In vitro field facing slowdown

The ''test-tube baby" industry seems to have grown up.

For more than two decades, the field expanded explosively, revolutionizing a whole generation's concept of babymaking and producing more than 1 million children worldwide who would otherwise never have been conceived.

But now, fertility doctors in Boston and across the country say they are seeing a slowdown in the growth of in vitro fertilization, or IVF. At Brigham and Women's Hospital, for instance, long renowned for its reproductive care, infertility patient volume failed to grow in the last year for the first time in recent memory.

The number of infertile people is still growing, said Joseph C. Isaacs, president of Resolve, the national infertility association. Soon-to-be-released federal figures show that there were more than 6 million infertile people in 1995, compared with 7.3 million at last count in 2002.

But the growth rates of IVF are falling in part, specialists say, because of the aging of baby boomers: The youngest members of that great demographic wave are now in their 40s and starting to think more about their 401(k) than IVF.

Also, because IVF is getting more efficient, patients more often become parents after just one or two cycles now, rather than trying again and again. The better the clinics do, the faster they lose their patients.

And the cost of IVF, which can run more than $10,000 per cycle and is not covered by insurance in most states, is driving people away during uncertain economic times, Isaacs said.

Lack of means is a constant theme among callers to Resolve's infertility help line, said its coordinator, Davina Fankhauser. She can relate: She is now 17 weeks pregnant through IVF, but she and her husband went through eight years of infertility treatments -- stopping short of IVF because they could not afford it -- before moving to Massachusetts, where they found that insurance would cover it.

''I have to say the economy made me not try, actually, until I moved to Massachusetts," she said.

In 1987, Massachusetts became the first state to mandate that insurance companies cover some infertility treatments. But Isaacs and others worry that current efforts on Beacon Hill to overhaul the health insurance system may end up stripping infertile couples of that guarantee. Infertility coverage is one of the mandates in play in the debate over how to get more people insured.

''If there's a mandated program with a bull's-eye on its forehead, it's IVF," said John McDonough, executive director of Health Care for All, an advocacy group.