Breaking the Barriers to Infertility Treatment: Finding the Right Clinic
When women and men start thinking about family-building, they are rarely planning to visit a fertility clinic. It is not uncommon to have a few questions for your OB/GYN or primary care provider, but most people think that their need for answers will stop there. As a result, it is overwhelming and confusing for most people when they are met with the idea of having to find a fertility clinic to assist with next steps.
One of the most basic issues is identifying the right clinic for you. The goal for every person starting their family building is to end with a baby, but the process of getting to that goal looks different for everybody; the same can be said for choosing a clinic.
The first step in choosing a fertility clinic is scheduling an initial consultation. Prior to going to your consultation you may experience some anxiety and have many different questions and thoughts bouncing around in your mind: “Do I really need to be seen at a fertility clinic?” “Is another year of trying on my own really going to be detrimental?” “Why can’t I continue to work with my OB/GYN?” “I don’t know anyone else that is experiencing fertility issues!” “What if I end up needing IVF?”
But, the most important question to ask yourself going into an initial consultation is: “Did the doctor ease these anxieties?” The initial consultation is as much of an interview opportunity for you as it is an opportunity for the physician to understand your journey and needs. If you do not leave the consultation feeling supported, heard, and cared for, that is an excellent sign that you need to have a consultation with a different fertility clinic.
You should go to as many consultations as you can until you find the doctor and clinic that leaves you feeling as though you have a confident plan of action and that you are a person that matters to them with unique needs and experiences.
Another factor to consider is the type of healthcare experience that you want to have: Either a large or small practice. For many patients, a large, academic center feels safe, and patients are willing to sacrifice an intimate interaction with providers for a known entity in the community.
I live in the Northern California area and some of the larger providers here are Kaiser and UCSF. These entities perform thousands of cycles each year. Some patients choose this care because they have been in their health systems for large periods of their lives and had good experiences, as well as the comfort of knowing that these centers already have access to their previous medical records.
For the average fertility patient, a larger fertility center that is part of a large medical practice may be the right choice. There is no question that the programs will be appropriately licensed and the physicians will be appropriately credentialed, but on the other hand, these programs tend to be inflexible, with more of a “one-size-fits-all” mindset. All of the treatment plans and possibilities will have to be in line with the institution's approved policies and procedures.
While most of their practices are based in peer-reviewed studies, it can be frustrating for the patient with a unique scenario that would benefit from trying a different option that might work better for them.
Wait times for initial consultations and then to cycle through treatment at large institutions can be months for each step, which can be concerning since it is known that intervals of more than three months can and do affect a woman’s fertility.
Cost is also less flexible with less likelihood of sliding scales for payment and more rigid fee schedules. That said, some of the large institutions are able to negotiate better rates on medications and outside services, and are also more likely to be broadly contracted with multiple insurances.
If looking into a small, intimate practice it is important to keep in mind that there are often less providers to choose from. Although this may be concerning to you, the benefit in this is that you know who you will work with and can develop a strong bond with that person.
Additionally, the staff will likely know you personally when you walk through the door (even if they are masked). However, if you find that you do not click with the provider, then you may need to find a new location because there may not be options for you to transition to within the practice.
Smaller intimate practices are usually more flexible with appointments, fee schedules, start times and treatment protocols. For instance, at Lane Fertility, we rarely take more than a week to see a new patient and generally start them with a cycle within a month.
One of the most common complaints from my patients who transition from larger practices is that it took months to get an appointment, and that they were on waitlists to begin a treatment cycle. Another advantage of working with a small clinic is the physician/team is often more accessible. My patients know that they can get in communication with me and/or our clinical coordinators any time of the day or night. They know that I will stop to spend extra time with them if an issue arises, but that they may wait for me if someone else has that issue and needs more time.
While we have rigid systems in place to keep our clinic running efficiently, we are more equipped to make changes and adjust accordingly to meet our patients’ needs. We are contracted with many insurances, but not as many as our colleagues at UCSF. As a smaller practice, we are able to partner with programs such as the Marin Community Center and offer care to patients who would otherwise not have access, all of which lends to a diverse and accessible practice for patients.
The cost of care is also an integral part of choosing a clinic. For patients that have fertility benefits through their insurance, it is important to find out what exactly is covered by that insurance, and what will need to be paid out of pocket, as well as find practices that work with your insurance. For example, many insurance programs will cover IVF, but not egg donation or gestational surrogacy. Many insurance companies, such as Progyny (with whom we do not work with at this time) and Kindbody (who we do work with) will partner directly with employers and provide a list of providers that are contacted to see the patients.
The benefit to the patient with fertility insurance is that they have very little money to exchange while receiving their fertility benefits. This can be one source of stress-relief in the fertility process. More traditional insurance companies, such as Blue Cross, Blue Shield, Aetna and UnitedHealthCare will provide services as per your employer’s package, but be prepared to pay large co-pays and realize that some clinics will not take insurance at all. Nonetheless, the data is clear that overall, fertility benefits will improve access for many patients, even though it does limit the volume of clinics you can choose from.
The reality right now is that most patients do not have fertility benefits through their insurance. For these patients, small practices, such as Lane Fertility, are able to find programs that will assist them like Compassionate Care, ReuniteRx, Heartbeat, and others. Additionally, we can help coordinate medical financing programs, such as United Medical Credit, and discount our services to match other discounts that they receive.
The last thing to keep in mind when considering cost is not every quote that you get from the clinic will include all services, so make sure that when comparing clinics that you are comparing the same services at each clinic. Ask about add-ons and request a financial consultation to ensure that you have a firm understanding of your financial liability. Although not the most important factor when choosing a clinic, understanding the finances associated with fertility is crucial.
In the end, the most important message to take from this is that you deserve to find and have the type of care that makes you comfortable, especially when your going through something as uncomfortable as infertility. There is no right or wrong in your choice, there is only what works best for you. I see too many patients who have stayed in a healthcare relationship that didn’t work for them, which makes them bitter and rarely brings success to their journey.
It is important to break this cycle! In the end, sometimes you will need to invest in more than one consultation to ensure that you have enough information to make the right decision in selecting a fertility clinic. You must be able to trust that you have the right partner to be able to forge ahead and build your family!