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Join RESOLVE’s leadership team for an in-depth look at what it takes to pass pro-family legislation, protect IVF, and what we’re up against.
HOSTS
President & CEO, Barb Collura
Chief Engagement Officer, Betsy Campbell
Chief External Affairs Officer, Rebecca Flick
ABOUT RESOLVE
RESOLVE: The National Infertility Association is the largest non-profit patient advocacy organization in the country focusing on increasing access to all family building options through insurance coverage and policy changes as well as protecting fertility care like IVF from legislation.
Welcome to this episode of Infertility Discourse, a podcast from RESOLVE, the National Infertility Association. I'm your host, Rebecca Flick.
Barb Collura:Hi there. I'm Barb Collura.
Alise Powell:Hi, I'm Alise Powell.
Rebecca Flick:And we're here today to talk about something really not so fun. So we thought we'd give it a really great song title. For this episode. We're going to call it No Scrubs. We're not referring to the doctor's attire, in the surgery room. We are talking about the song, no scrubs by TLC from 1999. Scrubs refers to a guy with no promise, no purpose, really just a lot of talk and no action. And that brings us to this topic, which is ethical IVF and something called RRM, both making some headlines online, on the web, in the news. I've heard some podcasts. I've started talking about this as well.
Rebecca Flick:So we're going to talk about it. But from RESOLVE's point of view, I am not the expert on this. I'm going to let Barb and Alise take it from here. But, this is a really important episode that we hope that you listen to intently. I know I've kind of, you know, picked a funny song to go with it, but it's actually pretty serious.
Rebecca Flick:And we hope that you get a lot from this episode and, share this episode because we really, really need to get the word out that, resolve will not support or or stand for what we like to call "IVF comma but." So, Barb, tell us a little bit about this, if you can get us started. And Alise, I want to hear from you in terms of what you're seeing, the community respond to this.
Barb Collura:Well, I'm so glad we're talking about this. I have had the pleasure and honor of giving some talks at some recent medical meetings and conferences. And I've had a chance to talk about both ethical IVF and restorative reproductive medicine. And it's been so interesting, the feedback I've getting. First of all, lot of people have no idea that this conversation is taking place.
Barb Collura:As medical professionals, they're very concerned, and it's really been kind of scary to think about. So, I have not done a super deep dive into the history of both of these, but I can tell you from my perspective that we started hearing about these two terms since Alabama, the Alabama Supreme Court ruling in February of 2024. Prior to that, I don't think I ever heard restorative reproductive medicine or ethical IVF. And so just a little bit of background. Again, this is this is really my perspective.
Barb Collura:It's not necessarily based on historical record, but I believe that as a result of the Alabama Supreme Court ruling, where we had a confluence of events with a presidential campaign, a lot of recent polling that had come out that showed that Americans, something like 85%, were overwhelmingly in support of IVF. You had a situation where elected officials, candidates running for presidential, office were saying, we love IVF, we support IVF. And yet organizations and groups that for years have been against IVF, we're suddenly saying, Woah, woah, woah, wait a minute, wait a minute, we don't actually support IVF. I liken it to a sleeping bear. This is the analogy that I've used.
Barb Collura:I say that this anti-IVF movement has always been there, Rebecca and Alise. It's been there for a number of years, but it's been pretty quiet. In fact, I like to say it's been asleep. There was really no national conversation around IVF. There was no attempt to make IVF coverage accessible to all.
Barb Collura:So what was the point of getting all riled up opposing it? When, when quite honestly, there was no chance of some of these things happening many years ago. So the sleeping bear was sound asleep. Alabama happened, and all of a sudden, everybody is like, we love IVF. Everybody should have IVF coverage.
Barb Collura:We need to make sure IVF is available to all. All of a sudden, that sleeping bear was poked with a big sharp stick and it woke up and it's pissed. It's hungry and gets very powerful and it's got a lot of money and it's looking around for where it's gonna attack. And so this bear is a lot of very powerful organizations that do not like IVF. And if you are faced with a situation where 85% of Americans support something you oppose, you gotta get creative.
Barb Collura:You gotta get you gotta get smart. And I'm telling you, these people are smart, and they know what they're doing.
Rebecca Flick:And they're well funded.
Barb Collura:And they come up with ethical IVF and restorative reproductive medicine.
Rebecca Flick:And I think when we hear the term "ethical IVF", it immediately implies to someone who's not gone through IVF or doesn't understand IVF that it's unethical.
Barb Collura:You got it.
Alise Powell:And I-
Rebecca Flick:We- Go ahead, Alise. Sorry.
Alise Powell:I think that's the dangerous part, especially for patients who are, you know, looking into starting their journey. I think that might give folks, you know, cause to pause and figure out, you know, what that means and how that would, affect their treatment and whose ethics and whose moral and ethical obligations are going to be considered when they're trying to access their treatment. And if it's not going to be the patients, then whose is it going to be?
Rebecca Flick:And they may, you know, so many patients that already come into this process with their own just personal dilemmas, whether it's faith based or, you know, something else that they bring to the table that is, that is getting them to question and it needs to be a personal choice, right? Their approach to treatment needs to be personal to them and not influenced by, you know, stakeholders or people that want to take away, or change the process on them.
Barb Collura:You know, this is exactly why we're having this conversation. It's not that restorative reproductive medicine or how ethical IVF is practiced are necessarily bad or that people who may choose to approach IVF in a certain way can do it that way. Just like you said, Rebecca, or even their family building journey. The reason why we're having this conversation is because they want to impose this on everybody. They want to instill this as policy, as regulation.
Barb Collura:They want to see federal laws, state laws. You know, you said we love IVF, but what do we mean by that? Well, it could mean that we get IVF coverage in a particular state, but it says you have to do it in an ethical IVF way. I have little air quotes going on there. Can you imagine if that was how coverage was now going to be offered for everybody?
Barb Collura:So this is the kind of potential dilemma that we could face. And that's why we're having this conversation.
Rebecca Flick:And leaving it up to state lawmakers to define ethical.
Barb Collura:Or federal.
Rebecca Flick:That would be a disaster. I'll put my very serious. That would be a disaster.
Rebecca Flick:Alise, let's do a little bit of a deeper dive into ethical IVF. Can you explain it a little bit for our listeners?
Alise Powell:Sure. So what we've been seeing kind of from the state level is, policymakers trying to impose their own personal, anti-IVF, ethical, or moral, you know, thought process into the practice of IVF. And that may look like proposed restrictions on how the practice of IVF, you know, is working. They might wanna do control or restrict the number of embryos that might be transferred or what you can do with your embryos, if you can discard them or not. So those are the types of things that we've seen proposed and essentially forcing a one size fits all policy and ignoring the individual needs that patients might have and the science that backs it up.
Barb Collura:I would also just say too that while we have seen a few bills with this kind of language, we haven't seen anything that, that goes super far yet, but we, we've seen a lot of organizations who have posted a lot of this information, through their blogs, through their white papers, through their websites, through their policy briefs. And it has been very clear what their goal is. You know, when you think about the kinds of things that Alise was just mentioning, it's sort of nibbling around the edges, but it actually is restricting care without outlawing IVF. It's restricting care and that's what they want, but they want it done in a certain way. As Alise said, they want it for everybody. And we just you know, we we can't let that happen.
Rebecca Flick:Is there, a reason to believe that if laws like this passed or if executive order comes out and wants to kind of define ethical IVF, that insurance companies will kind of kind of have an open, an open path to being even more restrictive on who gets access to IVF care through their insurance coverage. Is that a fear or, you know, just I'm just thinking how we've come so far in the way that insurance companies approach fertility care and fertility coverage for IVF in terms of like the number of cycles. And, and I know I've mentioned this on this podcast before, but I mean, I had a eighteen, nineteen years ago had a policy that wouldn't kick in, and start covering our IVF cycle until either I experienced three miscarriages or had been trying for three years. And that was just in the last two decades.
Rebecca Flick:Right? And so, Barb, do you think like these kind of conversations will give insurance companies pause to say they can start redefining what good care looks like?
Barb Collura:It could be. I'm so focused right now on preventing actual legislation from taking hold. But, you know, I could certainly see that happening down the road where payers, that's an insurance company, dictates what your care looks like. So it could be done through legislation. It could be done by the payers saying, sorry, you can't freeze embryos. You can't discard embryos.
Barb Collura:It's funny you say that because we have seen proposed legislation in Congress, it was last year, so it was last Congress for our military. And it would have offered some coverage to our service members to IVF, but there were those there was that but you wouldn't have you wouldn't have had rights over your embryo. So that would have been if it had passed, thank goodness, in many ways, the bad policy did not pass. Would have been the first time that a payer in this case, the Department of Defense is saying, We get to decide what you do with your embryos, right?
Rebecca Flick:Oh, the irony. My plan I was talking about was through the Department of Defense.
Barb Collura:Okay. Well, I think it was when your husband was a federal employee though.
Rebecca Flick:Yes.
Barb Collura:Right? Yeah.
Rebecca Flick:But he was with the Department of Defense.
Barb Collura:Yep. He was with Department of Defense. So what you're asking about is possible. There's nothing that I can think of that would prevent a payer or an insurance company from from not they do it all the time.
Rebecca Flick:And Alise, when you hear from the community or the advocates that you get to interact with, do they know about ethical IVF? Or like, what is it that you'd want them to know so they can start, you know, sharing with people that they interact with?
Alise Powell:I think it's kind of a mixed bag. I think it's it's still pretty new, in the past year or so, as Barb mentioned. But I think, what I'd want them to know is that this is something that RESOLVE does not support. And I think our guiding principles are patient bodily autonomy over their embryos, over their um...
Rebecca Flick:-treatment plans.
Alise Powell:Yup. And also we support, you know, the sanctity of the doctor patient relationship and the decisions that you make are, you know, guided in consultation with your doctor and should be private and should be what's best for you as the individual patient. And so kind of forcing these ethical you know, proposals onto people and changing the practice and making things, more confusing for doctors and patients is really not going be helpful and it's not going to expand access to care.
Rebecca Flick:So what is the difference, Barb, between ethical IVF and RRM?
Barb Collura:They're very different. Ethical IVF, as we've said, is how you approach IVF in a way that is a subjective, moral, religious lens. Restorative reproductive medicine is a fancy word, again, kind of a made up term, a fancy word for things that are not IVF. So it really is at its core restorative reproductive medicine. And again, every time I say this word, I kind of have a smirk on my face because it's not a it's not a term that is used in our in our space. But it's a term used by folks who don't like IVF. And they've come up with this fancy nice term and they now have some Institute for Restorative Reproductive Medicine.
Barb Collura:They even have a bill in Congress. We got a law passed in Arkansas this year on restorative reproductive medicine.
Rebecca Flick:WE did not get a law passed.
Barb Collura:We did not get a law passed. There was a law passed. Thank you. We opposed it. There was a bill that became a law. It was signed into law in, I believe, April of this year for the state of Arkansas on restorative reproductive medicine. There is now a bill in Congress, both in the House and the Senate, on restorative reproductive medicine. At its core, it is saying that our physiological body has the ability to heal itself, and by taking care of yourself and doing certain things, sometimes in consultation with some other medical practitioner, you can restore your body's health and have full fertility. So this is talking about things like nutrition and exercise and weight loss, and perhaps things like acupuncture and so forth. Now here's the thing, all of those sound amazing and those are all things that people do all the time, most of the time, because the reproductive endocrinologist recommended it.
Barb Collura:In other words, this is already part of standard care. You see an OBGYN, Hey, I want to go off birth control. I'm looking at starting a family. Hey, I've been doing this for a while, doc. Nothing's happening.
Barb Collura:All right. Let's, let's think about your health. Let's do some blood tests. Let's look at what you're doing. You do all of those things. You get referred to a reproductive endocrinologist. They're going to do all the same things. They're going to look at your overall health. They're going to look at what, you could be doing to maximize your health. They're also going to be trying to diagnose your infertility. Things like PCOS, like endometriosis, like uterine fibroids, you can't just nutrition this away.
Barb Collura:As I was talking to a researcher who works in this space and he goes, these aren't things that can be solved in the kitchen. And he said it in a way that was so eyeopening to me. We cannot let people think that this is going to cure their PCOS or cure their endometriosis. And so it's really important that we understand as a space that your whole health is always paramount.
Barb Collura:How, you show up at the doctor's office, what you share with them about your menstrual cycle, about your overall health, helps those medical practitioners serve you. And so I say that because restorative reproductive medicine at its face is something we already are doing that's integrated as part of medical care today. Here's the problem. It's forcing people down a path regardless of their diagnosis.
Barb Collura:Remember Alise's one size fits all. This is a one size fits all. And it is saying IVF, you almost should never ever do. And if you do it, it should be a very, very, very, very, very last resort. And that could take years.
Rebecca Flick:Yeah. I was gonna say the prognosis, the time of diagnosis for someone with endometriosis can be upwards of ten years. So to let you know, those are a whole separate host of problems that need to be fixed. There's lack of research for women's health overall. So putting the pressure on the patient to solve something that is already so broken in our health care system before they're allowed access to a treatment that can not cure their endometriosis or their PCOS or their fibroids, but get them to the outcome that they want, which is parenthood.
Barb Collura:Let's talk about that-
Rebecca Flick:That just feels so, so, so wrong.
Barb Collura:Yeah. And male factor infertility. I mean, this doesn't even account for all the causes of male factor infertility. And, you know, what are we supposed to do? Just say to men, you know, I don't know, you've got low sperm count, you have no sperm count, figure it out. I mean, we need to get to the point where people get the right diagnosis in a very timely manner, Rebecca.
Barb Collura:And then with their, in consultation with their doctor, be able to decide what's their best path forward. Your best path forward may be lose weight, quit smoking X, Y, and Z, and try for six months and then come back. Who knows? But this restorative reproductive medicine is at least how it's being presented appears to be a one size fits all. And it is imposing something that's already being done at the risk of all the other kind of care that is out there.
Barb Collura:So I'm very, very concerned that we're going to see more legislation at the state level. And you mentioned insurance companies a few minutes ago when we were talking about ethical IVF. You know, I'm fearful that we could potentially see payers say, you know, we're not going to cover IVF, but we're going to cover this restorative reproductive medicine. And all of our work is gonna, go down the drain. So that's a big fear I have.
Alise Powell:I think also, this strategy of being pro restorative reproductive medicine kind of came out of the fact that being anti-IVF didn't work by the folks that, you know, the big sleeping bear that Barb mentioned at the very beginning. This seems to be the strategy that they're going with because being anti IVF didn't work. And so being pro something seems to be their new strategy.
Alise Powell:And, you know, as Barb said, it's super concerning that there's a foothold in Arkansas and we're watching closely to make sure that we can, you know, stamp out any spread that might happen to other states.
Rebecca Flick:I think that's a great point to end on, Alise, because I think that's really helpful for our community to hear that it is a response to the fact that most Americans support IVF. So we're going to end on a positive note because this has been a little like, Oh, this is what keeps us up at night, everybody. And a reminder, you know, no, we don't want no scrub. A scrub is an ethical IVF and RRM that can get no love from us. And I'm like making Alise cringe like I would my 10 year old, to quote a 90's song. But, this is a really important conversation to have despite the lightheartedness of the song.
Rebecca Flick:And we really want you to share this podcast, leave a review and share this with others. And if you support this content, please head over to our website, resolve.org and click that donate button in the top right hand corner. We'd really appreciate it. So Barb, Alise, thank you for this very, very insightful conversation. And thanks for listening.
Barb Collura:Thank you.
Alise Powell:Thanks.