HOLDING ON TO HOPE, COUPLES BATTLE INFERTILITY

Three-year-old Caleb Landyn Hosey this summer learned to swim and ride a bicycle minus the training wheels.

As would most parents, Joann and Bobby Hosey of Egypt Mills adore Caleb and are amazed at his every accomplishment. Unlike most parents, their desire to have a child was complicated by fertility problems.

In a sense, Caleb's every feat has been preceded by a decade of hoping. "I wanted a baby so badly, I never gave up hope," Joann Hosey said.

While it may seem that conception is often so easily accomplished, in reality some 15 percent of couples nationwide are unable to achieve a pregnancy. Causes for fertility problems are evenly split among females and males. Oftentimes, both partners may have contributing problems, and 5 to 10 percent of the time, no cause for the inability to conceive can be found.

Infertility has been defined as failure to conceive after more than one year of frequent, unprotected intercourse.

A local husband and wife, who don't want to be named, know the frustration of an inability to conceive coupled with no reason why.

"It was the not knowing that would really drive you nuts," said Michelle -- not her real name.

"We were the typical situation that you find these days, putting off having children -- we had two careers," she said. "I always thought, 'I have been regular as clockwork, I'll not have a problem with this, it will be a piece of cake.' It was not a piece of cake."

Batteries of tests provided no clues. Hormone treatments with a drug called Clomid proved unsuccessful. Frustration increased.

"You say, 'Why me,'" Michelle said. "You think, 'I can have everything else that I might want, why can't I have a child?'"

There were times she didn't want to talk or think about it.

"At times I thought, 'I don't want my life to just focus on this anymore,'" she said.

Physicians aiding couples who experience fertility problems are sensitive to the discouragement that may creep into the minds of the most optimistic of patients. Whether undergoing testing or treatment, careful monitoring and attention to detail is often critical.

"Sometimes things are so structured and regimented that it increases their frustration level," explained Dr. Paul Clarke, a gynecologist and obstetrician with offices on Mount Auburn Road. "You have to look for that and try to counteract it."

A woman's age at the time a fertility problem is suspected plays an important role in when medical help may be necessary. Typically, older women should seek help earlier than younger women. Often, the problem can be resolved without an extensive fertility work up. It isn't unusual for a couple's failure to conceive to be a simple matter of poor timing of intercourse.

At Clarke's office, after the decision has been made to initiate an infertility investigation, the patient provides a medical history and undergoes a complete exam. Sometimes the reasons for the problem are readily apparent; other times they aren't so clear.

"With a lot of patients," Clarke said, "you will find neither an abnormal physical finding nor anything in their history. Then, you start out with less expensive and simpler steps and work through the work up."

And, in most cases, a sperm analysis is also sought.

Ovulation problems are often treated successfully, Clarke noted.

"Endometriosis is probably the second most successful area, and also a very common area," he said, adding that overall, doctors are able to help a good percentage of their patients.

Some cases do require referral to St. Louis specialists. "There is help available," Clarke said. "A lot of intense study and research is going on all the time."

Michelle and her husband decided to pursue one more method of treatment after the first fertility drug wasn't successful. They were under the care of a fertility specialist in St. Louis.

It was the right choice. The couple has been successful twice in becoming pregnant with the use of the hormone drug Pergonal.

And continuously, research is bringing about significant advancement in the science.

In vitro fertilization is just one technique seeing marked increase in use. In the process, eggs are retrieved from the female, fertilized in a laboratory, then transferred to the uterus. The process is done is specialized centers.

"We're seeing more and more patients now that have undergone in vitro fertilization and have had success," Clarke said. "Previous to this, if a woman's problem was obstructed tubes, the only thing we had to offer was repair of the tubes."

It is a method of treatment that worked for the Hoseys.

Even though a first attempt at in vitro fertilization was unsuccessful, Joann Hosey said, "It helped me know that I had tried everything."

Trisha Stahly knows the value of feeling that every possible avenue has been explored. After months of unsuccessful hormone treatment, she backed away from active treatment with something akin to a sense of peace. "I could not have had that attitude had I not done everything that was financially, emotionally and physically possible for us -- if I had not sought the help of medical professionals," she said.

About six months after her final Pergonal treatment, Stahly, of Cape Girardeau, became pregnant. "My doctor said that was not unusual," she said.

After the unsuccessful in vitro fertilization attempt in St. Louis, the Hoseys, too, backed away from active treatment. Time passed, and a few years later the Hosey's learned about an in vitro fertilization program in Birmingham.

"The glimmer of hope was there, but I was so terrified," Joann Hosey recalled. "I wanted to go through it again. But, I made myself kind of stay on an even keel -- try not to get overly excited -- because I did the first time and it really brought me down hard."

The Hoseys' efforts paid off. The in vitro fertilization embryo transfer process was a success, and Caleb was born at the end of a normal, healthy pregnancy.

For Bobby Hosey, a self-described outdoorsman, the most formidable obstacle in the whole process was dictated by the clock.

Spending a lot of time in a hospital wasn't what he called fun, but, the biggest thing was trying to work the schedule, he said.

He remembers the waiting. "After everything was done, it was kind of exciting," he said. There was about a two-week period after the in vitro fertilization process before the Hoseys knew the results.

Joann Hosey, Michelle and Stahly are adamant about encouraging others to seek help for suspected fertility problems.

"You can't go into it worrying, thinking about percentages," Joann Hosey said. "You have to go into it with a positive attitude. You have to think, 'I want a baby, and this is the way to get it.'"

Making the effort to check into possible fertility problems, Bobby Hosey agreed, is well advised. "It's worth everybody's effort, if they really want a baby," he said.