I hear some variation on this question with surprising frequency—or it seems surprising because many infertility doctors tell me they never hear it. I suspect
that the people asking are more comfortable asking in a non-medical setting or are asking before they go to an infertility clinic. Fortunately we received this question on yesterday’s Creating a Family show on Knowing When to Move up the Infertility Treatment Ladder, so our guest expert, Dr. Jaime Knopman, Reproductive Endocrinologist with RMA of New York and Assistant Professor in the Department of Obstetrics and Gynecology at the Mount Sinai School of Medicine, could address it.
Obviously the answer to what type of fertility treatments are available if you object for religious reasons depends on the exact nature of your objections. In general, I find that most people are open to “simpler” forms of treatment such as clomiphene citrate (Clomid) or letrozole, with or without intrauterine insemination (IUI), but these treatments won’t work for everyone. We discussed these beginning steps of fertility treatment in detail and for whom they work best on the show.
Is IVF Out of the Question?
Well, it depends. Some religions object to the fertilization of an egg outside of a woman’s body, which obviously rules out in vitro fertilization. Others have a general concern for “the sanctity of embryos” in the IVF treatment. In the past, I heard people worry over the loss of frozen embryos in thawing process, but with the cryopreservation techniques used now, this is much less of an issue. The concern I hear most now from people who think they can’t do IVF for religious reasons is with creating excess embryos that they will not be able to use. For those people, IVF is definitely an option, but it may cost more.
One option to consider is donating any unused embryos to another infertile couple or single woman. Many many people would love to be on the receiving end of donated embryos. The primary risk is that the embryos may not be of a high enough quality to donate and there are consent issues to work through if donor eggs or sperm were used, but this is a great option for some people who finish treatment with unused embryos.
Another option for those wanting to limit the possibility of left-over embryos is to talk with your reproductive endocrinologist about using less ovulatory stimulation medications, and only fertilizing the number of eggs that you would feel comfortable transferring, either fresh or frozen, and ultimately feel comfortable parenting. People tell me that the response they hear from fertility doctors to this request varies widely from totally accepting to totally dismissing it out of hand. If this option is important to you, take the time to find the right doctor, but be prepared to pay more. Knowing how many embryos it will take to get you pregnant is far from an exact science, so it may take more than a few IVF cycles, which obviously adds to the cost.
Egg Freezing Has Changed the Equation
As Dr. Knopman said on the show, egg freezing is rapidly changing the way we view IVF, and this is especially so for those who have religious objections to creating excess embryos. It is possible now for a woman to go through a regular stimulation IVF cycle and retrieve all the eggs produced. Her fertility clinic can fertilize the number of embryos she would feel comfortable transferring (fresh or frozen), then freeze the rest of the eggs to be used later if more embryos are needed. So far I haven’t heard from anyone who has a religious objection to discarding unused frozen eggs.
On the show, I was able to ask Dr. Knopman a question that I’ve been trying to find an answer—how effective is egg freezing for woman over 35? Most of the research on egg freezing has been done of eggs from young women donating to egg banks for donor egg IVF cycles, not on “older” women freezing their own eggs. Dr. Knopman confirmed that this data doesn’t exist yet, but at least so far, the eggs from woman over 35 seem to survive the thaw about the same as younger eggs. No good data is available on pregnancy rates.
If you have religious objections to some forms of infertility treatment, what have you done?
Image credit: RaghuP