By the second appointment with my infertility doctor, I could already tell that we weren’t a good fit. I’m a big question-asker, and my official diagnosis was the distressingly imprecise “unexplained infertility.” Would we start IVF, and if so, when? What exactly does making a in-vitro baby entail? Unfortunately, my physician is not a big question-answerer, and I’d rarely get more than “It depends” or “We have to wait and see” before he darted out the door to see his next patient.
But here’s the thing about infertility doctors: By the time you’re meeting them, you’ve likely already spent at least a year attempting to get pregnant. (If you’re over 35, it’s recommended that you seek help after just six months of trying.) You’ve also likely already spent a couple of months waiting for an appointment. (I waited four.) Impatience has set in. You settle.
It’s not as though I didn’t do my homework. I found ample evidence that my clinic has high success rates. I read the reviews on Yelp and Park Slope Parents. I had a recommendation from my OB-GYN, whom I adore. It felt like enough to go on. It wasn’t. While my doctor might be adept at getting women pregnant, he’s not that good at keeping them informed along the way. Overall, my experience closely resembles that of The Americans’ Philip and Elizabeth Jennings, a couple of Cold War–era Soviet spies living in the United States: Like them, I must wait for the instructions to come to me, one by one, from the motherland; like them, I am never to inquire into their long-term plan.
To be clear, I have absolutely no interest in meddling in any of my doctor’s medical decisions. My only desire is for someone to have sat down with me and and block out a couple possible courses of treatment, including the timing and costs. I began IVF five months ago, and have yet to be implanted with an embryo. The length of the process was never fully explained to me.
This is the information gap that the recently-launched website FertilityIQ is trying to fill. Husband-and-wife founders Jake Anderson and Deborah Anderson Bialis and have spent the last three years enduring a series of failed IVF treatments at a number of different clinics. They’ve discovered firsthand how difficult it is to find the right doctor, and why the stakes are so high.
For one thing, at a nationwide average of $12,400 a cycle, IVF is incredibly expensive and not often covered by insurance. And while clinics providing IVF treatment are easy to find in major cities, they can be incredibly rare in much of the country. According to the CDC, in 2013, Idaho, Montana, and New Mexico only had one or two IVF clinics; Wyoming had none. Resolve, the National Infertility Association, gave fertility treatment in 30 states a grade of C or below. Infertility patients in these states where treatment is hard to find and/or subpar have to add the cost of traveling and missing work to the overall costs of seeking help.
Once treatment starts, it requires a huge time investment. For a couple of weeks, there are daily or near-daily early-morning visits to the doctor and the self-administration of injections in the evening. Following the egg retrieval, there continue to be frequent doctor's appointments and, for some, more self-administered injections preparing the body for the embryo. The fact that so much of the treatment in IVF is done by the patients themselves makes it especially important that doctors and clinics are competent communicators with their patients. A lot goes into these test-tube babies.
What’s additionally confusing when choosing a clinic is the fact that protocols are not standard across practices. Some are more aggressive when it comes to ovarian stimulation;others are more conservative, hoping for fewer but higher-quality eggs. The CDC puts out charts showing how successful individual clinics are, but they themselves caution against relying on their data too heavily— some clinics might be more likely to accept patients with lower chances of success than others, which can skew the stats.
Anderson and Anderson-Bialis are banking on the power of crowdsourcing to give patients a better idea of what the experience at a particular doctor might look like. On FertilityIQ, which is currently free to use, patients answer questions about their diagnosis, treatment, and overall experience at various clinics. They can find out whether or not a doctor at a certain clinic is willing to implant multiple embryos at a time, how LGBT-friendly a practice is, and over the course of treatment, just how many different physicians you can anticipate sticking an ultrasound wand into your vagina. (I’ve had over 15 so far, easy. It’s open house in there.) When scrolling through reviews of my doctor, one patient described him as “curt” and the clinic as “a cattle call but well-oiled machine.” She added: “They have timers outside each door and they set it for 7 minutes.” I haven’t seen these timers firsthand, but can attest to the fact that something—a physical timer or a psychic habit—has those doctors consistently saying goodbye before I’ve managed to remove both feet from the stirrups.
So much of the stress surrounding infertility treatment comes from the fact that it is prohibitively expensive, which advocates are working to change. Until they do, resources like FertilityIQ will at least help us make sure that we are spending our money and time at the right place. It also might help us discover that, in the high-tech and costly world of fertility treatment, there is no “right place.” Or at least that there’s no right place—that is, a clinic that offers up-to-date science and adequate personal attention—that most of us can afford. Reading my doctor’s profile and comparing it to others gave me a better grasp on the ways mine could have been worse: longer wait times, impossible billing departments, painfully over-stimulated ovaries. Next time my doctor rushes out of the room after surprising me with some undesirable news, I suspect I’ll find some comfort in this.