Episode 12.7 How Evidence Breaks Down In IVF Add-Ons, Ectopic Care, And New Surgical Tech

We dig into how good stories and elegant mechanisms can seduce clinicians into using fertility and surgical “add-ons” long before the evidence is ready. We also connect policy, access, and misinformation to a disturbing rise in ectopic pregnancy deaths, then end with what better studies should look like when patient safety is on the line. 

• why low-dose naltrexone becomes a fertility add-on despite unclear mechanisms 
• biologic plausibility versus proof, and why theory cannot replace trials 
• what the available LDN data looks like, including weak endpoints and missing live birth outcomes 
• practice inertia, file drawer bias, and when a therapy belongs in routine care 
• ProPublica’s ectopic pregnancy mortality signal and how to interpret CDC WONDER data 
• COVID-era care disruptions, hospital closures, and delayed early pregnancy evaluation 
• Dobbs-era legal ambiguity, chilling effects, and implications for methotrexate timing 
• a new Nature Medicine finding on ISM2 as an early biomarker for preeclampsia and fetal growth restriction 
• V-NOTES versus vaginal hysterectomy trial design problems, including power, exclusions, and comparators 
• conflicts of interest, blinding failures, and how low-quality studies pollute meta-analyses 
Everybody remember to get your ABOG stuff done in the next month or so. 

Be sure to check out thinkingaboutobgyn.com for more information and be sure to follow us on Instagram. 

0:34 Low-Dose Naltrexone For Fertility

8:38 Evidence Gaps And Practice Inertia

17:14 Ectopic Pregnancy Deaths Are Rising

22:00 Access Problems And Social Media Misinformation

24:15 Abortion Bans And Delayed Ectopic Care

29:32 ISM2 Biomarker For Preeclampsia Risk

32:31 V-Notes Versus Vaginal Hysterectomy Study

41:40 Power, Outcomes, And Unfair Comparisons

47:50 Conflict Of Interest And Broken Blinding

55:09 Where V-Notes Came From

1:01:31 Skills, Tradeoffs, And Final Reminders

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