In Vitro Fertilization (IVF) has been in the news a lot recently. The recent Alabama Supreme Court decision and subsequent legislation passed in response to the ruling have started to pull back the curtain on a common way for families to grow. In the past, IVF has been perceived as an option reserved for a few people, but increasingly, more people have relied on this vital part of reproductive health care. However, patients, and even providers, often have misconceptions, which limit opportunities and harm many families that could benefit from this process. Now more than ever, it is crucial to expand the thinking behind who should have an opportunity to seek IVF care beyond infertility. Here are a few examples of who can benefit from a conversation about IVF.
Cancer
Anyone with cancer who is of reproductive age should be offered the opportunity for fertility preservation. For men, this is often as simple as storing sperm for the future. For women, the conversation is around using medications as a protective agent or doing IVF to store eggs or embryos for the future. Studies now show that for many individuals with cancer, IVF does not delay treatment, or if it does briefly delay treatment, overall survival rates have not been impacted.
In addition, genetic testing for cancer predispositions has become standard practice in cancer treatment. For those individuals that do have a genetic risk factor like BRCA, IVF offers the extra potential benefit of doing Preimplantation Genetic Testing (PGT) on their embryos to reduce the chances of passing along risk to future generations.
It is vital that anyone undergoing genetic testing be given information about PGT. Whether it is someone with a new diagnosis of cancer or someone who has a relative with hereditary cancer, families must know there is something they can do about passing these genetic variants to future generations.
Genetic Diseases
IVF with PGT benefits families who have had a previous child with a genetic condition that significantly impacts the child’s health or well-being. Surprisingly, PGT is not often discussed in families with genetic conditions that are not considered life-threatening. In our fertility and reproductive center, we often find family members with genetic conditions who have not been offered the opportunity to do IVF with PGT. Families with Neurofibromatosis (NF), polycystic kidney disease, Long QT syndrome, and other serious conditions are not consistently given information about the option to prevent passing these variants to future generations.
Unable to Carry a Baby
IVF is also important when considering that not everyone is able to carry a baby. For example, if surgery was done for cancer to remove the uterus or, if an individual was born with uterine anomalies that do not allow for carrying a baby. Also, for some individuals, IVF may the only option because of various concerns, including previous recurrent miscarriages.
Families Using Sperm or Egg Donation
Using a sperm or egg donor has become an essential option for some families. For example, a donor is a wonderful option for individuals for whom we cannot offer PGT. It can be helpful for those who have premature ovarian failure or have a genetic condition that does not allow for sperm or egg production. IVF is required in cases of egg donors but may not be necessary when using a sperm donor.
The Need For Increased Access to IVF
IVF has become a common resource in our reproductive tool bag and there are now several states that require insurance to pay for IVF coverage. In 2023, many insurances began to offer coverage for PGT when there is a known genetic risk factor that PGT could prevent. Additionally, many companies are now offering fertility benefits or insurance options that will pay for some or most IVF processes.
IVF is increasingly accessible, but we must protect the ability for all to pursue this option, particularly families in rural and lower-income communities. Most importantly, we need to do a better job of counseling families so they know that IVF is an option and allowing individuals to decide the best way to grow their family.
If you are interested in speaking with a genetic counselor who can help in one’s family planning journey, visit findageneticcounselor.nsgc.org
Jay Flanagan, MS, CGC, is a member of the National Society of Genetic Counselors and is a preconception/prenatal genetic counselor at Sanford Health in Sioux Falls, South Dakota.
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