How do you go about trying to locate the source of infertility?
When a couple comes in, it’s important to look at the basics: Are the eggs OK? Is the sperm OK? Is the uterus OK? Are the fallopian tubes normal? So we test the eggs through bloodwork and an ultrasound. We can see if a uterus is normal with an ultrasound. We can determine if the sperm is OK with a semen analysis. And we can tell if the fallopian tubes are open by doing an X-ray called an HSG, in which we inject dye through the cervix to tell whether or not it flows through the tubes.
Just by doing these basic tests, you’re usually going to pick up on a reason for infertility in almost all patients. So if you find a problem with the sperm, we can start with inseminations or in vitro fertilization, which involves implanting one normal embryo. If the fallopian tubes are blocked, we can unblock them surgically or do IVF and bypass them.
What should people take into consideration when they first start seeing a fertility specialist?
They should be prepared for physical, emotional and financial challenges. Walking into your specialist’s office empowered with questions to ask is my first piece of advice—and not necessary questions culled from random blogs or chatrooms that can sometimes heighten the hysteria surrounding infertility. Some questions to bring: What is your philosophy on twins? What is this going to cost? How has your practice performed compared to others? Are the technologies offered here the ones that I have the biggest need for? It’s OK to ask these questions. Cancer patients are certainly asking about their expected survival—and it’s only reasonable that a fertility patient know what are their chances for success.
Often, we’re finding that it’s more cost-effective to do a single, higher-tech treatment than multiple months of low-tech treatments.
What concern do you most often hear from patients who are just beginning treatments?
That they are going to wind up with twins or multiples. It can be unhealthy to carry twins—and certainly Octomom scared off a lot of patients—so I reassure couples that we’re striving for healthy, singleton births. We’ve tried to change treatments in recent years to minimize that risk by putting in one embryo, rather than two or three, because there’s more understanding that twin pregnancies can be complicated.
Fertility treatments are usually perceived as scary expensive. What financial considerations should you take into account?
This is such a complicated question. Different states have different mandates, and that might all be disappearing with the Affordable Healthcare Act. I would say that it’s important—upfront—for a patient to understand what the financial cost could be, and what their potential out-of-pocket expenses will be.
The practice should have a designated financial coordinator who understands their plan, and who will help them understand what it is to precertify treatments, what their pharmacy benefits are, and what the short- and long-term costs are going to be. It really is extremely variable—some people have very little covered, some people have almost everything covered, and most people have at least something covered.
I don’t usually like to speak to the financial side, but very generally speaking, the consultation and work-up can be in the hundreds, a cycle of fertility medications and inseminations can be in the thousands, in vitro can be $10,000 to $12,000, and getting pregnant using donated eggs can be over $20,000.
Often, we’re finding that it’s more cost-effective to do a single, higher-tech treatment than multiple months of low-tech treatments—i.e., trying in vitro fertilization, which has a very high success rate, rather than doing multiple low-tech treatments, such as taking fertility pills and trying to time intercourse or intrauterine insemination, which involves injecting sperm directly into the uterus. This way, you can also take advantage of any financial caps that your insurance may have on treatments.