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Injection of Hope

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NO ONE, NOT EVEN THE CLOWN HE hired for a party last August to celebrate the opening of his new clinic on Staten Island, N.Y., works a crowd better than fertility expert Dr. Alan Beer. Surrounded by 200 people arriving from 19 different states to honor him, Beer hugged and kissed most of the 50 children between the ages of 2½ months and 10 years whom he had helped bring into the world, uncannily recalling the name of each child. Then he turned to many of the mothers and recited their personal medical histories, including how many miscarriages they had had before giving birth. “I can remember the long journey,” Beer, 59, told the dozens of families he had helped create. “I can remember the first meeting, when hope was gone.”

Hope is precisely what Beer has given thousands of couples who have suffered multiple miscarriages. An innovator in the field of reproductive immunology, he has helped more than 3,000 couples—some of whom have had up to 13 miscarriages—deliver healthy babies since 1970. A professor of obstetrics, gynecology, microbiology and immunology at Chicago Medical School at Finch University of Health Sciences in North Chicago, he predicates his still-controversial treatment methods on the notion that recurrent miscarriages are often caused by problems in the immune system. “Basically, I am dealing with a group of disgustingly healthy people who have lost 4.4 babies,” says Beer, who monitors up to 300 pregnancies a year at clinics in Chicago, California and New York City and claims that 87 percent of his patients deliver healthy babies. “It’s not simply bad luck. Something is wrong.”

Conventional medical wisdom holds that miscarriage is usually the result of hormonal problems, uterine abnormalities or a genetically defective fetus. Beer’s view is that for some couples who experience multiple miscarriages (about 60 percent), the problem is actually an overactive immune response. Specifically, he believes that if the genes in the husband’s sperm—whose function it is to create the placenta that attaches the fetus to the mother’s uterus—are too similar to the mother’s genetic material, the result can be rejection of the fetus. “While kidney, bone marrow and heart transplants survive best when the donor is similar to the recipient,” explains Beer, at his clinic in North Chicago, “the opposite occurs in pregnancy.” When husband and wife share tissue proteins that are too similar, says Beer, the pregnant mother will not produce the “blocking antibodies” that protect a fetus from being attacked by her immune system.

Using DNA fingerprinting, Beer determines if this similarity exists. If so, he primes the woman’s immune system by taking white blood cells from the father, sometimes mixing them with white blood cells from a donor, and injects the concentrated mixture into the mother. These injections, says Beer, stimulate the blocking antibodies that form a shield around the embryo, protecting the pregnancy and preventing miscarriages. Some patients are also required to take blood-thinners, steroids, anticoagulants or immunoglobulin injections. (Initial screening fees run between $800 and $2,000, and treatments cost between $2,000 and $8,000. Beer receives only a salary from the school for his work.)

Not all of Beer’s colleagues accept either his claims of success or his theories. Dr. Carolyn Coulam, director of reproductive immunology at Chicago’s Center for Human Reproduction and highly respected in her field, says Dr. Beer’s research is innovative, “but it would be more helpful if he had more randomized controlled studies.” She adds that Beer’s theory that a pregnancy is rejected by the mother because of her genetic similarity to her husband is unproven. “There is no direct evidence for that, and people have looked,” says Coulam.

Nevertheless, says Dr. Geoffrey Sher, medical director of the Pacific Fertility Medical Centers of California, “Dr. Beer is a pioneer in the immunology field who has not gotten enough credit for his outstanding contribution. People say things about him, and yet he has blazed a trail for others.”

Beer, whose self-regard sometimes seems to match his talent, is apparently unperturbed by his critics. “Innovators are seldom received with joy,” he says. “For every crossroads of the future, there are a thousand self-appointed guardians of the past.”

Alan Beer’s own past began in Milford, Ind., where, in the second grade, he told his father, a conservative Apostolic, that he wanted to be a doctor. Later on, the elder Beer urged his son not to be the kind of physician who “treats people below the belt.” Explains Beer: “He felt it was too much of a temptation for a young man to be examining women in this region.” With a higher purpose in mind, Beer pursued medicine.

Before attending Indiana University’s medical school, Beer married Dorothy Gudeman, a former nurse anesthesiologist (who refused to be interviewed for this article). The couple, who have four children—Michael, now 33, Elizabeth, 32, Margaret, 27, and Laura, 26—share a house in Lincolnshire, Ill. In 1961, after graduating from med school, Beer spent a year in Nigeria treating eye diseases. Returning to the U.S. in 1962, he took a position with the Public Health Service in Tuba City, Ariz., where he was a doctor on the Navajo reservation. There he met Dr. Edward Wallach, an obstetrics specialist who piqued the young doctor’s interest in reproductive medicine. Beer went on to do his residency in obstetrics and gynecology at the University of Pennsylvania, where he also studied genetics and immunology and conducted experiments that changed his life. “We found that when animal brothers and sisters were mated in experiments to produce an inbred strain, the mother produced runts, and soon she was infertile,” says Beer. “So there was something about pregnancy compatibility that led to a type of rejection that was totally different from the rejection of a kidney or heart.”

In 1979, Beer was made chairman of obstetrics and gynecology at the University of Michigan Medical School. Nine years later he treated a couple who had failed to carry to term after 20 in vitro fertilization attempts. “It was clear to me that this woman had activated her natural killer cells that were killing her embryos. I devised a treatment, and within a year she delivered healthy twins. From then on I saw every IVF couple, no matter how difficult their case was, as long as there was hope.”

Since then, Beer has opened bustling clinics in New York, California and South America. While disagreements over his theories continue, families he has helped consider themselves forever in his debt. “I had five miscarriages before we had our son,” recalls Tricia DiMicelli, from Wharton, N.J. “We went through all kinds of tests, and they never found anything. We went through hell and 11 doctors, but Dr. Beer saved us. I was 37 when we delivered Steven. He is a miracle.”

Though Beer delights in his successes, “I spend much more time,” he reports, “with those that I have done everything for—and they have lost the baby. I know there is still a lot to be learned.”

PETER CASTRO

GIOVANNA BREU in Chicago