Don’t be fooled: There is no substitute for IVF
When then-candidate Trump first announced his plans to mandate insurance coverage for in vitro fertilization, many of my patients breathed a huge sigh of relief. IVF is often the only way for individuals to build their families, but the high cost leaves the treatment out of reach for many.
I was deeply disappointed when the White House recently confirmed that Trump has no plans to mandate IVF care — breaking a core campaign promise and backtracking on a February executive order to reduce the cost of IVF.
But I wasn’t surprised. After all, it isn’t the first time this president has put insurance company profits over the needs of American families.
For months, my colleagues in the medical community have been sounding the alarm on an even more dangerous shift percolating in conservative circles like the Heritage Foundation: “Restorative Reproductive Medicine” — an unproven, ideologically driven approach to fertility as opposed to IVF, which claims to treat the “root causes” of infertility.
Restorative Reproductive Medicine’s anti-IVF ideology is being mainstreamed under the guise of fertility support, sowing doubt about the efficacy of IVF and threatening access to real fertility care for every American family.
But to understand why Restorative Reproductive Medicine is so dangerous and misleading, it’s critical to first understand the current standard medical practice for treating infertility.
When a couple comes into my office experiencing infertility, my job is to provide individualized and evidence-based care.
According to the standard, I conduct thorough diagnostic testing, which includes comprehensive hormone tests, imaging and semen analysis to determine whether there is a clear reason in one or both individuals why they are struggling to conceive.
The purpose of the evaluation is to diagnose underlying conditions such as polycystic ovary syndrome (known more commonly by its acronym PCOS), endometriosis, thyroid dysfunction or other hormonal abnormalities, or male factor infertility.
Only after I understand the root cause of the infertility, or rule out other explanations, and determine that other treatments would not work (or have not worked), would I propose IVF.
Like most forms of medicine, fertility care is comprehensive and complex. What works for one person (or one couple) might not work for another in the same scenario.
As doctors, we need every tool in our toolbox to be able to properly diagnose and treat our patients. In my line of work as a reproductive endocrinologist and infertility specialist, IVF is a critical tool.
IVF works across a wide range of medical diagnoses and categories of infertility. Roughly 2 percent of babies born in the U.S. today are born through IVF. That number will likely rise, especially if we can find ways to make the procedure more affordable.
IVF is also the only option for some people to have biological children. This includes women with dilated and blocked fallopian tubes and men with only a few sperm.
Those who oppose IVF for political, religious or ideological reasons and would like to see it eliminated as an option have selectively chosen parts of legitimate medical practice in fertility care and called them “Restorative Reproductive Medicine.”
Those who promote Restorative Reproductive Medicine emphasize treatment of underlying infertility causes — but this is what fertility doctors already do for every patient. Those incorrectly touting the practice as something separate from standard-of-care infertility management do so from political or religious ideology.
They consider embryos to be human beings who should have legal rights, a concept called fetal personhood and therefore oppose IVF, which is the only effective infertility treatment for many people.
Sure, the premise of Restorative Reproductive Medicine may sound great, and as doctors it is our responsibility to treat underlying health conditions — that’s what we already do.
However, if you don’t use IVF when it is the appropriate fertility treatment, then the person in your care may never be able to have a child. To oppose IVF is to ignore the complexities of infertility diagnosis and care, and dismiss the heartbreak that those suffering from infertility endure.
Restorative Reproductive Medicine is not an alternative to IVF. The Restorative Reproductive Medicine movement’s ultimate goal is political: to get rid of IVF.
Yet even as it abandons its promises to make IVF more accessible, the Trump administration is also quietly signaling an intent to shift federal funding toward Restorative Reproductive Medicine. This could threaten access to IVF for hopeful parents across the country. We can’t let this happen.
Excluding IVF from fertility care would have serious consequences for patients — and they deserve to understand the consequences. When it comes to building families, IVF is an important and scientifically backed treatment that should be affordable and accessible to all.
Elizabeth Ginsburg, MD, is president of the American Society for Reproductive Medicine and the fellowship director of Reproductive Endocrinology and Infertility at Harvard University.