Difficulty conceiving a child can be a deeply troubling struggle for couples. And it’s more common than many people think.
“If you have eight friends, usually one of them will be really struggling with it—that’s how frequent it is,” said Dr. Russell Foulk of the Nevada Center for Reproductive Medicine.
According to the Centers for Disease Control and Prevention, just over 12 percent of women aged 15 to 44 have impaired fertility. The percentage of married women in that same age group who are infertile is 6.7 percent, yet only 12 percent of who’ve struggled to get pregnant have sought fertility services. Dr. Foulk has been providing them in Reno for more than 20 years.
He’s a board-certified reproductive endocrinologist and associate clinical professor at both the University of Washington School of Medicine and the University of Nevada, Reno, School of Medicine. His reasons for choosing infertility treatment as a specialization were personal.
“I was in my residency choosing which type of specialty to go into, and my wife and I had struggles with infertility for six years,” Foulk said. “I was planning to be an orthopedic surgeon … but then when I found that we suffered from infertility, I studied it really well and thought that would be a great career. I’ve made it my quest ever since.”
Foulk has started fertility treatment centers in four states, including centers in Northern and Southern Nevada—where he provides in vitro Fertilization (IVF) services and other fertility treatments. Within the month, he’s preparing to introduce a new type of IVF treatment to his Reno office.
“To understand what IVF is, you’re basically taking an egg out; you’re putting it with the sperm and letting it fertilize,” Foulk said. “In vitro Fertilization, conventionally, is to watch it grow in the lab over five days before it’s placed back in the uterine cavity.”
The new treatment, called Invocell, will bypass the five-day embryo in a Petri dish stage associated with traditional IVF.
“So [IFV] was originally invented for women who had tubes that didn’t work because of endometriosis or scar tissue or something in the past,” Foulk said. “Of course, it’s been expanded now to treat all forms of infertility, but the original intent of IVF was to bypass the tubes. … With Invocell, the idea is to put the egg and the sperm together in this little device, and then return the device back into the top of the vagina, so it’s right next to where the uterus is. … So it’s in the natural incubator of the patient’s body that basically provides the right temperature, gas exchange and everything that helps an embryo thrive.”
Patients should be aware that the process is different, but Invocell is still a form of IVF, Foulk said.
“Invitro means ’in glass’ in Greek—and so it’s just a name to describe the egg and sperm coming together in a Petri dish or glass dish. And here the Invocell device is a plastic dish still. It just happens to go inside the patient’s body. So it’s still considered in vitro fertilization, even though it’s placed in vivo—in her body.”
But, according to Foulk, because it bypasses the traditional five-day lab time and “lessens the degree of intervention” that’s necessary to get a woman pregnant, it may also be more cost-effective than traditional IVF—which can be expensive for each round of treatment. And many people require more than one.
“The typical cost ranges anywhere, depending on the type of IVF you do, from $8,000 to $15,000, which is very expensive for something that often isn’t covered by insurance,” Foulk said.
It’s true that fertility services are often not covered by insurance, and many people have heard this is because these services are considered voluntary.
“That’s not the reason, actually,” Foulk said. “It’s interesting. Some people say that, but lots of medical care that’s considered elective or voluntary is covered.”
In truth, he said, it’s often because the people who choose what coverage exists are employers, and fertility services is the type of coverage that can lead employees to miss more work, not less.
But, these days, more companies—including big ones like Tesla—are covering fertility treatment, Foulk said, “because they realize it’s not right to not cover it. Building a family is not elective. It’s essential for most of us. It’s a very important part of life.
“And with Invocell, the hope is that we can minimize some of that extra work, so that it becomes cheaper—it becomes more cost effective for the patient,” he said.
Foulk said he’s been using Invocell in his Salt Lake City and Las Vegas practices for almost nine months now and has been pleased with several resulting pregnancies. It’s a great, and possibly cheaper, option, he said—for the right type of patient, which isn’t everyone.
Facts of life
“The most ideal candidates, I’ve learned, are young women—young meaning women that have a good ovary reserve, and that’s just a measure of how many eggs they have left—who have tubal issues,” Foulk said. “Their Fallopian tubes don’t work well. What IVF is for, essentially, is to bypass what normally happens in the Fallopian tube. And normally fertilization happens in the distal Fallopian tube.”
In cases where a couples’ problems are different—say if sperm are unable to fertilize eggs on their own—Invocell is not a viable solution and different forms of IVF need to be considered.
“But it still gives us an alternative for a lot of folks that could otherwise not be able to afford it or just want a more natural way to let the process unfold,” Foulk said. “It’s very good for a group of people—and it’s usually the younger folks that tend to be struggling more financially. They’re not as set in there jobs and such, and those are the ones it helps most. So it’s directed toward those that need it the most.”
In his centers where Invocell has been deployed, Foulk said the resulting embryos—and pregnancies—have been encouraging.
“What’s remarkable is that the embryo quality you see from the Invocell often is better than what you’d see if it was grown in vitro, in artificial conditions—which kind of makes sense, right? We’re never going to be as good as mother nature.”