144. IVF Is Everywhere — But Is It Right for You?

IVF is dominating the national conversation about fertility right now — in the news, in legislation, and in doctors' offices across the country. But there are questions almost no one is asking. What if IVF is not the right first step for most couples who are struggling to conceive? And what are we missing when we skip straight to the most invasive and expensive option available?

In this episode of Cycle Wisdom, Dr. Monica Minjeur makes a compelling, evidence-informed case for why a thorough restorative evaluation should come before IVF is ever recommended — and what that evaluation can find that a standard workup almost always misses. Through Rachel and Nathan's story — a couple who went through a failed IVF cycle without a single new diagnosis — you will see what becomes possible when the right questions are finally asked.

You will learn:

• Why unexplained infertility is almost never a true diagnosis — and what it actually means when you receive one
• How IVF bypasses the reproductive system rather than fixing it — and why that distinction matters enormously for outcomes
• What a complete restorative reproductive medicine evaluation looks like, what it costs, and why it should come first

If you have been told your only option is IVF — or if you have already been through a failed cycle and still do not have answers — this episode is for you. Learn more or schedule a free discovery call at radiantclinic.com.

Transcript

Speaker 0:02

IVF is everywhere right now, in the news, in political debates, in legislation. And while access to fertility treatment absolutely matters, there is a question that almost no one is asking. What if IVF isn't the right first step for most of the couples who are struggling to conceive? What are we missing when we skip straight to the most invasive option? And what do couples actually deserve instead? I'm Dr. Monica Minjeur, the host of Cycle Wisdom, where we help women and couples restore hormonal balance and reclaim their well-being through personalized healthcare grounded in clinical excellence. So let's start off today, as always, with a patient story, and I'll call this patient Rachel. Now, Rachel came to us at thirty-one years of age. She was healthy and had no obvious health diagnoses. She had been told by her obstetrician that she and her husband struggled with what was deemed unexplained infertility, and they were referred directly to the IVF clinic. Rachel and Nathan felt physically and emotionally exhausted after a failed IVF cycle. They were told that this was the best answer for them, but they were financially strained, they were devastated, and they still didn't have answers as to why they were having troubles with conceiving in the first place. After the first failed embryo transfer, Rachel and Nathan refused to try again without understanding why. And a friend of theirs sent them to see us at the clinic because they were looking for a different kind of evaluation. We proceeded, as we always do, with a thorough cycle-informed workup that revealed what had been missed previously. Rachel had a short luteal phase that was confirmed with her charting. No one had previously identified or talked with her about that. We also revealed subclinical hypothyroidism and positive thyroid antibody testing, which had never been tested previously. Her progesterone levels were low in her luteal phase after ovulation, which means that the implantation environment was compromised from the start. And finally, we found chronic endometritis that was likely impacting both Rachel and Nathan, which meant that even if they had been able to conceive with IVF, she was going to be at significant risk for miscarriage secondary to implantation failure because of a chronic infection that had gone untreated. We proceeded with restorative treatment for both Rachel and Nathan over the course of several months, and they conceived naturally on the fourth cycle of balanced hormones after seven months of working with us, without another IVF cycle. Better yet, we improved Rachel's health, which will also improve health outcomes for her pregnancy and her baby, and she knows that she can conceive naturally if she wishes to try again in the future. Now, you might think that this story is crazy. Why would anybody go through IIVF when they actually can conceive naturally? But this story is not rare, and increasingly we are seeing that couples are quickly getting shuffled to IVF after a cursory evaluation fails to reveal any easy answers for a quick fix. Recently in the United States, the national fertility conversation has narrowed to one question. How do we expand IVF access? Now, this may be worth asking in some situations, but it certainly isn't the only question, and I would argue it should not be the first question we should ask. IVF bypasses the reproductive system. It does not fix it. If the underlying problem isn't identified, IVF can fail for the same reason that natural conception does. The other big picture item here is that the average cumulative costs of IVF can range anywhere from$25,000 to$60,000 per couple, which includes treatment, medications, testing, ultrasound scans, storage fees, genetic testing, and so much more. There is significant financial, physical, emotional, and relationship burden that's placed on the couples when they go through any sort of fertility process, but especially with IVF when the outcomes are uncertain and the financial burden is so high. In our practice, for the majority of couples with infertility, there are identifiable and treatable causes for infertility, and many times multiple causes. In fact, our average new diagnoses per couple ranges from six to eight new things that were not uncovered previously that a thorough evaluation typically can find and treat. So I want to address just a couple of myths before we jump into some more of the points for today. And the first being that unexplained infertility means there's no cause. I see so many couples that come in with an unexplained infertility diagnosis, and in nearly 15 years of practice, I have never given a couple an unexplained infertility diagnosis. Unexplained infertility almost always means your evaluation wasn't thorough enough. There is nearly always going to be a reason why you are struggling with infertility, and it doesn't necessarily mean that unexplained infertility is the diagnosis. Another common myth that couples are oftentimes told is that IVF improves your chances of pregnancy regardless of the underlying problem. The reality is that success depends heavily on whether the underlying issues have been identified, addressed, and treated. And IVF does not necessarily improve your overall chances of having a live birth, even if the numbers seem to appear that the pregnancy rates are higher. Because in many situations, IVF is not required to always report their live birth rates, but they do report pregnancy rates. So it's very important to make sure you understand what statistics you are getting quoted if you are to get any sort of IVF evaluation. And the last myth here is that moving to IVF quickly is a proactive choice. For most couples, a restorative evaluation first is both more effective, less costly, and does not significantly increase the time to conception when we do a thorough evaluation. So let's go back to that first myth and talk about what unexplained infertility actually means. It is the most common fertility diagnosis that couples are given, but again, it is not a diagnosis at all. It's typically documentation of an incomplete workup that was unable to find the cause. Instead, when we do a comprehensive cycle-informed evaluation, identifiable causes are found in the vast majority of these unexplained cases. Again, as I mentioned, in 15 years, I have never diagnosed a couple with unexplained infertility, and I know this is very common amongst my colleagues who practice similarly. Common findings that are often missed in a standard workup include that short luteal phase like Rachel had. So if you're not actually looking at somebody's charting, identifying when they're ovulation, this is really easy to overlook. Subclinical hypothyroidism or low thyroid, elevated thyroid antibodies, sperm DNA quality problems. So many men have a semen analysis done that's shown to be, quote-unquote,"normal," but that doesn't assess the quality of the sperm itself. And chronic endometritis, which we've talked a lot about on this podcast. All of these things are underlying conditions that once you go looking for them, you can find them, you can treat them, and you can improve the overall health of the couple that you're treating, which helps to improve the pregnancy outcomes and the health of baby as well. So what does IVF do? IVF retrieves eggs, retrieves sperm, fertilizes them externally, and then transfers an embryo in its early stages Now, some people will argue that there are some clear indications to send somebody to IVF. For example, bilateral blockage of the fallopian tubes. What I can tell you about this, I have had patients that have had this in the past. They go to see our skilled surgeons who are able to cannulate or to reopen that tube. So bilateral tubal occlusion is not an absolute necessary indication for IVF. Azoospermia is another clear indication that many people will say requires IVF, and azoospermia is the complete absence of sperm in the semen analysis. Now, I will admit this one is a bit more difficult to treat, but I do have colleagues who have seen azoospermia on initial semen analysis that go through the full process of evaluating things like looking for anatomic issues in the male, varicoceles, or testicular issues, looking for things like medications or supplements or other factors like infection or inflammation that may be playing a role. And although complete zero sperm count is definitely a challenge and it would make us pause before we would do any other more in-depth evaluation, it is not necessarily an absolute indication that IVF is going to be your only solution. In fact, the way that IVF handles complete azoospermia is it would recommend donor sperm rather than, again, fixing the underlying health condition that caused zero sperm in the first place. IVF does not fix these underlying conditions. It doesn't fix ovulation disorders or luteal phase defects or thyroid dysfunction or implantation issues or endometritis. And if that root cause is not addressed, IVF fails for the same biological reason that natural conception does. There was a research paper done back in 2011, published in the journal Human Reproduction, that documented a significant proportion of IVF failures that were attributed to factors that were actually identifiable and treatable prior to any sort of assisted reproductive technologies. The big argument here is that there is a case for doing a full restorative reproductive medicine workup first. First of all, this answers the one question that every couple deserves to be answered. Why isn't this working? For many couples, restorative treatment leads to natural conception, and a diagnosis, even a difficult one, is often better than no diagnosis at all. It gives couples something to work with, and in my practice, even if a couple is unable to conceive, they at least walk out with answers, understanding the why, understanding that they have decisions that can be made in order to work towards treatment, or they can choose not to continue to advance treatment based on a particular diagnosis. But it at least puts that diagnosis in their hands and lets them own what they choose to do with it. The second argument here is that a complete restorative reproductive medicine workup costs a fraction of the cost of a single IVF cycle. In fact, in many cases, insurance currently covers the full diagnostic evaluation. And for an example, at the time of this recording in twenty twenty-six, if I were to do a complete lab panel on both partners, as well as a hysterosalpingogram, checking to see if the tubes are open, an ultrasound assessing uterine anatomy, and a semen analysis to check total sperm counts, the total cost of that evaluation still comes in at a bit under one thousand dollars for the diagnostic evaluation plus the additional medical visit. So why are we starting with something that is so high cost, so invasive, and sending so many couples straight to IVF after twelve months of trying to conceive? Instead, I would argue that we should do this complete evaluation first, and ideally start evaluation as early as six months after trying, especially if a couple understands where their fertile window is when they're ovulating. Because if we treat the underlying cause of that infertility, we're improving health outcomes for mom, for dad, and for baby. If couples go through IVF and have a failed IVF cycle without any new diagnoses, it leaves them with the same question they started with. And this is what Rachel and Nathan faced. They still didn't have any answers. They left with less money, less emotional reserve, no baby, and no real answers. This void of a diagnosis is its own form of suffering, and oftentimes women blame themselves when the real issue was never identified by the healthcare professionals who are caring for these couples. A thorough evaluation instead, regardless of the findings, shifts that experience from helplessness to understanding. And I really always focus with my couples saying,"I can't make you pregnant. I can't guarantee pregnancy, but I can guarantee answers. I can guarantee a diagnosis. I can discuss treatment options with you, and from there you can decide what makes the most sense for you as to your treatment plan and how you would like to proceed." Couples deserve a thorough evaluation before jumping straight to invasive intervention and a real diagnosis, not just unexplained infertility, which often means we didn't look hard enough. You also deserve a healthcare professional who asks why. Why are you not ovulating consistently? Why do you have a shortened luteal phase? Why has nobody evaluated your thyroid fully? Couples deserve to restore their fertility, not just bypass it, and couples also deserve a more thorough option than,"Well, just keep trying," and they also deserve more answers than just jumping straight to,"Well, maybe go to IVF." And restorative reproductive medicine really is that middle ground where we can find additional options, look for what's going on, treat those underlying causes, and really be able to get people on board with understanding their unique diagnosis and what treatment path makes sense for you next. So we often get questions about IVF, couples calling us and saying,"Hey, my doctor recommended that I go through IVF right away. Should I get a second opinion?" And I always say,"Yes, please," especially if you haven't had a thorough cycle-informed evaluation. The way you know this is if nobody has ever looked at your charting to discern when am I ovulating, what does my bleeding pattern look like, what is my cycle looking at over and over and over again, month after month. If you have had a cursory lab evaluation done, perhaps you've had thyroid, prolactin, progesterone, and AMH checked and you were told it's unexplained, you should absolutely get a second opinion. If you've been listening to me for any period of time on this podcast, you will understand our complete diagnostic evaluation is very vast, ranging from evaluating hormones to adrenal gland function, thyroid function, as well as looking at nutritional deficiencies, male factors, semen analysis, ultrasound, endometritis. You deserve getting all of those things evaluated to understand which pieces are actually playing a role for you We also oftentimes get couples like Rachel and Nathan who have already done one IVF cycle, or two, or three, or seven, and then they ask,"Is it too late to try this approach instead?" And we say,"Not at all." Many couples come to us after one or more failed cycles, and helping to understand why those cycles failed and addressing those underlying causes oftentimes changes the outcome. Now again, we can't compare apples to apples. It's a very different procedure, but there have been studies done that look at outcomes comparing restorative approaches to IVF. And I would point to an article done recently by Dr. Phil Boyle that evaluated his practice in 2019 and compared his outcomes with natural conception and a restorative approach to those of IVF in his country in Ireland. And what his outcome showed was not only improved conception rates with natural conception, but also better birth outcomes, less miscarriages, less preterm births, less NICU stays, and healthier baby weights. All of this makes a difference, and couples deserve to understand that it is never too late to evaluate what is going on. Now, we oftentimes get asked,"Well, how is this different from a regular fertility clinic?" And most of the time, a fertility clinic focuses on procedures. It offers intrauterine insemination, IVF, egg freezing, donor egg, donor sperm. Instead, restorative medicine is diagnostic and restorative first. It identifies root causes and treats them rather than just trying to bypass the underlying concern of fertility. And finally, we oftentimes will get asked,"Well, doesn't doing a full evaluation just take a lot of time?" The reality is that a complete evaluation with our clinic typically takes weeks, not months. The time spent evaluating is almost always shorter than the time spent in failed treatment cycles without answers. We do lab draws over the course of a single month. We meet with couples, and then we go through your results to help you figure out what is causing your underlying fertility concerns and get you started on treatment right away. The focus here is on improving your overall health so that we are not continuing to waste time with trying same things over and over again that are not going to work for you if we don't address those underlying causes. Imagine if unexplained infertility was never accepted as a final answer, but was recognized as a signal that evaluation is not finished yet. Imagine if every couple experiencing infertility was offered a thorough, honest, cycle-informed evaluation before the conversation ever turned to IVF Imagine if the national debate about fertility wasn't just about access to technology, but about access to answers. The kind of answers that give couples a real chance to understand what is happening in their bodies and to heal. That is what couples deserve, and that is what it looks like to genuinely improve health and promote fertility.

Speaker 2 19:19

If you're ready to work with our elite team of healthcare professionals, go to our website, radiantclinic.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