 14 days before liquor can affect next month's ovulated egg.

But wait a second....  It takes two to tango.  Could the alcohol your husband is consuming be the reason you haven't gotten pregnant?  Could it be affecting his sperm count?  Before Gary pours for your husband again, you reach out and cover his glass.  He looks at you strangely.  Nervously you whisper to him that maybe, under the circumstances, neither of you should overdo.

GOING . . . GOING . . . GONE!

While it's true that a man's reproductive system usually doesn't begin to decline until his sixth or seventh decade of life, certain things can temporarily impact his sperm's quality, their quantity, and their ability to penetrate an egg.  Alcohol, recreational drugs such as cocaine and marijuana, smoking one to two packs of cigarettes a day, and high body temperature--produced, for example, by use of hot tubs--can all be linked to reduced fertility in the male.  The good news is, sperm suppression is usually reversible.  New sperm is created every 72 days.  The speed with which a man's sperm get back to normal all depends on the magnitude of the abuse.

After Gary moves on, you redirect your attention to the conversation at the table.  You realize it's no longer about who else is pregnant, but rather about how you can, with the correct guidance, get pregnant.  Pamela seems well informed.  She says that she and her husband have been seeing an infertility doctor for some time.  Now you really focus on the conversation, especially when she tells the group that the whole process of getting pregnant is much more complicated--and much less predictable--than we all have been led to believe.

Living Up to Expectations

If you're like most women, the concept of having babies was introduced to you at a very young age.  As a toddler you were encouraged to carry dolls, push toy baby carriages, and care for a make-believe infant.  It probably wasn't long before you and the little boy down the street started playing house.  And before you went to sleep, your parents read you stories about families, passing on the implied assumption that having one is a right, not a privilege.  It's no wonder that by the time you were in school, you were singing "First comes love, then comes marriage, then comes a baby in a baby carriage."  By mirroring your parents' behavior, you learned the most commonly accepted version of the way life should be.

Even Disney Told You

Walt Disney reinforced our childhood views of family.  In his world, even dogs played along.  Take 101 Dalmatians.  Pongo, the Dalmatian hero, helps his master win over a lady friend, Anita.  In the process, Pongo meets Anita's dog, Perdita.  The two couples fall in love, and it isn't long before puppies arrive.  Babies, naturally, soon follow.  The message to young children: Reproduction, for all species, is the natural course of events.

By the time you matured into a teenager, you were convinced that getting pregnant is an automatic and expected--even dreaded--event.  For you, the focus was no longer on getting pregnant--that was a given.  Instead it shifted to how not to get pregnant.  Ideas from books and fairy tales were replaced by the kind of advice only movies and television can give.  Scenes like the following infiltrated your life and convinced you that the danger of pregnancy was hard to avoid.

You've Got to Be Carefully Taught

In the 1970 movie Summer of '42, Hermie and Oscy, both 15, find a book detailing the twelve steps to sexual satisfaction.  Hermie responds in a predictably worried tone: "I know the book means well, but what if she has a baby?  I mean, if I follow these twelve points, she might just have a baby.  And I can't afford a kid at this stage of my life."  Oscy tells him not to worry, and sends him to the drugstore, where he experiences every teenager's worst nightmare as he tries to buy his first prophylactic.

Of course, you--all of us--feared the worst.  Yearning for a sexual encounter, you'd suddenly be faced with the need to protect yourself against the otherwise inevitable disaster.  So much energy was spent teaching you how not to get pregnant (as a teenager), it's no wonder you now feel confused, cheated, and depressed when it seems you're unable to anyway...as if you, and you alone, failed at what the rest of the world does automatically.  It's about now that you notice almost the entire dinner conversation is focused on the pregnancy issue.  Why?  Why is it the hot subject?  Why is it that so many more people are infertile today?

The simple answer is that, because the baby boom generation is so much larger than the generations that came before it, there simply are more people these days.  But these larger numbers of infertile people, resulting from a larger population, are misleading.  As Pamela's husband, Steve, explains, while the causes of infertility may have changed, the percentage of people in each generation who are infertile has remained the same.  That's because each generation has faced its own distinctive problems, which have been added to the varied causes of infertility.  In the sixties, the IUD contributed.  In the seventies, sexually transmitted diseases were a prominent cause of infertility.  And in the eighties, women who might otherwise have had families with no problem had difficulty getting pregnant because they were trying at a later age, after pursuing careers.  In other words, the woman who was potentially fertile in her twenties, may have lost that fertility by her late thirties, simply due to the passage of time.  The fertility challenges we face in the nineties, which include the added impact of delayed childbearing and the possibility of factors in the environment that may affect the reproductive system, are merely the latest twists in the infertility story.  

Changing Times, Changing Attitudes

In the fifties, things were perceived to be different.  Women's attentions were focused on the family, the source of all domestic bliss.  If women worked, it was because they had to.  Given this mind-set, when most of our parents came of age they married young and got pregnant early.  As a result, this period--roughly between 1945 and 1965--saw the highest birthrates and largest number of babies per family ever recorded in the history of this country.  Early marriage contributed to this baby boom in two ways.  First, since a woman can get pregnant only during a finite period of time--from roughly the ages of 12 to 45--women who married younger gave themselves more years in which to be pregnant.  Today's generation, which starts pregnancy attempts later in life, has shortened that finite time period.  In addition, marrying young helped women to avoid another problem--the decrease in fertility that follows as a woman ages.  Today's woman, who puts off getting pregnant only to be faced with reproductive dysfunction, might have conceived easily had she followed her mother's example and tried at a younger age.

Pamela points out that in the sixties and seventies attitudes changed, and so did birthrates.  Thanks in part to the invention of the birth control pill in the early sixties and the intrauterine device (IUD) in the late sixties, women began extending their education and becoming professionals: lawyers, doctors, and CPAs.  They wanted careers, not just jobs.  Striving to be the CEO of a corporation was suddenly acceptable.  Family became secondary--standing in line behind "self."  The seeds of a generation made up of highly competitive, goal-oriented, well-educated, success-driven people were sown.  A group that, by its very definition, postpones having children to a later age.

Along with this goal-oriented mind-set, better birth control helped women to grow more free-spirited.  They put off marriage and became sexually liberated.  They began to experiment with multiple partners, increasing the incidence of sexually transmitted diseases.  It wasn't until later on, when they wanted to have children, that the negative side effects of this sexual revolution--the hidden infections, tubal disease, uterine dysfunction, and ovarian abnormalities that had proliferated as a result of it--surfaced as fertility problems.  The group that passed through the era of sexual freedom began to realize that they bore emotional and physical scars as a result.

It was about this time--in the beginning of the eighties--that the same women who had gotten the message to pursue careers as ambitiously as men, slammed into an emotionally charged conflict between career and family.  A new message from society roared out at women: "You want to work...succeed...beat men at their own game?  Go ahead.  But don't expect to have a family too."  Women were informed that they could opt for satisfaction in either the work realm or the family realm, but they couldn't have both.

Sidney understands this all too well.  She pipes in that she feels she is a victim of today's society, where women are pushed to do it all, but never quite succeed.  After years of determined commitment, she has a flourishing career.  Now that she desperately desires children, and is looking toward family and motherhood, she feels she's being punished.  Sidney's feelings of being overwhelmed are understandable.  Today's society places a great burden on women, sending mixed signals about their place at home and in the workforce.

That's because things changed again as we approached the nineties.  The economy was no longer booming, and the high-powered lifestyle it had funded was threatened.  The need to have the biggest and the best was becoming, of necessity, less of a priority.  Looking toward life's simpler pleasures became the in-vogue path to inner satisfaction.The media, as they so often do, brought this problem into sharp focus.

Shifting Gears: The '80's

In the 1988 movie Baby Boom, Diane Keaton plays a professional woman caught up in the world of power and success, who opts out of the rat race for the sake of a child.  Her decision reflects the way society once again swung the pendulum of women's career paths back toward the family.

Infertility, the Social Disease of the Nineties

So now, in the nineties, "family" is it.  The new boom is the family boom.  Almost everything in life revolves around it...to such a degree that if you don't have one, you feel as if something is wrong with you.  Of course you understand what Sidney is feeling.  Women today who face infertility in their thirties and early forties become angry when they realize they bought in to the idea of having a career first, instead of children.  Some of their anger and frustration is directed toward the society that pressured them into a situation they would not necessarily have chosen on their own.

They're constantly reminded that having babies is now the "in" thing to do.  The world of babies is suddenly an acceptable conversation piece for either sex in any situation, and that includes the workplace.  Accessories and conveniences have been perfected to the point that babies are taken virtually everywhere, into public places as well as private ones.  If women weren't faced with so much baby overkill, they might not feel so needy about having a child.  The old adage "Out of sight, out of mind" may, for some, be truer than we realize.

The Media Won't Let You Forget

On the one hand, publications cite external factors that may explain why you are infertile in the nineties:

FROM THE PUBLISHER