Nationally, one in six adults experience infertility during their lifetime, and one in eight women of reproductive age report that they or their partner required fertility services.
As birth rates reach record lows in the U.S., federal efforts to promote pathways to parenthood accelerate.
The Trump administration says it wants to make in-vitro fertilization more affordable and have it covered by more insurance plans. What’s come of these proposals?
For Ohio couples, what does the journey to parenthood look like when infertility is an issue, and options range from IVF to surrogacy?
Guests:
- Usha Ranji, associate director, KFF Women’s Health Policy Program
- Dr. Brooke Rossi, board-certified in reproductive endocrinology & infertility and obstetrics & gynecology, Ohio Reproductive Medicine
- Dr. Rachel Warwar, reproductive endocrinology and infertility specialist, Pinnacle Fertility
- Bekah Gassin, registered nurse, founder/owner, Luna Fertility and Wellness
Transcript
This transcript is generated with AI. To ensure its accuracy, review the audio file.
Amy Juravich: Welcome to All Sides with Amy Juravich. Infertility affects roughly one in six couples worldwide trying to have a baby. But not every couple seeks treatment.
The barriers can be too high. In vitro fertilization or IVF remains the most popular and effective option, but the cost is out of reach for many. Some insurance plans provide coverage, but most don't. On the campaign trail in 2024, then candidate president then candidate Trump pledged free IVF. That hasn't happened yet, but last year he announced other proposals meant to lower the cost.
Here to talk about the latest developments at the federal level is Usha Ranji, associate director of KFF's Women's Health Policy Program. KFF is a nonpartisan health policy organization. Welcome to All Sides, Usha. Good morning. Thank you.
So President Trump has made a number of announcements related to fertility treatments, specifically in vitro fertilization or IVF. What is the motivation for the administration addressing fertility? Where does this come from that he talks about it?
Usha Ranji: Well, I think part of it comes from what you said just a moment ago, which is that there's a great need for care for infertility services or assistance with becoming pregnant. We have, like you said, one in six couples have said worldwide have needed fertility care. And so, and for a lot of people, it has also been out of reach.
So that's part of the motivation. I would add that, you know, during the presidential campaign in 2024, IVF really came in and fertility care came into the spotlight in the US because of a court case that was going on around the treatment of embryos in the IVF IVF process. And so it was during the presidential campaign and also got a lot of attention at that time.
Juravich: I want to play some audio from the 2024 campaign. It's from an event where then-candidate Trump and Tulsi Gabbard, a former congresswoman. She's now the director of national intelligence, starts off by talking about her very personal infertility story. And she says it's only the second time she had ever shared it publicly.
Tulsi Gabbard: For us, IVF seemed to be the only option and the last resort. As you know, it's a pretty difficult process. It's very, very expensive. I was in Congress at the time traveling. I would carry the medicine that I had to administer shots to myself sometimes in an airport bathroom. Amen. And ultimately, the most difficult part was every time going to the doctor for another transfer and hoping that it would result in a positive pregnancy test and then being heartbroken over and over every time that test came back negative.
Juravich: Trump offered his sympathies and said he wasn't aware of her fertility struggles, and then he made this pledge.
Donald Trump: For people that are using IVF, which is fertilization, we are going to, government is going to pay for it, or we're going to get or mandate your insurance company to pay it, which it's going to be great. We're going do that. We want to produce babies in this country, right? We want produce babies.
Juravich: So when you listen to those two pieces of audio, Usha, I mean, what struck you listening to Tulsi Gabbard speaking about her journey?
Ranji: Yeah, listening to that, you know, I think Ms. Gabbard really hit upon so many different elements of the fertility journey for many people. One, the great desire for many to have children, that, the need for medical care and medical assistance to be able to become pregnant, that it's a really, it can be a long and complex treatment path for some, and that it can really expensive and unaffordable.
And then also the sort of emotional underpinnings of the process for many. And these are people that seek IVF care or fertility assistance for the reason to be able to grow their families. And so, the emotional side plus the medical care plus the cost, I think that that really kind of touches upon so many elements of this process.
Juravich: So catch us up to today though, because it was then candidate Trump, he was on the campaign trail when he said that, and he made a pledge to the government would pay for it or he would mandate insurance companies to pay for IVF. Where do things stand with those policy pledges?
Ranji: Yes, I think that certainly took a lot of people by surprise in 2024 when President Trump made that pledge on the campaign trail. So President Trump's statement about the full coverage of IVF services for everybody was a pretty, like I said, unexpected statement. That is not the case today, far from it. You know, basically, you know since President Trump took office again.
He's made kind of two big statements around IVF care. Early on in his presidency, the second presidency, he came out with sort of a federal, an executive order saying that kind of directing all the health agencies within the federal government to really study, put more resources into fertility care, to make plans on trying to enhance access.
That was kind of early on in 2025. Then later last year in the fall, he came out with more specifics. In particular, the plan that the president or the proposal that the President put forward in last fall has kind of two major elements. One is around some discounted drug, discounted costs for some of the fertility medications that people use if they're trying to get fertility services.
And the other had to do with the structure of health insurance and kind of clarifying some of the rules around health insurance coverage for IVF. The drugs, the availability for discounted drugs, drugs just went into effect a couple of months ago through the website TrumpRx. That's a new website the president has set up. To allow people to get some discounts if they pay directly out of pocket to purchase drugs.
Juravich: You're listening to All Sides on 89.7 NPR News. We're talking about infertility and what's happening or not happening at the federal level to make treatment more affordable. And we're talking with Usha Runge, Associate Director of KFF Women's Health Policy Program. So tell me a little bit about your role at KFF, how it relates to fertility care access.
Ranji: Yeah. Well, KFF is a national organization, a nonprofit organization that studies health care policy and really tries to explain health care policies and how they affect people's access to and use of health care services.
And we do research on a wide range of topics that affect particularly related to health insurance coverage and health care costs, which are really do affect how people can get healthcare in the U.S. And on the women's health policy team that I'm a part of, we try to explain what the implications are of national healthcare policies and state healthcare policies, particularly for women and their families.
Juravich: How recently would you say that the issue of infertility became a public policy matter? I mean, in the past, it was kept very private, very personal, couples didn't really talk about it. What changed?
Ranji: Yeah, that's absolutely right. I think you heard it in Ms. Gabbard's remarks when she talked about the fact that this was the only the second time she had talked about this publicly. IVF or fertility, the need for fertility assistance for a long time. And still today, there has been a lot of stigma around it and people didn't really talk about it much.
That combined with the fact it can be really expensive. And that health insurance really didn't cover these many of the services for a long time, that kind of has perpetuated some of the stigma. That being said, over the years, there have been more people talking about their fertility journey and about their needs.
And there has slowly also been some increase in health insurance coverage, because for most people, the out-of-pocket cost for IVF care is really unaffordable. But... We are seeing some increase in coverage, and people are talking about it more.
Juravich: Fewer black and hispanic women report having used medical services to become pregnant compared to white women. Why is that? Why the disparity?
Ranji: Yeah, I think there are a lot of reasons that contribute to that. On average in this country, black and Hispanic women tend to have lower household incomes than white women. And like I said, the services can be really expensive. So some of it has to do with affordability.
And I would add also that there are a lot reasons that black and hispanic women have had on average poorer access to the health care in the medical care system. And some of the biases that I mentioned around IVF and the stigma around it can be heightened in those communities as well.
Juravich: Now, you mentioned earlier that the policies that President Trump is trying to enact, one is to lower the cost of some fertility drugs. That seems pretty straightforward. You know, if you go through TrumpRx, or even I've heard Costco, the drugs can be a little bit cheaper.
But the other part of it, where it's changing some definitions and some language with insurance companies, that seems a little more nebulous, like not understandable. Does that mean insurance companies are going to cover it more if they just like change the wording of a few things. What do you know about it?
Ranji: Yeah, when it comes to the health insurance system, it is by definition pretty complicated. But what we know is that as a couple of years ago, at KFF, we did some research on this, about one in four large employers reported that they cover IVF services. And health insurance, most people still get their health insurance through their jobs. So.
That's about a quarter of large firms recovering it. So still a lot were not. What the President Trump's proposal said last year was really kind of a clarification around existing health insurance laws. It kind of specifically said that employers, if they would like to add coverage for IVF services to their health insurance plan, that they could use.
You know, there are now some Benefits companies that really are focusing on offering benefits just for IVF or just for fertility services, maybe some other reproductive health services, that there's a pathway for employers to add that coverage on.
There have been companies out there, some like Carrot, for example, is a benefits company that really focuses on, you know, this is a package that employers can buy that would add on coverage for fertility services for their employees. Again, it does not, it is optional. It's not something that insurance companies or employers have to do. And there isn't any type of federal subsidy or cost assistance with.
Juravich: So like an incentive, so the employer can choose to add that as a rider on their insurance package and then they can say when they're trying to recruit women to work at their company, like we have these, we offer, our insurance plan offers fertility treatments, that kind of thing.
Ranji: Yeah. And health insurance is an important part of.
Juravich: A package when you're accepting a job. Yeah. Yeah, okay. So the US also saw another record low birth rate recently. So how much is that a factor in infertility and keeping the rate low or is the birth rate more reflect personal preference, the desire to not have children?
Ranji: You know, the factors that go into the birth rate are really complex and complicated. You know the fertility services for some, you know the fact that it's unaffordable for some may be a small part of that. But the decision to have a child or not really is typically tied to much larger factors including you know, people's desires, people's financial standing, people's you know kind of family composition.
Um, and typically, you know, the economy and people's, um, ability to feel like they can afford to not just become pregnant and have a child, but then to raise a family, so you know that is typically related to larger societal trends.
Juravich: I also wanted to ask you about maybe worldwide, like South Korea has the lowest birthrate in the world, but it makes me wonder how other countries regard infertility. Do other countries take in steps to make treatment more affordable than in the U.S.? We always talk about the U S. Health care system being so different than everywhere else.
Ranji: Yes, and it is because of our private health insurance being the dominant form where many others say, kind of comparable European countries or in Canada, they have public insurance plays a much larger role. My understanding of is that in some countries in Europe that there is greater access to and assistance for fertility services, but it is certainly not universal.
Um, and I will say that the kind of limited drug assistance program that, um, president Trump, um has put forth is tied in part to some of the costs of drugs in other countries. And that's, um you know, the cost of prescription medicines has been something he's talked about a lot.
Juravich: So for you, just to end on, as someone who studies women's health, where would you rate infertility in terms of the amount of attention it receives? And I'm thinking more in the lines of like, funding for research and that kind of thing of trying to figure out why this happens.
Ranji: I think we're actually at a point where it is growing. It has taken off for a long time. Like I said, the issue was so couched in stigma and just high costs and unaffordability that it didn't receive much attention at all, kind of on all ends in terms of public attention, but also research and just developments in benefits and coverage.
That being said, given that it has been in the spotlight, we do hear a lot more people talking about it. And it is getting more attention, certainly in the policy sphere, around coverage. I will add also that for President Trump, if he wanted to go through with that promise to make it accessible to everybody and covered for everybody, that would take for an act of Congress.
We do hear in some states are requiring coverage for IVF services, but that doesn't even reach most people in a lot of people in those states. It would require an act of Congress. And so far, that has not a bill that has been able to pass.
Juravich: We've been talking about infertility and efforts to make treatment more affordable with Usha Runji, a associate director at KFF Women's Health Policy Program. Usha, thank you so much for your time today. Thank you. And coming up, we're going to talk with a panel of local fertility specialists to learn more about treatment options in central Ohio.
Amy Juravich: You're listening to All Sides. I'm your host, Amy Juravich. Infertility affects roughly one in six couples worldwide trying to have a baby. But not every couple seeks treatment. The barriers can be too high. How about here in central Ohio? Who has access to reproductive care and who does not?
We've gathered a panel of three fertility specialists, two doctors and a nurse, to talk about their work, scientific advances in the treatment of infertility. And the types of policy changes that are needed to improve access and bring down costs.
Joining us today, we have Dr. Brooke Rossi, a board certified expert in reproductive endocrinology and infertility and obstetrics and gynecology. She works at Ohio Reproductive Medicine. Welcome to All Sides, Dr. Rossi. Hi, Amy. Nice to see you. And Dr. Rachel Warwar, a reproductive endocronologist and infertility specialist at Pinnacle Fertility. Welcome to All Sides, Dr. Warwar.
Dr. Rachel Warwar: All right. Thank you.
Juravich: And Bekah Gassin is a registered nurse and the founder and owner of Luna Fertility and Wellness. It's the only in-home fertility support service of its kind in the state. Welcome to All Sides, Bekah.
Bekah Gassin: Hi, excited to be here.
Juravich: Um, so I would like to go around and have each of you talk about your role in your respective clinic, um, maybe the range of services you offer. So Dr. Rossi, let's start with you. Can you talk to me about what services you offer at Ohio reproductive medicine.
Dr. Brooke Rossi: Sure. At Ohio Reproductive Medicine, we are focused on treating reproductive endocrine issues. So sometimes that's helping people with their hormone levels to try to help them ovulate and then conceive. We also offer intrauterine insemination and we also offer in vitro fertilization.
It's also important to note that we sometimes need to do surgery for patients to help then conceive and also we do something called third-party reproduction, which means that sometimes we use a third party, which might be an egg donor, an embryo donor, a gestational carrier, or a sperm donor.
Juravich: Okay. And so Dr. Warwar, I'm sure that your clinic does similar things. I don't know if anything's different, but maybe you can help us with some definitions. So Dr. Rossi just said, um, IVF in vitro fertilization. Tell me the difference between that. And then she mentioned IUI.
Warwar: Yeah so I'll start with IUI which is I would say the less aggressive route and typically we What is it?
Juravich: What does it stand for?
Warwar: I'm sorry.
Juravich: Uterine insemination. And it's what used to be called artificial inseminations or do we still use that term? Not so much. Right, yeah I know.
Warwar: Term, right, IUI? Okay, go continue. Yes. So typically that's paired with a form of either ovulation induction or a natural cycle if the female partner is ovulating naturally, or what we call super ovulation if they're ovulating, naturally haven't conceived, and then we want them to ovulate potentially more than one egg.
And so that's typically ultrasound monitoring and then the IUI itself. Is a minor office procedure. I typically tell women it's like a pap smear. There's no anesthesia involved. You're typically in and out of the office in 10 minutes. And then you take a pregnancy test at home about two weeks later.
And the actual IUI itself involves a sperm wash from either a donor or a male partner, and then placing that washed concentrated sperm at the top of the uterus.
Juravich: Basically like making it, giving you the best chance for it to work out the way it's supposed to.
Warwar: Yes, I basically tell patients trying to get more eggs and more sperm closer together at the right time.
Juravich: Right. And then, so then IVF, which Dr. Rossi mentioned, that is the more invasive, more involved, more expensive procedure.
Warwar: Correct. So that I say involves the lab because there we are getting typically many eggs to grow. We're retrieving those eggs directly from the ovaries and then using the sperm source and fertilizing those eggs, directly in the IVF lab with the use of embryologists.
Typically then allowing the embryos to grow in culture for about a week and then we can either transfer those embryos. Freeze the embryos, even biopsy the embryo's for genetic screening. All right, so Bekah, let's move on to you.
Juravich: Because your website calls what you offer, Fertility Concierge Service. Tell me about that. What kind of services do you offer?
Gassin: So we're basically an extension of the fertility clinic. So we partner with the fertility clinics. We go into patients homes. We're having
Juravich: We're having, I think we're having a little bit of trouble with your microphone. So, um, I don't exactly know why, but we're getting, uh, can you try one more time?
Gassin: Sure, is that better?
Juravich: Um, Okay, we're going to hold on for one second. I think I can bring someone in to help you with your microphone. So let's just pause that for one seconds.
President Trump in 2024 as a candidate talked about wanting to make IVF free and mandate insurance companies cover it. And those ideas never came to fruition. But last October, he announced a two part initiative on IVF that we talked about in the last segment.
Reducing costs for certain drugs and clarifying options for employers to offer standalone fertility benefits. So at his State of the Union address in February, he spoke about TrumpRx and he highlighted the case of Katherine Rainer. He introduced her as the first customer to receive a big discount on fertility drugs that she was taking.
He said that she and her husband had been trying to conceive for five years. And he went on to say this.
Trump: One drug has been costing Katherine $4,000 to purchase. But a few weeks ago, she logged on to the TrumpRx website and got that same drug that cost $4000, got it for under $500, a reduction of much more, actually, than $3,500. Katherine, we are all praying for you, and you're going to be.
Juravich: Dr. Rossi, can you talk about those ideas that Trump has either announced or unveiled? Are you seeing changes on the ground in central Ohio? Are drugs cheaper?
Rossi: Yeah, they actually have been. I think his message is important because he's drawing attention to the fact that one of the barriers that infertility patients experience is the cost of treatment.
And one of the main parts of the cost treatment is the medication, which can be thousands of dollars. And it kind of varies from person to person and what they need, but in general, it's a barrier. And so I think the idea that we are thinking of ways that we can help reduce costs to increase accessibility for patients is very important.
Juravich: And Dr. Warwar, besides the cost of the drugs, the whole entire procedure is costly. So let's talk about insurance for a moment. I mean, do you come across insurance companies who fully cover it?
Warwar: Yes. More and more I think. It's typically large employer services or employers and there are lots of different I should say several different private insurance groups that I would say are kind of like add on benefits to you know your typical like United, Aetna, things like that. And those, just to mention a couple of them, progeny, maven.
Are really nice benefits that employers offer because they are mostly fully covered for fertility treatments and there aren't a lot of stipulations as to how they require them to be used. And I think that's one of the hardest things that I think we face as physicians and providers is, okay, great, we have these benefits and we want to use them, but the insurance company then kind of stipulates how we use them and when.
And I think that's always a struggle because we want to take advantage of them and we don't want to complain about coverage. But when they're dictating how and when we use the coverage, I think it can make it a lot harder for the patient.
Juravich: Yeah, Dr. Rossi, what do you want to say about insurance?
Rossi: Well, I just wanted to, you know, to elaborate on what Dr. Warbar was saying. I'll give you an example. There are some patients who have insurance benefits for infertility treatment, but if they're in a same sex relationship, they can't use their benefits because, you know, the benefits say you must be having tried for 12 months, and if you can't try because your partner doesn't have sperm, they can't that benefit that maybe the person next to them who's in a heterosexual relationship can use.
Juravich: Okay, so are you finding what Dr. Warwar was saying is true, more and more insurance companies are covering it though? Because I feel like maybe 10 to 15 years ago, it wasn't covered.
Rossi: You know, when I've talked to our practice managers, it does seem like about 50% of our patients have some amount of infertility benefits, and it does see that it's larger employers. You know in the last five years, it's been really great because the state of Ohio has started to offer infertile treatment benefits, Franklin County, and so it's really great.
Some of the big hospitals in town will offer it too. It's, it's interesting when I. You know, one of the things we're taught is to ask patients about their occupational risks. So I always ask people what they do. But now I have this running tally in my head also of all the employers in town, because I'm trying to strategize with the patients about whether they may have benefits or not.
Warwar: Yeah, and sometimes they don't even know that they have benefits, which is...
Juravich: Always shocking to me. Yeah, so they're like, someone else came in here who works for your same company. You have to go check.
Rossi: Yeah and you know that's actually a problem because you know one of the reasons people don't even make the appointment to see us is because they think they don't have benefits. So they are surprised sometimes and it's such a relief to them to find out they have some benefits they can utilize.
Amy Juravich: You're listening to All Sides on 89.7 NPR News. We're talking about infertility this hour with Dr. Brooke Rossi from Ohio Reproductive Medicine, Dr. Rachel Warwar from Pinnacle Fertility. Also with us, we have Bekah Gassin, founder and owner of Luna Fertilty and Wellness. Bekah, let's see, is your mic working okay now?
Warwar: I hope so.
Juravich: I hope so, we're working on it. Okay, so Bekah, tell me what does Luna Fertility and Wellness do?
Gassin: Yeah, so we are like I said, we're an extension of the fertility clinics. We're a nursing driven business. So we partner with clinic patients and we take the stress of administering their injections at home away from them.
I personally went for through fertility treatment. And I'm a registered nurse and a type one diabetic. And when I opened to that giant box of medications for my fertility treatment, I was super overwhelmed.
And that just made me think, how can we get out there and help those other people going through this situation? And take that stress away from them. So we go into clients' homes and administer any IVF medications, injections, or educate them on how to properly administer them themselves.
Juravich: So I was telling, I said earlier, and yay, your microphone works, yay. And I'm sorry about that. That's just, you know, things break. Anyway, I called you a fertility concierge. So you just said you're a nurse and you also are a diabetic. So you're used to giving yourself shots, right? So why, when it came to the fertility medication, did you suddenly have this moment where you were like, wait, this is hard?
Gassin: But yeah, again, as a nurse, I'm no stranger to mixing medications or as a diabetic giving myself an injection with a pen. But you get a box of all of these, it's all of the medications at once.
And so you're overwhelmed because at that point in time, you don't know, okay, I need this medication at this point and this medication. At this point, you haven't been through the clinic process to understand when those are given. So it's really overwhelming.
And just from me personally, I put the extra pressure on myself of if I don't give this medication correctly, is it gonna mean that my cycle, this IVF cycle isn't successful? And so we wanna take that additional stress, you know, it's an emotional roller coaster ride going through fertility treatment.
There's ups and downs and your hormones are crazy. So that makes everything twice as uncomfortable. And so, you know we just wanna be there to alleviate that stress.
Juravich: So you were just listening to Dr. Rossi and Dr. Warwar both talk about whether insurance covers it or not and the high cost of the treatment. What do you hear from your patients about that too? They're sitting there with this box of medication that costs thousands of dollars and they don't wanna mess it up, is that?
Gassin: Yeah, we do hear that a lot. And it is, we hear a lot of similar things that the docs were talking about is that we're lucky here in central Ohio, there are a lot of businesses and corporations that do offer their employees fertility benefits, which I think is a blessing because Ohio as a state does not mandate that insurance covers fertility treatment.
Having these businesses opt to offer those benefits for their employees has been a huge game changer.
Juravich: Dr. Rossi or Dr. Warwar, do you have, whenever you try to explain to patients what they need to do, if they're at the point when they need IVF in order for the ability to conceive, do they look at you with like a look on their face of like, I can't do this? Like having a service like this, is that something that you can think of people in your head right now who need it?
Warwar: Yeah, absolutely. I think we're very lucky in Columbus, Ohio to have this service, because this is something that places like on the West Coast, LA, on the East Coast, New York City, they have a lot of these services. So the fact that we can offer them to our patients here as well I think is a huge benefit.
And like you said, I think it's taking one extra thing off their plate in terms of, I have to worry about this. And it's also, you know, acting as a little bit of an emotional support person as well. I mean, you're there with them, taking the shots, especially for patients who do like egg freezing, if they don't have a partner or someone who's at home with them. I think just even having someone else in the room with you is a huge asset.
Juravich: Dr. Rossi, what about you? Do you have patients who you can look at them and they're like, you might need a little help with these shots. Well, it's just that.
Rossi: Some people have issues with needles and it really ends up being a team effort. It involves often the patient, sometimes their partner, sometimes their moms or a different family member who's the nurse next door is coming over to give their shots.
It's people at work that are giving them their shots and it can be our nurses, our staff, teaching modules. There's a lot of things that go into this and I also just often give patients a pep talk and say all these other people around the world have been doing this, like you can do it too.
Juravich: Yeah, so, Bekah, tell me more about the Luna Fertility and Wellness because I've read that you've grown too. I mean, it's not just you driving around Franklin County doing this, right? Have other nurses with you?
Gassin: We do have a few other nurses and I also have a business partner, Corinne, who is the co-founder of Luna. She has her master's in nursing education so she's very passionate about getting out there and really educating and making fertility patients feel independent and feel confident and comfortable in administering these medications at home.
Juravich: Tell me a little bit more about that idea that you're gonna mess it up and lose the cycle. Like what does that mean to someone where they've been trying to have a baby for probably a long time and now they're like putting the money, the effort, the shots into it.
Gassin: Yeah, it's just a lot of added pressure. Through an entire IVF cycle, you're giving yourself, it could be multiple injections in the evening, sometimes an injection in the morning, an injection at night. And then there's the trigger shot, which is like the most important shot that you have to give it a very precise time in order to prepare for your egg retrieval.
And so that's just the stress of like, if I don't have this medication drawn up and administered in the exact right time, is my egg retriever gonna be successful the next?
Juravich: Dr. Rossi, tell me about the timing. This seems like a very time-sensitive process. I mean, we're not talking about, like, taking a pill every eight hours, like you're, you know, having ibuprofen or something.
Rossi: Yeah, it is important. I mean, these medications, because they're injectable, we're trying to mimic sort of what the body does normally. And so it is important to administer the medications properly.
When patients are doing IVF, we ask them to not travel during the cycle to be accessible to us, because it does require them to come into the office every couple of days for blood work, estrogen monitoring, and ultrasound to look at how the follicles or the eggs are growing.
The timing is important and it all has to do with the physiology and the biology of egg development and when the egg can be fertilized and when it's going to be mature. So there is definitely science behind it, but I do, somehow we have to make sure we can communicate to patients the importance without making it seem so stressful for them because there is a little bit of wiggle room often in different parts of it.
And so we don't wanna add so much stress to them that it's making it too hard for them.
Juravich: So Dr. Warwar, you noted when we were preparing for the show that conceiving a baby is not as easy as it may be seem to be portrayed in the media. Can you elaborate on that? Like what makes it so complex? I can understand how IVF is so complex, but just, I mean, the whole.
Warwar: Thing is complex. Right. I mean, I think it's always fun for me when I'm doing a consult and whether it's at the new patient visit or an IVF consult and kind of going through all the things that have to happen for this to go right, just in a purely naturally conceived pregnancy without any assistance.
I think people think about, oh, we're ready to start trying to have a baby, and we've got an 80% chance our first month. And it's really the opposite. I tell people, humans are not meant to procreate efficiently. We are not like rabbits or mice. We procreated very inefficiently at baseline. And then when there's an added inefficiency on top of that, like a tubal factor, a male factor, or an ovulatory factor, it just makes everything so much harder.
So, I mean, we're talking about a microscopic single cell, which is an egg that's being released, hopefully, from an ovary once a month, and then a fallopian tube, which is like free-floating in the pelvis, trying to move around, communicate with the ovary, and find that single cell. Pick it up, and hopefully we have sperm waiting in the fallopian tubes. Sperm have to fertilize that egg.
That egg has to have right energy, the right DNA, the right chromosomes in order to be able to create a healthy embryo along with the sperm, 50% of the DNA. And then there has to be implantation in the uterus. And you know that's just kind of the first two weeks of the process. Then it's the whole pregnancy from there. So I mean it is really you know when I explain that to patients they're just sitting there being like how does it ever go right? Like, and so, so the people who say.
Juravich: They get pregnant by accident they're actually the anomaly
Warwar: Yes, that's what I tell people.
Juravich: Absolutely. All right. Well, coming up, we're going to talk about how fertility care has evolved over time and we're gonna talk about the growing popularity of surrogacy.
Amy Juravich: You're listening to All Sides. I'm your host, Amy Juravich. We've gathered a panel of three fertility specialists to talk about their work, scientific advances in the treatment of infertility, and the types of policy changes we need to improve access and bring down the costs.
Still with us is Dr. Brooke Rossi, a board certified expert in reproductive endocrinology and infertile and obstetrics and gynecology at Ohio Reproductive Medicine. Thanks for being here, Dr. Rossi. I'm happy to be here.
And Dr. Rachel Warwar, reproductive endocrinologist and fertility specialist at Pinnacle Health. Thanks for being here, Dr. Warwar. Thank you. And registered nurse, Bekah Gassin, founder and owner of Luna Fertility and Wellness. Thanks for be here, Bekah. Thanks.
So Dr. Rossi, can you give us a sense of the evolution of fertility care over time from your vantage point? I mean, have we been doing IVF the same way for 20 years or has it gotten better?
Rossi: Yeah, so I'm going to touch on a few things. So IVF is over 40 years old, and it definitely has changed over time. Some of the more recent trends we're seeing in the last several years have been a real push to do single embryo transfers.
And that's been great because in the most recent data that has come out from the Society of Assisted Reproductive Technologies, the twin rate among IVF patients is now less than 2%. So you're less likely to have a twin with IVF than you are in the general population if you were to conceive on your own.
We are doing more freeze all cycles. Sometimes we do that to lower the risk of ovarian hyperstimulation syndrome. So that is much lower as well. Many practices are using pre-implantation genetic testing on embryos to look for different diseases or to check to see if the embryo has the right number of chromosomes. And also fertility preservation.
So some women are choosing to do egg freezing. And so there are definitely trends that have changed over time with IVF. It's actually much safer as well. And again, another little data point that came out from the recent SART data was that in 2024, there were more than 100,000 babies born in the US using IVF.
Juravich: And Dr. Warwar, what are we seeing when it comes to, I talked earlier about the United States' low birth rate and whether it's people having infertility issues or whether people are just choosing not to have a child. You know, there's, we can, that's probably not for this conversation, but more so if people are waiting longer to have the family because it costs so much money and you need to, you know, after you need to like...
Have enough money to have the job and you have all the debt, and then you have to, if you wanna raise a family, you wanna be financially stable, all of those things. So people are having children later. Are you seeing that? Is the age a factor here?
Warwar: Absolutely. I mean, you know, it mentioned earlier how difficult it is to get pregnant naturally when everything's normal. And that's even when you're young in your twenties, early thirties. But again, just naturally at baseline, that gets harder as we get older, mostly as women, but there is a paternal factor as well.
And that's because of the egg quality. We are born with all of our eggs as women and they're in our body our whole lives. So they're being exposed to everything that we're exposed to. And again, just naturally as we get older, the quality of our egg diminishes which decreases the chances that we are gonna have a successful pregnancy each month.
Juravich: And, Bekah, with your organization, Luna Fertility and Wellness, are you seeing, I don't know if you have a percentage, but how many of your patients are in their late 30s or maybe approaching 40 and feeling like they're running out of time?
Gassin: Yeah, I would say currently, the majority of our patients are in their 30s and late 40s, or early 40s. So we do see a trend of an older patient population. And I think that's super important to talk about egg freezing, too, as you're getting older as a female. You want to establish your profession and plan ahead for your future and your future family.
Juravich: So are people choosing to add on your service not just because they're afraid of needles but maybe because they feel like they don't have very many cycles to try this? Does that make sense? Am I asking that the right way?
Gassin: Yeah, we do have several clients who are a little bit older in age, and they are, again, like Dr. Warwar said, it is challenging as you get older to get pregnant, and so they do go through the IVF cycle and require our support.
Juravich: Dr. Rossi, I wanted to talk about the idea of who gets fertility treatments, because there is some data to back it up, but for the most part, more so white women are using infertility services than black and Hispanic women. Do you see that in your practice, or do you know, is it a situation of people who have the insurance coverage and come for the treatment versus have-nots.
Rossi: I think in general, we see some of the same health disparities that they see in other areas of medical care. There can be difficulties, as our last speaker talked about, with sort of access and sort of how society views infertility despite the fact that the WHO says that infertality is a disease for some reason in our society.
And maybe this is even more true of the United States. We seem to put a different. We put it in different contexts where people are sometimes embarrassed to ask for help or to seek care or to talk about it with family members or friends. So I think that that may affect who seeks care.
Juravich: And Dr. Warwar, do you, I mean, do you agree with that? Why do, it's being talked about more and more if you're having fertility issues, but why 10 years ago, 15 years ago did no one talk about it? Why was it a private matter?
Warwar: Yeah, I think, I mean, just with like social media, even the fact that, you know, people talk about lots of things on the internet now, and it's just a public facing forum. I think it's becoming more common that people are saying, hey, look, I want to be a support person for someone else. And I'm going to talk about this.
I think It's more commonly discussed politically. In legislature and also, you know, I think there's less of that stigma and more of this kind of empowerment of, okay, even just around egg freezing, like I'm excited to do this. I think a lot of the patients I have that do this say they feel really empowered and they want to tell all their friends about it after they do it.
And I think from a fertility perspective, I'm always amazed at the community that there is behind the patients. And they say, oh, you know, I didn't, they wouldn't have maybe otherwise known this person, but they met them through a community, either on Facebook or some social media forum. And they really utilize that support and then they wanna pay it forward and talk about their story so that someone else can kind of take comfort in that fact.
Juravich: You're listening to All Sides on 89.7 NPR News. We're talking about infertility this hour with Dr. Brooke Rossi from Ohio Reproductive Medicine, Dr. Rachel Warwar from Pinnacle Fertility, and Bekah Gassin, founder and owner of Luna Fertilty and Wellness. Axios wrote a story recently about the growth in surrogacy. Is that something that you are seeing as a part of the treatment that you offer in your clinics, Dr Rossi? Yeah, I just want...
Rossi: To clarify. So sometimes surrogacy is called different things. We can call it gestational carriers, sometimes gestational surrogates, and then sometimes surragacy. And basically what that means is that an embryo is created and then placed into the uterus of another woman to have that woman carry the pregnancy.
So the gestational carrier is not in any way genetically related to that child that is born. And so that can be used by women who have medical issues that they can't carry a pregnancy. It can be used by. You know, people who might not have been born with a uterus, who have had a hysterectomy, and sometimes can be used by two men who wanna have a child.
The rate does seem to be going up. Again, the SART data would tell us that over the last even, you know five to seven years, there's been an increase in surrogacy around the country. And I think to Dr. Warwar's point, it's something that more people are talking about.
They understand that it's available, and not only does that make patients seek it out more, but the more it's in the news, then there are other healthy women who have had children saying. You know, I loved being pregnant. I want to help another couple. Hey, maybe I should find out if I'm eligible to be a gestational carrier.
So I think it just allows it to be more in the media and out in the world so that more people are talking about it and considering it.
Juravich: And Bekah, is surrogacy a part of something that you offer with your, with Luna Fertility?
Gassin: We definitely could support somebody, a surrogate carrier. We haven't so far, we haven't seen a high patient population of that for us, but we definitely could. Report that.
Juravich: And Dr. Warwar, what are we seeing about the idea, like are there some women whose bodies don't react to pregnancy well, where this is an option for them?
Warwar: Absolutely, I think fair women, like Dr. Rossi said, maybe they just have baseline medical conditions that make pregnancy extremely dangerous or even contraindicated, we might say. That can be like significant cardiac or heart problems, significant lung problems, or there's an anatomical issue.
But I think even more so, we see women who are older. And just don't want to take on the risk that an advanced maternal age, which is a terrible term but AMA pregnancy, might put even on a healthy woman in their 40s. And so I think this is a really great option.
I think the hardest part about it is the financial inability for some people because that at least. To my knowledge is not typically ever covered by insurance and so it's a fully out of pocket expense for the what we call intended parents or the IPs.
Juravich: So surrogacy is not covered by
Rossi: In general, I feel like maybe I've seen it a couple times, or maybe insurance companies will cover parts of it for patients who have very progressive plans. But in general, it's, you know, and you're paying for, there's, I mean, you're payin' for someone to work for 10 months, and attorney fees, and medications, an entire IVF cycle, so it can be quite a costly treatment plan.
Juravich: And whatever term you just used, whatever term you used, you said is not a great term, but it's better than geriatric pregnancy. Yeah, that's true, I held off on that one. Yeah, which, isn't that the term if you're over 35? Yes. Which seems so young. And yet, okay. Well, yeah, that a story for another time.
Okay, we only have one minute left. If anyone just wants to end on, what would you say to someone who's listening right now who hasn't been talking about it? Would you encourage them to just try to come seek fertility treatment? Yeah, I think I want people to to understand that not all infertility treatment equals IVF.
And it's really important to just come in and talk about your options. It may be much more simple than you think and much less scary than you. And we're always happy to talk with you and try to make an appropriate treatment plan.
Juravich: And Bekah, what would you say to people if they feel intimidated by this whole situation?
Gassin: I echo what Dr. Rossi says. Having gone through it myself, it is overwhelming in the beginning. You don't really know what your options are, so just know you don't have to go through it alone. The clinics here in central Ohio are amazing, and Luna is here to support anybody that is challenged in the medication department.
Juravich: We have been talking about infertility treatments with Dr. Brooke Rossi from Ohio Reproductive Medicine. Thank you so much for being here, Dr. Rossi. Thank you. Dr. Rachel Warwar from Pinnacle Fertility. Thank you, Dr. Warwar. And Bekah Gassen, founder and owner of Luna Fertilty Wellness. Thank you for your time today. Thank you!
This has been All Sides on 89.7 NPR News. I'm Amy Juravich.