Infertility is a huge topic, as large in its own way as the topic of birth control. Unfortunately, I donâ€™t have the time to do it justice. I fully recognize that this can be an extremely sensitive issue for couples for many reasons. I absolutely do not judge any patients for making choices in dealing with infertility that I would not recommend professionally. I also fully celebrate the life of all children of God, regardless of how they were conceived. With this background in place, I wish simply to make three points.
1) Couples who have infertility are often pressured into believing that their medical options for treatment are much more limited than they actually are. I donâ€™t have any quantitative data on this, but I and my colleagues have heard countless stories from couples who are told that in vitro fertilization (IVF), or related procedures are their only option. In fact, there are few causes of infertility where IVF is the only option. These include tubal blockage that cannot be corrected by surgery, complete ovarian failure (in which case egg donation is required), or extremely low or zero sperm counts. In every other situation, including unexplained infertility, there are other kinds of treatments which have been shown to be effective. Now, they usually do not have as high a pregnancy rate as IVF does per cycle. (Depending on the type of infertility, the live birth rate per cycle of IVF treatment initiated ranges from under 10% to over 50%, on average about 30% per cycle.) But over time, the success rates for other treatments can be comparable, with far less cost and and substantially lower medical risk.
2) New options have been developed for infertility that are based on the principle of seeking to restore natural reproductive function, so that pregnancy occurs in vivo, from a natural act of sexual intercourse. The most advanced system is called natural procreative technology (NaProTechnology, or NPT). NPT was developed based on Creighton Model Fertility Care System (a natural family planning system), and incorporates medications and hormones that are also used in other infertility treatments. A strong foundation of medical evidence has been published for this option, and there are physicians throughout the United States and the world have been trained in this procedure. See http://www.iirrm.org
3) Finally, the mainstream of reproductive medicine has attitudes towards early human life and treatment that I regard as problematic. These include:
a) Treating human embryos as expendable and interchangeable building blocks for life, rather than as individual human entities. Among other things, this is evidenced by the huge number of frozen embryos in this country that have no prospect of being placed in a womanâ€™s body for further development. Also in the current approach to create as many embryos as possible, use (imprecise) criteria to define which ones look like they are most likely to successfully implant, and then freeze or discard the rest.
b) Minimization of the potential risks of assisted reproductive technologies in the pursuit of the distorted goal of a high pregnancy rate per cycle (as opposed to high pregnancy rate over a reasonable period of time). A good example of this is the current craze over intracytoplasmic sperm injection (ICSI), in which a single sperm cell is injected into an egg. ICSI was developed as a method to get around severely low sperm counts, but within a few years of its development is now being used in over half of all IVF procedures in the United States, a level of use that goes far beyond its original indication. Some clinics do 100% ICSI, for all patients regardless of their reason for infertility, because ICSI seems to result in a somewhat higher rate of pregnancy per cycle. And we have no data on long-term safety for children born with this procedure. A number of large studies and meta-analyses have been published in the major medical journals indicating that treatment with IVF procedures is associated with higher rates of preterm birth and genetic abnormalities. The absolute rates are still low, but are still of a magnitude that warrants a genuine concern and more caution. See for example the statements near the bottom of this link
c) In January 2006, an editorial by one of the top journals in the infertility field made the following statements that accurately reflect where the opinion leaders of the field of infertility medicine think the field is going [Fertil Steril 2006;85:12-3]:
â€œAre we ready to be the genetic engineers of the future?… In just over two decades, IVF has evolved from a laboratory curiosity to a commercialized, industrialized technology responsible for millions of births worldwide. More than 45,000 babies were born in the United States as a result of ART procedures done in 2002, an increase of approximately 10% over 2001. Just as laparoscopy replaced laparotomy, so will all traditional treatments for infertility be rendered obsolete by advanced reproductive technologies. Patient work-up will be minimalized and will be primarily targeted toward whether the couple can produce reproductively competent [sperm and eggs] and then followed immediately by treatment with a course of IVF and ET [embryo transfer]. Frozen eggs, frozen embryos, frozen blastomeres, libraries of genetic stem cells, and embryo genetic engineering will be the tools of the future. Aldous Huxley was clairvoyant when he prophesied, â€˜our civilization has chosen machinery and medicine and happiness.â€™ But what will be the role of the doctor then in the future? Will patients input their symptoms and their DNA samples into a computer and walk away with a printout of their differential diagnosis and treatment plan? Will procreation involve genetically engineering and choreographing the unification of a desired oocyte and spermatozoan?â€?
Thankfully, not all physicians in the field of infertility treatment would agree with these statements. But enough do that it is of great concern.
This is my last post as a guest blogger to T&S. I want to thank this community and all who have participated. I have worked in these issues for many years, but still your thoughtful comments have helped me explore angles that I had not fully considered before. It has been useful for me, and I hope it has been helpful for some of you.