In this excerpt from the brand new book, Making Babies (Little Brown, 2009), a noted fertility doctor and a practitioner of alternative medicine explain why high-tech fertility options often fail patients, and how women can take steps to maximize their own fertility.
Pamela had been through ten cycles of in vitro fertilization (IVF) at three different centers but had never been pregnant. Some of the best fertility doctors in New York had told her she was too old (39) and probably had “bad eggs.”
Over the course of ten years of trying to have a baby, Evelyn’s doctors had pumped her up with a total of fifty cycles of fertility drugs. She’d made hundreds of eggs, but she still wasn’t pregnant. Not one of the four doctors she’d seen had ever stopped to ask why she wasn’t getting pregnant.
Stephanie took high doses of fertility drugs in preparation for her first IVF cycle at the best clinic in the city. The doctors harvested lots of eggs, made nine embryos, and discovered on testing that every single embryo was genetically abnormal. Although they’d been willing to give IVF a try with her, they now told her there was nothing more they could do because of her age (41).
The good news is that, in the end, all these women got pregnant and had babies. The bad news is that they underwent difficult, unnecessary, and futile treatments before anyone figured out why they weren’t getting pregnant and what to do about it. The worse news is that these women are not exceptions to the rule. The way fertility medicine is practiced today routinely generates stories like these.
One in 100 babies born in the United States today was conceived with the help of assisted reproductive technologies (ARTs), according to the American Society for Reproductive Medicine (ASRM). Worldwide, more than 3 million babies have been born who were conceived through IVF — more than 400,000 of them in the United States. Each year in this country, 250,000 families consider IVF, and about half of those give it a try. They do so at their pick of 461 clinics nationwide. The numbers have skyrocketed since IVF technology was introduced three decades ago. Over time, ART has morphed from an option of last resort, available to only a few, to the first choice for every player in the game.
It’s cause for celebration when patients bring home babies thanks to amazing technological celebration. And it’s wonderful to have these options when other recommendations aren’t successful. But the sad truth underlying the good news is that ARTs, and in particular IVF, are frequently misused, grossly overprescribed, and too aggressively administered. We’ve arrived at this place because of a culture, both in society at large and in reproductive medicine in particular, that always goes for the quick fix regardless of other options or possible consequences. Based on our experience with thousands of patients coming to us in various phases of fertility treatment, as well as on what we hear from our colleagues, we estimate that as many as half of all women who receive IVF could conceive naturally or with minimal medical intervention.
These technologies can be miracle makers, but they must be used wisely to be used well. There is a better way: use all options available in their proper place and time, with a preference always for what’s closest to the way nature intended and what’s best (and most likely to work) for the patient.
With careful diagnosis, basic fertility education, and simple but detailed diet and lifestyle advice, many women using ARTs could conceive much more naturally. If any drugs or other interventions turn out to be necessary, minimal doses and least invasive procedures can be used, minimizing risks as well as unpleasant side effects — all while increasing success rates. The stories that opened this chapter ultimately illustrate the possibilities.
Pamela, who’d had ten IVF attempts and a diagnosis of “bad eggs,” also had scar tissue from having fibroids removed, which was effectively keeping her eggs from getting into her fallopian tubes. She’d started IVF to get around the scar tissue — a common approach. But clearly something about the IVF wasn’t working for her, even if it was circumventing the obvious roadblock. She had surgery to clear away the scar tissue, and then became pregnant two months later, with no drugs and no IVF.
Evelyn, who’d been treated with fertility drugs since before her 30th birthday, finally became pregnant at age 40 after a single course of antibiotics cleared up a mycoplasma infection in her cervical mucus. Two years after her daughter was born, she went on to have a son with no treatment and no delay.
Stephanie, all of whose embryos had tested genetically abnormal, fit into a pattern we have seen all too often: high doses of injectable fertility drugs predisposing eggs in older women to develop chromosomal irregularities. Stephanie had been given too many fertility drugs for a woman of 41. With a much lower dose of essentially the same drugs, her eggs and embryos were perfectly normal — and so is her young son.
It is not our intention to set anyone’s mind against IVF or any other ART. But we do want anyone who goes that route to do so with eyes wide open — and to know, before he or she heads down that road, that there are many other ways through the forest that are easier, safer, quicker, and cheaper. They all end up in the same place, so the difference between what exists now and the world you envision is understanding that you have a choice, including, but not limited to, ART.
So many patients come to us having failed IVF, or having been turned down as candidates for IVF, and their doctors don’t have anything else to offer them, with the possible exception of donor eggs. They’ve been told that they’ll never have a baby, perhaps because they are too old or their FSH is too high. For these women, that’s a terrifying position to be in. These are the risks of not knowing — not knowing what is preventing pregnancy and/or not knowing what to do about it — which the one- size- fits- all approach of fertility medicine today not only deems acceptable but also implicitly encourages. But you don’t have to accept them.
High- tech medicine produces all kinds of miracles for all kinds of people, not the least of which are people desperately wanting to be parents. It isn’t that we shouldn’t use the technology available to us. It’s just that we should use it wisely and well. The widespread availability of IVF and all ARTs is undeniably a good thing. The overreliance on them is not. Let technology work wonders for those who need it. Let nature work its wonders for those who don’t.
***Find out more about the 3-month program that combines Western medical science and traditional Chinese wisdom to maximize fertility. Click here for more information, or to purchase Making Babies from Amazon.com.