BLOG: ‘IVF is the reason why I am here today’
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There are many aspects of my identity as a Black female medical student.
I am in my second year at City University of New York (CUNY) School of Medicine and the child of Haitian immigrants, living in New York City. I love rock climbing, roller skating, eating Haitian patties with my family on Sundays after church ... and I am a triplet born via the miracle of in vitro fertilization (IVF).
‘The Monteau triplets’
My parents were married in 1990 and welcomed their first child the following year.
A couple of years later, my mother was awoken from sleep by intense abdominal pain. She visited her OBGYN twice, and despite her efforts, her symptoms were ignored (a known aspect of medical misogynoir).
My father, a physician assistant in practice in the ER, encouraged her to take a pregnancy test, and to her surprise, it was positive. They rushed to Harlem Hospital and discovered a fetal heartbeat in my mother’s fallopian tube: It was an ectopic pregnancy. After her life-saving surgery, her OB/GYN informed her that she had tubular scarring and cautioned against natural conception. This was a devastating diagnosis for my parents who were hoping to grow their family.
At the time, my mother’s job as an elementary school teacher covered three rounds of IVF; insurance coverage for IVF is rare, so this was a blessing. In her first round, only four embryos were viable, so my parents, along with the medical team, decided to implant them all. Seven months later, my family welcomed Regine, Reginald and Rachelle (me): The Monteau triplets.
Without IVF, my siblings and I would not exist, and my mother could have died of another ectopic pregnancy.
‘Under increasing attack’
Assisted reproductive technology (ART) includes fertility services that handle embryos and eggs. IVF is a form of ART where the eggs of a birthing person are harvested, fertilized in a laboratory and returned to the womb.
IVF has been transformative for preserving fertility. Many different conditions can cause infertility, including scarring of the reproductive tract (like for my mother), endometriosis, and polycystic ovary syndrome.
Additionally, IVF gives people with cancer or other serious conditions the chance to preserve fertility before toxic treatments like chemotherapy or radiation. It can also extend fertility for future physicians, like myself, who often have to make difficult decisions between family planning and career development.
Despite the immense impact of IVF, along with other forms of reproductive freedom, it has been under increasing attack in the U.S.
Alabama ruling
In February, the Alabama Supreme Court ruled that frozen embryos created through IVF should be considered “extrauterine children,” and clinics can be held liable if any frozen embryo is destroyed under the Wrongful Death of a Minor law.
Immediately, three of the seven IVF clinics in Alabama paused services in fear of the legal ramifications. In March, following weeks of protests, the Alabama governor signed a hastily written bill protecting IVF patients and providers from legal liability. Despite this quick fix, there are many concerns about IVF accessibility in the state. If embryos are considered human life, how long can they be preserved? Can parents decide to no longer preserve their embryos? Is this the beginning of more legislation against IVF?
Currently, there are many barriers to accessing IVF.
There is a significant financial cost; patients in America can expect to pay around $13,000 per round, and up to $30,000 in some cases. My mother was fortunate enough to have IVF covered by her insurance through her employer, but this is often not the case for many prospective birthing parents.
Along with the financial barrier, there is also a racial barrier. Racial and ethnic minorities, especially Black women, have historically had less access to fertility care such as IVF. Previous studies have also shown that even when Black women do undergo IVF, they are more likely to miscarry or have a complication. Meaning that, even when a Black woman, like my mother, has access to and can afford IVF, she may still have worse outcomes.
In the wake of the Alabama ruling, these disparities will likely only widen.
‘More of us’
For many patients with cancer, IVF is a vital part of improving survivorship, as treatment-related infertility is high.
Thus far, 16 states, including my own state of New York, have mandated fertility preservation insurance coverage for patients with cancer. However, it is not a perfect system, and many patients still fight with insurance companies for the coverage they are entitled to.
Additionally, for patients who may not know when they are going to use preserved embryos, the possibility of future prosecution due to the use of IVF is problematic and harmful.
To protect access to IVF and reproductive freedom, we, as future and current physicians, need to protest the discriminatory legislation that is being increasingly put forward.
Moreover, it is crucial that we advocate for the federal government to pass legislation to ensure further restrictions do not occur in other states.
As a medical student at CUNY — a school dedicated to training physicians in underserved communities to decrease medical gaps in those same communities — barriers to care are essential to me. I think about the fate of my future patients, colleagues, friends and family who continue to have their reproductive rights decreased yet again by this country.
My intersectional identity is a future physician, a graduate of the NYC public school system, a daughter of Haitian immigrants and, yes, an IVF baby all grown up.
There is a growing generation of IVF adults in America today and my prayers are that there will be more of us — not less — in the future.
References:
- Edmonds BT, et al. Clin Obstet Gynecol. 2023;doi:10.1097/GRF.0000000000000768.
- Ghidei L, et al. F S Rep. 2021;doi:10.1016/j.xfre.2021.12.002.
- Lee A, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.37558.
- State Laws and Legislation. Available at: State Laws & Legislation | Alliance for Fertility Preservation. Accessed March 21, 2024.
- What is Assisted Reproductive Technology? Available at: What is Assisted Reproductive Technology? | Reproductive Health | CDC. Accessed March 21, 2024.
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