Deborah Howell (Host): Welcome to another enlightening episode of Time to Talk Fertility, your go to resource for all things reproductive health. I'm your host, Deborah Howell. Today, we're going to dive into the intricacies of preparing for fertility treatments with a panel of experts ready to share their wisdom. Joining us is Dr. Karine Matevossian, a dedicated Reproductive Endocrinologist who believes in empowering patients with informed choices. We also have Erin Sarris, a patient and author who chronicled her journey in "Cupcakes Everywhere, One Sweet Tale of Overcoming Infertility", and Arelia Huff, a financial educator lead helping patients navigate the financial aspects of fertility care.

Get ready to be informed and inspired, and here we go! Dr.  Matevossian, what advice would you give to someone just starting this process?

Karine Matevossian, MD: Yeah, thank you. This is a great question and I kind of have, I think, two pieces of advice that go hand in hand. The first is that when you're starting this infertility journey or process, it can sometimes be overwhelming, especially if you start to think about all of the what ifs and the hypotheticals and kind of thinking maybe one, two, three months down the line.

 So I think taking a step back and just thinking about what is the next thing I need to do and focusing on that one thing can be really helpful. And that brings me to my second piece of advice, which I think the first and most important thing you should do is find a care team and a doctor that you feel is really supportive, that makes you feel safe to ask any of the questions that you need to, where you feel like you understand why you're doing things and that you're really integral in making decisions

when it comes to your care.

Host: Right, you're not just being talked to, you're part of the process. And what are some big fears or misconceptions going into fertility treatment?

Karine Matevossian, MD: One of the fears I really hear from my patients is that it's really scary to make and come to that first appointment. And I think that goes with that idea of all of those unknowns that come with the fertility journey. But also with some of the misconceptions that people hear.

And the most common one that I get in my clinic is, oh, if I'm here, that means that I have to do IVF or in vitro fertilization. And that's simply not true. There's other treatment options, and it's not necessarily the best option for every patient.

Host: Now, what can a patient expect during their initial doctor consult, and what should they prepare ahead of time?

Karine Matevossian, MD: So that first consult is really a chance for your doctor to learn about you, your medical history, your goals, and how you want to approach your care. And it's also a chance for you to learn about the clinic, how things are done, and what the next steps are for you. To kind of best prepare ahead of time, it's really helpful to have any of your results or testing sent over, to have a list of questions that you want to go through because sometimes in the actual appointment you may forget, things may slip your mind. And I think another thing that you can do to prepare is if you're coming to this appointment, with a partner, just to talk to them beforehand and make sure you guys are on the same page.

Things that only you guys could answer for yourselves, like how many children do you want to have? Are there any treatments that you don't want to do? Or how do you want to approach things together? It's nice if you've already chatted with that, uh, with your partner ahead of time.

Host: That is so smart. All right, Arelia, now to you. What advice do you have for patients about understanding the cost of treatment and figuring out their insurance coverage for fertility care?

Arelia Huff: The biggest thing that I would always tell patients to do is to ask as many questions as possible. There is no wrong question to ask, especially when it comes to your finances. I always tell our patients that they should reach out to their insurance companies just to find out if they do, in fact, have fertility benefits under their policy.

And in the case that they don't actually have fertility benefits; then they need to know what that would actually look like on our end. I always tell our patients to do is contact one of our financial educators, and we can go over the cost of what a cycle would cost for either IUI or IVF. We give a very detailed explanation of what those cycles look like and what the patient can definitely expect.

So they should always just reach out to their insurance company to find out if they do have benefits and what those benefits entail.

Host: And what about the government? I understand there might be some new legislation passing.

Arelia Huff: That is very true. It really depends on which state that you are in. Like, for instance, we're based in Illinois, so, we always go by the state mandate, meaning that there is infertility coverage if you do have a fully funded plan by your employer.

So, they actually provide four visits per calendar year for IVF, they may offer them IUIs that are unlimited, but in Illinois, we do have that state mandate. There are other states that don't actually offer the state mandate, but we do see that there is legislation being passed currently for patients who don't actually have infertility coverage so that they can have some type of coverage so that they can set up a family.

Host: Yeah, crossing fingers for that. What factors should a patient look for when choosing a fertility clinic?

Arelia Huff: The number one factor that they should look into is if their physician and their facility is in network. Financially, that will make the difference. If you do have a out of network policy, that doesn't mean that you don't have benefits, you may also have out of network benefits as well. So it's just very important that you make sure that it is in network because that will provide a lower cost for you.

Host: Got it. Erin, to you now. How did your care team support you throughout your journey?

Erin Sarris: I had a lot of support on the journey, but I'd say the primary support for me was my nurse. And that is true based on the experiences that I've spoken to with other patients at Fertility Centers of Illinois. I would email my nurse multiple times a day, any questions that I had or maybe something that we had changed that I needed to go over again. They were always willing to email me back very quickly or pick up the phone if it was something that required more of a consultation, pick up the phone if it was something that required more of an in depth consultation. But I felt like there was a lot of empathy across the board, from people at the front desk who I got to know to, the care team in terms of procedures like anesthesiologists. And I also like that there was an on-staff psychologist if you were dealing with circumstances that required a little extra mental health support too. That was really reassuring for me.

Host: Wow, that's amazing. What a team. And feel free and use every member of that team. Why see a fertility specialist sooner than later?

Erin Sarris: I think Dr.  Matevossian alluded to this, but that first appointment can be very intimidating, rightfully so, and I think that sometimes it's easier to just kind of hope for another month gone by, maybe you'll be lucky next month, or maybe within the next three to six months, but I think you don't know what you don't know, and by showing up to that appointment and getting your care going, you can at least be informed by the knowledge and the clinical data and medical resources that are available through a fertility clinic and really just having a more specific understanding of your unique situation, which you can't tell from waiting it out at home or doing internet research or any other things that us patients like to do.

Host: Right. I love you don't know what you don't know. That's so true. All right, Dr.  Matevossian, back to you. What are the most important medical tests or evaluations for someone beginning fertility treatment?

Karine Matevossian, MD: So when we see patients, we obviously do a very thorough evaluation, but if I had to pinpoint what's the most important. So for patients with testes, it would be a semen analysis where we look at different sperm parameters like the count, the motility, the shape of the heads and tails. And for people with ovaries, it would be ovarian reserve testing.

 So that is blood work to look at hormone levels. And a transvaginal ultrasound called an antral follicle count, where we actually look at the follicles or the fluid filled sacs in the ovary that contain an egg.

Deborah Howell (Host): Got it. And what lifestyle or health factors can patients focus on to improve their chances of success?

Karine Matevossian, MD: So there's several things that patients can do to kind of optimize their chance of success. Some of those things would include quitting smoking or use of any tobacco products, quitting cannabis or marijuana use, moderating other things, so limiting your alcohol and caffeine intake, adding healthy habits, so exercising regularly, making changes to your diet so that it's more in line with like a Mediterranean diet, so that's heavy in seafoods and fats from plants and lean proteins.

Host: And at what point should someone see a specialist?

Karine Matevossian, MD: For heterosexual couples, it goes off of the age of the female partner. So in those who are under 35 years old, we say to come see us after a year of trying to conceive. And in those where the female partner is 35 or over, we say to come after six months of trying. Obviously, if there's issues with your menstrual cycle or something in your history, you may need an evaluation sooner.

And for anyone who may be using donor sperm or egg or embryos, so people who are in same sex couples or single patients.

Host: Okay. Those are good guidelines. For Arelia, back to you. What are the most important financial considerations for someone planning fertility treatment?

Arelia Huff: Well, I think that key financial considerations include the potential of the high cost of procedures like IVF. You also want to take into consideration medication costs because medication costs can be an additional fee in conjunction with the IVF cycle within itself. And then also genetic testing fees.

When patients actually do genetic testing of their embryos, their insurance may cover the biopsy, but they don't always cover the testing portion. So that can be a separate fee as well that they would actually have to contact the outside lab for to discuss and then storage fees for both embryos and eggs.

While some insurances will, in fact, cover the retrievals, they don't always cover the freezing of your embryos or your eggs. So that's an additional cost that you have to take into consideration. And then also, limited insurance coverage. We do have patients who do have coverage for infertility, however, they don't have a lot of coverage.

So it's very limited, meaning that they may have a lifetime max on the policy, a dollar amount, or they may only have one cycle. So we want to try to make sure that they best use that in the way that will benefit them the most.

Host: To someone listening right now, this might seem a little bit overwhelming. So, how can patients best research and understand the costs of fertility treatment?

Arelia Huff: Well, I would always tell our patients, I know that a lot of patients, just like Erin said, that they do actually research and pretty much go on Google to find out like what the range would be for a cycle. However, I also tell patients to reach out if you're going to go to a fertility clinic, you might want to reach out to your financial educator or the person who is in finance to discuss what your journey would look like.

Host: 100%. And how do you support patients who feel financially overwhelmed by the financial aspects of treatment?

Arelia Huff: The way that we usually support patients are we provide them with a consult after they have their initial visit. And I know that that initial visit can definitely be overwhelming with their physician, but then, of course, the finances come with the added stress sometimes. So we do actually have a conversation with them within 48 hours of their initial visit, just to go over just the basics of their insurance. We usually provide them with a benefit details of what's covered under their insurance and what's not covered. And then we go over that information to let them know that you may have a co-insurance or you may be covered at 100%.

 I always tell our patients that even if you don't have coverage, there are still options available to you. Meaning that we do have loan options. We also have sometimes where patients utilize grants, we also have times where patients use our third party vendor, Fertility Access, that offers multi cycle discounts.

So, I definitely think that it's just more so of a detailed conversation that's had. And if they don't actually have benefits, then we also suggest to them in Illinois for marketplace plans. Marketplace plans within Illinois offer benefits as far as four per lifetime or four per calendar year for infertility.

So, that actually helps the patients feel a little bit more at ease knowing that they do have options.

Host: Yeah, so many more options than there used to be. For Erin, I have a couple more for you. Why did you choose Fertility Centers of Illinois to pursue fertility treatment?

Erin Sarris: For me, it was word of mouth. I had several friends that worked with FCI and had great results. So, that was really the deciding factor for me. I also think it's very much a feeling. You can read online reviews all day or look at somebody's social media presence, but it's really the feeling that you get when you talk to somebody in person or walk through the door.

Um, that's just something that I found was not able to be, it's something I found I couldn't find over the computer or the phone. So I was glad to be a word of mouth patient because it ended up being a great fit for me.

Host: I'm so glad to hear that. But I'm sure there were some challenges. What were some unexpected challenges you encountered during fertility treatment and how did you overcome them?

Erin Sarris: My unexpected challenges was that my first cycle, which took place in Las Vegas before I had moved home to Chicago, was that it was a failure and that was something that I was not prepared for at all. I think expectation management is huge with fertility treatments and I was just kind of wishfully thinking that I was going to be a one hit wonder, have one cycle of IVF and then have my baby.

And so it was just devastating when I realized that that actually wasn't my path and I would have to pursue multiple rounds of IVF just to have a shot at parenthood. But I think the only way to overcome those challenges is continuing to show up no matter how much it hurts. That's not to say if you need to take a break, take a break, or if you need more support, you can ask for it, but the only way out is through, unfortunately, with fertility treatments.

Host: Well, thank you for sharing that. I'm sure it was a little bit painful. How did you prepare emotionally for this journey?

Erin Sarris: This is, I think, an imperfect answer. I don't know if there's really a way to prepare for it until you go through it. And as a patient, that's really scary. But one way that I was able to get through it is by finding my team. And, maybe that's a partner, maybe that's a friend or an internet community.

That is one area where I'm all for advising people to go on the internet because you need a community. Infertility is just so isolating, so when you can find your team, they can be the ones to support you through everything.

Host: Absolutely. Well, we want to thank all of you for joining us on this episode of the Time to Talk Fertility. We hope our conversation has given you some valuable insights and encouragement as you navigate your fertility journey. Don't forget, Fertility Centers of Illinois is here to support you every step of the way to take the next step, call 877-324-4483 to schedule an appointment or visit fcionline.com for more info. Tune in next month for more enlightening discussions. Until then, take care and stay informed.