Dr. Ronald Feinberg’s Testimony Before Legislators

June 6, 2018

Good afternoon esteemed committee members,

My name is Dr. Ron Feinberg, and I am the IVF Medical Director for RADfertility, commonly known as RAD.  I am accompanied by other members of our care team.  Together, we represent the 4 physicians and over 60 staff at RAD who provide subspecialty reproductive endocrinology and fertility care to thousands of Delawareans every year, with centers in Dover, Newark, and Wilmington.  Our primary focus is family building for Delaware citizens who have challenges conceiving, and we have helped create thousands of healthy babies during our 23 years of practice.

In the few minutes I’ve been allotted, I’d like to focus my comments on the medical ethics surrounding Delawareans’ access to care in our subspecialty.  Unlike other medical challenges that Delawareans of all ages might face, the medical conditions surrounding impaired fertility are not generally well known by the lay public.  The earlier days of our subspecialty focused primarily on the medical conditions in women that caused infertility.  Many of these problems have reached epidemic proportions worldwide, including diseases such as endometriosis, polycystic ovary syndrome, pelvic adhesions, fibroids, polyps, and diseases of the fallopian tubes.  In addition, a combination of factors have contributed to a surge in male infertility.  Superimposed on these medical problems are the well-known concept of the “biological clock”, which is now known to impact both women and men.  While biological aging of an organ is not necessarily a disease per se, as a society we do not discriminate against treating other aging issues when impacting our health and well-being.  Likewise, diseases and conditions that harm our reproductive organs tend to be very private and intimate matters.  Nobody wants to have infertility.

Access to care for many Delawareans seeking medical treatments for family building has been woefully inadequate.  While the costs of advanced reproductive care are often considered high, those costs pale in comparison to other healthcare resources that are routinely available to women and men of all ages.  As examples, it is becoming routine for one ER visit, one hospitalization, or one surgical procedure in other specialties to cost much more than the cost of IVF treatments. 

It is well-documented in scientific publications, including the New England Journal of Medicine, that a lack of IVF coverage fosters significantly riskier outcomes.  While all patients feel pressure and stress to succeed with treatments, those who self-pay for IVF are more likely to demand from their doctor that two or more embryos be transferred to the uterus at the same time.  At RAD, we spend a very large amount of time counseling and educating our patients about the health advantages of single embryo transfer (or SET), and have designed self-pay programs that ease the pressure by including more than one SET at no additional cost.  As a result, we have consistently been #1 in the nation for many years with the percentage of single embryo transfers we perform — well over 90% — and the success rates are high with very low pregnancy complications.

Multiple births as a result of both IVF and lower tech fertility treatments are an ongoing and expensive problem nationwide.  We have proof-of-concept right here in Delaware that IVF with SET should be a reality, and the cost savings related to multiple gestation, risky pregnancies, and less-than-healthy babies can be huge. 

Another common misconception about our subspecialty is that the procedures we carry out are experimental, and don’t have high success.  This is completely untrue for the majority of our patients.  The fact is that each healthy embryo transferred to a woman’s uterus, under proper conditions, yields a 50 to 60% chance of success.  If additional healthy embryos are cryopreserved, the cumulative chance of IVF success can exceed 80%, and will often lead to more healthy pregnancies for the same patient.  In 2018, it is unethical for Delawareans to not have access to advanced treatments that will help them build families.  Likewise, it is unethical for our citizens with cancer and other severe medical issues to not have access to advanced treatments that will preserve their future fertility.

Fertility challenges and associated reproductive diseases do not discriminate.  At RAD we care for women and men across all ethnicities, religious beliefs, socioeconomic status, sexual and gender orientation, and yes, even political persuasion.  Likewise, access to medical care for family building should not discriminate, and should not be a political issue.  We trust that our esteemed elected officials will agree, and will do the right thing for Delaware’s citizens who aspire to build their families now and in the future.

Thank you for your time, and we’d be happy to answer any questions.