Medicine is weird, and Reproductive Medicine is even weirder! (Now THAT should get the internet buzzing!)
Why is the “practice” of medicine weird? Health insurance, is one reason. Expectations are another. And for the LGBTQ community, one thing that may be a stumbling block is the notion that you need to seek out a special fertility practice to meet your needs.
First and foremost, it shouldn’t be called health insurance. A more appropriate name is disease, trauma, catastrophe and accident insurance. So, given the myth that folks think they need insurance companies to get good health care, why aren’t these companies covering conditions like infertility?
Only a few states cover the diagnosis and treatment of infertility. Now, don’t get me wrong, I am happy about those few, but even then they limit coverage. The AMA and WHO classify infertility as a disease, wouldn’t it make more sense if insurance companies did too? Second, what’s the deal with limiting care for this disease? Over 25,000,000 folks in the U.S. are infertile, against their wishes. Why is there a debate about providing care? Health insurance companies have a requirement to cover podiatry (truly, how many of us even know what podiatry treats?), so why not infertility?
Here is the insurance conundrum for LGBTQ folks: they cannot, by definition, get pregnant without help or medical assistance, i.e., they are missing either eggs, sperm, a uterus, or some combination of those factors. Should insurance companies have an obligation to cover their care? I think so.
Why isn’t EVERY IVF center demanding insurance coverage for fertility care? Income streams from insurance-based care is lower than cash base, could that be one reason? Fertility clinics may think they are busy enough, due to the scarcity of clinics, perhaps that’s why there’s no impetus to push for universal coverage. Private Infertility coverage companies are also canvassing high-dollar tech companies to pay for these services without the support of health insurance companies or government agencies.
But the biggest obstacle, in my view, is that patients are simply not helping themselves! For 3 years I had a prewritten letter in my waiting room, ready for any patient to fill in the blanks and send to their representatives to demand infertility coverage. In 3 years, only one person wrote a letter. (Yikes!)
Many people have a notion of pregnancy and conception as a natural, easy process. What most folks don’t understand is that treatment is often necessary to mitigate factors that hamper the odds of a successful conception, such as pollution, pesticides, herbicides, poor nutrition, poor rest, excess cortisol (the stress hormone), obesity, smoking, caffeine usage, alcohol or marijuana use, prescription drug use, and population density, among others. Humans are predators, and predators actually have a very low reproductive potential. Their peak fertility occurs at under 23 years of age but cultural norms, and personal and professional choices, often delay trying to conceive, and can significantly impact future fertility.
Another factor is that the health status of parents directly impacts their children’s and grandchildren’s future fertility (look up for epigenetics online). Diseases such as PCOS, endometriosis, poor sperm parameters, and others can be passed on. Given that an LGBTQ patient can’t “biologically” reproduce, aren’t they (and shouldn’t they be) exceptions to the health insurance paradigms?
Unique needs of LGBTQ patients
Finally, what is so different about a lesbian couple compared to a heterosexual couple that does not have access to sperm? None, truly. A sperm donor is needed in either case. For a gay couple, a donor egg and uterus are need. Likewise for a heterosexual couple where the woman has had a hysterectomy, or is menopausal, but wants to add to her family.
Transgender couples are only slightly more complicated. If the transition is male to female, then sperm should be saved before transition or they can use donor sperm. For female to male transitions, eggs should be saved beforehand or donor eggs can be used.
So, for me, each and every patient has “unique” circumstances regarding their fertility options. In some cases lesbian couples, for example, actually have an advantage in that sperm is relatively cheap to purchase from sperm banks, and if each female is of reproductive age, then the “best” egg and “best” uterus can be used, simple as that! Gay men can use donor eggs (which have the highest reproductive potential) and an optimized uterus (wherein the gestational carrier is usually a proven carrier) so their chances of success are phenomenal. Don’t let marketing forces make you think you need “special” (read: “more expensive”) treatments.
Please, please, please talk to the HR department at your job and ask for documentation of infertility coverage, in writing, and send a copy to the company’s board of directors or owners. Please, please, please ask your fertility practice for a letter (you can copy the one on our website) that you can send to your congressman and senators. Finally, follow developments with and pledge support to Resolve, Path2Parenthood and other organizations that support legislation mandating insurance coverage for fertility care.
You see, your “unique” circumstances aren’t really that unique. When I meet with LGBTQ patients, I see loving couples who want to create a family together. Together, we can make that happen for your family too.
Some facts are needed that will help us understand cheap vs. affordable.
At Magarelli Fertility, our Affordable IVF utilizes the finest technologies available. We prescribe the same medications used by every other IVF center in the U.S. The media we used is hailed as the best in the industry for embryo culture. Our incubators and embryology lab were designed and certified by the leading IVF lab designer in the country (Antonia Gilligan Ph.D.). And besides, Dr. Magarelli has designed and built 5 IVF centers (most IVF doctors have never built an IVF lab)! Dr. Mag was also instrumental in the design of the stem cell labs at the University of New Mexico and a molecular biology lab at Michigan State University.
Our air handling system for embryos exceeds every known standard in the industry; it is over 40 feet long and attached to our building. We are a CAP certified, FDA approved IVF center. Our embryologists have been trained by the best in the industry and are both lab inspectors for CAP (College of American Pathologist). Each IVF and FET patient receives an individualized IVF/FET optimized protocol that is inspected, daily, by Dr. Magarelli and his team to determine if the patient is responding optimally, both in the quantity of egg retrieval and the quality of those eggs/embryos.
We add Traditional Chinese Medicine (TCM) to our services because Dr. Mag believes in One Medicine: all healthcare practices are utilized to enhance IVF outcomes including the well-published, world famous CMAP protocol that Dr. Magarelli and Dr. Cridennda invented (Cridennda Magarelli Acupuncture Protocol). Dr. Magarelli recommends his patients utilize optimized nutraceuticals to enhance outcomes. Dr. Magarelli and his team also spearhead new technologies designed to reduce inefficiencies and optimize local and remote monitoring to reduce costs and improve patient compliance, and thereby their IVF outcomes.
What Sets Magarelli Fertility Apart?
Well, then what is the difference between Magarelli Fertility IVF cycles and others? Well, our IVF process is a 3-month program of care; IVF prime month, IVF stim month, and FET month are all included in the standard fees. All embryos are frozen and then transferred in another cycle to augment the chances for implantation (there are no extra fees for these services). Unlimited ultrasound and blood work is included as is up to 7 days of embryo culture (even the slow-poke embryos can make babies – unlike most IVF centers that stop at day 5 and discard embryos.) Also, we do not charge additional fees for longer culture.
ICSI, Assisted Hatching (if needed), ultrasound guided embryo transfer, and the final pregnancy test are also included. We even include up to 12 months of free extra-embryo storage on and off site, too, so you can await the outcome of your pregnancy prior to paying for storage. There is no limit on the number of embryos we culture or biopsy. Neat, huh?
So why is Magarelli Fertility Premium IVF $8,000 when most other program’s IVF cycles are $15,000+ and may not include FET cycle, 3 months care, unlimited US, etc.? The answer = efficiency and choice.
Every aspect of the IVF process has been optimized for delivery of the finest product with the least amount of wasted time, personnel, and supplies thereby lowering the costs. The fees charged for IVF in the U.S. are completely arbitrary. In most states, IVF is not mandated by insurance companies so it is up to the owners of the IVF centers to set prices.
What is really dangerous about today is that there are many venture capital firms that are purchasing IVF centers, so they set the prices not for what the patients can afford, but for the shareholders’ profits and returns on investment. Yikes! So, EVERY IVF center can match Magarelli Fertility’s fees no problem, IF they are willing to work harder, be more efficient in the provision of their services, and finally reduce the profits they expect. We want a fair profit for excellent work, and Magarelli Fertility is growing leaps and bounds because folks reading this blog understand. All IVF centers provide regulated care; there are no shortcuts you can take in the U.S. and call yourself a regulated IVF center.
So, you’re seeking a baby and you would like to have one ASAP? We get it. You want the best care (Rolls Royce, right?) You want people that know your name and care about you and provide you-centered protocols and management? Magarelli Fertility has all of that, and more!
Well, there you have it…Live long and Reproduce!
What is all the craziness about genetic testing of embryos?
PGD, PGS, CCS, PGT-A, NGS – jeez, this is a lot! Let’s walk through a little biology lesson first. (more…)
Star date 190101-01: If you’re a Star trek fan, you certainly understand this reference. This is my Day 1 Blog for Magarelli Fertility, and mostly for you, our patients. My goal is information, knowledge dissemination, and power. Why Power? Well, what I’ve come to realize over the last 30 years treating infertility is that patients simply don’t know about fertility. Sadly, even today infertility is a mystery to most doctors and healthcare providers. What I hope is that you find these blog posts a resource for decision-making based on the best knowledge about infertility and its management out there. I’ve always believed that as a profession (M.D., Ph.D.) my job is not only care, but education and professional advocacy for our dear patients.
Healthy Bodies, Fertile Bodies
“Healthy Body is a Fertile Body” and “One Medicine™” are terms I coined.
First, One Medicine™ is defined as medicine that utilizes the best of all practices: allopathic (Western), TCM (Eastern), cultural medicine (Mom and Grandma’s “health tips”), and others, to create or recreate a healthy body. Healthy being defined as a body, mind, and spirit that reflects the maximum potential of that organism: you.
Healthy Body is a Fertile Body™ is best understood as a mantra for couples/individuals to practice when it comes to assisting your assistors (me) in creating One Healthy Baby™(OHB), another term I coined as my goal for all couples being cared for by fertility professionals. There are many factors that can affect someone’s fertility, and these factors “should” be changed into behaviors (even temporary) that augment rather than decrease your fertility. Here are some examples.
The Power of Vitamins
Aneuploid means abnormal embryos. So the more vitamin D in your bloodstream, the fewer abnormal embryos. Neat huh!?
This data suggests that if men take an antioxidant, the live birth rates in their partners increase two- to three-fold.
Well, there you have it. Star date 190101-01: Live long and Reproduce! Remember a Healthy Body is a Fertile Body!
Do you have eggs? Then you need a blood test. Do you have sperm? Then a semen analysis (or access to donated sperm) is a must. Are the fallopian tubes open? An HSG or surgery should happen. Finally, is the uterus a safe place for the baby to grow? You’ll need an HSG or diagnostic hysteroscopy. Then, and only then, can options for treatments make any sense.
Here are some examples of pitfalls that most non-fertility doctors and patients fall into:
My husband had a baby with another woman so he does not need to get his sperm checked!
Men can stop making sperm in one day (maturation arrest)
I had a baby before, so I don’t need to have my eggs, uterus, or fallopian tubes checked!
Pregnancy is not like a water pump that is primed once and then keeps working. Each cycle is unique and aging impacts fertility in women and men.
Let’s try clomid and see how it works!
How does the doctor know your tubes are open or that your partner has sperm?
We were successful with IUI 10 years ago (when 30 years old) and now at 40 we want to do IUI again!
Same answer as above, as well as, men can stop making sperm at any time, also impact of age on uterus and fallopian tubes can not be underestimated… check first, treat after you KNOW what the issues are.
It doesn’t matter how old you are, try clomid first!
What about the 42 year-old that is rapidly losing her eggs? Is it worth the 6 months of failure before appropriate treatments are started?
So, what does this all mean?
Here are some decision examples:
1. 21 year-old woman: never pregnant, normal tubes and uterus, not ovulating, sperm parameters are acceptable (count, motility and shape of sperm).
a. OI – 15 % chance of success per try
b. OI/IUI – 25 % chance of success
c. IVF – 45% chance of success
d. IVF with Chromosomal Testing – 75% chance per try
2. 36 year-old woman: never pregnant, normal tubes and uterus, not ovulating, sperm ok.
a. OI – 3 % chance of success per try
b. OI/IUI – 8 % chance of success
c. IVF – 30% chance of success
d. IVF with Chromosomal Testing – 60% chance per try
3. 40 year-old woman: never pregnant, normal tubes and uterus, not ovulating, sperm ok.
a. OI – <1 % chance of success per try
b. OI/IUI – 1 % chance of success
c. IVF – 6% chance of success
d. IVF with Chromosomal Testing – 45% chance per try
There are many other factors, especially regarding sperm. If the sperm parameters demonstrate even one abnormality, then the pregnancy rates for OI alone and OI + IUI drop by more than half.
Contact us today to learn more, or check out last week’s blog on infertility treatment options.