Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. In this episode, the Docs welcome Dr. Sara Reid, reproductive endocrinologist at Reproductive Science Center of the Bay Area, to talk about one of the most important steps on your fertility journey: choosing the right fertility clinic.

With so many options available, how do you know where to start? Dr. Reid walks us through the practical ways patients can evaluate clinics—from checking the SART website for data on cycle numbers and donor egg outcomes, to considering factors like clinic size, accessibility, and whether IVF cycles are offered monthly or spaced out. We also discuss how to weigh online reviews, which can sometimes skew negative, and why word of mouth from trusted friends or family members may be one of the most reliable ways to find the right fit. Your insurance coverage may also play a big role in where you go.

Most importantly, it’s okay to “interview” clinics—visit more than one, ask questions, and trust your instincts before making a decision. This podcast was sponsored by Reproductive Science Center of the Bay Area.

Episode Transcript:

Abby Eblen MD (00:01)

Hi everyone, we’re back with another episode of Fertility Docs Uncensored. I’m one of your hosts, Dr. Abby Eblen from Nashville Fertility Center. And today I’m joined by my fearless, fun, fabulous, feisty co-host, Dr. Susan Hudson from Texas Fertility Center.

Susan Hudson MD (00:15)

Hello.

Abby Eblen MD (00:17)

and Dr. Carrie Bedient from the Fertility Center of Las Vegas. Extra adjectives today. And more importantly, we are joined also, we are very lucky to have Sara Reid, who’s a physician, she’s a reproductive endocrinologist at the Reproductive Science Center in San Francisco, is that right?

Carrie Bedient MD (00:20)

I love the adjectives today. Those are simply fantastic.

Sara Reid MD (00:35)

San Francisco Bay Area.

Abby Eblen MD (00:37)

San Francisco Bay area. And we are very excited to join with her and talk to her today. And we were just admiring as we’re looking at her house, on Zoom, we’re admiring her wooden walls and the trees that we see outside. And she was talking about how her house has been around for a while. And I said, it’s a mid-century modern. And your reply was…

Sara Reid MD (00:39)

Yeah.

It is decidedly mid-century and just like a little bit modern. So it’s a bit of a time capsule, but it’s been really fun to get to know the quirks and the character of this house as we’ve just moved into it a couple months ago.

Abby Eblen MD (01:01)

And you were talking about making some changes maybe.

Carrie Bedient MD (01:16)

What have you found in there that you were not necessarily expecting to find?

Sara Reid MD (01:16)

So one of the most sort of interesting features is the, in the bathrooms, all of the plumbing is 1963 original. So with some pros and cons, but in our shower in particular, the height of the shower head, and I’m 5’2″, so I’m not a statuesque person, but the height of the shower head kind of hits me at the nape of the neck. So I’m very confused as to why this bathroom was designed this way.

Abby Eblen MD (01:32)

⁓ that’s not good.

Sara Reid MD (01:50)

And my best guess is that I don’t think like ladies wash their hair all the time. I think they’d like get their hair set and like keep it set. So that’s my guess as to maybe why the shower head doesn’t seem to be built for washing hair.

Abby Eblen MD (01:51)

That is amazing.

That’s actually that’s a really good. Yeah,

Susan Hudson MD (02:07)

That’s a very good rationale for that. Exactly.

Abby Eblen MD (02:07)

Because when I think my mom back in the 19 early 70s she would she get the hair salon once a week and get her hair set and you’re right. They would wash.

Sara Reid MD (02:09)

So that’s my best guess.

I should ask the children who grew up in this house are still in the area and they come by to like pick up mail that still comes here. So I need to ask them if that’s the true story or if I’ve just made that up.

Abby Eblen MD (02:27)

Yeah.

So I’m guessing if you make some changes, one of them is gonna be with the shower. What other big changes are you gonna make?

Sara Reid MD (02:37)

Yes. ⁓

Definitely the plumbing and the electric systems need to be brought up to some current code. ⁓ The kitchen’s also pretty snug and we’ve got this, you can kind of see a little bit of it behind me, but we’ve got this beautiful yard with lots of old lovely trees. And so I think we’re going try to open that up and be able to see the backyard and the kids running around in it a little better from the kitchen. So just modernizing it a little.

Abby Eblen MD (02:55)

Yeah, it’s beautiful.

Susan Hudson MD (03:06)

What’s something that you do like that you did not expect to come to love?

Sara Reid MD (03:11)

Yes, so you all noticed all the wood around me. And I think when we think of modern homes, we see a lot more, you know, clean drywall and white, but it actually feels super warm and cozy. And I think we’re actually really learning to like it. So some of the some of the character we’re going to try to make sure we hang on to.

Abby Eblen MD (03:30)

We know you could always paint that and that could be like the shiplap kind of thing that Joanna Gaines does. I will say, I had a reproductive endocrinologist who was one of my mentors and she had a very beautiful old house in Louisville and she said, you know, when they started out, they planned to just remodel like this one room and a lot of it was the plumbing. Well, once they started tearing out the drywall to fix the plumbing, then like pipes got…messed up and then somewhere else. So it was like one thing led to another and they didn’t expect to do the whole house at one time, but it turned into like a whole big remodel project for basically the whole house. So just…

Sara Reid MD (03:59)

Yep.

It could be coming. It could definitely be coming. Yeah. ⁓

Abby Eblen MD (04:10)

Well, very good. Well, so Susan, ⁓ usually this is about the point where we ask questions. Do you have a question for us that we can all answer?

Susan Hudson MD (04:18)

I do. All right. So here is our question. Thank you for everything you do at this podcast. Thank you so much for listening. My question is, do you see better outcomes for women who take time off work during IVF? I’ve taken a few months off for back-to-back egg retrievals and a lot of women my age think I’m crazy for doing it and tell me I’ll regret it. But I had a really stressful job with lots of late nights and odd hours.

I really think taking time off to dial down the stress has helped me have a good result. She’s a 35 year old female with an AMH of 0.5, no other known infertility factors, banked seven euploids. Would you recommend women taking off time for IVF if they can afford it?

Abby Eblen MD (05:06)

What think, Carrie?

Carrie Bedient MD (05:08)

I’m really mixed on this one. Part of the reason for that is that everybody interprets stress differently. And so there are some people who live and die by having a calendar that is so chalk full of things that you can’t breathe. And there are other people where if you put two things on in a week, they’re overwhelmed. And I think a lot of this depends on the person and how you’re processing it and how you’re dealing with it and what attention you are able to pay to the physical things. Can you get sleep? Can you eat? Can you exercise? Can you maintain a healthy weight? Can you do all the stuff that doctors are forever fussing at our patients to do that nobody listens to, including us, for our own advice? And so I think a lot of that is highly variable. Women get pregnant in war zones. And so that’s not to underestimate or overestimate anybody’s stress, but it’s also a very clear demonstration that stress isn’t everything. And so I think a lot of it depends on what you can do. I would much rather you know, personally be able to take that time off once I have a kid. And so for me, I’m more inclined to say, keep myself busy, keep myself occupied, not be thinking about all the fertility stress that I’m going through, stay working up to the last minute. And then for the things that are more important for me personally taking time off when I get a child in my arms, I’d rather have the time for that. But that’s not the same for everyone and not all jobs are created equal and not all stress management systems are created equal. And so I think there’s a lot of variation in this. What do you guys think?

Susan Hudson MD (06:49)

What do think?

Sara Reid MD (06:50)

Yeah, I agree. think Very well said. For some patients, it seems like adding in what I affectionately refer to as another part-time job of being a fertility patient, following the calendar, making space for the appointments, all the things we are asking our patients to do, sometimes adding that on top of their busy schedule is just too much. And they feel like they can’t give everything they need to, or it’s taking too big of a toll on them. And so the time away is helpful.

But then there are also those that that then can lead them too much time and space to worry and, ⁓ you know, develop even more anxiety about what they’re going through in the fertility world. So I agree. I personally ⁓ would feel much better busy and a little distracted and having time pass with all the other things that fill my life rather than focusing all on my fertility treatment. But it’s different for different patients. And it really is important to listen to yourself and figure out what’s going to be right for you.

And I certainly don’t want people to feel like they must or they ought to because financially it’s not feasible for everybody to take that much time off of work to go through fertility treatment.

Susan Hudson MD (07:59)

A little comment about the science of what we know. There are some relatively good studies that saying what I call everyday American stress actually doesn’t impact your fertility outcomes. Now, I think people who have acutely stressful events, like they lose a job or lose a family member, I think those things can affect your hormone levels that can make things not ideal. ⁓ But we also know that having good mental health is equally as important as everything else we we talk about when it comes to getting pregnant, staying pregnant, developing a healthy ⁓ pregnancy and baby and all that type of thing. And so if your mental health is suffering because of your work, and you’re having anxiety, depression, all of those types of things, and it is not able to be managed in any other way, then that might be the best option for you. I think a lot of people are able to use different resources to help keep the things at bay so that they can keep on going and focus on their end result. One thing that I did notice that this ⁓ listener was talking about was lots of late nights and odd hours. Now we do know that people who work night shifts do tend to have poorer fertility outcomes than people who work within normal diurnal rhythm. So normal days, normal nights. And so sometimes we’re trying to get work accommodations that while you’re going through your fertility therapy and especially during your first trimester, trying to have traditional days and nights can improve your outcomes. But just as Sara and Carrie said, most people can’t financially take off just an extra one or two months of the year to get pregnant and then still have time left after you deliver your baby. So I know I’ve spoken about my fertility journey in the past and I was doing all kinds of crazy stuff trying to manage work and fly across the country to do my IVF cycle. And I was trying to miss as little work as possible because what was important to me was being home after my baby was going to be there and not necessarily have all those extra hours to sit there and just think about fertility all day long. I needed something else in focusing on other people’s fertility all day long and not my own. What do you think Abby?

Abby Eblen MD (10:39)

Well, I think my two cents would be just, and Carrie kind of hit on this, is different people perceive stress in different ways, and we may all have the same stressor, but we perceive it a lot of different ways. So the best example I will give is in my family. Everyone in my family but me has been skydiving. They think it’s great. Two of my family members have even been skydiving twice, because they love it so much. And they were like, well, what would it take to get you up there? And I’m like, you would have to hold me at gunpoint and probably shoot me and push me out before I would ever skydive. I can tell you my blood pressure would be really high and my stress hormones would be high. So I think it really, That’s kind of an extreme example, but I think it’s the same way with people going through IVF. As physicians, we see people who kind of sail through and not, it’s no big deal. And then we have other patients who are just terrified and everything they get to and all the information that they get.

Nothing is a molehill, everything’s a mountain and they’re just really just upset and stressed. And so for those patients, maybe taking some time off if you can do it financially and if your job will allow it, then I think it’s great, but I think it’s different for different people and it’s just you have to know yourself to know if it’s something that would be worthwhile for you or not.

Carrie Bedient MD (11:54)

The funny thing about that, Abby, is that you may not be willing to dive out of a plane intentionally, but I would also bet good money that you could be in the operating room having someone who’s hemorrhaging in front of you and be completely cool, calm, collected and just know, okay, yeah, I mean, the adrenaline rush after, fair, but I also have no doubt that you would just, you know, start calling out what needs to happen and it’d be fine.

Abby Eblen MD (12:08)

Yeah. At least in the moment anyway. Yeah.

I’ve had more practice, Well, I would say I’ve had more practice with that specifically, but stressors of the job are different than the stressors of jumping out of an airplane. All right, well very good. Well are so glad to have Sara here today and we are gonna talk about how to choose a fertility clinic. So Sara, someone asked you that question. What would be kind of one of the first things you’d suggest?

Sara Reid MD (12:47)

Well, I think you know, it’s a great question because this is a big investment that people are making in not only in time and money and emotion, but you’re you’re really kind of committing to the team that’s gonna help usher you through something very important in your life. So I think it’s very wise to be thoughtful about how you do it and we’re fortunate in our area in the Bay Area and I think throughout the United States have several amazing fertility centers that people can find. and so I always encourage people to take time to find a good fit for them. ⁓ There is the sort of objective bar of good science to be met for a fertility clinic that deserves you as a patient. And then there’s a whole bunch of fit that comes into deciding where you are gonna feel best taken care of and supported through the process.

Abby Eblen MD (13:40)

And what are the objective things, or at least one of the objective things that a patient just, if they’re shopping around going, okay, where do I start? What’s one objective way that they can figure out this is a better fit than this clinic for me?

Sara Reid MD (13:52)

Yeah, from an objective data standpoint, I think the SART database is a really helpful place to start. ⁓ Many clinics in the United States, most will report their outcomes to SART that will compile them and try their best to present them in a fairly uniform way so that patients who are new to this world can compare semi-objectively between clinics, you what the success rates are. And I always encourage patients not to focus too much on like the very specific group that is them and the SART data, but to sort of get an overall idea of does this clinic look like they are average, above average, below average for the area? Because we know that when we start to slice and dice data that individual data cells can be a little small in terms of the sample size in them. So they’re not always so easy to read. But if you look over the whole amount of data that SART can present to you, you’ll get a sense of whether a clinic feels like it’s you know, average or above average. And that’s what I would certainly be looking for.

Abby Eblen MD (14:56)

For people who don’t know what that is, can you explain what SART is and how you find that if you’re looking for that?

Sara Reid MD (15:02)

Yeah, good question. So SART is the Society for Assisted Reproductive Technology and we all report in our statistics in a fairly, in a very uniform way. So we have to collect certain data for every cycle that we do and then outcomes for those cycles as well. And we report that in and then it is centralized and reported out to patients ⁓ and to anybody who wants to look it up. And there’s actually a website, SART.gov where patients can go and they can type in their zip code, their city, a specific clinic name, a specific doctor name, and then they can access data for past years. And it won’t have the most current year, because it does take time to compile this, as we all know, reporting in. It’s a Herculean effort to get the data there. And of course, we need to wait enough time for outcomes to be reported and then enough time for it to be compiled. It’ll be like a two-year lag when you’re looking at the data, but it’ll give you a sense of sort of where the clinic falls.

Susan Hudson MD (16:06)

A couple of things I would like to mention about the SART data. One, if you go and look at it, I want to let you know that even when we look at it, we get confused. It is not an easy thing to look at. So to make things simpler, think probably the biggest things to get those general overviews are one, you can get an idea of size of clinic. Now size of clinic has nothing to do with how good or bad a clinic is. It will give you an idea of the feel. Okay, If you want to go to a very large clinic, you’re going to get a feeling of what large looks like. Or if you want to go to something smaller and potentially a little more intimate, you’ll get that feel by looking at general numbers. Another thing to look at to really compare more apples to apples is looking at donor success numbers. Now I’m not saying that anybody listening necessarily has to look at donor eggs, but it’s a uniform population of young, healthy, fertile women who are trying to get pregnant using IVF to help other people. And the reason why I recommend that is, as Sara mentioned, if you get stuck looking for your segment, it’s gonna be hard to figure out where exactly you fall, but also know that there are places that kind of cherry pick without a better term who they usher to do certain treatments or qualify to do certain treatments. What I am saying in layman’s terms are there are clinics that based on your age, your ovarian reserve testing, so like your FSH, estradiol, AMH, antral follicle count, those types of things may say you don’t qualify here to go through a cycle based on your demographics, okay, and your only option is to seek donor. Whereas there are other clinics that don’t have hard and fast rules for some of those things. And So there’s no way, there really is no way to know which clinic is which, unless you know word of mouth and you have an inside scoop. I mean, a lot of us know these things, but it’s because we’ve got the inside scoop, but for people searching for a clinic, really looking at those donor numbers are gonna give you ideas of quality of their lab. And I think that’s really what the focus of that is.

Sara Reid MD (18:42)

And then one step further, there are even those clinics that see like the hardest of the hard cases. And so they’re like a specialty center where people who’ve failed multiple cycles are going to filter into them. And so their success rates in a given age group may even look lower than you would expect them to because they’re really tackling some of the most challenging cases. And SART doesn’t really have a way to tease some of that out.

So I really like finding that index population of say 35 and under or using egg donor and using that as your kind of baseline to assess the quality of the lab because it is very difficult to understand how a given practices patterns of practice may impact what they end up reporting to SART.

Carrie Bedient MD (19:28)

And even with that, there’s still some pitfalls to not live and die by. And what I mean by that is if you’ve got, ⁓ like Sara was saying, if you’ve got a clinic that works with the special population of people who, let’s say, are less likely to have goods sperm samples for whatever reason, even if they’re working with donors, you’re still going to see lower success rates. And it doesn’t necessarily mean that they’re not good at what they do.

It means that again, they’re taking on some of the hardest, toughest things to do, and they’re making a situation that’s otherwise really complicated functional that otherwise wouldn’t happen at all.

Susan Hudson MD (20:09)

How could, As another tangible thing that you can identify, one thing I think about insurance, how does your insurance play into how you select a fertility clinic?

Sara Reid MD (20:22)

Absolutely important and I’d say probably, you know, I’m in an area of the country where we’re fortunate a lot of patients do have access to coverage. And insurance is the first step for a lot of people in trying to figure out what clinics are even on my list of options. You know, I ask every patient, how did you find me? And many of them say, I looked at the Progyny website or I looked at the Anthem website and this was listed as a center of excellence or this was listed as one that I could have coverage with. So I think that is a really good place to start because if you have coverage, it’s going to give you more access to care. And it’s super helpful to know which clinics are going to be able to utilize the benefit that you have.

Abby Eblen MD (21:06)

So Sara, I have a question for you. This is a little off topic kind of, but we have a lot of younger patients, I would say, sometimes younger than 25, but maybe 25 to 45. And I think some of the patients that we tend to see are more like 25 to 35. And in that population, I know those patients tend to look at things like Yelp reviews and things like that. What are your thoughts about that in choosing a physician?

Sara Reid MD (21:31)

Yeah, I think it’s tricky because we all want that ⁓ inside scoop. We all want that piece of knowledge to make us feel confident and we don’t want to go in not knowing anything about who we’re going to see. So the older, I shouldn’t say the older way, but formerly everybody was referred by their OBGYN. And so that referral network was the way that you found all your doctors. Increasingly, as people move around a lot, or maybe they have a family doc who does their pap smear every two years because they’re low risk, they might not have that relationship with an OB-GYN to send in directly. So I think a lot of people are going to review sites and social media to try to get a sense of what clinic may be a good fit. And I think it can be really helpful. But just like if you’re trying to pick a restaurant, you know that some of those reviews are going to be polar.

Meaning the person who took the time to sit down and write that review is probably super, super happy or super, super disappointed. And a lot of the kind of average experience may not come through as clearly in those reviews. So I think it’s important to look, it’s important to sort of zoom out when you’re looking at them and ⁓ try to get some substance of, okay, I’m seeing a pattern of people having a frustration with this, or I’m seeing mostly people happy and then a couple people seem really upset. So think if you’re going to do reviews, you probably want to look at a few different ways of looking at reviews. Google reviews in our area tend to be really helpful. There are some sort of review aggregator sites in the fertility world that can be really helpful. Around us, think Yelp is not as helpful, but it kind of depends on your region of the country and people are more actively ⁓ putting information into and then what the quality of that information is.

Susan Hudson MD (23:22)

One thing I always think about with reviews, my general law about reviews is number one, happy people are off living their lives and happy people are the ones who are generally writing reviews. However, when I go and look at reviews, if there’s nothing that’s negative on someone or something, whatever it is, then I’m like, okay, these aren’t real reviews. These are probably written by bots. Okay, because like, because it’s real life. There’s going to be some people that are super happy, you’re going to have a few people who are unhappy and most people are going to be in between. And so if you have no negative reviews, that makes me think that like, this isn’t real, okay, because nothing’s perfect. And whereas But you you do have to use those things with ⁓ a grain of salt.

Carrie Bedient MD (24:12)

There’s other things like, for example, Yelp, if you happen to be a paying customer of Yelp as a clinic, your reviews look different than if you’re not. ⁓ The other thing is that we can’t, as a clinic, effectively answer someone who comes at us on whatever review site. We are not allowed to acknowledge it. And you could end up in huge trouble by doing that. And so there have been some reviews where we’ve gotten them and we’ve looked at it and we were like, you know, we have documentation to support that that was not what happened at all. And either the patient missed something or there’s some other influence coming into play. And we just, we don’t have a response and it may make us look like we are the worst human beings on the planet. But in reality, we’re like, no, I told you that and I have six notes to document that.

You didn’t listen and here we are. And so that’s one of the things that I think is very frustrating to us because it’s good because it keeps us out of the mud. But also it means that we get dragged through the mud with absolutely no way to come back at it because somebody’s, we can’t defend ourselves and we can’t say no.

Susan Hudson MD (25:26)

We can’t defend because we can’t even, If somebody writes a negative review, we can’t even acknowledge that that person was a patient. And so for privacy reasons, yeah.

Abby Eblen MD (25:35)

Yeah. Yeah.

Sara Reid MD (25:35)

Right, for privacy reasons, yeah.

And this is where I think ⁓ reading the reviews to get a little general sense of color is helpful, but then also looking to some kind of trusted advisors in your community is really helpful too. And if you have that OBGYN, friends and family, coworkers, increasingly people are more comfortable talking about this aspect of their lives. ⁓

You know, again, In our region, in Silicon Valley, a lot of the companies here have internal boards where people share tons of information, including, you know, where they’re going for fertility care or how they’re utilizing their benefits. And that’s a great place to look to, to see, okay, has this clinic come up in good or bad ways? ⁓ And that can be super helpful too. So there are a lot of resources out there to try to get a fuller picture.

And then at the end of the day, just go walk in there. And if you go to a couple consultations and you get a sense of where you’re gonna feel the most comfortable, feel the best supported, it’s okay to do a couple of consults before you decide which clinic is gonna be the right fit for you.

Susan Hudson MD (26:46)

What do you think about location? How much does that play into a decision-making factor?

Sara Reid MD (26:51)

Great, great question. I mean, location is certainly important and you have to appreciate when you go through treatment that there may be a period of time where there are sort of intensive visits, meaning several visits in a relatively short period of time. And ⁓ knowing that you can get to them without totally upending your life is helpful. ⁓ But also, if driving 20 minutes further gets you to a clinic that’s much better or even 30 minutes further gets you to a clinic that’s much better, it could be a worthwhile investment. So absolutely it’s a factor that you should think about, but I think it has to be balanced with all of the other aspects of what you’re trying to accomplish.

Abby Eblen MD (27:35)

And one other thing I would say too about sort of choosing the clinic based on different characteristics, and this is something you wouldn’t know right off the bat, but if you’re somebody that’s gonna do IVF, and I don’t know how many clinics still do this now, but sometimes smaller clinics will batch the cycles so that you only have the opportunity like every three months to do IVF. And if you’re somebody that wants to get going right away, you know, they go, sorry, you’re gonna have to wait for three months to get started, that can play a role as well too.

Susan Hudson MD (28:03)

I would say just because somebody may batch, you need to maybe get more information on that because once every three months versus maybe two weeks out of every month, those are very different logistics.

Sara Reid MD (28:18)

Yeah, at the end of the day, you just have to ask these questions. You know, How does your clinic run? ⁓ If I’m ready to cycle, when can I cycle? Do I have to like reserve six months in advance? So there’s no one perfect format for a clinic. It’s just a matter of getting the information that you need to decide what’s going to fit with your life.

Carrie Bedient MD (28:40)

When you’re thinking about the financial in all of this, insurance will dictate a lot of where you go, but make sure you’re asking all of the questions that go with that. So things like being identified as a center of excellence, it sounds amazing, but the insurance company’s primary goal is as a for-profit company. And many times the definition of a center of excellence is based off of whether the insurance company thinks that they are excellent based on the insurance company’s objectives. That is not always true, but that can absolutely play a part. And so keep that in mind. Also keep in mind that there’s frequently a lot of costs that come from different directions. There’s the clinic fees, there’s the retrieval fees, the lab fees, the surgery center, PGT-A, if you’re doing that.

There’s a bunch of things that can come into play. You’re probably not going to know what every single one of them is when you go to your first visit. And there’s a decent chance your doctor’s not gonna know that either because it’s gonna vary based on you. And so I will frequently have people who say, okay, I wanna know at the very first visit, well, how much is this gonna cost? And I can’t give them those answers for two reasons. One is because I’m probably the worst person in my clinic to ask anybody any question to.

⁓ Because that is not my area of expertise, but also it’s because we don’t know what you need yet. You know, If I look at your testing, even if you know that you’re going to do IVF, if I look at your testing and think you’re a shoe in, this is going to be really straightforward versus, well, crap, we have to pull out every trick in the book. The financial for that is going to look really different in the expectation of that of, no, we’re going to probably have to do a couple of cycles, multiple transfers, PGT-A, planning X, Y, Z plus ABC through all the way through Q, like that can be very different from patient to patient. And so we know that this is a stressor. We know that this is a pain point. We would dearly love to give you all the information from the very first part of it, but we are treating you as an individual. And so your answer will be individualized and there will be some places that say here you’re going to pay X number of dollars and that’s fine, but that’s that may not include all the information that is relevant for you.

Abby Eblen MD (31:01)

Yeah, Carrie, when you said about the Center of Excellence, it made me think. When one of our doctors started, was newer, she was really kind of perplexed. And she goes, you know, this patient said she was going to come see us, but she said she couldn’t come see us because we’re not, know, Nashville Fertility is not deemed as a center of excellence. And so she asked, goes, well, what makes us a center of excellence? And my senior partner was, well, only if we accept their insurance. If we don’t accept their insurance, we’re not a center of excellence.

So it’s all in how they package and market stuff. So just be careful about particularly something like that, for sure.

Susan Hudson MD (31:34)

Along these lines, but in a little bit different direction. What if somebody is considering leaving the country to do their fertility treatments? What are some things to be aware of in that type of situation that might be good or bad?

Sara Reid MD (31:50)

Certainly, I appreciate why affording fertility care in the United States can be tricky for some patients. And so there absolutely can be temptation to look outside. And there are scenarios where it probably does make sense. I’ve had patients who were from another country or had families still living somewhere and they really were savvy and integrated into the healthcare system in that country and had a lot of ⁓ insight and understanding and comfort with it. And that could be a time where it makes more sense.

I do worry about some places, ⁓ where there is sort of less oversight of, of sort of medical quality of medications. And certainly it’s not something that we can, where we can prescribe medications that are going to be filled outside the U S it’s just not something that we can do. I’ve had patients ask for that because they said, Hey, if we order these drugs, you know, from wherever they’ll cost me less. ⁓ you know, For safety reasons, we can’t do that. 

I think you just have to be a really cautious customer. If you’re going to do that, you’ve got to do your own research and your own investigation. ⁓ And one thing that’s really tricky in the fertility world in particular, especially if you start getting into donor gametes, especially if you get into gestational carriers, the laws are very different from country to country. And so you want to be super sure that you know what the laws in the specific place you’re looking at are.

Probably consult an attorney who’s an expert in that area. You just don’t want to end up in a situation ⁓ where your family’s at risk because of laws changing or less flexibility in the place that you’re traveling to.

Abby Eblen MD (33:36)

And there’s even differences state to state too in terms of just different years and things like that, not just out of the country.

Susan Hudson MD (33:43)

One thing I wanted to mention, I recently had a patient who is thinking about seeking care in Europe and this couple very, very specifically wanted to do PGT-A. And I was trying to explain to them that although PGT-A is very accessible in the United States, PGT-A in general is relatively hard to get in Europe because of different laws and there are not a lot of countries that support PGT-A as much as the United States does. And yes, Abby.

Abby Eblen MD (34:19)

What is PGT-A?

Susan Hudson MD (34:21)

PGT-A is ⁓ genetic testing, pre-implantation genetic testing that we do on embryos, usually once they reach the day five, six or seven stage that helps us know if embryos are chromosomally normal or not, thereby allowing us to selectively transfer chromosomally normal embryos, ⁓ which does improve the time to achieve pregnancy. And so this couple had contacted this clinic, in Europe and they’re like, yes, they definitely do PGT-A and I’m like, hold tight. I’m like, I’m almost certain that this country doesn’t. I do a little Google search because that was the easiest thing for me to do. And I’m like, and what I had to explain to them is yes, technically they have the capabilities of doing PGT-A. However, in this country, it is only legal to do PGT-A in the situation that there is a known chromosomal abnormality in one of the parents or they’re having to do gender selection for what we call an X-linked abnormality, which is a disease that is only seen on an X chromosome, thereby it would cause any males to be affected. And it was one of those, were getting true information, but it was not necessarily complete information. because we didn’t know that they were, Yes, we can do PGT-A.

Susan Hudson MD (35:49)

Are we going to allow you to be do PGT-A in your specific situation? Probably not, but you’ll figure that out when get here. That’s not the best situation. So you gotta watch for things like that.

Carrie Bedient MD (36:01)

Knowing what the specific environment is in that country. And that can be you know, is PGT-A truly available or not? Is gender selection available? Can you use a donor? Can you use a donor dependent on what your specific circumstances is? A single woman or a same-sex couple is going to find a very different response than a heterosexual married couple. What is the religious cultural environment? A couple that, a country that is very heavily dominated by one religion or another will very likely have some influence on that on what type of IVF you can do, who you can do it on, and how you can do it. The other thing is knowing what the insurance and financial restrictions and permissiveness allows. So for example, in a lot of Europe, all of IVF is totally covered if you happen to hit the demographic of whatever that country happens to allow, which is more or less permissive depending on where you are. But the other thing to consider when it’s widely covered, there is an emphasis that is placed on how cheaply can we do this? And so things that we in the United States take for granted, like day five embryo transfers, growing out to blastocysts, doing PGT-A, doing a separate frozen embryo transfer versus a fresh transfer, those things don’t necessarily occur in those countries. And those doctors don’t agree with it. But part of the reason they don’t agree with it is because they don’t have the environment to support it. So they’re not necessarily good at it. It doesn’t mean that the doctors are bad.

Doesn’t mean that those countries are bad. It just means that they’re in a very different environment than what we have here in the United States, where it’s incredibly competitive. You damn well better be the best at what you do because there’s a ton of competition. And so as a result, very few people do Day 3s. Most people do at least offer PGT-A with the pros and cons that go with it. And so it is not just about the dollars and cents. And if that’s how you have to make your decision, we get that.

Know that there’s an awful lot more that’s influencing it that plays into this.

Abby Eblen MD (38:01)

And the bottom line is probably, although you can’t make a blanket statement, those patients are probably gonna have a lower success rate than patients who do IVF here in this country because of all those limitations.

Sara Reid MD (38:13)

And I would say if cost is really driving selection and you don’t have coverage, another super important thing to talk to the clinics about is what do you do to help couples and people that need help paying for this? Do you have access to a shared risk program? Do you have access to a financing program? ⁓ Are you connected with anybody who offers grants for fertility treatment?

So I would encourage patients who feel concerned that they may not be able to afford fertility care to one, still go in and find out what your options are. It could be that you’re worried they’re gonna say it’s IVF or nothing, and you may have several options that are lower cost. And the clinic may also be able to give you some resources to help defray the cost. They may have ways to make this reachable for you. 

Never hesitate to ask the questions and ⁓ don’t be embarrassed that you have to bring it up. We know this is expensive. We know this is a major piece of how people make their decisions. And so, you know, Any fertility clinic should be prepared to help you navigate that.

Abby Eblen MD (39:18)

Very good. Well, this has been a great discussion. Any last words of wisdom any of you ladies would like to add?

Carrie Bedient MD (39:27)

I would say the one thing is if you don’t feel comfortable there for whatever reason, go somewhere else.

And that can be, ⁓ you know, because you see mice running around in the bathroom. can all just be, that can also be Because you just are not comfortable there. And it seems kind of silly, but you’re going to be spending a lot of time with these people and you have to trust them because they’re doing an awful lot with you and for you. And if you get a bad feeling, just walk away. It doesn’t mean that you’re bad. It doesn’t mean that they’re bad. It just means that you’re not right for each other.

Sara Reid MD (39:36)

100%.

Carrie Bedient MD (40:06)

Not everyone is meant to be best friends. That applies to clinics and patients.

Abby Eblen MD (40:10)

All right, well, very good. To our audience, thanks for listening and subscribe to Apple Podcasts to have Tuesday’s episode pop up automatically for you. Also be sure to subscribe to YouTube. It really helps us spread reliable information and it really helps us get to reach as many people as possible.

Carrie Bedient MD (40:27)

Visit fertilitydocsuncensored.com to submit questions and sign up for our email list. Keep an eye out for our book that’s being released September 23rd. Check out Instagram and TikTok for quick hits of fertility tips between weekly episodes.

Susan Hudson MD (40:42)

As always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we’ll talk to you soon. Bye!

Carrie Bedient MD (40:51)

Thank you so much for joining us today.

Sara Reid MD (40:54)

Thank you.