There Is No ‘Alternative’ to IVF, Ob/Gyns Warn

While new Republican-led proposed legislation is trying to direct federal funds to “restorative reproductive medicine” — a so-called “alternative” to fertility treatments like in vitro fertilization (IVF) — fertility physicians said there is no alternative to IVF and standard infertility care already involves a holistic assessment of a couple’s health.

The Reproductive Empowerment and Support through Optimal Restoration (RESTORE) Act was introduced by Senate Republicans last month, including Sen. Cindy Hyde-Smith (R-Miss.), chair of the Senate Pro-Life Caucus. In a press release, Hyde-Smith said she supports IVF, but families need options to treat the underlying factors of infertility.

The bill defines restorative reproductive medicine as “any scientific approach to reproductive medicine that seeks to cooperate with, or restore the normal physiology and anatomy of, the human reproductive system, without the use of methods that are inherently suppressive, circumventive, or destructive to natural human functions.”

The vague definition notably excludes IVF, which has been the subject of increasing attacks by some religious groups, in part because discarding some embryos is inherent to the IVF process.

However, a spokesperson for the American Society for Reproductive Medicine (ASRM) debunked this proposed approach plainly: “‘Restorative reproductive medicine’ appears to be a political rather than a scientific concept,” they told MedPage Today.

“Ideologically driven groups have offered dressed-up versions of the rhythm method for many, many years; this appears to be the latest attempt,” the spokesperson wrote in an emailed statement, also noting that ASRM would still “be happy to meet with [restorative reproductive medicine’s] proponents to discuss their newfound interest in reproductive health.”

Indeed, one of the methods touted by restorative reproductive medicine is “natural procreative technology,” or “NaProTechnology,” which doesn’t actually involve innovative technology or technique; the bill defines it as “an approach to healthcare that monitors and maintains a woman’s reproductive and gynecological health.”

NaProTechnology is credited to Thomas W. Hilgers, MD, the founder and director of the Saint Paul VI Institute for the Study of Human Reproduction in Omaha, Nebraska, a Catholic pro-life medical institute. Hilgers also coined the Creighton model, another similar fertility tracking method.

Rachel Weinerman, MD, an ob/gyn and reproductive endocrinologist at Case Western Reserve University in Cleveland, explained that there is no true alternative to IVF, but added that “depending on the clinical situation, there are other treatments that can help a couple achieve pregnancy.”

Fertility physicians usually start by assessing patients and figuring out a strategy to meet their fertility needs, including surgical interventions for structural problems, like blocked fallopian tubes, fibroids in the uterus, or endometriosis for women, and structural issues preventing sperm from being ejaculated for men. There are also medications to increase sperm count or induce ovulation, as well as intrauterine insemination, where sperm is injected directly into the uterus. For patients with unexplained infertility, they start with one of these strategies before moving onto IVF.

Weinerman said that IVF is the “most powerful tool we have” and “is reserved for situations in which those treatments are either not an option or not effective.” IVF offers the most control over the whole reproductive process, “from improving reproductive efficiency by collecting multiple eggs at one time to physically bringing sperm and egg together to put an embryo into a woman’s uterus — there’s no other treatment that we have that can replicate all of those steps,” Weinerman said. “No fertility doctor is doing IVF unless there’s a clinical indication.”

In some cases, surgery, medication, or artificial insemination aren’t enough. For instance, Weinerman explained, if a woman has blocked fallopian tubes that cannot be surgically corrected, or if the tubes had previously been removed, IVF is her only option to conceive. In addition, when there’s a non-hormonal reason that a man has no sperm, the only way he and his partner can conceive is by surgically extracting sperm and doing IVF with intracytoplasmic sperm injection, where a single healthy sperm is injected into a mature egg with an extremely thin needle.

“So there are treatment alternatives to IVF in certain situations, but in others there are not,” Weinerman said. Still, she noted that she heavily considers her patients’ moral, ethical, and religious beliefs when working with them on a treatment plan, and not all patients are interested in pursuing all fertility treatments.

“But removing that choice from the patient would ultimately prevent many patients from creating life and bringing children into this world,” Weinerman said. “Making laws that prevent patients from getting the best treatment for them is overly restrictive and ultimately prevents successful fertility treatment.”

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