Providers, patients promote IVF alternatives

By summer 2019, Hannah Kellogg and her husband had only been trying to get pregnant for about five months, but she already guessed something was wrong. After running tests through a fertility clinic in Austin, Texas, they discovered the problem: Kellogg’s husband had low sperm quality. Kellogg said she asked about exploring for possible food allergies or other conditions he had that could be affecting his fertility. But the doctor told her they would be excellent candidates for in vitro fertilization.

“And I was like, ‘Oh, that’s not what I want to hear,’” Kellogg remembers. She questioned the ethics of IVF, and the $16,000 price tag deterred her. Now, she realizes she was asking the fertility clinic about more than the doctors were equipped to address.

“They know the fastest way to give you a baby,” Kellogg said. “Their goal isn’t to fix your gut health so that you can naturally conceive on your own. That’s not what you’re paying them for. You’re there for a baby.”

The Kelloggs are one of many couples who have looked to the fertility industry for help to address their infertility only to feel pressured into the expensive and ethically complex realm of IVF. As lawmakers and advocacy groups in the United States scramble to protect access to IVF, even some professionals within the fertility industry take issue with the technology. They say the industry’s hyper-focus on IVF sidelines holistic treatments that seek to treat the underlying causes of infertility, forcing research and promotion of these alternatives into the background.

Allison Jung is a self-employed health, hormone, and fertility coach and a licensed physician assistant trained in a fertility treatment approach known as restorative reproductive medicine. She works with couples struggling to conceive to isolate the causes of their infertility. Jung said she has helped more than 300 patients since she started her business in 2017. Of those couples, 85 percent have given birth to a child, Jung said. She estimates that about half of her total patients have tried methods of artificial reproduction before coming to her—and, like Kellogg and her husband, felt pushed towards IVF.

“If [they] walk into an infertility clinic or a reproductive endocrinologist … then all of them, I would say, are pushed towards IVF within the first week,” Jung said. “They do a few tests, and then that’s the route that’s always recommended.” The approach of the mainstream fertility industry, she said, ignores underlying causes and focuses instead on “creating a pregnancy at all costs.”

She had the same experience herself years ago when she and her husband were struggling to get pregnant. Even after they communicated that they were not interested in IVF, medical staff still recommended it “every single visit,” Jung said.

At the time, she didn’t have religious reasons for wanting to avoid IVF. But she didn’t want to create embryos that would be destroyed. IVF providers routinely create more embryos than a couple can use in one pregnancy to increase the chances of success and to avoid the costs of repeated egg retrieval. Some IVF providers avoid these ethical concerns by limiting the number of eggs they fertilize and by not discarding extra embryos.

With the help of hormone medications, Jung was able to conceive. But it wasn’t until later that she began paying attention to signals from her body to determine the point in a woman’s menstrual cycle known as a “fertile window.” That allowed her to get pregnant with another child without the help of drugs. After connecting with a doctor trained in natural approaches to treating fertility, Jung made dietary changes and started taking a few supplements. She said her menstrual cycle became regular for the first time in her life.

“Infertility is a symptom and an expression of usually multiple underlying chronic ill health conditions,” said Dr. Phil Boyle, a fertility specialist in Ireland. In 25 years, he said he’s facilitated more than 3,000 successful pregnancies in couples who have struggled with some form of infertility. Boyle said he focuses on gathering information the body offers but that mainstream fertility clinics overlook or don’t look for at all—such as the absence of cervical fluid in the woman. He said he can often solve the underlying health condition by helping patients balance their hormones or by providing essential surgeries, such as to remove endometriosis, a condition in which tissue similar to the uterine lining grows outside of the uterus.

Boyle estimates that 20 to 25 percent of his patients have previously tried IVF with no success, and some of these couples have become pregnant after receiving treatment at Boyle’s clinic. According to 2019 data from the U.K. government, the birth rate per IVF treatment cycle involving frozen embryos that year was 34 percent for the youngest age group and went down for older patient groups. Meanwhile, premature births and low birth weights are common for IVF pregnancies, even when the pregnancy does not involve multiple babies.

By solving the underlying issue causing infertility, Boyle said he can achieve healthier pregnancies than those created by IVF. According to data in a paper Boyle submitted for publication in January that has not yet been peer-reviewed, Boyle’s practice in 2019 achieved a 40.4 percent live birth rate across age groups with no babies born before 35 weeks and the average birth weight at 7 pounds and 10 ounces—information that he wants to pit against the U.K.’s IVF birth data.

The Irish government provides funding for IVF treatments but not Boyle’s approach. In the academic world, Boyle has observed that publications about infertility tend to focus on how to improve IVF, not on studying the alternatives. Meanwhile, he said he receives few referrals from other providers, connecting with patients primarily by word of mouth. He knows the number of doctors trained in restorative reproductive medicine are limited, making it difficult for couples who know about the approach to find a provider. That’s why Boyle is working to convince his peers to embrace this alternative solution to infertility. “And that’s on us as a group in the world of restorative reproductive medicine to make this more widely known and practiced among physicians,” he said.

But, on the downside, Jung recognizes that searching for the root causes of infertility takes time and energy. It involves paying close attention to signals and symptoms from the body and making difficult lifestyle changes, such as changing eating and exercise habits. It can also involve longer appointments and lengthier surgeries. “If someone wants a quick fix, going the natural route is absolutely not a quick fix,” Jung said. And it’s not guaranteed to work.

For Kellogg and her husband in Texas, addressing underlying health conditions did the trick. Her husband went on a diet to address his irritable bowel syndrome and underwent surgery to repair varicose veins in his reproductive region. After that surgery, his sperm counts were still low, but they had doubled. The couple eventually became pregnant with their first child. Today, the Kelloggs have two living children and a third that they lost through miscarriage.

Kellogg estimates that the alternative treatments she and her husband tried likely saved them more than $14,000. “It took time and no guarantees, but IVF takes time. There’s no guarantees there either,” she said.

Boyle said the majority of couples don’t need IVF as long as they have at least one clear fallopian tube and an acceptable sperm count. But for couples that have very low sperm count or in which both of the female’s fallopian tubes are blocked, IVF may still be the only medical solution for them. He estimates that 5 percent of infertility cases fall into these categories.

Kellogg recognizes the struggle of those remaining couples. Her sister, Martha Dorr, and her husband have also struggled with infertility and chosen not to do IVF. Dorr and her husband pursued lifestyle changes to address her husband’s zero sperm count and low testosterone. They ate healthier, increased vitamin intake, and identified food intolerances. They started him on medication to increase testosterone and replaced plastic food containers in their kitchen with glass alternatives—since chemicals in certain plastics can mimic estrogen in the body. About five years after their initial diagnosis, the Dorrs still have no children. But Dorr said the efforts improved her husband’s testosterone and energy levels and resolved ongoing back pain he had been experiencing.

“For me, it’s also about quality of life,” Dorr said. “Even if we never have kids … there were still things that were unhealthy. And seeing those become better and seeing his quality of life improve is huge.”