Laura Elm, MBA  |   05  June 2020

It seems logical that I would oppose IVF. I am pro-life and a practicing Catholic. But in my experience, arguing against IVF using these two qualifiers sometimes leaves people confused (“but IVF creates life”), annoyed (“the Church needs to get with the times”), or even angry.

On the other hand, arguments in favor of “pro-family infertility legislation”[i] (i.e., legislation that mandates coverage of IVF) tend to be more well-received; their messaging delivers a seemingly charitable, just, and logical position.  IVF advocates lay the groundwork with prevalence statistics: “1 in 8 couples have trouble getting pregnant or sustaining a pregnancy.”[ii] Then, a heart-felt personal experience that genuinely shows the pain and devastation of infertility. At some point the IVF advocate will stress that “infertility is a disease,”[iii] that IVF is a Nobel prize-winning medical treatment,[iv] but is arbitrarily and wrongly excluded from many insurance plans, making “cost a key barrier” for many deserving families.[v] IVF legislation helps people “build their families.” “Everyone deserves the chance to be a parent."[vi]

IVF coverage bills continue to emerge in state legislatures, primarily through the work of groups like RESOLVE: The National Infertility Association and the American Society of Reproductive Medicine (ASRM).[vii] The bills go by names like “Infertility Treatment Coverage Required”[viii] and include a variety of diagnostics, medications, and treatments. But at their core these bills are about increased access to IVF. Thirteen states currently have mandated coverage specific to IVF[ix] but terms of coverage vary across the states. Such variability could be solved by the Access to Infertility Treatment and Care Act (S1461, Sen. Cory Booker; HR2803, Rep. Rosa DeLauro).[x] This federal legislation would standardize IVF coverage across all plan types (except Medicaid) and mandate coverage in every state. Interestingly, IVF bills are typically sponsored by pro-abortion legislators, reflecting a consistent application of their position that not all human beings have an equal right to life.

IVF: Profitability’s Role in Clinical Process

IVF, or in vitro fertilization, is the process of surgically retrieving a woman’s egg(s), fertilizing them with sperm in the lab, and transferring the resulting embryo(s) to the woman’s uterus. Please remember now and throughout this article that the terms “fertilized egg,” blastocyst, and embryo all refer to a living human being. A round or “cycle” of IVF refers to the end-to-end process, starting with medication management and ending with the result of an HCG pregnancy test. Most IVF cycles deploy a complex pharmaceutical regimen to produce a state of controlled ovarian hyperstimulation in order that multiple eggs may be retrieved.

“Even if ovulation is normal, fertility drugs are used to produce more than a single egg because pregnancy rates are higher with more eggs. An average of 10 – 20 eggs are usually retrieved for IVF.”[xi]

In the United States, there is no limit on how many eggs an embryologist may attempt to fertilize. And there is no guarantee that any particular egg will fertilize successfully. One cycle may result in many embryos or none at all.  A patient who asks their clinic to limit the number of eggs retrieved or the number of eggs fertilized would likely be met with raised eyebrows, persuasive coaching on why more is better (especially given the $15-20K price tag)[xii], or refusal to treat.

IVF clinics operate in a highly competitive environment, making efficiency and efficacy critically important to their business success. More eggs mean more embryos, and many embryos mean a greater chance of getting a few so-called high quality, healthy embryos. Highest ranking embryos are seen as having the highest likelihood of implanting and being born alive and are thus transferred first. IVF centers’ pregnancy and birth rates are reported annually through the Center for Disease Control’s (CDC) Art Fertility Clinic Success Rates Report.[xiii]  These reports are used by prospective patients, but perhaps more importantly, by insurance companies that leverage them as important inputs towards their network inclusion decisions and reimbursement negotiations. Clinics with underperforming outcomes or whose laboratory and medical protocol are found to deviate from those prescribed by the insurance company’s network medical directors could face warnings, “peer-to-peer counseling,” additional paperwork requirements, and even network removal, an action which would negatively impact the clinics’ patient volume and cash flows. Remember too that the insurance company or employer assuming risk for IVF medical expenses is also doing so for NICU costs. Triplets, higher-order multiples, and babies with significant health conditions at birth may have six-figure medical expenses. IVF offers the financially responsible party a controllable avenue with which to mitigate against some of these high-cost cases.

“Embryo Attrition” in IVF

Only 8% of embryos conceived in the embryology lab are born alive.[xiv] Some die post-transfer by failing to implant, are miscarried, or are killed through selective reduction or abortion. However, the majority die (“arrest”) in the lab. And there are many causes of lab-based death.

Until fairly recently, most embryos would be transferred from the incubator to the woman’s uterus on the third day after fertilization. In the current practice of IVF, most embryos are forced to survive in an artificial environment for up to five, perhaps even six days before being transferred or frozen. 2016 CDC data shows that 61.7% of “fresh” IVF cycles transfer embryos on Day 5, when the embryo has reached the blastocyst stage of development. There is significant embryo loss (“attrition”) between Day 3 and Day 5.[xv]

“… only one-third of all embryos are capable of growing to this stage. Some laboratories are unable to cultivate an embryo to this stage. If your embryo develops to the blastocyst stage, it has a stronger chance of implanting because it is a superior, healthy embryo.”[xvi]

This is not to say that embryos who have not yet reached the blastocyst stage would not implant and survive. Louise Brown, the first IVF-conceived baby to be born alive, was relocated from the incubator to her mom’s uterus on Day 3 when she was just 8-cells big.[xvii] Would she have survived to tell her story had Edwards and Steptoe kept her in the incubator for 1 more day?

Incubated embryos are periodically observed for grading based on the embryologists’ visual assessment of their morphological development. This grade, along with any available genetic testing results, will be used by the embryologist to determine the embryos’ next destination: uterus, cryopreservation tank, or medical waste disposal. Genetic testing can identify the presence of inheritable diseases, chromosomal abnormalities, and sex. It is one of the primary reasons why embryos are removed from the incubator, monitored until cellular movement stops (it is hoped), and disposed of as waste.

Embryos not selected for transfer but who have demonstrated a certain level of “quality” will likely be dehydrated, vitrified, and stored in cryopreservation tanks. When it comes time to thaw the embryo(s) for a frozen embryo transfer (FET), the embryo(s) may be found to be “nonviable;” that is, they did not survive the initial freeze or thaw process. It is also possible that technical malfunction or process failure may bring about their death (ex. California and Ohio tank failures, 2018).[xviii] We currently have no reliable accounting for how many frozen human beings are stored under lab counters and in warehouse parks across the country. Some say hundreds of thousands, others put estimates over a million.[xix]

The final cause of embryonic death seems, at least to me, to be the greatest paradox of IVF: people who pursued IVF because they wanted to love and care for a child find themselves authorizing a lab to thaw and discard their embryonic children, “allowing them to die.”

The magnitude of lab-based embryo mortality is astonishing. In 2018, 81,478 babies were born who were conceived with IVF. By applying the 8% survival rate above, it is reasonable to assume more than 1,000,000 embryos were created. How many of the deceased 900,000 met their end in the lab, never having the chance to at least attempt to survive in the womb, the place he or she should have been in the first place?

IVF is an Embryo-Destructive Technology

Mandating insurance coverage of IVF through so-called “pro-family legislation” will further exacerbate the already staggering number of human deaths that take place in the embryology lab, not to mention adding to the unknown inventory of embryonic human beings currently in storage. The modus operandi of IVF today is to make a lot of human beings in the lab, select the best, and discard the rest. Mandated insurance coverage will make sure it remains that way into the future.

This doesn’t sound very “pro-family” or “pro-life” to me. 

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[i] Helping Families Grow. A one-page leave-behind for 5/22/2020 federal advocacy day. RESOLVE: The National Infertility Association, in Participation with ASRM. https://resolve.org/wp-content/uploads/2020/05/RESOLVE2020_AdvocacyDay_leave-behind.pdf

[ii] Ibid.

[iii] Ibid.

[iv]https://www.nobelprize.org/prizes/medicine/2010/press-release/. Spoken by volunteer advocate in preparation for RESOLVE’s national advocacy day on 5/22/2020. 

[v] Helping Families Grow.

[vi] https://resolve.org/wp-content/uploads/2020/05/Social-Media-2020.pdf

[vii] IVF coverage mandate has been proposed in recent sessions include (list may not be exhaustive): California (AB-767); Kentucky (SB 54; iatrogenic (medically-induced) infertility; Minnesota (HF2867, SF2776); Mississippi (HB837); Missouri (HB 2251 – iatrogenic (medically-induced) infertility); Nebraska (LB501); Oklahoma (SB 139); Utah (HB 204); Virginia (SB1086, HB1567); West Virginia (HB 4553, HB 4928); Wisconsin (AB 989).

[viii] Minnesota HF 2867. https://www.house.leg.state.mn.us/bills/Info/HF2867

[ix] Arkansas; Colorado, passed 2020, effective 2022); Connecticut; Delaware; Hawaii; Illinois; Maryland; Massachusetts; New Hampshire; New Jersey; New York; Rhode Island; Texas, mandate to offer IVF; Utah (passed 2020, effective 2021, pertains to IVF +PGS/PGD for Medicaid and Public Employees' Health Benefit Program).

[x] https://www.congress.gov/bill/116th-congress/senate-bill/1461. https://www.congress.gov/bill/116th-congress/house-bill/2803?q=%7B%22search%22%3A%5B%22HR2803%22%5D%7D&s=1&r=1

[xi] https://www.arcfertility.com/how-is-ivf-done-step-by-step/#:~:text=Ovarian%20stimulation%20is%20used%20to,are%20usually%20retrieved%20for%20IVF.

[xii] https://www.ccrmivf.com/ivf-cost/

[xiii] https://www.cdc.gov/art/artdata/index.html

[xiv] “Conception is a rare event, fertility study shows.” Reuters. October 25, 2010. https://www.reuters.com/article/us-fertility/conception-is-a-rare-event-fertility-study-shows-idUSTRE69O50T20101025

[xv] https://www.cdc.gov/art/pdf/2016-report/ART-2016-National-Summary-Report.pdf

[xvi] https://www.bostonivf.com/getting-started/egg-embryo-quality-101/

[xvii] https://www.nobelprize.org/prizes/medicine/2010/press-release/

[xviii] https://www.washingtonpost.com/national/health-science/these-would-be-parents-embryos-were-lost-now-theyre-grieving--and-suing/2018/08/24/57040ab0-733c-11e8-805c-4b67019fcfe4_story.html

[xix] https://medicalxpress.com/news/2019-01-limbo-leftover-embryos-clinics-couples.html