The Heritage Foundation issued a white paper earlier this year urging would-be parents with fertility issues to explore non-IVF options. Clinics and industry observers say it’s not going anywhere.
BY RON SHINKMAN
The Heritage Foundation’s recommendation of infertility treatment options other than IVF has yet to find traction among fertility providers, say fertility doctors and executives.
In March, the conservative think tank released a 63-page document entitled “Treating Infertility: The New Frontier of Reproductive Medicine.” It promoted an approach it calls restorative reproductive medicine (RRM) for individuals experiencing fertility issues. It recommended women having trouble conceiving be examined for potential issues such as endometriosis instead.
The document – published about a year after the Alabama Supreme Court conferred personhood on all embryos – is not particularly scientific. It stated that the terms “reproductive health” and women’s health” are often euphemisms for abortion, without providing any proof. It also claimed the live birth rate for patients relying only on RRM topped that of IVF. However, the group of patients undergoing RRM in 2012 and 2019 cited by the white paper totaled less than 300. They were compared against more than 350,000 patients who underwent IVF in those same timeframes, raising questions about the statistical significance of such a comparison.
For now, those operating in the IVF space say the Heritage Foundation has had no impact on the way they practice. They also say they’re already doing what the white paper recommends.
“Why is this even a discussion point?” asked John David Gordon, M.D., medical director of Rejoice Fertility, an IVF clinic in Knoxville, Tenn. “You always go through the diagnostic steps, you then sit down and review the range of options, which include doing nothing, all the way up to IVF – maybe with or without donor gametes, maybe with or without gestational carrier. That’s what we are supposed to do as physicians.”
Matt Maruca, chief legal officer for Inception Fertility, agreed that fertility physicians engage in an enormous amount of diagnostic work prior to performing IVF.
“It’s part of practicing good medicine,” he said. Maruca observed that volumes at Inception clinics have not changed since the RRM white paper was published.
Gordon, who had a Jewish upbringing but converted to Presbyterianism in 2000 and wears a silver cross on his lab jacket, runs an IVF practice with distinctly spiritual undertones. Rejoice states on its website that its IVF program bars the discarding of unused embryos. “We believe that that the only embryo that cannot result in a baby is the one that you don’t transfer,” it says, adding that it many patients morally conflicted about IVF “are relieved to find a clinic that not only respects these concerns but welcomes an honest and frank discussion about the issues…” The Atlantic magazine recently described Rejoice as “a destination for Christian parents trying to navigate the morals and ethics of IVF.”
If patients express qualms about IVF, Gordon automatically discusses other options, such as lifestyle changes, surgery, ovulation induction possibly with or without IUI depending on the sperm count and motility of the father. If IVF is desired, he asks patients if they want a single-embryo cycle to avoid freezing other embryos, and also goes over the potential risks of implanting multiple embryos.
“That discussion hasn’t changed,” he said, adding that traffic into his clinic has remained strong all year. Gordon also noted he was invited to write an article on IVF for the Heritage Foundation white paper, but that it was not included.
David Sable, M.D., who practiced reproductive medicine at St. Barnabas Healthcare and sat on the board of Resolve for several years and now serves as a director at a couple of fertility firms, also questioned the efficacy of RRM.
For example, he noted that “a workup for endometriosis is implicit in what we do,” but added that even undergoing a procedure to treat the condition does not guarantee pregnancy, and may even damage the blood supply to the ovaries if performed too aggressively.
Sable, who sits on the boards of several reproductive medicine companies, said he is unaware of RRM obtaining any sort of foothold in clinics.
“Much of it we’re doing already,” he said. “Yet there’s this implicit accusation that we are intentionally cutting short the workup, or ignore a thorough workup in order to just do IVF. We were all trained to be thorough and to be precise.”
For patients who might have qualms about plunging straight in, Sable recommends what he calls a diagnostic IVF. That would be undergoing the procedure using both IVF and intracytoplasmic sperm injection. The preparation for the process is so thorough that any issues with either the mother or father can be identified quickly, Sable said. And if it works, there are rarely any complaints.
“The IVF world is blessed with one of the world's most unequivocal medical endpoints. You either had a baby or you didn't,” Sable said.
Correction: It was originally stated that diagnostic steps and review the range of motions maybe with or without gestational care. It's actually gestational carrier.
Additional: It was originally stated that if patients express qualms about IVF, Gordon automatically discusses other options, such as ovulation induction or checking on the sperm count and motility of the father. Gordon added options: such as such as lifestyle changes, surgery, ovulation induction possibly with or without IUI depending on the sperm count and motility of the father.