118. Why IVF Should NOT Be the First Step for Infertility

What if the first thing you were offered for infertility wasn’t a diagnosis, but a $20,000 procedure? In this episode, Dr. Monica Minjeur unpacks the growing trend of couples being fast-tracked to IVF before a true evaluation of their health. Learn what’s often missed—hormone timing, male factor issues, inflammation, thyroid dysfunction, insulin resistance—and how a restorative reproductive medicine approach gets to the why before jumping to high-cost treatments.

Learn more or schedule your free discovery call at radiantclinic.com.

Transcript

Speaker: 0:00

Before we get into the episode today, I want to make sure you know about our free discovery calls to work with our clinic. If you are interested in learning how the medical services charting instruction or coaching programs we provide would be a good fit for you, go to our website, radiant clinic.com and click on the link that says Book free discovery call. One of our team members will get back to you and get all your questions answered about our process towards healing your cycles and restoring fertility. If you still have more questions after that call, my team can arrange for a time to talk directly with me and make sure we are the right fit for you. We're looking forward to visiting more with you soon and learning how we can walk this journey together, and now onto the episode.

Speaker 2: 0:51

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What if when you were trying to conceive the first thing you were offered before anyone checked a full hormone panel or even your partner's sperm quality was a 15 to$20,000 procedure? With a 30 to 40% chance of live birth per cycle, depending upon your age. In today's episode, we're not going to be bashing IVF, but I am going to have an honest conversation about a growing trend, and that is of couples that are being fast tracked to IVF before anyone has asked why pregnancy isn't happening. We're going to talk about the medical, financial, and emotional cost of skipping root cause care, and how a restorative model can look at your care differently. So let's start off today with a patient story about a couple that came to see me, and we'll call them Carrie and Lucas. Now, they were in their early thirties and they had been trying to conceive for 11 months with no prior pregnancies. Carrie cycles were a little bit irregular with some brown spotting before her cycle started, and she did have some chronic fatigue. She had had some initial blood work done and after Lucas had a normal sperm test done, they were given a diagnosis of unexplained infertility and were referred to the local reproductive endocrinology clinic at their first fertility clinic consult, they were told Your good candidates for IVF, we can get you started next cycle. And they were met with a financial coordinator. The financial coordinator talked about financing, and they were quoted$18,000 for their first cycle, but that prices could be more because it did not include medications, genetic testing, or storage. When they asked about the success rates, they were told that success is around 50%, but there wasn't any additional conversation about what those numbers actually meant. Nationally across all ages and diagnoses, around 37% of cycles lead to a live birth, and many couples need multiple cycles to get to that 50% success rate they were quoted. If they can get there at all, depending upon their age. Carrie left that initial visit in tears, not because she was against IVF, but because she felt like she was a product in an assembly line, and they didn't have any additional answers as to why they were having difficulties with conceiving, and they were given only one option. Before signing a finance agreement with the IVF clinic, Carrie and Lucas had some friends who referred them to our office for a second opinion. So we took a cycle based restorative approach and as always got them started with charting and identified multiple issues between the two of them. With Carrie, we found that she had a luteal phase, hormone deficiency, thyroid dysfunction, insulin resistance, and chronic endometritis. For Lucas, although he had a normal sperm count, he had low testosterone which can cause sperm quality issues, and when we tried to uncover the reason why he had low testosterone, further evaluation revealed that he actually was pre-diabetic and had sleep apnea. So we are still continuing to work together to improve their health, but over the course of the next few months, lab findings are now in an optimal range, and the charting pattern is much improved from initial evaluation. Carrie's comment is, I wasn't necessarily against IVF, I just didn't want it to be the first step, and I wanted to have a better understanding of why we are seeing the problems with trying to conceive. And this is something we are seeing in the United States. There have actually been a couple of recent surveys done that show that although IVF and restorative reproductive medicine are seen as favorable, that many, many couples want to have an answer as to the why. They want to know their underlying diagnosis, and they want to know that their health is being monitored, managed, and treated in an appropriate way, regardless of the outcome. And so what we're seeing right now in the US is that IVF is increasingly marketed directly to consumers, and oftentimes we're seeing words used as fast or quick or most reliable, even before a diagnosis is established in many cases. Across the US a single IVF cycle can range anywhere from 12 to$25,000 or more, and this often doesn't include things like the medications that are needed, genetic testing, embryo freezing storage, additional transfers or donor gametes like donor eggs or donor sperm, which can push those total costs much higher. Ultimately, many couples spend tens of thousands of dollars going through the IVF process at the time of this recording. Most states in the US do not require insurance to cover IVF, nor do they require employers to cover IVF, which means that payment is most often out of pocket or financed with loans. And nationally assisted reproductive technology, which includes IVF accounts for about two to 3% of all US births and national CDC data show that around 37% of these assisted reproductive technology cycles result in a live birth overall. But that number changes dramatically with Age of Mom diagnosis. Egg quality and sperm factors. For example, after age 35, those numbers drop off dramatically. Now this means two things at once. Number one, we know that IVF does work for many couples. It's responsible for tens of thousands of births a year. But it also means it's not a guarantee, and we believe it should not be the first thing that is offered to all couples. And the concern with that is that we're seeing many couples being offered IVF. As the first step when they have never had a complete lab evaluation done, when they haven't had autoimmune factors looked at when they haven't done a deep dive on thyroid or adrenal evaluation, looking for insulin resistance or other metabolic dysfunction, chronic endometritis or endometriosis, a semen analysis that is more than just that looking additionally for male lab testing or consideration for underlying male infections or quality of the sperm. A clear understanding of whether ovulation is even strong and consistent, and I strongly believe this is not informed consent unless we are doing all of these things and giving a clear diagnosis. We are just trying to sell a procedure without treating those underlying causes, and that is where the problem exists. So instead, before you mortgage your future in order to try and afford IVF, I would recommend we try a different approach. Restorative reproductive medicine is not do nothing and hope and pray. It is targeted medical and timing specific. So I wanna go through a few pieces that are so important when you're looking at this and I've done some detailed, um, podcast episodes on this recently, and I'll be referring to those. So before you do IVF, please make sure that you are evaluated for ovulation quality and luteal phase support of your hormones after that ovulation has occurred. So you can listen back to episode number 1 0 1, where I talk about ultrasounds for follicle tracking, and episode number 110 where I talk about full lab testing. So what we're looking at here with the ovulation quality is not just. Are you ovulating? But is it an optimal ovulation? Is the follicle an appropriate size? Is your luteal phase appropriate length? And are your hormones supported enough to allow implantation to occur? Rather than just checking a random day 21 lab test, we evaluate your hormone levels seven days. After ovulation in order to have the most accurate sense of when they should be at their highest point. If your luteal phase is weak or it's shortened, it can lead to an early miscarriage or what is oftentimes called a chemical pregnancy. Many times people are told that this is infertility, but this is actually correctable. The second is a deep dive on thyroid and other immune factors. So yes, we also want to evaluate for TSH, but we also want to do a much more detailed thyroid panel that tells us how well are the thyroid hormones actually binding to your cells. We also look for thyroid antibodies, thyroid peroxidase, and thyroglobulin, because thyroid autoimmunity, even if the rest of your thyroid panel is normal, can be linked to a higher miscarriage risk, and identifying and treating that early can absolutely change outcomes. We also look at insulin resistance and your metabolic health. So for more information on this, go back and listen to episode number 1 0 7. We don't just look at blood sugar readings or your weight. We do more intensive evaluation for insulin resistance because this can interfere with ovulation and the ability for implantation to occur even if you have a normal weight and normal blood sugar. Insulin resistance is treatable through nutrition changes, focused movement goals, improved sleep, targeted supplements and medications when necessary. We also always want to consider your anatomy. Now, this is going to include pelvic anatomy, so things like endometriosis, which I talk more about in episodes 1 0 8 and 1 0 9. This also is going to look at what's the environment of the uterine lining. Its. Self, if you're having brown spotting before or after your period, or persistent end of cycle spotting or recurrent early miscarriages, we consider chronic endometritis, which I talk about more in episode number one 13. And last but very not least, we talk about male factor early. So I talk more about this in episode number 85. Now, in addition to evaluating the actual presence of appropriate levels of sperm counts, we also wanna look at motility at the pH, ruling out infectious causes, and sometimes looking at DNA fragmentation, which is the actual quality of the sperm itself. Yeah, rather than just assuming, oh, it must be her because there's so many complex hormones going on. We also optimize male health from the start. So this is going to include things like focused evaluation for optimizing lifestyle changes like sleep, nutrients, heat exposure, metabolic status, and this can change the entire plan if we identify a concurrent or sometimes a sole male factor that might be playing a role. So before you sign IVF paperwork, here are some questions that I want every couple to be empowered to ask. So first and foremost, what is our diagnosis? If you are told that your diagnosis is unexplained infertility, please ask what has been ruled out. Because unexplained infertility is not the same thing as saying nothing is wrong. It typically means we haven't looked for or we haven't found any underlying causes yet. The second thing I'd like you to consider is have I had a full lab panel checked, and again, I would refer you back to episode 110 over the course of the last 15 years of reviewing charts from IVF clinics. I find that in most clinics that we evaluate. Less than five or six lab tests are done, and in comparison in our clinic, our initial profile looks at about 40 different lab tests. Again, timed specifically with your cycle so that we get a better picture of what's going on from the hormone status. I also want people to understand that there are anatomic things that can play a role when it comes to IVF. Now, this can play a role, not just with trying to conceive, but even if you are able to conceive in an IVF cycle, you can have a recurrent miscarriage if there are underlying factors like chronic endometritis or endometriosis that have not been evaluated and treated. You also wanna make sure that there's been a full lab panel done for male evaluation. Male factor plays a role in infertility cases 40 to 50% of the time, and it deserves real attention and treatment with more than just a semen analysis. And then specific to each individual clinic that you would see for IVF consultation, you want to ask, what is the actual live birth rate for someone my age at this clinic using my own eggs per retrieval? And again, as I mentioned in the introduction nationally in the US, across all ages, about 37% of cycles result in a live birth. Success is incredibly age dependent and many clinics are quoting 50%, but that number is oftentimes for patients under the age of 35 and maybe the cumulative number over multiple cycles. You deserve numbers that reflect your case, not just the clinic's best case subgroup. So make sure to ask how many average cycles couples of your age require to get to that best case scenario, live birth rate. And finally make sure that you know the full cost beyond just the cycle itself. Oftentimes, you can call and be quoted the cost of the actual IVF cycle, which again is typically anywhere between 12 to$25,000 or more, but this is before medications, add-ons, storage transfers, additional imaging studies that are done, and many couples need multiple cycles. You deserve to walk into this eyes wide open and to know what to expect for the other costs that go along with the cost of the actual IVF cycle before you just jump in. Imagine if we could change the paradigm that happens here in the US and rather than being rushed to a straight to a five figure procedure before being asked what your body was actually trying to tell us. Instead, we could focus on a full workup, identifying ovulation quality, hormone timing, metabolic evaluation, anatomy evaluation, and male factor with clear plans to correct what is fixable. Over the course of cycles, you would be making decisions from a standpoint of clarity rather than of panic or with a clock ticking over your head. And most importantly, you walk out with a body that is healthy, truly prepared for both male and female factor, which helps long-term to improve your overall health and promote fertility. If this is the kind of care that you would rather receive when it comes to your fertility, I can't wait to work with you.

Speaker 3: 16:29

If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit if you live in many different states across the us. Check out our website for current states that we can serve medical clients and let us know if your state is not listed to see if we can still cover you there as we are constantly expanding our reach. Please note that our fertility educators are able to take care of clients no matter where they live. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.