Transcripts

text | pdf |

---

KAREN BARTA: Good morning. I'm Karen Barta with news from Minnesota Public Radio.

The Saint Paul City Council votes today on an interim financing plan for a $130 million arena to attract an NHL franchise. The vote comes two days before an expansion committee of the NHL is to consider bids from six cities, including Saint Paul.

Scholars and educators from across the country are in Minneapolis this week to examine the merits and biases of standardized testing. Keynote speaker Claude Steele of Stanford University says negative stereotypes can bias test results, but he says the solution is not clear.

CLAUDE STEELE: Are there things that we can do to rid the test-taking situation of the stereotype threat that we're talking about? Are there things that you can do to prepare minorities and women to be less threatened by this experience when they take the test? Those are the avenues that we've been exploring in our research.

KAREN BARTA: Steele says his research indicates the pressure to overcome stereotypes even hampers the performance of junior high school students.

The adopted daughter of the late author Michael Dorris is challenging his will at a court hearing in Minneapolis today. Madeline Dorris also filed a lawsuit accusing Dorris of sexually abusing her.

The state forecast, there is a chance of thunderstorms in the northwest, partly to mostly cloudy in the west and north, mostly sunny in the southeast. Highs from the upper 70s to middle 80s, cooler along Lake Superior. For the Twin Cities, mostly sunny with a high near 85.

Around the region in Rochester, it's partly sunny and 70 degrees. It's cloudy and 71 in Saint Cloud. Partly sunny skies in Duluth and 67. And in the Twin Cities, partly sunny and 73.

That's news from Minnesota Public Radio. I'm Karen Barta.

PAULA SCHROEDER: Today's programming is supported by 3M, which generously matches more than 900 employee contributions to Minnesota Public Radio. It's 10:06 o'clock. I'm Paula Schroeder, and this is Midmorning.

[MUSIC PLAYING]

In today's Voices of Minnesota interview, we hear from Dr. Ronald Cranford, a national leader in the ethics of medical treatment at the end of life. Dr. Cranford is a practicing neurologist at the Hennepin County Medical Center and a professor of neurology at the University of Minnesota Medical School.

He helped pioneer the development of ethics committees in hospitals. He has served as a courtroom consultant and an advisor to families in landmark right-to-die cases, including the case of Nancy Cruzan, which went to the US Supreme Court in 1990. Cranford told Minnesota Public Radio's John Biewen that he got involved in end-of-life issues in the early 1970s, shortly after he started his practice in Minnesota.

RONALD CRANFORD: It was pretty straightforward because I was a neurologist, and when I came to Hennepin County Medical Center in 1971, a lot of the ethical dilemmas were neurologic. So I was called in on a lot of the cases involving patients in a vegetative state, brain death, severely demented, locked in, and we didn't have an Ethics Committee at Hennepin. We started one in 1971, and I often was the neurology consultant on these cases and became very interested in the ethical issues.

And back in 1971, we didn't have anything. We didn't have the Quinlan case. We had no ethics centers. We had nothing back then. So we were literally flying by the seat of our pants. And unbeknownst to us, we were probably the first ethics committee in the United States forming an ethics committee, and we called it the Thanatology Committee.

So over a period of about four years, we just did a lot of consults in this hospital, just gained a lot of experience doing consults. And I acquired some expertise not only in the neurology of these issues, but in the ethics and the law. And so by 1975, '76, when the Quinlan case came along, people recognized this was a major case.

The State Medical Association formed an ad-hoc committee on death and dying. Without recognizing it myself or anyone else, I guess I was the expert in Minnesota on legal ethical issues related to stopping treatment. And then after that, it went from state to national at that point. So basically, my lead-in was that I was a neurologist who knew the neurology, who could explain the neurology to the ethicists and to the lawyers and to the family as a lead-in to trying to cope with these dilemmas.

JOHN BIEWEN: We have, over those 20-plus years, gone through the Quinlan case and the whole debate about who gets to decide when to pull the plug and when to pull the plug on brain dead people, things of that kind, to now through Jack Kevorkian and state laws either banning or permitting physician-assisted suicide. Are we making progress on these issues?

RONALD CRANFORD: Yes and no. We're making progress in the sense that there have been dramatic changes over 20, 25 years in terms of a much more humanitarian approach to these issues. Knowing the standpoint, the technology is still overwhelming. It's like it's a never ending battle to catch up on the indiscriminate use of technology. So we have made overwhelming changes over this period of time, but the technology becomes more awesome as we go along.

The debate over physician-assisted suicide, an act of euthanasia, is different though because we've developed a consensus on a lot of issues over 20, 25 years among the courts, among state medical societies, among ethicists, and lawyers working together on a social consensus on who should decide, when they can decide, what kind of treatments can be stopped. But this is going to be different because you're going to get a split among all of us. We're going to be all over the board, and it's going to be more controversial than abortion ever was, I think, because it's going to affect all of us a lot more.

And we're just in our very early stages, and we're going to look back 5 or 10 years now and say, gee, this early stage of the physician-assisted suicide debate in the early or middle 1990s was just a prelude to a far more complicated debate what's coming about in the future.

JOHN BIEWEN: Now, this summer or in the next couple of months, the Supreme Court is expected to rule on whether state bans on physician-assisted suicide are constitutional. In other words, do Americans have a constitutional right to commit suicide with the help of a doctor? What kind of decision are you hoping for?

RONALD CRANFORD: Well, I'm hoping for the only decision they can actually come out with. Because the only decision they come out is turn it back to the courts-- excuse me, turn it back to the states. Because that they did in the Cruzan case, was the only right-to-die case, stopping treatment case they had. And notwithstanding the strong views of all the Supreme Court justices, they're going to have to leave it to the states. They may come up with strong language condemning physician-assisted suicide. They're certainly not going to find a constitutional right to commit suicide in no way.

And so they're going to-- essentially, the bottom line is they're going to be similar to Judge-- Justice-- Judge Calabrese's opinion in New York on the one case that they're going to turn it back to the states-- the only way they can do it.

JOHN BIEWEN: So then what will happen?

RONALD CRANFORD: Then what will happen is that some states like Oregon and Washington will do it. And they'll develop this practice, and then we'll get some. Idea of how it works in practice, and other states will begin to develop the notion that physician-assisted suicide is proper, whatever I feel about the situation. And then you're going to have this groundswell among the public.

Well, the studies show now 60%, 70% of the American public favors it, physician-assisted suicide, whereas the leaders in medicine, the leaders in ethics don't favor it. And so you're going to see this groundswell among the population wanting it and demanding it. And that's what's going to happen over 5, 10, 20, 30 years. But it's going to be a very vigorous debate.

JOHN BIEWEN: What do you imagine happening in Minnesota?

RONALD CRANFORD: [LAUGHS]

Minnesota is going to be all over the board because we're a very liberal state, a very progressive state, as evidenced by the development ethics committees on right-to-die issues. This is a wonderful state because people really get along well until you get to the legislature. Then it's a different story. And you've got such a conservative wing or whatever you want to call them, the legislature. That's going to be so politicized.

And since the legislature passed laws in this year, they're going to be all over the board, and they may be out of the 15th century or out of the 21st century. Who knows?

JOHN BIEWEN: Where do you come down?

RONALD CRANFORD: In the middle. I really have some strong concerns for and against it. I've been opposed to physician-assisted suicide and active euthanasia, and I just have very mixed feelings. And that's what I'm going to do in the next few years is just try to articulate the pros and cons without being for or against it.

But generally, over the years, I've been pretty opposed to it. I'm less opposed now than I have been in the past for a variety of reasons. One is that I think doctors are doing a terrible job in the care of the dying. A lot of patients feel like they're going to be prisoners of medical technology, and they want control, and they see physician-assisted suicide as in control. And given the fact that doctors are doing a poor job and that a lot of people see themselves as prisoner of medical technology-- and they're right-- I'm more supportive of it.

But you can go back and forth because you're saying doctors are doing a lousy job on stopping treatment. Why are they going to do a good job on killing patients? And it's a contradiction, and in any of the arguments I bring up, you can bring the counter argument in. So I'm very mixed on it, and I'm not going to be for it or against it. I'm going to try to articulate as best I can, which I think is what a clinical ethicist should, the pros and cons.

And I think some of the pros and some of the cons are very strong. I think some of them are very weak. And I think one of my responsibilities would be to articulate the strengths and the weaknesses of some of these arguments in the future debate.

JOHN BIEWEN: How often do doctors help patients die now?

RONALD CRANFORD: Well, the term "help die" can mean a lot of things. Stopping treatment happens 3,000 to 4,000 times a day in the United States in terms of the 6,000 deaths. How often do people actually do physician-assisted suicide and active euthanasia? Nobody knows. But it's more common than we think.

And in studies and with the AIDS population in San Francisco, recent data showed that more than 50% of these doctors had done physician-assisted suicide or active euthanasia. So it's under the counter right now. It's definitely covert. Nobody's going to go overt with it, but it's a little more common, we think. How often. I don't know, and I don't think anybody in the country who knows in this area really can give you any reasonable estimate.

It's going to vary state by state with the population AIDS patients. It's really going to vary tremendously. But in the future, there'll be a lot of situations like Alzheimer's disease and other situations where patients are going to say, I don't want this, and families are going to say, I don't want this, but they're not going to be respirator or feeding-tube dependent. And you could really see a real groundswell towards a common situation.

I'm not saying that's good or bad. I'm just saying that's what's going to happen. And so it's going to be much more common than we ever thought before, but nobody really knows how frequent it is, notwithstanding a lot of studies in the literature.

JOHN BIEWEN: Has anybody ever asked you to help them commit suicide?

RONALD CRANFORD: Twice I've had patients, and both times I refused for various reasons. One, I didn't know the patient and the family well enough. I will tell you this. There's no doubt in my mind that if I were in a certain circumstance or my family's in a certain circumstance, I would opt for physician-assisted suicide, an act of euthanasia. And I have friends now who have worked out an informal pact with me that should they become prisoners of medical technology, should they become extremely deteriorated in certain conditions, are in a lot of suffering, that I would help them. There's no doubt I would.

I've never done it, but people that I'm very close to, I wouldn't allow treatment to go on when they've got a lot of suffering. So I've never done it, but I certainly would be willing to do it for certain friends of mine and close colleagues or family. There's no doubt. But I've never been in that situation yet. If it happens, I will.

But I won't tell you, and I won't make it a public issue. I'm not going to make it a test case unless-- I'll probably not make it a test case. I think it's unlikely.

JOHN BIEWEN: Can you think of an incident that has brought this into focus for you? Something that you've faced in your practice?

RONALD CRANFORD: I think when my mother-in-law died in Florida, we felt so strongly about her not suffering. And I spent so much time on the phone working with Florida physicians who were not the typical physicians trying to help her die comfortably. Not physician-assisted suicide, but after it was over and after we let her die comfortably with palliative care. But it was a real struggle.

You realized-- I realized, where physicians are in the United States and how they really are not close to their patients. She was dying of cancer. There was no hope for recovery. The doctors in Florida were resisting. We finally got her a hospice nurse, which helped a great deal.

And that culminated something in me because that was a personal situation because my wife's father had died-- a lot of suffering. When the doctor said at the end they would help him, they didn't. They chickened out, which a lot of doctors do. She didn't want to go through that again with her mother, and so I was very strong in making sure she didn't suffer.

But I thought to myself after it was over with, would I've gone that extra step with physician-assisted suicide in her case, and I would have. There's no doubt in my mind I would have. But I didn't have to go to that step.

PAULA SCHROEDER: You're listening to our Voices of Minnesota interview with Dr. Ronald Cranford, neurologist and medical ethicist at the Hennepin County Medical Center. He's speaking with John Biewen of Minnesota Public Radio.

It's 10:18 o'clock. You're listening to Midmorning on Minnesota Public Radio. I'm Paula Schroeder.

Coming up, after we complete our interview with Dr. Cranford, we'll be hearing from Dr. Robert Jansen, who is one of the world's leading authorities on treatment for infertility, and he has some fascinating things to say about people getting pregnant. And we'll be talking with him after we hear from Dr. Cranford.

Just a quick update on the weather here today. It's going to be another beautiful day in our region, although there could be some thunderstorms developing in the northwestern part of Minnesota. Partly to mostly cloudy elsewhere, with highs from the upper 70s to the mid 80s. A little bit cooler along Lake Superior. Right now, it's already 81 degrees in Bemidji. Think of that. Also in Brainerd, cloudy skies being reported in Brainerd.

In Saint Cloud, it's cloudy and 71 degrees. It's 79 in Thief River Falls. In Duluth, it's partly sunny and 67 degrees. Fargo-Moorhead reports cloudy skies and 64 degrees. And Mankato, 79. In Rochester, it's 70 degrees. Here in the Twin Cities, it's 73 degrees under partly sunny skies.

We continue now with our interview with Dr. Ronald Cranford. Dr. Cranford was born in Peoria, Illinois, in 1940. He told John Biewen his belief that patients in the medical system should be able to control their own destinies began forming early in his life.

RONALD CRANFORD: Well, I came from a very poor family. My father was a bus driver and a policeman. He never had very much money. We were either upper lower class or lower middle class. I'm not sure which. I worked as a caddy at a golf course, and through golf I was able to get a-- Evans Scholarship was very good and a state scholarship. So I did well, and golf has been good to me from that standpoint.

So my father wasn't able to contribute anything to my education, and so I went through college and part of medical school on scholarships. So I was very appreciative from that standpoint. I certainly came from the wrong side of the tracks, if you will, and can appreciate where I am today versus where I was now. I'm the only person in my family that's gone past high school, let alone college, so that worked out well being the oldest son in the family.

And along the way, I went to Vietnam for two years in Southeast Asia and-- as a flight surgeon for air medical evacuation of casualty. I was one step away from a MASH unit. Not as clever as Alan Alda, but one step away from him. And I saw a lot of death and dying then.

And we saw a lot of cas. We saw anywhere from 50 to 300 to 400 casualties a night five nights a week for 22 months. And so I thought a lot about death and dying, but I never, ever thought I would go into this area. This was just bedside screening of casualties from Vietnam, et cetera. And recognized over there, of course, the Vietnam War was terribly, terribly wrong, but since I was over there, it wasn't much I could do about it.

And when I came back to Minnesota, I went through my training in neurology. And then when I went to Hennepin County Medical Center here in 1971, totally coincidentally, they'd formed a committee at the same time, and I got involved in these issues. And I realized maybe before that I'd had an interest in this area or how people react to death and dying and from my experience in Vietnam that I had an interest in this area.

And so it just naturally developed from there, and it went from there to a local and then national-- and then a national situation.

JOHN BIEWEN: How do you think growing up without a lot of money in Illinois shaped your approach to medicine later?

RONALD CRANFORD: Well, I think it shaped my approach a lot because at a very early age, I guess, like a lot of other people, I was very observant of the rich and the poor. When I went to a country club, I saw the rich. I worked with the rich. And I came from a poor family, so I could really observe the difference in the classes.

And I guess I, just like a lot of people, became observant of the socioeconomic differences and what some groups have and what some groups didn't and how they were treated differently, and the American justice system, the American medical system, how it was favoring the rich. So I think it was just something I did just starting out as a boy and then working my way up like that.

And it made me appreciate things. It made me appreciate life. It made me appreciate the difference between the various socioeconomic classes and appreciate what I have now. And then, being in Vietnam made me appreciate life and having all my limbs together.

And so I became appreciative of what I had and what other people did. And so I think I was attuned somewhat and sensitized to the-- hopefully-- suffering of my patients and the families. I feel the family is very important in these situations. A lot of suffering goes on by the families because the patients are incompetent. They're no longer capable of suffering, but the families have to suffer through the situation, and I think I became attuned to this through starting where I did and working my way up.

JOHN BIEWEN: So after you spent a couple of years as a military surgeon in the late '60s, right, in Southeast Asia, then it was after that that you came to Minnesota in, what, '68?

RONALD CRANFORD: Right? I came in 1968, did my residency at that time in neurology from '68 through '71, then came to Hennepin County Medical Center and stayed here ever since and loved the people in Minnesota, but not the weather, but love the people. And it was such a refreshing change to see how people work together in Minnesota. It really is a very progressive, liberal state where people really do work together.

JOHN BIEWEN: Remind us of the Cruzan case and your involvement in it.

RONALD CRANFORD: Nancy Cruzan was a young lady in her 20s who had been in a severe auto accident in 1983. And she's so typical of the dilemmas we had because the initial part of that, she was severely injured. The doctor said, well, let's see what she gets better. And so they waited two to three years.

Well, she never got better. And by that time, they were like a bait and switch. And a lot of doctors do this. By then, they weren't willing to stop the feeding tube, which is a medical treatment. So the family felt like they were prisoners of medical technology. And then they realized after two, three, four years that Nancy would never want this. So they were like hundreds and thousands of other people out there.

But Joe Cruzan was in Missouri, which you know was a real state out of the 15th century with the governor and the assistant governor at that time. And so he wanted to stop treatment, and he was resisted at every step of the way. And, of course, that case went to the Missouri Supreme Court, and that was the first case to go to the US Supreme Court on the question of the right to stop treatment, including nutrition and hydration.

In the US Supreme Court, eight out of the nine justices said, really, the state should make these decisions. So they upheld the Missouri decision, which I think was a terrible decision. But that created a lot of discussion. And just like Quinlan did in 1975 and 1976, Cruzan in 1990 created a great deal of discussion about right to die.

And that's the other side of these legal cases. The vast-- the most important part of these legal cases is not the law or what you decide, it's how you educate the public through the media. And that's really important. There are a lot of gratifying things that happened after Cruzan in 1990, 1991, which educate the public, saying, we don't want this. We don't want feeding tubes. We don't want to be in a vegetative state. We want our family to decide.

And we're still in the throes of trying to implement those. So that was a very important case, and I was just-- started on the ground level. I was testified at the trial court and worked with the Cruzan family. And in these cases, I not only work with the courts and work with the lawyers, but I work with the families. I feel very strongly committed to helping the families.

And, of course, it puts me in a conflict because as an advocate for the family, the best thing for the family would be if we just stopped treatment on the side and forget it. But as these cases get out of hand, they go up higher, then I've become an advocate for social policy, which can be a conflict with the family. So I console the family, work with the families, but then when they get out of hand, like the Cruzan case does, then this is an opportunity to advocate.

Social policy is important. The Cruzan case was a landmark case. And a case in Minnesota, like the Torres case in 1984 and then the Butcher case more recently, it creates social policy change. And it educates people who want their living wills or advance directives, things like that. So it's very worthwhile from that standpoint.

JOHN BIEWEN: You have been and you are still involved in many professional associations and organizations. You chaired the Ethics and Humanities Subcommittee of the American Academy of Neurology. You're a member of Physicians for Social Responsibility. You're on the board of an organization called Choice in Dying, which is based in New York.

Do you still have time to play golf, too?

RONALD CRANFORD: Yeah, I still have time to play golf, and I still have time to practice medicine, which is my primary responsibility. I'm still a clinical neurologist and still time to practice. And I've-- it's harder as you get older because you just don't have the energy you had when you were younger. But I still have time to do the national stuff.

Some of the stuff I've done already was pioneering stuff in terms of ethics committees, in terms of national guidelines through the president's commission, through the Hastings Center, through National Center of State Courts, and I'm very proud of that stuff. That's laid the groundwork for a lot of the right-to-die stuff, not for euthanasia, and so we're developing a consensus. And now, what we have to do is take those guidelines and implement them.

And so I still have time for the other things, too, but I don't travel as much anymore. I'm just-- I can't travel as much as I did before. I've traveled a million and a half, 2 million miles doing some of this national stuff, and I just-- I can't do it anymore like I used to. I'm just getting a little older. And so--

JOHN BIEWEN: Beyond the daily business of healing the sick, though, you seem to think that physicians have a responsibility to the larger society to play an important role.

RONALD CRANFORD: Yeah, I really think they do. And a lot of what we've done in Minnesota has been pioneering in setting social. policy. So I feel very strongly that we have some role for that, which the average physician can't do. He doesn't have time for it. So those of us who are privileged to have been in the situation where we can advocate social policy change, I think we should.

So I think we have a real responsibility there. Part of that is just to explain to people the medical reality of some of these conditions. And like the vegetative state, brain death, and all these others, that's been one of my central features around these cases and also when I have right-to-die cases around the country, just explaining to the courts and working with families on these conditions to explain what we're doing through our technology for the downside and what I call the creatures of modern medical technology, which is unfortunate.

But I've done a lot of explaining in that area, a lot of clarifying these issues, and it's been worthwhile. In a landmark case, I've been involved with a lot of families, and I'm still involved with a lot of families behind the scenes. People don't realize that, but I'm involved with families around the country who want to stop treatment and who are caught in a bad situation. At any time I probably have five or 10 families behind the scenes here and in Australia, in California, Montana, other situations where I'm helping the families because they're prisoners of medical technology.

And these are not landmark legal cases. They're not going to go anywhere. We want to do things covertly. So the idea of going behind the scenes, doing something covertly, which I happen to believe is right, is a fairly common thing. And when you hear some of these horror stories around the country of how people are treated-- the Butcher case from Minnesota was a classic example of a loving, caring family who wanted to stop treatment on their son after being in a vegetative state for 17 years, and the pro-life or the disability groups were against them. They said it was a rash decision? Please spare me.

And so that's all behind the scenes, and that just takes extra time, but it's worthwhile.

[MUSIC PLAYING]

PAULA SCHROEDER: Neurologist Ronald Cranford, a physician at the Hennepin County Medical Center, talking with Minnesota Public Radio's John Biewen. Our voices of Minnesota interviews are heard nearly every Monday on Midmorning. The producer is Dan Olson with help from intern Becky Sisko.

[MUSIC PLAYING]

Today's programming is sponsored in part by Clouds and Water Zen Center in Minneapolis, presenting Natalie Goldberg in Thunder and Lightning, Zen writing workshop, June 7th and 8th. It's 10:30.

MELINDA PENKAVA: I'm Melinda Penkava. Monday is Election Day in Canada. One pollster says Prime Minister Jean Chrétien is overly confident that he'll enjoy another five-year term.

JEAN CHRETIEN: I think there's plenty of potential for errors and mistakes and volatility in the election, and the Canadians are more volatile than they've ever been.

MELINDA PENKAVA: Join us for a look at the thorny issues in Canada's elections on the next Talk of the Nation from NPR News.

PAULA SCHROEDER: 1:00 o'clock this afternoon right here on Minnesota Public Radio. I'm Paula Schroeder. You're listening to Midmorning.

Well, not being able to have a baby is as devastating as the death of a sibling or a divorce according to one of the world's leading infertility doctors. Dr. Robert Jansen is professor in reproductive medicine and surgery at the University of Sydney in Australia and medical director of Sydney IVF, an internationally-known fertility clinic. He's the author of Overcoming Infertility, a compassionate resource for getting pregnant.

In his book, he reminds those frustrated with the process of trying to get pregnant that getting pregnant is always a matter of chance and luck, and that it's just as unusual to conceive immediately as it is for it to take a long time. One in six American couples will experience infertility. Fortunately, there are many methods available now to overcome it.

Dr. Robert Jansen talked with Minnesota Public Radio's Stephanie Curtis about some of those methods.

An advisory note is in order here. This is a frank discussion of sexuality as well as infertility.

ROBERT JANSEN: It's generally longer than you would think. Now, sure, if you're a teenager in your early 20s, then you can expect it to happen within the first couple of months. But by the time a woman's in her 30s, then it's pretty normal to take four, five, six, seven months, something like that. If it's taken more than 12, though, it's time to see a doctor.

STEPHANIE CURTIS: What are the chances of a woman getting pregnant by month?

ROBERT JANSEN: Yeah, this is actually a new way of looking at infertility. You wouldn't think so. It seems so obvious. But pregnancy at the best of times is a matter of chance, and you'd need to look at it as a probability every month. And as the months go by, of course, that probability accumulates a bit. But a typical monthly probability of getting pregnant would be only 20% or so for couples around the age of 30.

STEPHANIE CURTIS: And if a couple is trying to get pregnant, is there a time of day they should be having sex?

ROBERT JANSEN: Yeah, that's an interesting point, too, because the research behind that is surprisingly recent. But we know that a woman usually ovulates during the afternoon, and if the sperm count is at all problematical, then it's best to have sex just before ovulation. And that generally means morning sex rather than evening sex.

STEPHANIE CURTIS: So take some time off work?

ROBERT JANSEN: Yeah, I guess it's one reason why vacations might have a bit of a reputation for leading to pregnancy.

STEPHANIE CURTIS: If a couple is trying to get pregnant, should they wait and wait and wait--

ROBERT JANSEN: And save up the sperm?

STEPHANIE CURTIS: Yeah--

ROBERT JANSEN: No, that's generally not a good idea. It's one of the more popular myths. In fact, if you're trying to get pregnant, you basically can't have sex too often. Now, that doesn't mean that you have to have sex twice a day.

And the-- but the important point to remember is that sperm actually survives better in the mucus in the cervix, so in the woman, than it does in the man's seminal vesicles. And although your lab result might look better if you've saved up for days and days, that does not translate into the best chance of getting pregnant. And really, the more often you can have sexual intercourse around the time of ovulation, then the higher the chance of pregnancy.

STEPHANIE CURTIS: Is there anything about positions that couples should be in when they're having sex or anything afterwards?

ROBERT JANSEN: No, it's-- the position is very much what's comfortable to you. And I find in talking to patients that one of the things that happens is that it becomes very mechanical and you feel like engineers almost. And if there are ways that you can have sex that make it more fun or make it more comfortable, then you should follow them.

And that begins all the way back in-- if you know when ovulation is going to happen either because you've been charting carefully or you've been using a test from the drugstore, then you can actually plan for it to be a bit of fun. You know, to go to a restaurant that you've been waiting to go to first and then enjoy yourselves afterwards.

As far as position is concerned, again, this is-- boredom with sex when you're trying to get pregnant is something that's ever present. And, well, I've heard Germaine Greer say in one of her books that the most comfortable position for sex for a woman or the most exciting is with the woman on top and the man underneath, and that's certainly fine for getting pregnant.

The so-called missionary position with the woman underneath and the man on top, you just don't have to follow that prescription if it's pregnancy or after. And men have told me that they find it most interesting and the easiest to cope with. If their wife is not going to have an orgasm because they've had sex every 12 hours for the last three days, that a rear-entry position can be very comfortable for both. The man can have pleasure, then that does not necessarily require the woman to have an orgasm, and that's equally technically fine for getting pregnant. The position really doesn't matter.

STEPHANIE CURTIS: Does having an orgasm in any way affect a woman's getting pregnant?

ROBERT JANSEN: Yeah, orgasm in relation to getting pregnant really is interesting. It obviously does no harm to have an orgasm, you would think, otherwise God wouldn't have designed it or nature wouldn't have evolved it. But studies have recently shown that if a woman has an orgasm before the man ejaculates, it can actually keep sperm out.

Now, that's quite a thing to deal with in the late-20th century when the sensitive new-age guy generally, if he's got good manners, if he's polite, will wait for his partner to have an orgasm before he ejaculates. But for getting pregnant, that's not the best.

It's, in fact, the man should ejaculate and then the woman can have an orgasm any time up to maybe 45 minutes after. And it will help sperm into the uterus, and it will steer it, we know now, towards the side where the ovulation is going to take place.

STEPHANIE CURTIS: So what causes infertility?

ROBERT JANSEN: There are a number of general reasons why people have trouble getting pregnant, and let's look at them in two groups. There are those where the doctor does the tests and you end up with an answer, and there are the situations where the doctor does the tests and there are no conclusive answers. Let's look first at the situations where you can get a conclusive diagnosis.

I generally break those into four. One is obvious. It's a low sperm count. The second is probably equally obvious, and that's when the ovaries are not ovulating eggs regularly.

The third group is when there's a blockage when the egg and the sperm can't get together, and a blockage in the Fallopian tubes would be the commonest of those. The fourth is where the embryos that form, in other words when the eggs are fertilized, they don't have what it takes to implant and produce a pregnancy properly.

And this is a very frustrating situation. It can be because the eggs are older. This is what happens when women are over the age of 40, for example. Or it can be that the embryo can't implant in the uterus properly because there's a problem in the uterus. So there the group of specific-- you can put a label on it. You can define what the problem is.

The other group, the frustrating situation for many infertile couples, is that there's no single cause that seems to be it. Let's go back to that 20% per month figure that I was talking about. If you've got a single factor like a decreased sperm count that might decrease that chance to a quarter of what it would otherwise be-- so we're talking now about 5% in any one month rather than 20%, well, that's OK. That means it might take eight or ten months to get pregnant instead of three or four.

But say that there's a factor in the woman as well. Say she doesn't ovulate so regularly, and her chance is also decreased to a quarter of what it would otherwise be. Now we've got a quarter of a quarter. We're not going to add those two quarters together. We're not talking about an eight. We're talking about a sixteenth or so of what it would be. And if you start off with about 20%, well, you're down to a 1% chance of getting pregnant in a month, and now, you're looking at years before the odds are likely to fall your way.

And this is how a combination of mild things can multiply together and really put you behind the eight ball.

STEPHANIE CURTIS: If a couple is having problems getting pregnant, they go to the doctor. What is going to be the first thing that they go through?

ROBERT JANSEN: The first thing the doctor is going to want to know is whether the periods are irregular because that immediately gives you a pretty good clue as to where the ovulation is taking place. So at 12 months, the periods are irregular and tests for ovulation seem to be OK. Then, a sperm count will be the sensible next investigation, and then some sort of test to see that the Fallopian tubes are open by doing an operation called a laparoscopy. It can show the outside of the Fallopian tubes, and it also enables the diagnosis of endometriosis to be made.

Endometriosis is where tissue like the endometrium, which is the lining of the uterus, grows outside the uterus, generally near the ovaries or the ligaments supporting the uterus, and sets up an irritation that although it doesn't usually kill fertility-- It doesn't mean sterility-- it reduces the chance of getting pregnant, probably by shortening the life of sperm and maybe sometimes by preventing the egg finding its way into the Fallopian tube normally.

STEPHANIE CURTIS: What kind of drugs are women put on to make them fertile?

ROBERT JANSEN: Drugs find their place in treating infertility in a number of ways. One is in trying to reduce the effects of endometriosis. Here, they're a bit of a two-edged sword because any time spent on the drugs which stops ovulation means that you can't get pregnant while you're on the drug. I don't know that I'd like treating endometriosis that way very often.

The other main area where drugs are used is to help ovulation. That, in turn, there are two circumstances in which you might want to do that. Firstly, if the woman's not ovulating, they work very well. They work with very few side effects, and they are very reliable in causing an egg to be released from the ovary.

The drugs become a little bit more controversial-- and expensive for that matter-- when they're part of the in-vitro program. You can easily double your chance of pregnancy by transferring two embryos instead of one, and likewise with three or four. Now, this is one area of difference between the US and some other countries.

In Australia, for instance, we rarely transfer more than three embryos at once. Instead, we put them in the deep freeze, if you like-- store them so that there are further opportunities down the track without risking too serious a multiple pregnancy. If there are three embryos transferred, then just by chance they might all take, and then you've got triplets, which might be more than you've bargained for.

In America, it's not uncommon to transfer four or five or six embryos. Most of the time you get away with it, and on the occasions when they do all implant, there is the operation of selective reduction or selective feticide it's sometimes called where the ability of the embryos to keep developing is interrupted for a couple of them to spare the ones that are still there and mean that the pregnancy becomes manageable again.

Now, not everyone will have the same views on the ethics and morals of that. The fact is that in the US that that is carried out and is one of the rationales between-- it's one of the rationales for implanting as many embryos as you can. It's an area of difference between different countries in terms of practice.

STEPHANIE CURTIS: So what's the future of fertility? Are there going to be any breakthroughs in embryo research, or what are they trying to work on next?

ROBERT JANSEN: The areas where we've made a lot of progress in fertility recently are in overcoming male-related problems with in-vitro and the ability to fertilize eggs by actually placing an individual sperm inside the substance of the egg. We call this intracytoplasmic sperm insertion. More commonly, it's just abbreviated ICSI.

ICSI can overcome astonishing degrees of male infertility-- male sterility really. This is a situation where the man can have no sperm in the ejaculate at all, yet we can find a sperm in the testes. We can fertilize an egg, and a normal baby results. The real hurdle is still older women. For women, all the eggs that she's ever going to have are there before she's born. And most of the eggs, in fact, are used up in ways that don't involve ovulation.

A woman starts off with about 7 million eggs, and that's 20 weeks before she's born. So as a fetus, she's got all the eggs she's ever going to have, and she loses about 5 million of them before being born. At birth, there are about 2 million. And then by the time that the first menstrual period comes, it's down to about 300,000. And from then on, it continues to decline.

But what happens at about the age of 40 is that the eggs seem quite suddenly to lose their ability to form healthy pregnancies. All cells in the body, and that includes egg cells, have little structures in them called mitochondria, which not only make the energy but store it until it's needed. Now, these mitochondria, they almost lead an independent life in your body. They've got their own DNA, for example, and you inherit all your mitochondria and the DNA that goes with it from your mother, so this is one form of genetics where you don't get a 50/50 split from your mom and your dad.

And the mitochondria in the egg stamped with this use-by date, which means that after about the age of 40, on average, they run out of the oomph, the steam, the power to form a new embryo properly. And this means that a woman's fertility from about the age of 38 to 42 takes a very rapid decline. And we've heard a lot of publicity about pregnancy in 63-year-old women from the donation of eggs from a much younger woman.

Progress in research there is going to be slow, but the technology that does seem to be here today-- and I guess it's still an experimental situation in the sense that we don't have babies from it yet, but we know now from-- that we can store bits of human ovary containing thousands of eggs. We can store that tissue and later graft that tissue back into the ovary and have the egg survive.

Now this, it's not something that you go down to your local medical center and have done tomorrow. But, in principle, this I think we're going to see a lot more of it. This is going to be women who, say, are reaching the age of 30, figure that it's still going to be a number of years before their career allows them to have babies, that they might well decide to have some small amounts of ovary put into an egg bank in a reputable institution.

And then if around late thirties when she does figure it's time to start a family, if all goes well, yeah, when she's pregnant, no problem. But if she then has difficulties, then she at least has this other resource to draw on. It does require a surgical operation to put that small amount of ovarian tissue back, and I would suggest that in-vitro would almost certainly follow to make the most of the eggs that then available to grow.

It's very high tech, as you can see. It's high tech from start to finish. But at the moment that is the only method on the horizon by which we're going to be able to deal with this very biological phenomenon of female fertility taking such a dive at around the age of 40.

PAULA SCHROEDER: Dr. Robert Jansen is professor in reproductive medicine and surgery at the University of Sydney in Australia and the author of Overcoming Infertility, a compassionate resource for getting pregnant. He spoke with Minnesota Public Radio's Stephanie Curtis.

I'm Paula Schroeder. It's 13 minutes before 11:00. Say coming up tomorrow on Midmorning, we are going to be talking with Dr. Brooks Edwards from the Mayo Clinic about finding health information on the internet and how to tell what's legitimate and reliable and what's not. That's tomorrow at 10:00 here on Midmorning.

13 minutes now before 11:00, and we're going to go down to Rochester to take a look at a new carousel that rolled to life in Minnesota this weekend. 20 hand-carved animals dip and bob to calliope music at Lark Toys, actually in the small town of Kellogg along the Mississippi River. It's the first carousel carved of Minnesota wood by Minnesotans and features many native animals. Minnesota Public Radio's Brent Wolfe prepared this report.

BRENT WOLFE: Don and Sarah Kreofsky watched nearly a decade of work pay off as children rushed to mount up animals they'd been eyeing impatiently from the long line. The new carousel is the latest and biggest attraction at their toy store, which began as a simple shop in their garage 14 years ago. They're surrounded by family, friends and co-workers as the carousel starts its first counterclockwise spin and animals begin to rise and fall.

[CAROUSEL MUSIC]

[APPLAUSE]

The carousel is an expression of their passion for toys, especially those made by hand. Don researched and designed each animal. He wanted many of them to be Minnesota natives.

DON KREOFSKY: Now we have a river otter. The otter has shells from Lake Pepin carved onto it with buttons from the button factories. They used to pump the buttons out of them, and it's all inlaid with actual buttons from Lake Pepin from clam shells.

BRENT WOLFE: Don notes his creation is a carousel, not a merry-go-round. Merry-go-rounds are populated solely by horses.

DON KREOFSKY: I've never really enjoyed a lot of horses. I'd rather have all the different animals, and it's easier to decorate and do different things with various animals. The giraffe is covered with monkeys. The goat over there has gnomes and elves crawling around it and sticking their faces out of the beards.

There's the lead piece, which is a 8-foot dragon, and the dragon has a snake on the back. A wizard sitting in front will have a staff with a Bavarian crystal on it.

BRENT WOLFE: Is the dragon your favorite, or do you have a favorite?

DON KREOFSKY: I think the dragon is my favorite. There are two bags that are being carved, and the bags have fireflies on all the way around. The bags are hollow, and when I die, a little part of me of the cremation will go into one bag, and the other bag my wife can be put into some of that so we can ride the carousel the rest of our lives.

BRENT WOLFE: Creating a carousel from the imagination wasn't without its challenges or its early mistakes. A 1,200-pound stegosaurus proved too heavy for the carousel and became the basis for Larkasaurus Park, an area near the carousel that also features a 16-foot hand-carved cedar table for birthday parties.

Each animal began as a block of basswood beams glued together. The Kreofskys bought kiln-dried basswood because greener wood might crack as it dries out. After the blocks were carved into shape, Mary Everson sanded and stained them.

MARY EVERSON: I'm just feeling as I go along to make sure the rough chisel edges are smooth to the touch. We actually leave a lot of the texture on the piece. We want people to really actually know and look at it that it is wood, and you can see that by leaving the chisel marks in it.

BRENT WOLFE: The carousel is designed to be flexible. There are six animals in reserve that can be rotated on when others need maintenance, and the carousel's only horse easily becomes a unicorn by strapping a horn between the eyes. Sarah Kreofsky wanted the music to be flexible too, and she's in charge of the compact disk player and baby grand player piano.

[MUSIC PLAYING]

SARAH KREOFSKY: We think it's going to give us the variety that's going to be just magic. I mean, I don't particularly like the oom-pah-pah of a steam organ or a calliope. I think that would drive me nuts if I had to listen to it. But if I can vary that sound with other things too, get some waltz music in there and get some Judy Collins in there, that's my target audience is that sort of music.

BRENT WOLFE: On opening day, the question was, which animal to ride first?

You know which animal you're going to ride?

SPEAKER 1: The sea serpent.

BRENT WOLFE: And why that one?

SPEAKER 1: I just like mythical creatures.

BRENT WOLFE: You know which one you want to ride?

SPEAKER 2: The wolf.

BRENT WOLFE: Why the wolf?

SPEAKER 2: Because it's always been my favorite one.

BRENT WOLFE: Do you know which one you're going to ride?

SPEAKER 3: No.

BRENT WOLFE: Are you taking a look and seeing what's on there?

SPEAKER 3: Yeah.

BRENT WOLFE: Any of them you like?

SPEAKER 3: Yeah.

BRENT WOLFE: Which ones?

SPEAKER 3: The dragon.

BRENT WOLFE: What do you like about the dragon?

SPEAKER 3: It's cool.

BRENT WOLFE: A spin around, the carousel costs $1, and the Kreofskys have already sold 20,000 memberships that include lifetime riding privileges. I'm Brent Wolfe, Minnesota Public Radio.

[CAROUSEL MUSIC PLAYING]

[MUSIC PLAYING]

[MOTOWN MUSIC] Do you like good music?

SPEAKER 4: 1968, Little Rock, Arkansas. Civil rights activists seek affirmation in the courts for victories won on the streets.

SPEAKER 5: Witness history in the next episode of Will The Circle Be Unbroken? on Public Radio International.

GARY EICHTEN: Coming up at noon here on Minnesota Public Radio.

PAULA SCHROEDER: And coming up at 11 o'clock on midday, we'll get the latest on the Saint Paul City Council's meeting today to vote on a financing package for a new hockey arena. We'll also talk with a former Minnesota North Stars official on whether professional hockey can survive in the Twin Cities. Also hear about an effort to find storage space for nuclear waste in Utah. All that's coming up on midday getting underway at 11:00. It's 6.5 minutes before 11:00. Time now for Garrison Keillor in the Writer's Almanac.

[MUSIC PLAYING]

GARRISON KEILLOR: And here is the Writer's Almanac for Monday. It's the 2nd of June, 1997. Queen Elizabeth II of England was coronated on this day in 1953 at Westminster Abbey in London, on a day selected because weather forecasters said it was the most likely day of the year to be sunny. And, of course, it poured rain.

It's the birthday of the English novelist Barbara Pym, born in Oswestry, Shropshire, on this day in 1913. She edited the anthropological journal Africa for more than 20 years as she was writing her comic novels about the English middle class. It's the birthday of physicist Robert Morris Page in Saint Paul on this day in 1903. He was the man who invented pulse radar technology, which uses short bursts of electromagnetic radiation to detect and locate distant objects. The use of pulse radar was a significant factor in the allied victory in World War II.

It's the birthday of English poet and novelist Thomas Hardy in Dorset on this day in 1840. He looked on novels as a way simply to make a living in order to support his habit of poetry. And he wrote them for a fictional place, Wessex, his name for his native Dorset. Far From the Madding Crowd, 1874, The Return of the Native, 1878 Tess of the D'urbervilles, 1891, and Jude the Obscure, 1896, among his best known.

And today is the birthday of the First Lady of the United states, Martha Washington, at Chestnut Grove plantation in New Kent county, Virginia, 1731. She had little formal education. She was married when she was 18 to a man 20 years older than she. She was widowed by the age of 26, had two children, whereupon she married a young plantation owner, George Washington. She managed his household at Mount Vernon and later managed his household in Washington when he became president.

Here's a poem for today by Maxine Kumin. The chambermaids in the Marriott in mid-morning. are having a sort of coffee klatch as they clean, calling across the corridors in their rich contraltos while laughing fresh sheets in the flickering gloom of the turgid, passionate soaps they follow from room to room.

In Atlanta, they are Black, young, with eloquent eyes. In Toledo, white, middle aged, wearing nurse's shoes. In El Paso, always in motion. Diminutive Chicanas gesture and lift and trill in liquid Spanish. Behind my do not disturb sign, I go wherever they go. Sorely tried by their menfolk, their husbands, lovers or sons, who have jobs or have lost them, who drink, and run around, who total their cars and are maimed, or lie idle in traction.

The funerals, weddings, and births, the quarrels, the fatal gunshots happen again and again, inventively reenacted, except that the story is framed by ads and coming attractions. Except that what takes a week in real life took only minutes. I think how static my life is with its careful speeches and classes and how I admire the women who daily clean up my messes who are never done scrubbing with Rabelaisian vigor through the Marriott's morning soaps up and down every corridor.

A poem by Maxine Kumin, The Chambermaids in the Marriott in Mid-morning from her collection Looking for Luck, published by WW Norton and used by permission here on the Writer's Almanac for Monday, June the 2nd. Made possible by Cowles Enthusiast Media, publishers of America's Civil War and other magazines. Be well. Do good work. And keep in touch.

PAULA SCHROEDER: By the way, you can hear Garrison Keillor every Sunday at noon right here on Minnesota Public Radio on A Prairie Home Companion. Programming on Minnesota Public Radio is supported by the Virginia Piper Cancer Institute's Piper Breast Center, part of Abbott Northwestern Hospital, providing innovative breast care in a compassionate environment. I'm Paula Schroeder. Thanks for joining us on mid-morning today and come back tomorrow. We'll be talking about how to find reliable health information on the internet. Stay tuned for Midday coming up next.

JOHN GORDON: The three golden rules of naming your technology venture. I'm John Gordon. You can hear that story and more on the next Future Tense. Future Tense in one half hour on Minnesota Public Radio, KNOW FM 91.1.

PAULA SCHROEDER: You're listening to Minnesota Public Radio. 73 degrees under partly sunny skies at KNOW FM 91.1, Minneapolis, Saint Paul. It will be partly sunny in the Twin Cities today with a high between 80 and 85 degrees. Look for an overnight low, near 57 under clear skies. And tomorrow, it's going to be sunny with a high near 80. Looks like we'll have the same all through the week.

[MUSIC PLAYING]

GARY EICHTEN: Good morning. It's 11:00 and this is Midday on Minnesota Public Radio with Monitor Radio's David Brown. I'm Gary Eichten. In the news this morning, the Saint Paul City Council has approved a plan to build a $130 million hockey arena. Saint Paul Mayor Norm Coleman says the new arena is needed to bring a national.