Groggy but conscious, Toni Marlow is wheeled into a tiny room at the California Medical Center in Downtown Los Angeles.
Inside, Dr. Mark V. Sauer, dressed in burgundy scrubs and with a surgeon's cap over his graying hair, waits by the ultrasound machine that will help him retrieve Marlow's eggs. He hopes they will be healthy enough to eventually impregnate their intended recipient, a childless woman in her early 40s.
Sauer's pioneering work in egg donation has made him a hero to would-be moms, some of whom are long past their reproductive primes. As such, his face--an earnest one, with kind blue eyes--has appeared regularly in millions of living rooms via such shows as "Today," "Nightline" and "48 Hours," as well as in a 1994 People magazine spread.
In the last three years, the procedure Sauer helped develop and refine has become common in the nation's 300 in-vitro fertilization (IVF) centers, and he is among its leading advocates, particularly for women past 40. His research at USC has been published extensively in medical journals. His protocols for the technique, created with his colleagues at the USC-IVF Program, are in practice worldwide. More than any other U.S. infertility expert, perhaps, Sauer pushes the envelope, accepting women up to age 55 while doctors elsewhere routinely draw the line a decade earlier.
"He's not afraid of controversy and he can be a risk-taker," says Dr. Lawrence Platt, chairman of obstetrics and gynecology at Cedars-Sinai Medical Center, who has tried to recruit Sauer for his staff.
That willingness to crash boundaries may endear Sauer to infertile women, but it also inspires scorn from critics who believe he's tinkering too much with Mother Nature. Some bioethicists accuse him of promoting a society of "Medicare orphans." And a Los Angeles woman is awaiting trial for faxing death threats to the USC-IVF Program offices, across the street from California Medical Center. "We know where you live," she allegedly wrote. "We know what your loved ones look like."
If the criticism and threats have been getting to Sauer, a 40-year-old father of three, it doesn't show.
Prepped on a recent morning to extract Marlow's eggs, he carefully picks up a transvaginal probe equipped with a hollow needle. As he guides it toward the ovaries, an assisting physician squints at the ultrasound monitor. "She's got 10 or more (eggs) on each side," estimates Dr. Tina Koopersmith, who is completing a fellowship at the USC-IVF Program.
Taking turns, the two doctors draw off fluid from the egg-filled sacs, collecting it in test tubes that are passed to an adjacent lab. The eggs will later be mixed with sperm--one egg to 200,000 sperm--to produce fertilized embryos. Meanwhile, the hopeful future mother has been injecting herself with hormones to support a pregnancy.
"Toni, you OK?" Sauer asks the donor.
She moans and asks for more painkiller. Soon, she is talking in a "conscious sedation" babble. She mumbles something about going skiing.
"Water-skiing or snow?" Sauer plays along.
"Water," she says.
"You could probably ski right down Santa Monica Boulevard," he jokes, referring to the recent heavy rains.
After the retrieval is complete, the doctors learn from embryologist Thelma Macaso that the yield is 30 eggs. They are delighted. Sauer always worries that he will overlook an egg and, he jokes, that "oversight could have become President."
Egg donation tends to make the news, particularly the tabloids, when a woman in her 50s or 60s gives birth. (During medical talks, Sauer amuses audiences by displaying one such headline about one woman "having another gal's baby.") But the technique was developed more than a decade ago to help women of traditional childbearing age whose ovaries had failed. Physicians initially didn't consider the procedure for older women, assuming that as the ovaries aged, prompting the onset of menopause, so did the uterus.
Then Sauer and others began to ask: What if the uterus ages more gracefully than the ovaries? Could egg donation, used in conjunction with hormone treatments to create a hospitable uterus, make motherhood possible for menopausal women?
It generally does, and it can.
In 1984, Sauer had just signed on as a fellow in reproductive endocrinology at Harbor/UCLA Medical Center when its physicians performed this country's first embryo-transfer procedure, in which the donor egg is fertilized in the donor's body, then removed and implanted in the recipient. These days, fertilization occurs in an IVF lab.
Three years later, Sauer joined USC-IVF and was charged with developing its egg-donor program. In an unusual arrangement, Sauer and his partners, Drs. Roger Lobo and Richard Paulson, divide their time among research, teaching duties at Women's Hospital of County-USC Medical Center and a private practice. Paulson oversees the IVF lab and directs the program; Lobo is chief of the reproductive endocrinology division at USC.