How to Make a Family: The Blog

Should You Borrow Money From Your Doctor For Fertility Treatment?

Does it matter to you how your fertility treatment is funded? I'm trying to remember if it mattered to me, 14 years ago. Sure, it's one thing for me to comment now, almost 13 years after finally, finally having that baby that I'd tried to have for 5 years and through 4 miscarriages. 

Hopefully without embarassing my son's dad (we're long divorced now, but still friends and co-parents of The Wonder Boy), I'll let you know that we were not in a financial position to even consider IVF after that last miscarriage. And PGD was in the pipeline, only available within clinical trial, and man, oh, man, was I willing to donate my body to science by that point. Of course, as soon as I started to explore that path (which would've been a long road to nowhere from Houston, I know in hindsight), I wound up pregnant again (our last ditch on Clomid with heparin shots) and he stuck. 

So the question of how I could afford to get pregnant became moot to me. But it's been impossible to stay in this line of work and not think about it every time another related story comes up.

Is the drive to get pregnant so visceral that we really don't care HOW the process is paid for? 

The question came to mind again when I read this Wall Street Journal article by Jessica Silver-Greenberg. She talks about the booming business of fertility treatment financing. Nothing new, and after all, I was employed for several years as the newsletter editor of IntegraMed America, one of the oldest and biggest vehicles for people who aren't flush enough to shell out tens of thousands of dollars for multiple IVF cycles. To clarify, IntegraMed America isn't a bank or even a lending company. Rather, as the article explains: 

"IntegraMed sets up couples with loans through a partnership with Springstone [Financial LLC] and NBT Bancorp of Norwich, N.Y. The partnership's number of loans jumped 41% in 2011 from a year earlier, and totaled $15.4 million."

I have no problem with people financing their medical treatments. In fact, I'm one of the too many in this country without a speck of health insurance. I know very well why the medical loan and medical tourism industries have blossomed. But there's one part of this WSJ article that prompted this conversation with my faithful listener, The Roommate:

Me: "I just read in the WSJ that loans made to patients by companies who are backed by private investors aren't monitored by the same Federal or state agencies that oversee banks."

The Roomie: "Yeah?"

Me: "And what's even crazier is that some of those lending companies are funded by the doctors whose clinics offer the loans."

The Roomie: "Yeah?!"

Me: "Isn't that a conflict of interests?"

The Roomie: "No. That's a coordination of interest."

Me: "And the docs aren't required to disclose this information to their patients!"

The Roomie: "Wow! Those doctors are pretty smart! Win-win-win!"

Is it me?
Signing off, From the Pollyanna Department

I Just Want You All To Have Plain Ol' Health Insurance

At the risk of sounding like a crabby old mama who finally got hers and has no memory left, I feel compelled to finally say what I think about the notion of insurance for infertility treatment. 

Okay, it's not exactly the first time. But it's been awhile, and I don't think I've ever approached the touchy topic from this angle.

"Touchy?" you ask. What could be sensitive about insurance coverage for medical treatments that help men and women achieve what's supposed to be a natural life event, namely, procreation?

Most readers of this blog already know that most people have no insurance coverage for infertility treatment. It feels unfair to those who want that coverage. Even people with huge policies can't get their fertility treatment paid for. It's an old story and one that's been hammered on for decades now by advocates and patients and, sometimes, physicians who each year encourage legislation at different levels that will presumably, one fine day, make all things equal.

So what nudged me over the edge today?

An innocent Facebook post by RESOLVE, echoing the sentiment of Parents Magazine in wishing that all states would mandate fertility insurance coverage. (For those of my friends not in know, some states already do...)

Anybody ever vote for elected officials here?
Ever heard of "divide and conquer" as a strategy to defeat a group's ideas?

Folks. Are you aware of the current situation in this country regarding plain ol' ordinary health insurance?

From CNN's The Chart, March 23, 2011:

"Almost 50 million Americans are without health insurance– 3 million more than a year ago, according to a report from the Centers for Disease Control and Prevention.  The report finds one in five people were uninsured during some portion of the last 12 months."

You know, I was going to rant on and on like I tend to do, but really, I don't think I need to say anything else. Pretty sure you're all smart enough to figure this point out on your own.

Goodbye Ugs. Hello Unicorns.

From The We're So Shallow Ain't We Grand department, the tacky social site, Beautiful People, is now becoming a way station for the genetic material of their clients.

Glad to hear that folks who would frequent such a venue are wanting to procreate. Really. The world needs more beautiful people. What's really heartwarming is how the company has opened their new, potentially very lucrative egg and sperm donor connection to The Ugly.

That's right. Even you and I could take our ugly mugs and find the doors open wide to the Inner Sanctum of The Gorgeous. After all, says founder Robert Hintze, everyone, "including ugly people -- would like to bring good looking children in to the world..."

Sort of a new take on "the golden unicorn" concept, I guess. The Golden Unicorn's Genes.

Suddenly, I feel a song wafting through my ugly brain...

When You're Selling Fertility, Size Matters

The words "corporation" and "national network" conjure up a certain image. Besides the tendency to think "bigger is better" in terms of almost everything, Americans have come to expect constant and huge advancements in medical science. When you add to that the fact that fertility medicine's buzz is just out-and-out sexier than a lot of other branches of medicine, you arrive at a playing field that seems destined for a lot of chest-beating.

In the field of medicine, it's still a fairly shaky consumer relations move to present your company as a behemoth. Half of your 'prospects' (that's just a pithy term used for "people in need of medical care whom doctors hope will brighten waiting rooms one day soon") will be swayed by the 'We're The Biggest' image while half will be deterred.

Perhaps it's more prudent for health care services to just lay low and not bring the issue of size up at all. Maybe it makes more sense to focus instead on what consumers really want to hear -- that is, present how much you care so that they'll care about what you offer.

But what if your showy display doesn't ring true? What if prospects don't really buy that you care about their plights? Will they simply shrug with resignation and buy your offerings anyway?

Sure, particularly in a field of medicine where a sense of desperation prevails among patients. Even in a field where most prospects can't afford the very best technology available, wannabe-patients can at least teeter on the edge of hope for years. Especially if you give great front office. Take IntegraMed America, Incorporated, for example.

Just like with a lot of sexy things in this world, size isn't really the issue. It's a matter of style.

Here, I take a quick step back to acknowledge my relationship to this "national network of fertility centers," which at last look number around 40 reproductive medicine practices from coast to coast. I was the editor of their e-newsletter for six years, and I created and opened their initial Facebook presence.

Am I a disgruntled ex-employee? Yes, and no. I was never an actual employee. Nor was I really a contractor, truth be told, except for the fact that agreements by email hold up in courts. I do not, however, perform work for IntegraMed any longer -- though the company has yet to tell their own affiliate practices that they can no longer expect a consumer e-newsletter as part of IntegraMed's services rendered.

Which brings me back to the front office appeal...

The individual fertility clinics and reproductive specialists that comprise IntegraMed's network are truly worthy of consideration by prospective patients. Ranging from small double-doc practices to several of the oldest and largest in the world, covering nearly every state in America, the practitioners who choose to affiliate with IntegraMed are the type of physicians you want to tackle your infertility.

But who would know about those fantastic individual network components, based on the corporation's efforts at consumer communication up to now?
 
The company's undergoing a bit of overhaul to make up for lost time, fortunately for their affiliates, who pay hundreds of thousands of dollars to IntegraMed for, among other things, garnering the attention of prospective patients. Over the past year, the New York-based company has reached out to Internet marketing pros for help. They've revamped their stale company website, created a new name for their main consumer product (the shared risk refund plan now known as Attain), and will soon be inviting us all to kick the tires on another site that promises to have more community appeal to people who are struggling with infertility. Presumably this new community-oriented appeal -- where prospects become patients who are people -- is starting off by way of a blog.

Hats off to the company's upfront ownership and claims on the blog. Kudos to IntegraMed for putting a qualified medical professional in charge of Fertility Focus. After all, the blog's stated purpose is "to bring clarity" to [readers'] "path through the assisted reproduction process..."  Nurse Practitioner Maureen Gill Higgins' voice and information delivery is on target.

But if, as the blog's purpose statement continues, their "focus is the same as yours: having a baby" -- then I'm completely confused about the rest of the team. Listed are a baffling mix of customer call center employees (one of whom is apparently keeping his last name private), as well as advertising/marketing staff and an intern. Each of their bios appropriately advises readers of their lack of medical training and, in some cases, even any personal experience with fertility problems. So we're left to wonder: why are these the folks IntegraMed chose to start off their new Internet patient community?

If you're a bottom line-watcher, you know that IntegraMed, the Biggest National Chain of Fertility Docs, is faring relatively well through this tough economic period (Public, NASDAQ:INMD). Men and women who are grasping at straws in order to become parents -- and who are now presumably also struggling just to make household ends meet -- have been deftly led to IntegraMed affiliate clinics to apply for loans and shared risk plans. Read through the Fan comments on their Facebook page (now found at "Attain Fertility") and you'll learn that not everyone is qualified for the financial assistance programs, and not everyone is happy about that fact. It's tough to hear "ineligible" when up to that point all you ever heard was how they were offering "a better path," a "proven course," and "the greatest possible opportunity for success." Medical copywriting for patients who feel as panicked as any with a terminal illness -- that's a tricky business.

Hiring at the corporate level is also tricky. It's hardly done randomly with success. One easily imagines that corporations are well-versed in how to appropriately staff departments for optimizing overall achievement. So what can we think when a company that proudly proclaims itself "the largest network of fertility centers in the United States" offers up a webpost on the crucial hot-button of donor egg legalities written by someone who identifies as "a marketing copywriter" responsible for the oversight of "content development for AttainFertility.com"?

What conclusions can be drawn when of the six contributors to the community blog, only one discloses a direct connection to the infertility experience (on a personal level, the last-name-less James) and all are primarily or indirectly charged with driving traffic to the Attain financial product or managing phone and email contacts by inquiring prospective patients?

In short, why pull from your marketing staff -- rather than from health care professionals or even para-professionals with personal experience -- to lead an internet community for people with a medical condition? Is IntegraMed counting on filling in the information gaps with corrective input from other online fertility pros and advocates? Why wouldn't they instead make use of their own huge pool of fertility specialists? Smaller companies that create and run online communities, like Fertility Authority and Fertility Ties, manage to construct strong bases by way of friendly collaboration with professionals and patient advocates. Why can't IntegraMed?

A business like IntegraMed has always been hard to define for patients. Are they a clinic? No. Are they a research facility? No. Well, what do they do? The easiest answer has always been that IntegraMed provides support services to fertility clinics.

The idea is to free physicians from the time and entanglements of attention-seeking & patient-procurement tasks in this highly competitive market. Let doctors do doctoring while the support staff drums up noise. Questions about the quality of that support are obviously between the parties in the network, the physicians, the clinic financial officers, and the networking corporation. Patient response is the best measure of that quality. Creating an online community for fertility patients -- finally -- will indeed render a public accounting for this behemoth mixture of medical and financial services.

If anyone knows how little size can matter to something like getting pregnant, and about smoke getting blown up one's skirt, it's a fertility patient.

On Social Media, Dogs, and Infertility Patients

It's no secret: I'm infatuated with social media. I blended into the Facebook game relatively early because of my online copywriting and consumer relations work. By the time I started tweeting in early 2009, it seemed like I was behind the times, though I wasn't -- in April 2009, eMarketer reported through Mashable that a mere 7.4% of adult Internet users were using Twitter, and only monthly at that. Imagine how few were doing the everyday tweet thing.

Just like back in the venture-driven, careening 90's, infertility patients arrived at this new wave's forefront before the pros. Just as we saw back in the day when chatrooms and bulletin boards were filled with querying mama-wannabe's wondering where the caring professionals were lurking, the docs are taking their time. But this time, instead of a queue of tech-timid newbie consumers wondering about the real value of this thing called the Internet, what we have are gadget-savvy emboldened consumers expecting 24/7 action. This is no time for docs to arrive fashionably late -- but that's exactly what most of them are doing.

Even some of the Biggest Dogs are merely meandering toward the banquet.

Being both a long-time dog owner and Internet professional, I have some ideas on why larger spokes in an industry wheel are slower than smaller ones at moving toward their audience.

First, there are the obvious correlations between size, weight, and movement. Plain as day, right? Of course, a consumer may be led to believe the contrary, that the bigger a network of clinics is, the faster, the better, the more successful... After all, those multi-million dollar centers spend a good chunk on steering what consumers think. It's true that you get what you pay for, even in the "free" world of Twitter and Facebook, as detailed by Forrester's Augie Ray last September. But we're talking overhead percentages here -- even with piles of ecstatically happy patients, if you're a small practice, your budget for getting the word out is still practically nil. With traditional marketing, you're lucky if Ms. Happy Patient's cousins hear about your fantastic repro med practice. On the other hand, if you're looming on top of the feeding pile, you can make all the noise you want, of any variety. It's the only sound that most consumers will hear.

Then there are notions about power displays among competitors of different sizes. Big dogs might stand back and watch while the little guys deftly move in for the kill, especially when the prize is an unknown (like social media return-on-investment). If you're big enough, you know that you can wait to see how the new eats are digested, then you can scarf up the smaller competitors with their initial 'wins' (loyal consumers).

So my take is that individual practices have moved quickly into social media, most often using available office staff, while the nationally-networked practices have watched and waited for a couple of years. Now that they see the real results, we'll all see the fertility industry giants bringing their money and action to the consultant table.

That's just how business goes. It really is 'dog eat dog', even in medicine, no matter what we'd like to believe about individuals who go into the helping professions. By now, most of us 'get' that fact, whether by acceptance or resignation. My bet is that 2010 will make social media tools *appear* to be nothing more than yet another box of pliers and wrenches for re-working what health care consumers think.

For now, though, soc med also provides a decent sleuthing pipeline. Individuals can't help but chatter about their pursuits, even (especially?) when things are in a planning or building phase. An example from just the other day -- things anyone can know without knowing the people involved: Lindsay Lebresco, Foursquare user and Account Director for social media agency Converseon, was meeting at IntegraMed Fertility's national headquarters in Purchase, NY today. Kip Finch was there, too, and thought it was a great meeting. My guess is that online infertility communities like Fertility Authority and Fertility Ties will soon see some repro med muscle with which to contend. Or maybe a cozy union is just down the road?

But remember the mid-2000's, after the Internet imploded and tongues clicked about how it was all dog-and-pony show anyway? Out of that mess, when most 'net biz crumbled, those who resurrected did so only because they found a newly educated audience, one that not only reveled in the amount of health information they could access online but who also started looking to separate the wheat from the chaff. Health consumers cared about *who* was giving them information. Behind that 'who' was always a 'why'...

The very thing that makes social media so valuable is the thing that big corporations simply cannot get behind: The Person.

It's not that they don't want to, bless their hearts. They just can't. Ever. By definition.

Welcome to The Personal Brand Era, proposed by Ed Schipul last October. What I really love about the idea as described by Ed is how social media tools seem to have a real, tangible (even while virtual) impact based not on competition, but collaboration, a biz model that's gotten a lot of hot air in the recent past with little real-life play. Of course, as those who know me well can attest, I also dig nearly any idea that charges forward against that status quo.

I'm mesmerized by the melding of individual lives by way of these communication blips cast out to whomever wants to scoop them up. When you combine the relative anonymity of tweeting with the more socially confined Facebook status rendering, it's fascinating to compare responses from the differing circles that ripple out from one individual.

My friends (even those who are "only Facebook amigos") kindly watch as I display my circus-like personal life all over the Internet by way of hastily shot photos and commentary. Some have cringed out loud, though, because they know I combine work colleagues with loved ones in my social media roux. As a long-time telecommuting contractor, that means I have a lot of folks who (a) don't really know me, and (b) are sometimes employing me or who may be considering such a relationship, all jamming along with the daily exploits of my home-schooled son, other family members, and loved ones.

It means that the people who hire me have the opportunity to really know me, really well, via Facebook.

Tweet followers, on another hand, are privy to less revelation about me and mine, and we all know how far titillation can go toward beckoning someone closer.

I daresay, as Ed and others are alluding to, that soon enough one of the shiniest facets of the social media gem will wind up being personal accountability. The individuals who make up an organization or business -- and their 'character' as revealed in their brand -- will matter more. Sort of a Karma Transducer.

The bigger a company, the scarier that kind of talk will be. Reproductive medicine specialists -- the individuals -- tend to become more conservative in their approach to both medicine and business as they become more ensconced in bulkier settings. The bigger the bottom line, the higher the fear factor. It's only human.

UK Fertility Show Offers Plenty of Compassion Ops

Infertility pros from around the world descended upon London recently for what was apparently well-named The Fertility Show. I have to say, I got a kick out of reading Claudia Connell's 'undercover' piece from the MailOnline.

And naturally, some readers responded with hurt and angry feelings.

I didn't get the clear impression that Claudia was being insulting toward people who seek fertility treatment. Rather, it seemed that her main digs were square on the noses of the fertility industry, healthcare professionals whose lives are supported by offering (promoting?) the use of assisted reproductive technology.
 
She even took a few swipes at psychosocial support group, More to Life, which serves those who in the end are calling the baby chase quits. (Surely the beleaguered MTL'ers who commented on the article are familiar with the concept that 'bad' attention is still attention.)

According to her article, more than 80 exhibitors were present at London's Olympia hall, and some of them had traipsed over from the United States. Frankly, I find that funny -- as we waffle over here about whether or not everyone should have access to life-saving medical treatment, a small contingent of pros break free to go sell, I mean, offer life-making treatment to people with national health care.

My opinion: Claudia snarkily called out the industry with more humor than I could've mustered if I was in her 40-something no-child-yet shoes. Touché.
 

Conception Collaborators' Ears Should Ring With Voices of the Donor Egg Market

The DoubleX crowd is chewing up the question of whether or not donating your eggs is "smart" versus the stance that doing so equates to a woman selling her body.

I enjoyed reading the sentiments, but I think the proposed question is worded... awkwardly?

Granted, it's not much of a stretch to say that my DNA-carrying eggs are products of my body. It's reaching for a breaking point, though, when we label a woman's egg cells as "her body".

My whine might seem a tad moot, or at least uninteresting, but I think the repro med pros have to maintain a bit more than a passing curiosity about the perspectives of the women who are donating their eggs, some of whom are quoted in this XXfactor piece.

The Buddhist in me particularly likes the women's viewpoints on the related question of fertility hysteria and infertility treatment.

My favorite comment is from Samantha Henig, associate editor at DoubleX, who muses about the high-dollar offers beckoning to college co-eds with "just so" traits: "... I never thought about how insulting it would be to be told your eggs are worth less because you lack [those traits]. I think it's a sign of the desperation that infertility can spark, and how it can bring people to make these borderline-eugenic demands."

Well said. Are we listening?

Fundraising & Praying for Babies

I'm pretty sure that if we all did everything "right," there would be no child born into any household that wasn't fully financially afloat.

So much for that pie in the sky.

It comes up from time to time, the notion that access to infertility treatment should be just as much a "right" as access to other things, like therapies to quell life-threatening conditions.

In all these years of talking about it and listening to others, I've decided the arguments are usually circular. Maybe we need to redefine "right".

Dear Abby's latest incarnation recently vented her 'negative gut reaction' toward a reader's query about throwing a fertility treatment fundraiser. Needless to say, the TTC Crowd's reaction was quick.   Fortunately, the charge was led by Melissa Ford, who shed a little light on the columnist's missed opportunity to help the inquiring reader. Melissa offered well-founded points -- that aside from the necessarily judgmental quagmire of healthcare access and priorities, other family-building adventures, like adoption, cost a heap, too, Abby.

Then Padmini Mangunta put a little ethics spin on the discussion over at BeliefNet. Her open-ended questions -- is there a line that infertility patients cross in their expectations? -- demonstrate an intention for harmony and understanding, a wise stance for any person who hasn't yet started down the baby-making path. Padmini lost me for just a trace when she wrote "God-willing, I very much hope to have a family one day."

Shades of those old online discussions about the pain caused by using such references to juxtapose those with and those without children. In effect, if God wills you have children, what's up with those who don't get their heart's desire?

On a somewhat related note, Michele Kennon, who is the Dallas Infertility & Miscarriage Examiner wrote on her more personal blog, The Squawkery "Is it possible to be on G-d's bad side?" A lot of women I know would answer with a resounding 'absolutely' at certain times in their life.

So back we come to the whole notion of doing things "right" -- whether that's in terms of bringing new life into the world or choosing whole wheat over bleached flour.

And the circle just goes on.

How Much of Baby-Making Is About Who You Know?

Repro med is a small world. Who you know can matter, and timing is everything. On January 30th, Facebook Fans of My Fertility Plan were alerted to a situation that might benefit from being the right kind of acquaintance with the right people at the right time.

The gist of it: an infertility patient story with a more poignant twist than usual, an otherwise reputable clinic's foible, and the patients' search for financial assistance or in-kind services to finish what they started a few years ago.

Eye-opening Part 1 of the couple's story: the young man is experiencing a recurrence of a rare cancer he had as a child. Prior to that upheaval, though, Chris and his 28-year-old wife went through the rigors of TESE (testicular sperm extraction) and IVF to create six embryos. Four failed after transfer.

Brow-furrowing Part 2: the clinic misplaced Chris and Maddie's final two embryos. For two years. When the little creations turned up again last Fall, the couple was alerted by way of a bill in the mail.

Cut to the chase: childless Maddie, married now for eight years, having been through counseling with her husband about the issues surrounding their circumstance, contacted Angie Best-Boss for help. Their goal: to find someone who could facilitate a frozen embryo transfer for the couple.

My Fertility Plan wasn't Maddie's first call. Only after being turned down or otherwise unheard by Fertile Hopes, Fertile Dreams, INCIID, and a "new npo in Atlanta that's already raised 20K" did she reach out to MFP.

You can start at the beginning, catch up, and keep up with the family-building story of Maddie & Chris (and the good folks who are helping her) on the blog of MFP: http://www.myfertilityplanblog.com/maddie/


The pace of growth in the infertility world's helping community can make your head spin. That's a good thing. Making use of the myriad sources of assistance in a timely manner -- that's hard. See what you may have missed if you weren't hooked up with Facebook?

Tempted to Sell Those Unused Fertility Medications?

When I was chatting daily with (mostly) women in the throes of infertility treatment, it was so common to be approached for unused fertility drugs that I had to prominently display clear warnings all over the About.com Web community I ran.
"Any attempt to post messages here or to contact individuals you've become acquainted with here regarding the proposed exchange of fertility medication will result in your membership being banned from further use in the community." I and my volunteer managers found ourselves routinely patrolling the virtual hallways for cryptic drug deals.

Just in case folks who are newer to the whole "How Do I Afford Infertility Treatment?" scene haven't heard yet, selling leftover medications (even if you didn't procure the meds for the purpose of reselling, as it seems Heidi Benham may have) is illegal. Way.

This article says the New Jersey woman (who lived in Massachusetts during her selling spree that netted more than $100k) now faces up to 20 years in prison.

Feds: Guilty plea likely in Hub fertility drugs case - BostonHerald.com