Minnesota experiencing an IVF baby boom even as overall births decline

Brigette Kerber wanted to try for a second child through in-vitro fertilization in 2020, but she was worried because COVID-19 was taking a harsh toll on pregnant women.

The Edina woman hesitated even after her fertility clinic reopened that summer following a two-month statewide pandemic shutdown. But time wasn't on her side.

"'This isn't going away,'" she recalled thinking about the pandemic. "We couldn't wait forever."

Kerber restarted IVF that fall and gave birth in March 2021 to her second daughter, Elsie. Turns out, she wasn't alone in her decision-making regarding IVF — the combining of eggs and sperm in a culture dish to form embryos that are transferred into women struggling to get pregnant.

IVF cycles increased in Minnesota in 2020 despite the pandemic disruptions and clinic closures, according to new outcomes data from the Society for Assisted Reproductive Technology. The following year, Minnesota's five IVF clinics performed a record 7,566 cycles, a 36% increase in five years.

Research and case reports demonstrated early on that COVID-19 presented risks to pregnant women and their babies, but the pandemic influenced couples in other ways, said Dr. April Batcheller, co-founder of CCRM Fertility in Minneapolis.

"The pandemic was quite a reset for people on a number of levels, and for sure created a sense of the importance of home and family," she said.

Working and sheltering at home created a "different Zoom lifestyle" that motivated people to pursue fertility treatments, she added. "That's just normal now and has more people thinking, 'You know, I can fit kids into the mix.'"

The 1,445 children born in 2021 through IVF and other forms of assisted reproductive technology made up 2% of births in Minnesota that year. There were 807 such births in 2016, according to the Centers for Disease Control and Prevention. The increase occurred even as total births declined by more than 7% in Minnesota over that same span.

Clinicians weren't surprised, because birth trends through IVF are somewhat independent of overall trends. Women seeking IVF often are older or have delayed childbirth for careers, leaving them with narrower time frames to overcome infertility, Batcheller said.

Improving insurance coverage likely has played a role, though it remains inconsistent — leaving people to pay some or all of the $10,000 to $20,000 cost per IVF cycle. Minnesota Sen. Erin Maye Quade, DFL-Apple Valley, offered legislation this session to require that health plans cover infertility treatments if they offer broader maternity benefits. The proposal was added to a larger health budget bill, increasing its chances of adoption in 2023.

"Fertility treatment is limited to those who are fortunate enough to afford it, or go into debt, or raise money, cash in their 401ks, or take out second mortgages," the lawmaker said last month. "This is not how we want people to be building their families in Minnesota."

Higher-order births of twins and triplets have declined since 2016 at a much faster pace than total births, and changes in IVF procedures and technology likely played a role.

IVF attempts with two or more embryos (fertilized eggs) were common two decades ago, because the procedures were expensive and clinics wanted to maximize the odds of pregnancies — even at the risk of multiple births.

Optional single-embryo transfers became common as clinics improved their processes for fertilizing and selecting high-quality embryos. Genetic tests have helped with embryo selection, but Batcheller said they can only be done if embryos are frozen, then thawed for transfer after the results have been analyzed. Improved techniques reduced the rate of embryos lost to freezing, making single-embryo transfers more popular.

The rate of women younger than 35 who opted for single embryos in their first transfers increased at CCRM in Minneapolis from 66% in 2016 to 96% in 2021. The rate increased at three other IVF clinics in Minnesota.

The exception was the Midwest Center for Reproductive Health in Maple Grove, where less than 13% of women in that age range opted for single embryos on their first transfers. The clinic in 2021 had the highest rate of transfers resulting in births for patients younger than 35, but by far the highest rate of twins or triplets — which can increase risks of complications and preterm births.

Kerber, 37, didn't have a choice because of her age and complications from her first use of IVF — which produced one failed attempt, then a stillbirth pregnancy and, finally, in 2018 the birth of her first daughter, Ada. Carrying twins in a new pregnancy was too great a risk for her.

Instead, the CCRM clinic maximized use of fertility drugs to end up with seven embryos and picked the best one for Kerber. The strategy worked, but Kerber said it was then a nerve-racking pregnancy. She had to go to appointments alone because of pandemic restrictions. A physician assistant, she also had to take leave from her work weeks before her due date to reduce her infection risks.

Through a Resolve support group, she found others who were struggling — either from clinic closures or personal decisions to delay IVF because of COVID-19 risks.

"The pandemic was so hard for a lot of people," she said. "It was just more waiting when the whole process is waiting to begin with."

Access hasn't been a problem, though, with five IVF clinics in Minnesota. The Midwest Center closed this year with the retirement of its medical director, but a new Kindbody clinic opened in downtown Minneapolis. RMIA is adding a clinic in Maple Grove to its IVF sites in Edina and Woodbury.

Kerber gets choked up thinking about the difficult journey with infertility, but is joyful over the 4- and 2-year-old daughters she is raising with her husband.

The youngest is her wild child who teases the dog, climbs things and plays princess mostly to copy her sister. The names Elsie and Ada were coincidental to Elsa and Ana from the movie "Frozen" but it's noticeable now that the girls treasure the movie.

Sitting on a table at home is the latest $750 annual bill for storing six frozen embryos left from the most recent round of IVF. Options include donations for research or to women who need them for IVF. A third attempt at IVF is unlikely.

"Right now, we're just going to keep paying," she said. "We'll have to make a decision at some point. It kind of felt like we had spent enough time and energy on that chapter of our lives."