On Oct. 25, 1990, the New England Journal of Medicine published a paper by the three partners detailing their success in using egg donations for women over 40. The study was small--only seven patients. Of the six who became pregnant, one miscarried and another gave birth to a stillborn infant. But the other four delivered healthy babies, including one set of twins.
With that news, so many calls flooded USC-IVF offices, Sauer recalls, that the lines went berserk; it is now known among staffers as "The Day the Phones Broke." "Suddenly all these patients all over the country and all over the world were seeking the service," Sauer says.
The research also impressed the medical community. The USC team was and is hotly recruited by other IVF centers hoping to duplicate its success. Lobo recently accepted a job as head of obstetrics and gynecology at Columbia University Medical School in New York, and Sauer fielded offers this month from Columbia and the University of Chicago. Both Sauer and Paulson are also candidates to replace Lobo at USC.
The Journal report snowballed into a blizzard of media attention. It was an about-face from the early days when Sauer tried but failed to persuade magazines to write about egg donation. When traveling to medical meetings, he would rip editors' names out of in-flight magazines and send off letters suggesting articles. "Somebody should pay attention to this," he thought. "There's gotta be a story here."
These days, Sauer is more media savvy. He is generous about giving interviews to print and broadcast media, but declines to appear with his patients on television talk shows. He's turned down Oprah, Donahue and the others.
"I don't want to make this a circus--and that's out of respect for my patients, not out of fear," Sauer says. "I love my patients. I consider these women pioneers. This is not a freak show."
Still, he concedes, the attention sometimes goes to his head. The first time one of his 50-year-old patients became pregnant via egg donation, he recalls gloating to himself: "I can make anyone pregnant." Then he came down to Earth, Sauer says.
Jonie Mosby Mitchell, a 55-year-old country singer from Ventura and mother of a 2-year-old USC-IVF son, can't say enough good things about Sauer, calling him warm, funny and a nice guy. She keeps in touch by phone and mails him photos of her toddler.
"(He) was my easiest delivery," says Mitchell, who also has four grown children and a 7-year-old adopted daughter. She and her second husband, Donnie, had been thinking of adopting again when she read a blurb in a newspaper about Sauer's work. Now she appears on talk shows, urging other women to follow their hearts and find a competent doctor. "I don't think all doctors do this as well as (Sauer)," she says.
But Sauer can't guarantee pregnancy. And when things don't go well, or as quickly as had been hoped, he finds himself in the middle of warring couples, each half blaming the other. The pressure to conceive is intense.
"There's a lot of obsession, pathological obsession," Sauer says. "Having a baby becomes more than just having a baby. It becomes a mark of their life's work."
Sauer's role as a spokesman for "the baby-making industry," as he calls it, also makes him a target for critics and cranks.
The complaint that egg donation is accessible only to well-off patients is often heard. Each USC-IVF cycle, including retrieval, fertilization and implantation, costs $12,000. Reimbursement from insurance companies is extremely rare.
Sauer hates to turn away patients who cannot afford the procedure, especially those whom he believes would be good parents. ("He can be a jellyfish without a spine," confirms Nanette Bahl, office manager at USC-IVF.) But budget constraints allow only an occasional discount.
Some critics also question the investment of time and money in IVF research. "I think in a time of increasingly restricted resources in health care, it's hard to argue that extending the frontiers of fertility should be a top priority," says Arthur Caplan, director of the Center of Bioethics at the University of Pennsylvania.
He also worries about the age factor, particularly if both parents are older, say 55. They may be "literally creating an orphan," Caplan says, if they don't live long enough to see their child reach 18.
Statistically, a 40-year-old woman can expect to live 41 more years; a 40-year-old man, 36 more years.
Sauer steadfastly believes that almost any woman who desperately wants to be a mother should have the chance, whether she is young or old, married or single, heterosexual or gay. "To me, there is no one way to raise a child," he says. He doubts, however, that he will extend his age limit of 55. It's his personal comfort zone. "It's a reproductive rights issue," he says.