Patients travel from as far away as Europe to visit Attila Toth, MD, a physician in New York who claims his extreme treatment will help infertile women conceive. Couples are going home with babies, but doctors think his methods are far from sound.
For 10 days straight in the summer of 2010, Samantha*, a lawyer from Greenwich, Connecticut, and her husband came into New York City to visit the office of Attila Toth, MD, a fertility specialist who thought he could solve the mystery of why, at age 28, she couldn’t get pregnant.
On the first morning, Toth put in their arms IVs that delivered an antibiotic that they each carried around in a fanny pack for the entire 10 days. He then threaded a catheter into the pinpoint opening of Samantha’s cervix so that, for the next hour, a cocktail of four antibiotics, the steroid Medrol, and a large dose of the yeast-infection medication Diflucan could wash out her uterus. The first two mornings, Samantha suffered excruciating cramps from these daily washes, but by the third, the pain had subsided, and she settled into a routine of watching Dr. Phil on the examining-room television until Toth returned to remove the catheter and insert a paste containing a fifth antibiotic that would be absorbed into her body for the next 24 hours. Meanwhile, every other day Toth gave her husband a painkiller and then injected antibiotics through his rectum and into his prostate; twice Toth also injected his seminal vesicles. After their last visits, Toth gave the couple prescriptions for still two more antibiotics that they’d take for a month.
When their treatments were over, Samantha and her husband returned to see Toth, who declared them both “clean,” by which he meant they were free of Chlamydia trachomatis, a bacterium that can cause infertility in women and has been linked to recurrent miscarriage, premature labor, ectopic pregnancy, and pelvic inflammatory disease.
Outside of Toth’s office, such an elaborate antibiotic assault on chlamydia is practically unheard of. The standard treatment—which health officials say is at least 97 percent effective—is a seven-day course of the antibiotic doxycycline or a single dose of azithromycin. But Toth thinks chlamydia is far harder to detect and treat than most doctors do. In fact, he thinks it may be responsible for a substantial portion of the one third of infertility cases that doctors now classify as “unexplained.”
Toth, 72, came up with the idea of administering intrauterine washes (also known as lavages) to patients in the late 1970s after learning about the horse breeder who successfully put the racing legend Secretariat to stud. The breeder would flush out the uteruses of mares with antibiotics to kill the microbacteria that could interfere with conception. Why couldn’t humans benefit from such a therapy too? Toth thought. In 1977, he started testing infertile couples for a little-studied bacterium called mycoplasma that had been linked to infertility. He gave men who tested positive an oral antibiotic, and many of their wives soon became pregnant, Toth says.
Around this time, public health officials were becoming increasingly concerned about chlamydia, and his boss at New York Hospital suggested he look into it. “He said, ‘That’s far more important and can do much more damage to the reproductive tract’ ” than mycoplasma, Toth recalls. Pictures of this were telling: scarred and blocked fallopian tubes, uterine adhesions, blocked epididymides (the coiled ducts that collect sperm). “I thought, This is destroying people’s anatomy,” he says.
At first, Toth treated people who tested positive for chlamydia with a conventional dose of oral antibiotics. But when cultures from his patients continued to show traces of the bacteria, he lengthened the time to four weeks. He added another antibiotic. Then he doubled the duration of both medications to eight weeks. “The longer they took them, the faster they got pregnant,” he says. In the early ’80s, he introduced IVs for men and women; patients would cluster in his office basement while they were hooked up to the then primitive machines and call themselves the “IV League.” By the late ’80s he had refined his regimen further, introducing the uterine lavages; five years ago he added prostate injections.
Toth, a man whose bear-hug personality endears him to his patients, now sees some 150 couples a year for infertility, a third of whom, he estimates, are referred by gynecologists, urologists, or fertility specialists who are at a loss as to how to help them. Gideon G. Panter, MD, a Manhattan-based gynecologist and infertility specialist, has sent Toth 40 to 50 patients, he says, and “always with the same story,” of unsuccessful IVF cycles, including one couple who traveled from Europe after four had failed. “Toth has been saying this stuff for 20 years,” Panter says. “But fertility medicine is big business. Doctors don’t stop to think, Wait! My patient’s IVF cycle failed twice. Something else must be going on. Toth’s treatments cut into the economic overhead of infertility treatment. He’s ahead of his time.”
After finishing medical school in Hungary in the late ’60s, Toth emigrated to the U.S., where he received a fellowship at the Cleveland Clinic and finished a residency in pathology at The Mount Sinai Hospital before opening up a private practice at New York Hospital in 1977. Fifteen years later, he moved his practice to the Upper East Side townhouse where he remains today. A tall man with a mustache, a full head of sandy brown hair, and a thick accent, he avoids conferences and has published infrequently. He says he encountered such cynical resistance from the medical community early in his career that he retreated to his office and relied on his evangelistic patients’ word of mouth to grow his practice. “I just became frustrated by the lack of interest in the role of infections on fertility, no matter what ideas I put forward,” he explains. “So I treat my patients according to my best understanding, and my reward is seeing them get pregnant.”