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Analysis finds that addressing infertility’s root causes isn’t standard practice
The American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG) consistently justify their attacks on the medical specialty of restorative reproductive medicine (RRM) by insisting that addressing root causes of infertility is already the standard of care. But is that true?
A new analysis suggests infertile couples are quickly pushed towards in vitro fertilization rather than toward addressing the root causes of infertility.
Insurance claims from five million patients were analyzed.
The analysis found that patients rarely were given treatment based on common causes of infertility, such as endometriosis or low sperm count.
A new retrospective insurance claims analysis conducted by researchers from the International Institute of Restorative Reproductive Medicine (IIRRM) paints a different picture about how quickly infertile women and couples are ushered towards in vitro fertilization (IVF), and how little exploration is done of the leading (and potentially correctible) causes of male and female infertility and/or recurrent pregnancy loss.
IIRRM researchers studied claims from five million commercially insured patients. Their goal was to answer a simple question: How consistently are guideline-recommended diagnostic and therapeutic steps completed before IVF in real-world practice?
Researchers examined whether appropriate diagnostic testing was run, effective medical treatments initiated, and time given for them to work before turning to IVF.
The study was not perfect, as no study is, because the claims analysis could not capture cash pay infertility interventions or testing done apart from procedures covered by insurance. However, the claims analysis revealed troubling information about the timeline and scope for infertility diagnosis and treatment relative to IVF.
Consistently, women did not receive evidence-based workups and medical interventions for reproductive conditions highly connected to female infertility — including endometriosis, polycystic ovarian syndrome (PCOS), and high prolactin (hyperprolactinemia).
In a majority of cases, ASRM and the American Urological Association's (AUA) own protocols and guidelines were not followed before women and couples underwent costly, time-intensive, and invasive IVF procedures:
Endometriosis: By month nine after the infertility diagnosis, among women suspected to have endometriosis, 78.8% had begun IVF, while only 11.6% had had an exploratory laparoscopy to confirm and treat the condition.
PCOS: Many women with PCOS cannot conceive because they are not ovulating, but while 78.4% had begun IVF at nine months, just one in three (34.1%) had been prescribed first-line medication Letrozole to induce ovulation. In the same time frame, just 2.6% of women with PCOS had had second-line treatment laparoscopic ovarian surgery.
Amenorrhea: Just 17.9% of women who were not having periods (amenorrhea) had had an AMH level tested, which ASRM calls a “core element” of hormonal evaluation, though 70% had begun IVF.
According to joint guidelines issued by the AUA and ASRM, an infertility workup for males should include, as summarized by the IIRRM study, “repeated semen analysis, endocrine evaluation with hormonal testing in selected populations, genetic and anatomic evaluation for men with azoospermia [no measurable sperm] or severe oligospermia [low sperm counts], assessment of sperm DNA integrity and karyotype in selected recurrent pregnancy loss populations, and treatment of clinically significant conditions such as varicocele when appropriate.”
And yet, nine months after an infertility diagnosis:
72.9% of couples where the male partner had no measurable sperm had begun IVF, whereas only 20.8% of men had had karyotype testing to check for genetic causes of their azoospermia.
Hormone testing amongst this same population topped out at 37.5% and 43.8%, respectively having basic blood testing of FSH and testosterone done.
In men with a diagnosed varicocele (a fixable possible cause of male infertility), only 14.5% had had a varicocelectomy surgery nine months later, while 71.1% of female partners had started IVF.
And among all men being worked up for infertility, only 7.8% had had the basic, bare minimum diagnostic testing of two (or more) semen analyses by nine months, whereas their female partners had begun IVF 79.8% of the time.
These significant gaps between evidence-based recommendations and the reality of care come even as surveys indicate that women and couples desire more options before or instead of IVF.
Certainly, there’s a profit motive for clinicians to recommend IVF and other assisted reproductive technology (ART) procedures.
As Natural Womanhood explained, current medical coding fails to adequately reimburse RRM workups and procedures aimed at restoring natural function, compensating an 8-hour-long endometriosis excision surgery at the same rate as a 5-minute ablation of the visible endometriosis tissue on one organ.
In reality, many health insurance companies have little or no coverage for proper infertility workups, leading some women and couples to go straight to IVF or other assisted reproductive technologies (ART) procedures, which are covered. And sometimes a woman’s OB/GYN or primary care doctor may have prescribed Letrozole, for instance, or ordered a semen analysis before the couple arrived at the fertility center’s doors.
Yet the claims analysis suggests that in many cases, root causes analysis and treatment is simply not happening.
One comment on the Natural Womanhood Facebook post about the IIRRM study implied that IVF centers are simply respecting the time-sensitive nature of women’s ticking biological clocks.
The comment read, “People are not getting to the fertility center with time to spare for ‘root cause’ stuff.” Another commenter concurred, writing, “right. If you go to an academic medical center and want a thorough work up, you’ll get that! But if your priority is fertility ASAP and you go to an IVF clinic, that’s what you’re going to get. Money talks, and when so much of IVF is self-pay people put their money where their priorities are.”
But the perceived urgency of conceiving a yearned-for child is not the same thing as seeking out the emergency room in a hospital.
It’s no secret that IVF, which overrides the system by bypassing diseased or poorly functioning tissues and organs, can sometimes produce a baby faster than a RRM approach, which methodically explores each of these areas and then seeks to restore healthy functioning where needed.
Infertility is tricky in part because it often sits at the intersection of “reproductive, endocrine, metabolic, inflammatory, immunologic, anatomic, genetic and gamete specific factors,” as the IIRRM study noted.
Unsurprisingly, untangling the roles dysfunction in each system plays takes time, and this untangling needs to occur for both the female and the male partner.
At the end of the day, RRM does not promise a baby, but strives to uncover and help heal dysfunction to the greatest extent possible.
This does not always lead to successful conception and a full-term pregnancy. But RRM doesn’t come with IVF’s health risks for moms and babies, which includes increasing risk of birth defects, childhood leukemia, low birth weight, cardiovascular issues and cerebral palsy, as well as doubling the risk of stillbirth, nor does it commodify human beings and lead to the creation of excess “unwanted” embryos or “selective reduction” abortion if “too many” babies survive implantation.
“An ounce of prevention is worth a pound of cure” rings particularly true when it comes to infertility and IVF.
Restorative reproductive medicine’s approach of teaching body literacy and cycle charting for health to young girls entering puberty allows for identifying potential threats to infertility years, even decades, before six or even twelve months of “failed” pregnancy tests lands a woman in her OB/GYN’s office or an IVF center.
Live Action News is pro-life news and commentary from a pro-life perspective.
Our work is possible because of our donors. Please consider giving to further our work of changing hearts and minds on issues of life and human dignity.
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Joanna Calhoun
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UPDATEIssues
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Issues
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Opinion
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Human Interest
Anne Marie Williams, RN, BSN
·
Analysis
Anne Marie Williams, RN, BSN
·
Issues
Anne Marie Williams, RN, BSN
·Issues·By Anne Marie Williams, RN, BSN
Analysis finds that addressing infertility’s root causes isn’t standard practice
The American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG) consistently justify their attacks on the medical specialty of restorative reproductive medicine (RRM) by insisting that addressing root causes of infertility is already the standard of care. But is that true?
A new analysis suggests infertile couples are quickly pushed towards in vitro fertilization rather than toward addressing the root causes of infertility.
Insurance claims from five million patients were analyzed.
The analysis found that patients rarely were given treatment based on common causes of infertility, such as endometriosis or low sperm count.
A new retrospective insurance claims analysis conducted by researchers from the International Institute of Restorative Reproductive Medicine (IIRRM) paints a different picture about how quickly infertile women and couples are ushered towards in vitro fertilization (IVF), and how little exploration is done of the leading (and potentially correctible) causes of male and female infertility and/or recurrent pregnancy loss.
IIRRM researchers studied claims from five million commercially insured patients. Their goal was to answer a simple question: How consistently are guideline-recommended diagnostic and therapeutic steps completed before IVF in real-world practice?
Researchers examined whether appropriate diagnostic testing was run, effective medical treatments initiated, and time given for them to work before turning to IVF.
The study was not perfect, as no study is, because the claims analysis could not capture cash pay infertility interventions or testing done apart from procedures covered by insurance. However, the claims analysis revealed troubling information about the timeline and scope for infertility diagnosis and treatment relative to IVF.
Consistently, women did not receive evidence-based workups and medical interventions for reproductive conditions highly connected to female infertility — including endometriosis, polycystic ovarian syndrome (PCOS), and high prolactin (hyperprolactinemia).
In a majority of cases, ASRM and the American Urological Association's (AUA) own protocols and guidelines were not followed before women and couples underwent costly, time-intensive, and invasive IVF procedures:
Endometriosis: By month nine after the infertility diagnosis, among women suspected to have endometriosis, 78.8% had begun IVF, while only 11.6% had had an exploratory laparoscopy to confirm and treat the condition.
PCOS: Many women with PCOS cannot conceive because they are not ovulating, but while 78.4% had begun IVF at nine months, just one in three (34.1%) had been prescribed first-line medication Letrozole to induce ovulation. In the same time frame, just 2.6% of women with PCOS had had second-line treatment laparoscopic ovarian surgery.
Amenorrhea: Just 17.9% of women who were not having periods (amenorrhea) had had an AMH level tested, which ASRM calls a “core element” of hormonal evaluation, though 70% had begun IVF.
According to joint guidelines issued by the AUA and ASRM, an infertility workup for males should include, as summarized by the IIRRM study, “repeated semen analysis, endocrine evaluation with hormonal testing in selected populations, genetic and anatomic evaluation for men with azoospermia [no measurable sperm] or severe oligospermia [low sperm counts], assessment of sperm DNA integrity and karyotype in selected recurrent pregnancy loss populations, and treatment of clinically significant conditions such as varicocele when appropriate.”
And yet, nine months after an infertility diagnosis:
72.9% of couples where the male partner had no measurable sperm had begun IVF, whereas only 20.8% of men had had karyotype testing to check for genetic causes of their azoospermia.
Hormone testing amongst this same population topped out at 37.5% and 43.8%, respectively having basic blood testing of FSH and testosterone done.
In men with a diagnosed varicocele (a fixable possible cause of male infertility), only 14.5% had had a varicocelectomy surgery nine months later, while 71.1% of female partners had started IVF.
And among all men being worked up for infertility, only 7.8% had had the basic, bare minimum diagnostic testing of two (or more) semen analyses by nine months, whereas their female partners had begun IVF 79.8% of the time.
These significant gaps between evidence-based recommendations and the reality of care come even as surveys indicate that women and couples desire more options before or instead of IVF.
Certainly, there’s a profit motive for clinicians to recommend IVF and other assisted reproductive technology (ART) procedures.
As Natural Womanhood explained, current medical coding fails to adequately reimburse RRM workups and procedures aimed at restoring natural function, compensating an 8-hour-long endometriosis excision surgery at the same rate as a 5-minute ablation of the visible endometriosis tissue on one organ.
In reality, many health insurance companies have little or no coverage for proper infertility workups, leading some women and couples to go straight to IVF or other assisted reproductive technologies (ART) procedures, which are covered. And sometimes a woman’s OB/GYN or primary care doctor may have prescribed Letrozole, for instance, or ordered a semen analysis before the couple arrived at the fertility center’s doors.
Yet the claims analysis suggests that in many cases, root causes analysis and treatment is simply not happening.
One comment on the Natural Womanhood Facebook post about the IIRRM study implied that IVF centers are simply respecting the time-sensitive nature of women’s ticking biological clocks.
The comment read, “People are not getting to the fertility center with time to spare for ‘root cause’ stuff.” Another commenter concurred, writing, “right. If you go to an academic medical center and want a thorough work up, you’ll get that! But if your priority is fertility ASAP and you go to an IVF clinic, that’s what you’re going to get. Money talks, and when so much of IVF is self-pay people put their money where their priorities are.”
But the perceived urgency of conceiving a yearned-for child is not the same thing as seeking out the emergency room in a hospital.
It’s no secret that IVF, which overrides the system by bypassing diseased or poorly functioning tissues and organs, can sometimes produce a baby faster than a RRM approach, which methodically explores each of these areas and then seeks to restore healthy functioning where needed.
Infertility is tricky in part because it often sits at the intersection of “reproductive, endocrine, metabolic, inflammatory, immunologic, anatomic, genetic and gamete specific factors,” as the IIRRM study noted.
Unsurprisingly, untangling the roles dysfunction in each system plays takes time, and this untangling needs to occur for both the female and the male partner.
At the end of the day, RRM does not promise a baby, but strives to uncover and help heal dysfunction to the greatest extent possible.
This does not always lead to successful conception and a full-term pregnancy. But RRM doesn’t come with IVF’s health risks for moms and babies, which includes increasing risk of birth defects, childhood leukemia, low birth weight, cardiovascular issues and cerebral palsy, as well as doubling the risk of stillbirth, nor does it commodify human beings and lead to the creation of excess “unwanted” embryos or “selective reduction” abortion if “too many” babies survive implantation.
“An ounce of prevention is worth a pound of cure” rings particularly true when it comes to infertility and IVF.
Restorative reproductive medicine’s approach of teaching body literacy and cycle charting for health to young girls entering puberty allows for identifying potential threats to infertility years, even decades, before six or even twelve months of “failed” pregnancy tests lands a woman in her OB/GYN’s office or an IVF center.
Live Action News is pro-life news and commentary from a pro-life perspective.
Our work is possible because of our donors. Please consider giving to further our work of changing hearts and minds on issues of life and human dignity.
Contact editor@liveaction.org for questions, corrections, or if you are seeking permission to reprint any Live Action News content.
Guest Articles: To submit a guest article to Live Action News, email editor@liveaction.org with an attached Word document of 800-1000 words. Please also attach any photos relevant to your submission if applicable. If your submission is accepted for publication, you will be notified within three weeks. Guest articles are not compensated (see our Open License Agreement). Thank you for your interest in Live Action News!
Joanna Calhoun
·Issues
Nancy Flanders
·International
Cassy Cooke
·Issues
Nancy Flanders
·Issues
Sheena Rodriguez
·UPDATEIssues
Nancy Flanders
·Issues
Anne Marie Williams, RN, BSN
·Opinion
Anne Marie Williams, RN, BSN
·Human Interest
Anne Marie Williams, RN, BSN
·Analysis
Anne Marie Williams, RN, BSN
·Issues
Anne Marie Williams, RN, BSN
·