Babies…Naturally

Posted on by Paul Turek, MD

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In the daily life of my fertility practice, I’ve noticed a trend lately as I help couples conceive a child: patients are less interested in using high levels of “assisted reproduction” to have children. In particular, they would like to avoid in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), the Cadillac of all techniques. Even before they meet me, they have decided against it. Not all couples, mind you, but certainly more than I have encountered in the past.

Understanding IVF-ICSI

Briefly, IVF-ICSI is a busy month for women. It involves stimulating them with daily, injectable hormones during the first half of the menstrual cycle to generate more eggs than normal within the ovary. Ovulation of eggs is induced by injection of a second hormone, which is closely followed by egg retrieval using needle aspiration under anesthesia. Retrieved eggs are then stripped of their cell coats in a dish, and a single sperm is individually injected into each egg by an embryologist. The sperm are chosen based on their shape, appearance, and movement. Eggs then become embryos in a Petri dish and are either transferred back to the female reproductive tract or biopsied and frozen for later use. Typically, only a single embryo is transferred back to the female and extra embryos are frozen in case they are needed. A pregnancy test is obtained two weeks after the embryo is put back.

As a male fertility specialist whose practice mantra has been “treat the male, cure the disease,” I find this trend very interesting. Assisted reproduction is almost always an option for couples, but I have spent a good deal of time publishing research showing that classic male infertility treatments such as varicocele repair and vasectomy reversal are very cost-effective ways to conceive compared to more expensive techniques like IVF-ICSI. On the other hand, these techniques are the only option for many men with azoospermia, or the absence of ejaculated sperm, and I am glad that it exists for these men.

Why the Natural Approach

I wrote down what patients said when I asked them why IVF-ICSI is not an option for them, and here are some of the responses:

  • “It seems pretty invasive and unnatural.”
  • “Isn’t it relatively new?” (IVF is 45 years old; ICSI is 32 years old)
  • “Who selects the sperm?” (Since it is not God or Darwin)
  • “Wasn’t ICSI developed as an experimental mistake?” (Yes)
  • “How do we know that those are our eggs and our sperm? (Rarely an issue)
  • “It’s only a single try at having children.” (Maybe two)
  • “Isn’t there an issue with higher birth defects and syndromes in babies?” (Yes, risk is higher)
  • “Are our children going to be infertile?” (Unknown)
  • “We’d prefer to have the hope of trying every month at home.”
  • “IVF-ICSI is too expensive.”

These statements are poignant. Note that some are based in fact, some in fiction, and others are rooted in emotion. As a fertility specialist, my job is not to tell couples how to become pregnant. Instead, I present couples with all of their options and use statistics to explain the chances of success with each option. Ultimately, what matters most is that couples are fully informed of all relevant information when making their very personal decisions about their family building options. Indeed, the best educated patients make the best decisions.

What I think is happening is that as IVF-ICSI is more commonly being offered to consumers (currently 3% of U.S. babies are born from these techniques), patients are becoming better educated about the technology, including its costs, benefits and limitations, and are making more informed, personal choices that fit their goals. My gut also says that good, old-fashioned sex still has a strong following among infertile couples as a way to conceive. As the old adage says, “sex is the most fun you can have without laughing.”