Medical Weblog

In 1977 two British scientists captured several eggs from the ovary of a woman who had been told she would never have children. Her fallopian tubes were blocked, and her eggs could not travel from her ovary to her uterus. The scientists slipped the tiny globs of potential life into a glass dish filled with liquid. They collected the husband’s sperm and poured it into the same flat saucer. After a few days of incubation, the physicians inserted the embryo into the woman’s uterus.

Nine months later, Louise Joy Brown came into the world. She was the first “test-tube baby.” Since then, more than 65,000 children around the world have found life in a glass dish. The United States alone has produced 44,000 such babies.

At the start, the procedure -called in vitro fertilization, or IVF -yielded only one live baby out of every 16 attempts, a 6 percent success rate. Today, however, the overall success rate has climbed to more than 18 percent. And new variations of the method have boosted many couples’ chances even further. More than 300 hospitals and clinics around the country offer a wide range of infertility services. At the best treatment centers, the success rate for IVF or one of its technical cousins is almost 40 percent.

There is more good news: The price has dropped. Fifteen years ago, a couple could spend about 100,000 dollars in efforts to have a baby, with no guarantees. Today, the price for IVF or other assisted reproductive technology hovers between 10,000 and 20,000 dollars. And it is still coming down, according to Dr. Alan DeCherney, president of the American Society for Reproductive Medicine. The cost may be covered in whole or in part by insurance.

The new technology has helped thousands of couples fulfill their dreams of having children. But there are still difficulties to overcome. Getting pregnant the new way may mean taking powerful chemicals, the long-term effects of which are unknown. And women who undergo IVF tend to have a higher rate of miscarriage. Moreover, even though the price has dropped, going through infertility treatments can put a big dent in the family budget. Successful couples invariably say that the investment was the best they ever made. Failing couples, however, have likened the process to playing a slot machine with a 2,500 dollars minimum bet.

“The most important factor in determining success is the age of the woman,” explains Dr. Zev Rosenwaks, director of the Division of Reproductive Medicine and Fertility at New York Hospital. “Women younger than 34 have a 45 percent to 50 percent success rate. This figure drops until, by age 44, the success rate is 2 percent to 3 percent.”

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A correct, nutritious, attractive, and well-prepared meal for a patient requires the teamwork of the medical, nursing, and dietary services. In the hospital the dietitian translates the diet prescription into a menu and supervises the food preparation and service to the patient. If a selective menu is used, the dietary technician or nurse may help the patient to select his meals according to the diet prescription.

The nurse has the most continual direct contact with the patient and makes certain that he receives and consumes his meals under the best circumstances. As a nurse you would expect to prepare the patient for his meals so that his tray can be served as soon as it arrives. Perhaps you may need to feed him. Helping the patient to accept his diet by giving encouragement and praise is a decided contribution. This also means that you avoid criticism if he is not eating well or pity because the diet is one you would not like very much.

Observing, listening, and reporting are three important functions performed by the nurse in nutritional care. How well the patient eats his food, what kinds and amounts of food are refused, and the patient’s attitude toward his food are readily determined. You are more likely than anyone else to observe problems such as these: poorly fitting dentures and inability to chew; a sore mouth and pain when acid juices are taken; arthritic fingers that make it difficult to cut up food; portions that are too large for some elderly persons or too small for teen-agers; difficulty in breathing so that eating a large meal at one time is not possible; between-meal feedings interfering with the appetite for the meals; fatigue and poor appetite at the end of the day; and many others.

By listening you show your general interest in and your understanding of the patient, and help him to express his feelings and perhaps to “blow off steam.” You begin to learn that some foods are favorites, others are thoroughly disliked, and still others cannot be eaten because of religious beliefs. You become aware of what food means to the patient, and what concerns the patient may have about the diet he will have when at home.

Acting upon your information is essential to the best care of the patient. Sometimes it is direct action on your part. More often it involves reporting to the nursing supervisor, dietitian, or physician, depending upon the circumstances.

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