Rescripted_EP6_Paying Treatment: Audio automatically transcribed by Sonix

Rescripted_EP6_Paying Treatment: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi, I'm Kristyn Hodgdon, an IVF mom, current IVF patient, and co-founder of Rescripted.

Ali Domar:
And I'm Dr. Ali Domar, a thirty-four-year fertility industry veteran, psychologist, and expert in the mind body relationship between stress and infertility.

Kristyn Hodgdon:
Welcome to Dear Infertility, the first ever podcast that doubles as an advice column for those dealing with the daily stressors related to infertility and pregnancy loss.

Ali Domar:
We're here to answer your real-life questions related to the mental and emotional toll of infertility, while providing research-backed tactics and strategies for overcoming these dilemmas.

Kristyn Hodgdon:
Now, let's dive in and help you find calm on this stressful journey.

Kristyn Hodgdon:
Hi, everyone, and welcome back to the Dereham Fertility podcast, I'm your host, Kristyn, and I'm here with Dr. Ali Donmar. Hi, Ali.

Ali Domar:
Hey, Kristyn, how's it going?

Kristyn Hodgdon:
Everything's going well, thank you. I'm really excited for today's topic because I think it's one of the biggest stressors when it comes to infertility and IVF specifically, which is paying for treatment. You know, IVF is expensive, insurance is not a guarantee, I feel like, you know, you have to be one of the lucky few if you actually have full coverage, and then all the other things that come with it, just really take a toll on your wallet and I think your mental health. So I wanted to chat with you all about paying for treatment. And I mean, is that something that your patients typically come to you with a lot of stressors about?

Ali Domar:
Oh, yeah. Well, you know, I don't if I mentioned this before, but I remember in a class in grad school on couples counseling, they said the top three things couples fight about are money, sex, and kids. And, you know, infertility pretty much covers those three things. And the thing I do want to say is that I think when people are trying for a year and aren't getting pregnant or get a diagnosis of infertility, there's instantly this oh my god, IVF is so expensive, how are we going to pay for it? And I think people need to sort of dial back because most people who have infertility don't need IVF to get pregnant.

Kristyn Hodgdon:
Right.

Ali Domar:
And I think we have to remember that because I've had patients who have been trying for a year and come see me right away because they're so worried about how they're going to pay for it. And it turned out they needed to take a pill of clomiphene for five days and boom got pregnant and it cost them fifty dollars. So I think we have to sort of separate the cost of infertility versus the cost of IVF because yeah, IVF is expensive and we can talk about how to handle that. But I don't want people to be scared away from doing initial treatment because the initial treatment isn't nearly as expensive.

Kristyn Hodgdon:
Now, that's a great point, and some OB-GYNs even prescribe Clomid and Letrozole at their offices. So you may not even need to see a fertility specialist if that's the case.

Ali Domar:
A lot of women who, in fact, you know, go to their OB-GYN, their quote-unquote infertility can be solved by taking clomiphene or letrozole, and they never have to see an infertility specialist, or they see an infertility specialist, you know, like a woman, for example, who doesn't get her periods, you know, she may have PCOS or something else, and she, all she may need is, you know, maybe even initial small dose of those either of those medications and maybe up for a little higher. But she'll never need to do any of the high-tech stuff. Or if the, if the partner has sort of a borderline sperm count, maybe just an insemination, they do it for them. So there's a huge gradation. I mean, I don't want people to shy away from talking to their OB-GYN or, or going to see an infertility specialist thinking, oh my god, this is $30,000, it may not be anywhere close to that.

Kristyn Hodgdon:
Right. No, that's a great point. But in the case of a patient who is told by their doctor that they will need IVF and they're just, they don't even know where to start when it comes to how to pay for it, they kind of think it's out of their reach, what would you say to that patient?

Ali Domar:
I had this conversation about once a week, because even though I practice in Massachusetts, which actually has the best coverage, you know, supposedly everyone gets six cycles of IVF for each baby. So if they have a baby, they get another six cycles. But in fact, there are so many loopholes and companies are self-insured. And I think somewhat of Boston have just published a study, that only like a third of our patients, truly have six full IVF cycles because there's deductibles and co-pays and stuff like that. So I think, first of all, not to panic because there are lots of things one can do. You know, you might sit down with the financial coordinator and they're like, OK, we're anticipating this cycle is going to be 15 to 20 thousand dollars, well, first of all, even if your state doesn't have mandated insurance coverage, your company might offer infertility coverage or your partner's company might offer infertility coverage and more and more companies now, especially the big companies. Even if there's not a state mandate, they carve out an insurance benefit. And then there are a number of companies like Carrot and I think MAVEN and Progeny and Ark, that are sort of the intermediaries between companies and clinics. And so, you know, you need to sort of beat the bushes in terms of HR or your benefits because a lot more companies are offering benefits, including IVF, than people may think. But you know, they're not going to advertise it necessarily. You might need to do the research on your own to find out if there, in fact, is coverage from your company and or your partners.

Kristyn Hodgdon:
Absolutely. But if you don't have coverage, one of the questions we received from our community is, how can I accept the exorbitant cost of treatments when a baby isn't guaranteed at the end?

Ali Domar:
You know, that's a really tough one. I mean, you know, when I have patients who have done all the treatment they feel comfortable with and their options are adoption or donor egg, and, in Massachusetts is, you know, ballpark equal pricing between adoption and donor egg. And there's a little temptation with adoption because if you're working with a reputable agency and you plunk down your 30 or 40 thousand dollars, you're guaranteed to get a baby. And if you're doing donor egg and you plunk down your 30 or 40 thousand dollars, you know you're very likely to end up with a baby, but you're not guaranteed. So I think that's when you want to do your research and find out what programs have the best success rates with people with your age, your partner's age, your diagnosis, et cetera. I mean, you know, you might want to just do some research with friends, talk to your OB-GYN because you want to get someplace to sort of the greatest bang for your buck.

Kristyn Hodgdon:
Yeah, I do know some clinics offer refund programs if you don't get pregnant after a certain amount of cycles. I know Donor Egg Bank USA actually has an assured refund plan where you get your money back if you don't get pregnant after a certain amount of cycles. So definitely, like you said, look into all of your options for sure.

Ali Domar:
And then, you know, then you still have to be creative. If the two of you, I mean, I just published a study, a worldwide study on why, how long it takes people in this, in the world, not just here in the world, people wait an average of three years between starting to try and when they actually see a doctor say, wait three years to try naturally, and then they wait two more years to start treatment. So the average individual or couple in the world or in the U.S. actually is pretty comparable. Wait an average of five years between throwing away the birth control and starting treatment. And that's something that I would encourage none of you to do because in fact, age is probably the biggest obstacle, not just for female infertility, it can have an impact on male fertility as well. And so, you know, if you've been, you know, trying and you've been hit with this, oh gosh, IVF is going to be this amount, don't wait three years before doing it. You know, the quicker you do it, the more likely it is you're going to get pregnant, especially maybe even your first cycle. And so this is the time where you need to sort of sit back and maybe swallow your pride a little bit and think about, do you have any family members that could help you? I mean, obviously, the first step is to go to your parents and or your partner's parents.

Kristyn Hodgdon:
Yeah.

Ali Domar:
You know, a lot of people, you know, if your parents are baby boomers, they may have resources and they be, they're going to be highly interested in having a grandchild, and they might feel it's totally fine to write you a check for $20,000.

Kristyn Hodgdon:
That was actually one of the questions that I was going to ask you today. Someone did ask how to navigate getting or receiving monetary support from family or friends.

Kristyn Hodgdon:
Yeah. I mean, people, obviously, I've seen a lot of people do GoFundMe pages. And, you know, if you feel comfortable doing that, go for it. Other people are somewhat more private, and I had probably had hundreds of patients go to their parents or in-laws, and it's very rare to not get any help at all. I mean, obviously, some of my patients and partners have parents who don't have any resources whatsoever. And if your parents or your in-laws don't have any resources, do not humiliate them by asking if you know they just can't or that they're going to have to go into debt to help you. But, again, if you suspect your parents or in-laws have the resources to help you, then you know, that's not, not a bad way to go.

Kristyn Hodgdon:
Yeah, agreed. Someone also asked, how do I not let saving money for IVF overrun my daily life? I mean, I think, you know, it's one thing to save up, but to get a second job or a third job when you're already going through treatment, that can add to your stress, so how do you sort of balance it all?

Ali Domar:
You know, again, I've had lots of patients get second jobs, like doing things in the evenings or weekends, and that's their IVF money. So they just save that money. I mean, I've also sat down with patients to sort of go over, and I know this sounds insane because I'm a psychologist, but I feel like I'm an accountant sometimes, we'll actually go over what their income is and what they're spending money on. And it's amazing to me how much money people spend on certain things that they don't need to have when they feel they need to have a baby.

Kristyn Hodgdon:
Right.

Ali Domar:
And so when you go over the list, is this a, is this a want to have or a need to have? Because if you classify having a baby as a need to have, then you need to get rid of the want to haves. And that often can work really quickly.

Kristyn Hodgdon:
No, that's, that's terrific advice. I mean, I think we all have our things we enjoy spending money on whether it be clothes or, you know, home furnishings. And but if you think at the end of the day that that could all go towards your future family, that, it's just a different way of thinking about it.

Ali Domar:
Oh, I think also, you know, shopping online is too easy. I mean, if you needed something 10 years ago when you had to haul your body out of your house and into your car, onto the subway to get to a store, that takes energy. I can just go to my computer and click on Smile.Amazon and boom! I can buy anything I want and it'll be here in two days. And that makes it way too tempting. You know, I think, you know, one of our mind-body groups years ago, we always have a guest-speakers, I think it's the seventh session, a woman who's adopted comes in and talks about her experience, and a woman who's done egg donation comes in and talks about her experience just to let people know how they made the decision to stop treatment, how they chose adoption versus egg donation, what was the process like, and how is it parenting a non-genetic child? And someone asked the speaker in adoption, well, how much did it cost you to adopt your daughter? And I think she said it was $35,000, and the group said and the speaker said, how much did you spend on your last car?

Kristyn Hodgdon:
Yeah.

Ali Domar:
And, you know, there are things that we buy that we don't really think about and we think, how can we possibly spend 20 or 30 thousand dollars to get a baby? Well, first of all, you know, we spend that kind of money on other things, and B, kids are expensive. I mean, I know it's an awful thing, thing to say to people who would do anything to have a baby. But if you are just living paycheck to paycheck now, a child, especially child care expenses, I just went over this with a patient yesterday who, who had a baby, she doesn't understand how they can afford child care. And I said some advice that I'd gotten when I first had my kids that between birth and when your last child goes to kindergarten, don't expect to save.

Kristyn Hodgdon:
Yeah.

Ali Domar:
And so, you know, and I think that's just a reasonable thing. But having a kid is expensive and so looking for other ways to increase your income or decrease your spending now is actually a good thing. It's like I tell my patients, you know, start doing all the health habits now that an OB is going to tell you when you get pregnant because it's far easier to change your health habits now when you're feeling healthy than when you're feeling potentially awful in your first trimester. And so I would say now, start looking at your budget and your spending patterns so that when you do have a child, it's not going to hit you so hard of those extra expenses.

Kristyn Hodgdon:
Yeah, I think the hard part sometimes emotionally, is that others get to do it for free.

Ali Domar:
Yes, they do, and it's completely unfair.

Kristyn Hodgdon:
Yeah.

Ali Domar:
But it's the down payment is a down payment on, what is it that they say, is the average child is like $50,000 a year or something.

Kristyn Hodgdon:
Mmhmm. Yeah, I don't doubt that. I also wanted to mention before we wrap up that there are grants out there that, that fertility patients can apply for. Baby Quest Grants is one of them, but there are, you know, grants based on the state you live in and local grants, so do your research and Co-Fertility actually has a good find a grant tool, so there are things out there that you can apply it forward to, to make paying for treatment easier.

Ali Domar:
You know, I would second that. Plus there are a lot of private IVF clinics that do giveaways.

Kristyn Hodgdon:
Yeah!

Ali Domar:
So, you know, I remember giving a talk at a clinic, I want to say it was Missouri, maybe? And I think every year they give away a few IVF cycles. I think FertilityIQ.com lists some of those giveaways.

Kristyn Hodgdon:
Oh!

Ali Domar:
And there's also I think it's called the Cage Foundation, they give grants for IVF cycles. And if you or your partner have had a history of cancer, they're a number of charities that actually will fund cancer. I mean, for cancer, they'll fund infertility treatment, or they'll help you with egg or sperm storage fees. I know that Livestrong has a program for people who want to have children. So if one of you have had cancer in the past, there's probably at least somewhere between 5 and 10 foundations that will support you.

Kristyn Hodgdon:
Amazing. And lastly, I, I would be remiss not to mention Rescripted RX, we have really great pricing on fertility meds and, you know, can help lower the cost in that department because a lot of times you don't really account for the meds on top of the actual cost of the IVF cycle, and it can be stressful. So well, this is so helpful, Ali. Thank you. And until next time!

Ali Domar:
Bye!

Kristyn Hodgdon:
Thank you for tuning in to this episode of Dear Infertility. We hope it helps you find calm during this incredibly stressful time. Whatever you're currently struggling with, Rescripted is here to hold your hand every step of the way. If you like today's episode and want to stay up to date on our podcast, don't forget to click Subscribe. To find this episode, show notes, resources and more, head to Rescripted.com, and be sure to join our free fertility support community while you're there.

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