By Adele Slaughter, Spotlight Health, with medical adviser Stephen A. Shoop, M.D.

Cindy Margolis has had her image downloaded more than 58 million times. But when it came to getting pregnant, something wasn't clicking. So Margolis and her husband, Guy Starkman, turned to a high-tech solution — in vitro fertilization (IVF).

"I married the man of my dreams in 1998," says Margolis. "We were hoping that we would get pregnant on our honeymoon. When that didn't happen we were disappointed. We knew these things take time, so for the next year we tried everything we could on our own — the ovulating kit and all the fun things you can do naturally. We had a great time trying, but every month when I tried the pregnancy test, it was heartbreaking."

Her gynecologist recommended that Margolis and Starkman see a fertility specialist.

"We decided to be tested for everything," adds the Internet supermodel. "After three months, I felt like I had no blood left in my veins. You almost want there to be a problem so you can take a pill, get a shot, or have surgery to fix it, but when you're diagnosed with unexplained infertility, as so many couples are, it's difficult."

Infertility affects more than 6 million American couples — roughly 10% of reproductive age people. Infertility is a disease of the reproductive system that afflicts men and women almost equally.

Since Margolis was only 30 years old, the doctors suggested that the couple keep trying to get pregnant.

"Fertility starts to decline when a woman reaches 35," says Snunit Ben-Ozer, a reproductive endocrinologist, at the Center for Fertility and Gynecology in Encino, Calif. "Women who are over 38 should just start with an endocrinologist because time is of essence."

"At the time I didn't want to wait," says Margolis. "I really wanted to be a mom."

"Cindy and Guy are such a healthy couple. They're in good shape, down to earth and don't use drugs," adds Ben-Ozer. "They don't have any apparent risk factors, yet they end up infertile. It's difficult to treat."

Option plan

Only 20% of infertile couples have unexplainable factors. For women there are a variety of reasons they might be having difficulty conceiving, which include:

• Tubal and pelvic pathology
• Ovulatory dysfunction
• Unusable eggs

"For men that have poor sperm that can't get a woman pregnant, we put the sperm and the eggs next to each other so conception can occur," says Ben-Ozer. "There are a number of ways to achieve fertilization."

These treatments for infertile couples include:

• Inducing ovulation with medication
• Egg donation
• Artificial Insemination (IUI)
• Gammete intrafallopian transfer (GIFT)
• In Vitro Fertilization (IVF)
• Intracystoplasmic sperm injection (ICSI)

"We thought that IVF was the best option for us," says Margolis.

"There are approximately 70,000 cycles of IVF that are performed annually in the US," says Ben-Ozer." Resulting in about 22,000 births with approximately 30,000 babies being born. A little less than one-third of the births are multiple births."

There are four steps in the process of impregnating a woman in vitro:

• Medications — "I took a series of shots for six weeks every day at the same time," says Margolis. "We were even at a Madonna concert and we had to leave to take a shot. You have to be accurate and it does impinge on your lifestyle, but if your dream is to be parents, then nothing matters and you'll go to every length to do what it takes to become pregnant."
• Monitoring follicular growth — "The basic premise of IVF is that a woman's normal cycle is oppressed, so we have control over it," says Ben-Ozer. "Then the woman's ovaries are stimulated to produce multiple eggs."
• Retrieving eggs and sperm for insemination — "At the end of the six weeks, it is a very simple procedure," says Margolis. "They take your eggs and your husband's sperm, put them together in the lab, and make an embryo."
• Inserting embryos into uterine cavity — "Three days later they insert the embryo into the woman and 12 days after that you find out if you're pregnant," says Margolis. "I was not pregnant the first time, which was completely devastating."

Trial and error

According to the American Society of Reproductive Medicine (ASRM), the success rate of IVF is nearly 23%. This is compared to a 20% chance of conception by a reproductively healthy couple in any given month.

"At our clinic the success rate of IVF, when you take all comers, averages about 50%," says Ben-Ozer. "An average person does it twice. But there are people who will get pregnant the first time, but then there are people who will do it more than twice. It will depend somewhat on their age, their diagnosis, stimulation ability, sperm quality, and uterine factors."

After four in vitro attempts without getting pregnant, Margolis was looking into adoption. But Ben-Ozer decided to become even more aggressive.

"Cindy had IVF plus GIFT," says Ben-Ozer. "GIFT is when some of the eggs and sperm are put directly into the tubes. We know that the combination of IVF with GIFT has a higher chance of success than either one alone. The embryos assist each other."

"GIFT is a very simple, minor surgery, called a laparoscopy," says Margolis. "The incision is a little dot in your belly button. You go through the IVF as usual. When they implant the embryos, the doctor also takes the man's sperm and your eggs, inserting them through your belly button into your fallopian tubes and uterus. So your body acts as the lab. I'm sure this is the procedure that got me pregnant."

IVF costs are variable depending on the medical facility or the patient's insurance. It can range from nothing if insurance covers it, to as much as $25,0000 per attempt. The general accepted average is about $10,000 per attempt.

Women who become pregnant using IVF can expect a normal pregnancy and pre-natal medical care, providing there are no pregnancy complications. IVF babies have the same incidence of birth defects as children who are conceived naturally.