WCI #269: Infertility Among Doctors

This is the White Coat Investor Podcast where we help those who wear the white coat get a fair shake on Wall Street. We've been helping doctors and other high income professionals stop doing dumb things with their money since 2011.

All right, your hosts today are Dr. Thisha Spath and Dr. Jim Dali. We are excited to bring this great episode to you. Welcome Titia.

Thank you so much for having me.

This is White coat Investor podcast. 269 Infertility among doctors. Do you ever find yourself wishing there was somewhere to go to ask your finance, insurance or investing questions? The White Coat Investor community is a great place to turn. We have a thriving community across all of our social, Facebook, Twitter, Instagram, Reddit and our WCI forum. We've been discussing solutions to your money problems since 2011. Join the Conversation with thousands of other white coat investors. Follow WCI on your favorite social media platform for financial reasons, resources, tips and strategies. Just head to your platform of choice and search for the White Coat Investor. You can do this and the White Coat Investor can help.

Our quote of the day today is focus on being balanced. Success is a balance. That's said by Laila Ali. That is so true. Especially when we talk about families and being a physician and being money wise. I think it applies to all of it and I think also is a really good introduction into our guest today.

Yeah, great choice, Cindy, on picking that particular quote for today's episode.

Absolutely. So we're going to have the author of practice balance, Dr. Dawn Baker here with us today. So Jim, do you want to tell them about that and then I'll tell them about our conference coming up.

Sure, sure. We've got a great episode today. We've got a couple of women physicians that are coming on today and are going to enlighten us about all things in relation to fertility treatments, which is a huge issue among physicians. It's about twice as frequent. We're going to learn among physicians as it is in the general population and it's really expensive and there's a lot of financial aspects to it as well as non financial aspects to it. So we're excited to have a pretty awesome episode today all about this topic, but we'll bring them on the line in just a moment. Before we do that, why don't you tell people how they can and potentially even come meet these people in person because I think one of them may very well be at WCICON 2023. She's spoken at a couple of our other episodes or our other conferences.

Absolutely.

Dr.

Dawn Baker actually Gave a great talk on this topic at WCICON 22 and I hope she'll come back for 23. So WCICON 23 speaker application is due now. Guys, if you guys want to talk at the conference, come because it is so, so fun. We had such a great time last year. The, the hotel was amazing, the food was amazing, the talks were amazing. There's so much learning going on and there's really nothing like just being around like minded people and especially people in the finance world. Doctors that are interested, interested in finance is just hard to find.

Right.

And the fact that we can all get together and nerd out together is so great. So come apply to be a speaker. And you know, there are perks of, you know, coming free that way it's frugal.

Yeah, yeah, for sure. I mean, the conference is worth paying for. Don't get me wrong, this is a great conference. You should totally pay. When we open it up to applications this fall, you should come to the.

Conference a hundred percent.

But if you want to come free and you actually want to get paid to be there, you got to be a speaker. So this is your chance to come to WCICON. Free is applying today at www.wcievents. all right, I think that's probably enough for now. Let's get them on the line and let's get into our content.

Okay, so today we're going to be talking about a very important topic for women physicians in particular. This is one thing that exists in our community. It's very common, but unfortunately it's not very talked about and unfortunately also really affects our finances. So it's an important thing for us to cover here at the White Code Investor today. I am so thankful to welcome Dr. Dawn Baker and Dr. Natalie Frieden to share their information and journey with us. Welcome.

Thank you so much.

Thank you for having us.

Absolutely.

Dr.

Dawn Baker, would you please tell us a little bit about yourself and your interest in this topic?

Sure. I am an anesthesiologist. I've been in practice for a little bit over 10 years. I have a long and roundabout history of infertility that started with having some problems during my residency. And if anyone has ever heard me speak or has read any of my writings, knows that I suffered from a large pituitary adenoma that had to be surgically removed. And the diagnosis of that was delayed by my own lack of self awareness and self care, which is the subject that I write about a lot and my blog and in other writings. The surgical removal of this tumor left me with permanent infertility. It was only found initially by me looking into my fertility when I turned about 35 years old. Long story short, after my tumor was removed and I was stabilized, I spent three years doing both IUI and IVF in order to have my daughter, who is now six years old. And I have recently embarked on another infertility journey that has been prolonged by Covid restrictions, in which I am pursuing a surrogacy journey using a gestational carrier. Yes. And we are going to be transplanting our only viable embryo later on this summer. Wow.

Dawn, thank you so much for being here and sharing that really difficult and long journey with us. I'm so excited to hear all the details and have you teach us about this really important topic. Dr. Natalie, can you please tell us a little bit about yourself and your journey?

Sure. So, as you can tell from my accent, I wasn't born in the U.S. i'm from Australia. I ended up completing my residency over in the Pacific, Northwestern Fellowship, and then moved down to the Southeast to be an attending. I'm an academic nephrologist. My husband and I are very fortunate that we have three children, but they were all conceived through fertility treatments. Kind of like Dawn. We didn't start until I was a little bit later, till I was 35 years old. And until the first appointment with our REI specialist, I didn't realize that I had polycystic ovarian syndrome. Finding two physician parents, no idea just wasn't on my radar that that could be an issue. And then once we were diagnosed, we went through a lot of work to be able to conceive our three children. We were very, very lucky that they worked.

Wow. Yeah. Sometimes we're so blind to our own health problems just because we're so outwardly focus focused on giving as much as possible. It's a very important message that both of you are sharing for us to also look in words and also have a doctor. Right. So many doctors don't have doctors.

Are we supposed to have a doctor? Nobody ever told me that.

I sound like my husband now.

Well, they just changed the colonoscopy age, and so apparently I'm in need of my first major visit to a doctor.

So I joke that I'm a nephrologist, and I told my husband the other day, we're buying a blood pressure machine. And he said, for you. I was like, no, for you. So I get it.

Oh, my goodness. Well, yeah, just. Jim, we forgot about you. Sorry about that. Welcome to the podcast.

I don't have an infertility journey to share. But I'm here because I'm super interested in this because this is a big problem among doctors. I get emails all the time from people asking, you know, how do we deal with this? Should we. I don't have the money, but we know we don't want to wait any longer to start having our family. And this is going to cost us 30 grand or 40 grand to do this, and we don't even know if it's going to work. So this is a really important financial topic. So I'm excited to do it on the podcast, even if it is not an area where I have any expertise whatsoever.

Well, thank you so much, Jim, for making this possible for us to discuss. Dawn, can you tell us a little bit about the background of infertility among physicians and why it's such a big problem?

Sure. Infertility is actually really common just in the general population. It is estimated to be be one in eight couples in the United States. We have limited data among physicians, but of the data that we do have, it is more common than that in women physicians. There are a few different studies that people point to to give a number, but again, limited population studies, surveys mainly, that have, as you can imagine, low response rates. So the one study that's most often quoted lists a rate of 24% among women physicians. So that's quite high. Whatever it is, whatever the percentage is, even if it's one in eight or slightly more, it's still a very common thing. This is an issue because an infertility journey is very incompatible with a typical physician's work schedule. And then also the debt burden that we have as physicians is really high. And then it can be quite an expensive journey as well.

Yeah. So how much does a typical cycle cost?

So a typical IVF cycle, if you look at Internet sources such as SART or ASRM or Resolve.org, those are like the typical infertility websites that people can resource is 10 to $15,000, and that is not including medication. So your medications will cost you on average an extra maybe one to $2,000. And it really depends on your infertility diagnosis, why you are pursuing infertility treatments, as to the exact cost, and then as far as how many rounds you have to do, that has to do with your age, has to do with your diagnosis. So there is such a wide range in how much people end up paying for this.

Oh, my goodness, Natalie, how much did you end up paying?

That's kind of interesting. I started looking back at all of our medical bills going back since 2015. And I was able to find for the IUI, so the intrauterine insemination cost for the ovulation induction. So without the medications, that's $300. The IUI procedure itself was $700. And then with monitoring and everything else you have to go through for one cycle, it ends up being about 1700-2100 per cycle. It was. That was what was quoted for us. And again, we were in different states. Every place is different. So that was for IUI and then for IVF, so we had to do in vitro fertilization with ICSI. So intracytoplasmic sperm injection. I really. I'm not an REI specialist, and I'm sorry for REIs who are listening out there if I stuffed up the way that I pronounce that. But I actually found out the cost for everything. The estimate for one IVF retrieval, a transfer cycle with meds, the procedure, the anesthesia, was between 16 and $20,000. And then there's a storage fee associated with embryos. And then if you want to do embryo testing, which we did because I was older, cost us another $800. So all in all, lots of money. I'm just going to say lots of money. By the time we went through everything and the medications, it was very expensive.

Yeah. So how does insurance cover this at all?

So I think it depends on the insurance that you're with. So initially we had. Sorry, we were under my husband's insurance, which was through the military, and they actually have an incredibly generous infertility availability. So they covered most of it for the first two. For the iui, it was the medications we had to pay out of pocket for. IVF was different, though. Insurance paid for the initial consult, so the initial consult would have been about $300, $400. And they pay for some labs and some procedures, but not for the medications and not for the retrieval. So I think with insurance, I'm looking here, the total was 14,000, and we got maybe $6,000 back. But I do remember we paid a lot more than that.

It's interesting, though, you mentioned IUI is dramatically cheaper than ivf.

Yeah, it is dramatically cheaper, but it also is dramatically less effective depending on your diagnosis and your age. So, John, can you.

Can you break down these different methods of infertility treatments for us real fast?

Well, infertility treatments have a wide range of what is considered under that umbrella. And it goes all the way from just taking a medication to induce ovulation if you have irregular ovulation. So that would be a very minimal cost. And then actually as the next step would be like intrauterine insemination, maybe using some injectable medications to regulate the cycle, and then doing insemination up to ivf. And then there's further testing, as Natalie mentioned, like doing the genetic testing, and then all the way up to using donor eggs, using donor sperm, having a surrogate. And then you can consider adoption in some cases under infertility treatments, if you're choosing to adopt based on your infertility treatment results. So that can go up to the range is up to like 50 to 100k per child for surrogacy and adoption type of situations. But it really is such a wide range of treatments, and it depends on why you have the problem.

Wow, thank you so much for breaking all of that down. And it sounds like they're. There's a huge range of prices for all of this stuff, and it really depends on what the underlying issue is as to how much you end up paying. I'm just thinking I have the hardest time getting to a doctor. And we talked about how we don't go to the doctors. Right. I mean, just making one appointment is very difficult when you're working as a working physician. So how are, you know, with all these treatments, with the injections and checking the labs and stuff, how are you even getting to all these appointments as a physician?

That's a really good question. I want to mention one thing before we go on to this about insurance coverage. There are 16 states in this country out of 50 that mandate some level of insurance coverage for in vitro fertilization, and the others have no mandates. So if you happen to live in one of those states, you have some level of coverage, but there usually has a cap. It either has a dollar cap or it has number of cycle cap. If you're talking about in vitro fertilization or like as Natalie mentioned, some of the things that she did when she was doing the IUIs were covered and some of the things weren't. So before we moved on, there's a wide variety of coverages as well.

Thank you so much for sharing that. I mean, I'm sure there could be some serious arbitrage if you wanted to move to those states. We move so much. I mean, if I were having that issue, I might consider it.

That was actually one that was going to be one of the things I'd recommend that you can actually look around at the different costs. But we can, we can talk about it at the end. All right, to answer your question about how involved it is unbelievably involved. The beauty of it is that most of the appointments and the lab drawers and ultrasounds are first thing in the morning, usually around 7 or 7:30. But I had to do the most incredible amount of shuffling of my clinic, of my inpatient service. I had to share with a lot of my colleagues what we were doing because I needed to be covered. My husband works away a lot. And so when it came time for the actual, for the embryo transfer, I actually had to have a friend come and pick me up and take me home because you get propofol, so I can't drive. So I had to take a day off work for that. So there is just, there is a lot involved in every second day of a cycle you are going back. And it's not just one cycle, it's over two cycles because you'll do your ovulation induction and then you need to rest everything. And they'll usually freeze. They may freeze the embryos and then they re implanted the following month. And there's just a lot of very, very, a lot more involved than I recognized before we started. More so even the IVF than the iui.

Wow.

I recently gave a talk on this subject, the epidemic of physician infertility, at the WCICON in 2022, as you guys know, which is awesome. Thank you. I interviewed basically through a survey and then also face to face a lot of women physician colleagues. Over 150 people responded to an, an anonymous survey that I put out and I asked them about how they dealt with this issue. And it was by far and away the most problematic thing of going through infertility for physicians, which was trying to shuffle their schedule and manage their work schedule around these treatments because they are very short notice. They change on a dime based on the results of like the appointment that you go to that day, you may have to go the next morning or it may be the next morning. So you can imagine that having your patient load or being like, you know, you're talking about how the appointments are in the morning. Well, as an anesthesiologist, that didn't work for me at all because everybody has to be in the operating room at 7am basically. And so having the morning appointments isn't always useful for everyone if you are in an OR setting or a hospital setting versus a clinic setting. And 68% of the people that responded to my survey or that I interviewed about, and these are women physicians that are in practice either in residency or attendings said that they had difficulty scheduling their treatments around their work. And 30% of the people said that they were either forced or they elected to decrease their work responsibilities or change their work in some way related to their infertility diagnosis.

Wow, I like that. Yeah, that sounds like a double whammy. You're paying for all this stuff and you're going to cut your time back and not have the income coming either. So how can colleagues help? Like, I know, you know, coverage is huge and how can we make it easier to share this with our colleagues?

I can answer that. I think the first thing is to be compassionate about it. If you know somebody who's going through infertility treatment, be kind to them and ask them how they're doing because the emotional toll is incredibly real. Even just talking about it now, even though we have three beautiful kids, I still get goosebumps thinking about the uncertainty of it. And I think the thing is we always worry as females. Sorry, we frequently worry as females, you know, in our 20s, worrying about kids. And then there's this thing that you get to your mid to late 30s and you're like, oh my God, it's either now or never. And that time crunch really comes up. So I think talking about it and recognizing that infertility is a really big problem for female physicians especially. And we should really support. If people want to have kids, we should support that because we'll always be doctors, we will always be doctors, but we won't always have the opportunity to have kids. And it can get really complicated. So I think just really offering a lot of support, you know, how can I help you? What can I do to get you through this?

Along the same lines, I think it's important to be supportive without trying to offer advice. And as physicians, we want to help people, we want to solve problems. But if you aren't going through infertility, you don't even really know what it's about or even if you have. It's just good to be open ended with your support and not try to tell people what to do. Watch what you say because it can be really hurtful and people are in a very emotional, vulnerable spot. Some people really keep it a secret because they don't want to have these awkward conversations. However, I think that it's very important for all of our colleagues to be aware of this issue. This is a medical diagnosis and a medical issue just like anything else. If a colleague of yours had cancer or if someone and their family was dying, you would Help them. You would fill in for them. You would be flexible. So that's what we need. We need awareness and we need flexibility.

I love that. Yeah, absolutely. And how can we get leadership to put in policies in place that make this happen? That's the next step.

I had, I thought a lot about this and I think awareness is the first thing. I think that we need some really sensible maternity leave policies to encourage pregnancy earlier if somebody is interested. Because I know we delayed because I was in residency. My residency was great, but I was a resident and then I was in fellowship and there's never a good time to have a baby. I think we need support from all the different medical colleges, from the ABIM for me, for the ABM for my husband as example. I think we need support from the GME officers because I've heard horror stories. One of our fellows told me he got two days paternity leave in his residency, which is just absurd. I think talking about having physicians talk about it at Wellness Activities, we talk about finances all the time. We should be talking about infertility and the implications of that. I think also, like we mentioned before, some time off for medical leave that isn't going to then interrupt your IVU generation or your scheduling or that sort of thing.

Absolutely, yeah.

I think raising awareness again to the fact that this is so common, and it's even more common to some degree than the general population among physicians. And if leaders know that they can help to advocate for better insurance policies that do have some sort of coverage, that they have a culture of flexibility, not having punitive consequences for short term absences, medical related absences. I talked to people in my survey and also in my interviews that said that they had been reprimanded in their performance reviews in their job for too many unplanned absences and things like that. And that's just unacceptable in this kind of case. If people realized how common this was and normalized it as a medical diagnosis, then I don't think that that would happen as often. And then I believe that the culture of just having general wellness programs in place is very important because these women who are going through this need psychological support. We need to have employee assistance programs, coaching, available support groups if possible. And those are going to help everybody in the practice or in the institution. Also, another thing for raising awareness is have someone come and talk to your grand rounds or have an education program if you're in an academic program that is geared toward the residents and the medical students. I am happy to come to anybody's or do a virtual presentation about this topic at anyone's grand rounds if they are interested, because I think that will help to raise awareness as well.

Thank you, really, Don, for the work that you're doing. I mean, it's so important. Women physicians in general, we have a lot to offer, but unfortunately, because of the biological cycle, we need a lot of support early on because of the childbearing and through the infertility treatments, if necessary. But if people treat their employees right and they take care of them, you know, we have a very long career. We tend to be way more productive in the later stages of our life. And I think it's so important for our entire system to realize that this is a change that needs to happen to sustain medicine for the future.

Agree, agree.

You know, it's interesting you mentioned this is. I mean, it's also an epidemic among women physicians. If it's 25% when. When the normal rate in the population is half that. Has anybody looked into whether this is just age? Is it just that people aren't starting until they're 30 or 35 or 40? Or is there something else unique about being a physician that causes us to be much more likely to have this? Is it working night shifts? Is it having interrupted sleep from call? Is it the stress of the job? Is there more to it than just starting late?

It's a good point.

I think there is, but the research or the literature is just not there at this point. I have combed the literature in order to give the talks that I've given and written the articles that I've written in the book chapter that I've written about this topic. And there is just not a lot of information out there. There's not mechanistic data at all. But I do think that it's probably a combination of factors. And age is one factor we do on aver, there is data that shows that as physicians, we on average start our families at age 30, whereas the general population of US women is 26. And compare that to 50 years ago. I think it was 21 or 22. Everybody has changed their age. But then there are also factors in the fact that we are, as a population, less healthy. However you define that at any given age than we used to be related to metabolic health, obesity rates, autoimmune disease, and different factors. And then you throw in the circadian rhythm disruption that physicians experience and the stresses that we have at work, you've basically got a perfect storm to have an increased risk for infertility. Now, as far as the data, though, goes. There's just not a lot out there yet.

Dawn, what are a couple of things you would tell younger doctors, younger med students coming through to try to avoid, you know, or to try to increase their. Their fertility? I guess that sounds weird, but how to. What are the best things to do to try to avoid this problem?

Well, because the problem has so many different facets. There's the financial costs, there's the physical costs, the mental health costs.

Right.

I would say that you want to think about having kids earlier, and that is a really difficult thing. I didn't do it. Natalie didn't do it. We were just talking about. We were in our mid-30s. It wasn't even on my radar. Didn't really realize. But if people know more how much their egg quality goes down as they get older, as just a function of age, regardless of how healthy you are, that might make you change your mind about when you want to build a family. There is no perfect time, and everyone knows that in medical school, it's really hard, and in intern year and in residency, it's hard. But think about the other costs. If you wait, that might incur. Also consider cryopreservation of your eggs. There are some medical school and residency programs that are starting to educate their women physicians about this. It costs approximately one IVF cycle, like 10 to $15,000. You could consider it an insurance policy. It's not a guarantee that you will have a child, but it could help if you already have a partner. You can do the cycle and then make embryos that's even better than cryopreservation. And then all of the basic stuff that Jim talks about as a white coat investor to make sure that your finances are optimized. Try to save as much money as you can. Continue living like a resident when you're an attending. Maximize your retirement savings. Make sure that you have an emergency fund. The most common way that the women who responded to my survey and my interviews finance their infertility is by using an emergency fund or just savings that they saved. And you may have to change around and balance your budget and forego your Tesla and forego your nice doctor house for a little while longer.

Well, you might have to forego more than that. I mean, we recorded a podcast this morning. It ran a few weeks ago. Those who are listening to this, but we talked about all the many things you need money for, right when you're becoming an attending. Remember this. Thisha. We talked about emergency funds, and we talked about doing Roth conversions of your residency Retirement accounts and saving up a down payment for your house and maxing out retirement accounts and that stuff. For a lot of couples, this is probably one of those big items as you're coming out of training to have some money set aside for IVF. And if that means that you don't do a 401k contribution this year, well, maybe that's what it means and you have to decide your priorities and where you're going to put that money.

Absolutely.

I was going to agree with dawn about the finances, about having a separate account and just putting money into there. And if you don't use it for that, great, you have a big chunk of change to throw in the market or build some other wealth. And just one other thing, stay off the Internet. And how does that is that you read about all these stories about these women having babies in their 40s and 50s and whatever, it just does your head in. Especially when you go through all the hormonal treatments. It just makes you feel kind of, I don't want to say crazy. It just makes you feel very uncomfortable. Get some really close friends and consider getting a counselor to help you through it. Because it's just that the uncertainty of it is very, very difficult.

That sounds horrible. So Natalie, you had mentioned that you got fertility treatments in different states, in three different states. Can you tell us about the state to state variation that you encountered?

Sure. So we were in Oregon, Washington and then South Carolina. And I think the biggest difference between them was actually going from one of practice was a university practice and the other two were private practices. That's where my husband and I noticed the difference. It was more that at a university practice, as you'd expect, things were a bit slower. Our lab drills took longer, those sorts of things. The private practices, well oiled machines. We were in and out. We knew the email address for our nurses. It was just this very smooth and seamless process. So in terms of the treatments, they were the same between the different states and the cost of the medications were the same. What was different was that the quote for IVF was less here than it was in the Northwest, which surprises me. So that was one of the recommendations, was if this is a path you need to go down, you can actually contact different clinics and find out how much they charge. And if you have the means to be able to do it, if you wanted to save some money, you potentially could go to a different treatment facility in a different state because we're talking it could end up costing tens of thousands of dollars. So that may be Something you might want to think about.

So what are the more frugal states to have fertility treatments?

Well, just from my only personal experience, it seems like South Carolina was less expensive compared to the other ones. But the drugs were the same because the drugs were shipped from different pharmacies. They were all shipped from, I think, New Jersey. But you can also shop around at the different pharmacies. There are different fertility pharmacies that will quote you different prices, which is, again, I never would have thought that there was even a business for this, but of course there is.

When I was doing my first infertility journey, I had really big medication costs because being having hypopituitarism, I really need a lot of stimulation. And I had long cycles and they wanted to give me growth hormone on top of all the other stuff. Growth hormone. And the typical, like, pharmacy is $2,000 an injection. Wow, that is insane. So I have like a couple per cycle. But I did not shop around at medications and at pharmacies. I just got them from my university pharmacy where I was working. And in retrospect, pharmacy arbitrage is big. You can find medications in even in different countries legitimately. And other places there are medication exchanges where people had a canceled cycle and they don't need their medications anymore. And you can get their medications either for a discounted rate or they donate them. Sometimes your clinic or different clinics will have donated medications that aren't expired yet, so you can go that way. And clinic arbitrage is a thing for sure, as Natalie mentioned. But I do want to say, as far as infertility getting in the way of your work life balance, the closer your infertility clinic is, the easier it's going to be to manage your work schedule and manage your infertility treatments. If you can walk over there or if it's on site, that is going to be big. So you have to factor in that part of the cost. It's not all about the money cost.

Something that my husband and I that we run into. That was funny. Consider the tax implications. Our last payment for our treatment was on December 31, 2020. And when we're doing our taxes, we didn't realize we could have used that as part of our medical deduction. So if we had have waited one day, we could have used it the following day. Again, one of those things that was not on our radar. We could have waited a day and it could have. So somebody learned from that mistake.

Sounds like all the people getting induced on December 31st to try to get that tax deduction. Let me ask you a question I've gotten several times over the years by email and it basically comes from a doc, often in training still. And they say, you know, we're trying to have a baby, it's not working, we're going to need some sort of assistance, ivf, whatever. We don't have the money. Should we borrow for it? And these are people that are going to be docs, you know, they're going to have a high income eventually. What do you think about borrowing for something that's so uncertain, but yet that is time limited?

I can answer that one to start with, I think being in the position of really desperately wanting a child, I would have done anything. And if finances were the thing that would have stopped me, I think I would have been very resentful of that later on in my career. So I think you have to work out what your priority is because you can work as a physician and make all the money you like, but if you don't have the life that you foresee outside of medicine, then what's the point? I can understand why someone would take out a loan to go through something like this because then at least you know, you've tried. At the end of the day, it is just money and you will earn that money back at some point.

I completely agree with you, Natalie. I tell people all the time, think about what your values are first, what is important to you in the end of the day. And if that means that you're going to delay extra retirement contributions and things like that, and you're going to take this loan out, then it's worth it to you. Having a child is priceless, right? That's what they say. And a lot of the women that I interviewed said that they used, if they did a loan, they either did home equity line of credit as long as they had that available to them, and then other types of loans, such as using family or friends too, are a possibility.

Now, I think some of these clinics will essentially let you finance it, correct?

It's also an option.

Kind of like a lot of dental practices have financing programs that they brought in to help pay for things. And I think a lot of the reproductive clinics have similar programs in place. Because think about it, if it's this hard for a doctor to do it, what's everybody else doing? They're financing it. They're financing it. And it might be if you got to do three or four cycles, this could be a high five figure amount. It's not insignificant. So obviously, like any Other loan. Shop around and try to find the best terms and the best interest rates you can get for it. Whether that is a home equity line of credit or whether that's from the practice itself or any other source of borrowed funds that you might have.0% credit card for 15 months or something like that might work out. It just depends on what's available to you.

Ladies, thank you so much for sharing your journey with us and all of your valuable knowledge. I just feel like this is such an important part of our lives that just needs to be talked about. And you guys are so brave for coming here and teaching us about infertility and all the obstacles and the ways we can optimize some of the treatments that we have to get. So thank you.

Thank you so much for having us. This is such an important topic.

Thank you. Thank you for having us.

All right. That was great. That was really impressive, actually. I thought that they were willing to be so vulnerable to come on here and talk about this.

Absolutely, yeah. It's such a brave thing to do. It's such a hard thing. I mean, kids and family are everything. Money is just a tool.

Yeah. It's interesting. You know, we didn't have kids immediately when we got married. We got married fairly young. You know, maybe not by Utah standards, but by nationwide standards. I was 24 when I got married and Katie was younger, and we waited about five years. I was an intern when we had our first child, but Katie was still, you know, mid-20s when we had our first child. And so, you know, we had, like, the opposite problem. Right. We were going to have kids when we didn't want them, but. But that is not the case for lots and lots and lots of docs. I mean, this is so common. People don't talk about it that much, but it's really common. I wouldn't have been surprised if somebody told me it was the majority of doctors that had some sort of fertility treatment, because I feel like I talk to people all the time that have this issue, and maybe not with the first couple of kids. Maybe it's a later child. Maybe it's only the fourth one they needed assistance with.

Absolutely. I feel like in my life, it was just like, for the first half of it was like, definitely, do not get pregnant. Do not get pregnant. And like, you're just trying so hard, and then all of a sudden you're like, okay, medical school, gotta finish that. But now, you know, at the end of residency, gotta get pregnant right now. Because between residency and attending hood is like, great time to be, you know, on maternity leave. So I don't know how we did it. And we didn't, you know, we planned it.

Right. But we.

And we were so, so lucky that it worked out. But it happened at the right time. Right at the end of residency, right before the. Before Internet, my attending job. And then the second one happened, you know, during my attending job. And that's probably how I would have liked to time it, but it was so difficult still, you know, even then. Even so. It was so difficult. But the first maternity leave was completely unpaid, which is, you know, you know, my story. And that's. That was my financial awakening because I just. It was tough. And the second maternity leave, again, you know, being an attending and pumping and let's talk about, like, breastfeeding and how difficult that is. We should do that next time. But, you know, it's. It's all very difficult in medicine to be a mother, to have a family, and we just need to be aware of it. And the process of making it more normal to talk about all of our struggles is what we need. So thank you, Jim, for making this possible.

Yeah, Maybe we need to normalize more, you know, having family earlier in the process, because I think the normal thing right now is everyone says, well, I'll have kids when I'm an attending.

Yeah.

You know, and looking back, it's not that much easier as an attending other than the finances. It's not that much easier as an attending than it is as a fourth year college student, than it is as a first or second year medical student. Even a fourth year medical student. You know, I'm not going to say it's easy to do during residency. That's certainly not the case. But, you know, maybe earlier in the process, if it was more normalized, then the percentages of docs needing these sorts of treatments would be lower. But instead it's, you got to be focused on your schooling, your career and all that. And maybe we should be able to find a little better work life balance earlier in the training pipeline.

Right, right, absolutely. And support our colleagues that, you know, have many different reasons for infertility. And Don and Natalie were so good about sharing ways we can do that without saying the wrong thing, because I tend to put my foot in my mouth a lot. Exactly.

Exactly.

Yeah.

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