IVF is a multi-month process and I have a lot to say about it so buckle up.
The most important thing to know is that it is hard. (Do you have your mantra yet? This is a great time to get one.) Yes, there are things you have to do, physically, that suck, but what affected me more was the stress of getting started. I am not a super emotional person and there were times when I was crying daily from staying on the phone with insurance companies for hours. I just felt stupid and like I was doing everything wrong which I think is what insurance companies are designed to make you feel. I am thankful that my procedures were covered but it was exhausting.
To know how to deal with insurance and find a clinic, you’re going to need to know the IVF process, so let’s start there.
IVF (in-vitro fertilization) is about a three-month process with a lot of waiting. Broadly, it is broken down into:
Ovarian stimulation - Making your body produce lots of eggs
Egg retrieval - Taking the eggs out of your body
Embryo creation - Fertilizing the eggs with sperm and monitoring their growth
Genetic testing (optional) - Making sure the embryos have all their chromosomes
Embryo transfer - Putting a viable embryo back inside your uterus
*Note that there is a significant dropoff at each step after retrieval. So, if you retrieve 12 eggs, maybe only 6 fertilize and 3 are genetically normal to transfer, and those have a 50% chance of implanting.
I’ll come back to the details of this later but first let’s talk some shit about Austin fertility clinics.
Choosing a clinic is very important for IVF because it’s a much more involved process than IUIs. Yes, it is important to look at success rates, but what made the biggest difference for me were the intangibles. It is possible to find a doctor who will make you feel hopeful instead of stressed out, and I highly recommend finding that doctor. You’re about to go through some shit and how a clinic communicates with you will greatly reduce your stress levels.
You can check clinic success rates at the CDC. But what I found more helpful was these super-detailed reviews at fertilityiq.com.
I ended up talking with virtually every fertility clinic in Austin. Here were my experiences:
Texas Fertility Center (TFC)
I did all my IUIs with Texas Fertility Center literally because they were what came up when I googled, their website looked professional, and they had good reviews.
I have no problems with TFC. I would say they are the second-best of all the clinics I interacted with. They were prompt at getting back with me, everything was very business-like. When it came time for IVF, TFC was not in-network with my new insurance that covered IVF. So, I needed to switch, but I wasn’t super bummed about it because I wasn’t in love with my doctor there.
In contrast, switching away from TFC is a lengthy process because rather than using electronic medical records, all of their notes are handwritten (yes, even in the year two-thousand twenty-two). One other clinic told me to expect to wait 30 business days to get my records (in reality it was just a couple of weeks). Also TFC straight up never responded to my calls and questions following up about the records transfer, so there’s that.
Fora Fertility
Fora was my next stop after TFC and, spoiler alert: woof.
The tl;dr here is:
They seemingly did not release my lab results until I paid them, delaying my treatment
They prescribed me an insane dose of medication that made me sick and wouldn’t help me fix it
They were going to charge me for things my insurance covered
Overall communication with the clinic was a nightmare
Now for the details:
I chose them because a single mothers podcast I listened to said switching to Fora was a magical experience for her. I looked up Dr. Crawford on Instagram (she is Insta-famous) and she does have a lot of great information on there, although I was a little skeptical at the use of the word “toxins” on the Fora website.
Calling to set up an initial consultation was no problem. Dr. Crawford had reviewed my charts thoroughly when I met with her and had noticed some inconsistencies that she wanted to check out. I liked her already!
Things started to go downhill during my first appointment. Dr. Crawford did an ultrasound and we ran some tests — that part was fine. However, my nurse was super curt and wouldn’t answer any of my questions about starting the process, she just kept saying we were just going to take it one step at a time.
The finances here were also super murky. I had pre-paid for my appointment, but it didn’t go through on their end so I had to pay again. They also told me it was going to cost $10,100. No line-item costs or anything, just, it’s going to be $10K. I kept asking what was covered in the $10K and getting nonanswers. (All messaging is done through their portal which can take up to three business days for a response which made me stressed — and was not what I expected from a “boutique” clinic.) They did mention that they had to do the retrieval surgery at a different clinic (Aspire) and couldn’t bill my insurance for it because of some weird passthrough billing regulations. At the time, I was unable to get answers from my insurance company about what was covered (more on this later) so I just assumed things were fine but expensive and I could maybe submit the bill to my insurance directly.
Where things broke down for me was when they HELD MY LAB RESULTS HOSTAGE UNTIL I PAID THE FULL $10K. (They also tried to double-charge me for my appointment again but whatever). I was confused as to why I hadn’t gotten my lab results back 14 days after my exam when they said it would take 72 hours. When I paid, the labs all magically appeared.
Unfortunately the tests showed my thyroid was within normal range but a little low for people trying to conceive (mine was out of range by 0.1 magical thyroid units). They wanted me to take thyroid meds for three weeks and then retest me to see if I could start IVF. It felt like they had delayed my treatment by not sharing that information, and I was pissed.
Even thought I was unhappy, I thought switching clinics AGAIN would delay my treatment even more, and I thought Dr. Crawford was a good doctor, so I was willing to stay the course. That is, until they asked me to sign a form saying that I wouldn’t submit an insurance claim for procedures that Fora required me to do as self-pay, even if the procedures were covered by my insurance. This seemed scary so I did a final check with my HR benefits coordinator to see if egg retrieval was covered and it turned out it was. So Fora was going to charge me thousands of dollars for something my insurance covered and just not tell me about it.
I was furious. I got on the phone with the one nice human person who worked there, who said yes she understood what was going on and told me what I needed to do to get a refund.
The refund took a couple of days longer than it should have and I only got $9,900 back (apparently I had to pay $200 to sign some consent forms???) but whatever, I was just so glad to be out of there.
(Also, if you are thinking $10K sounds cheap for IVF, that’s because that is just for the egg retrieval — not inclusive of meds or embryo transfer, which was also self-pay.)
Oh, I’m not done though. Remember the thyroid medication I was taking (which, by the way, Fora told me needed to be name brand 🤑)? The nurse told me some heart palpitations were normal but I was having chest pains and waking up with my heart beating out of my chest. After almost passing out in the shower, I messaged Fora, the clinic that prescribed the medication. This was their response:
Hello Erin, I know you are establishing yourself with another fertility practice currently. Until you get established with them you could speak to you PCP about recommendations on dose. If you chose to completely stop for now, it just may take a little time for the medication to get built back into your system again. Does this make sense? Thank you!
Thanks for all the help!
When I talked to my next doctor and mentioned I was on thyroid medication, she asked if my dosage was 25 mcg or 50. I was on 88 mcg. Other doctors have also told me that this is an insane dose for someone whose thyroid is functioning within normal range. At least I had an answer to why I was feeling so shitty!
(Being on a lower dose of thyroid meds has made a huge difference in my life. It’s kind of like being pleasantly caffeinated: I wake up in the morning ready to seize the day and generally have a lot more energy. It’s one of those, “Is this how normal people feel every day???” sort of feelings.)
Anyway, not a fan of Fora.
Austin Fertility/Westlake IVF
This one was a big LOL for me. After my frustrations with Fora, I had very specific questions about what was covered by insurance and how much things would cost me. Austin Fertility has a policy that they won’t tell you costs until you’re a patient and I was like, that’s fine, I guess I can burden your office with paperwork if you want, but also I am just trying to see if you will bill my insurance. The receptionist I spoke to was very much trying to shut me down here but eventually I got on the phone with their financial coordinator Ann who is an absolute angel and helped me understand costs. She also talked up Dr. Barsky so I was excited for my consultation with her.
Dr. Barsky showed up to my appointment late, without my medical records, which I had sent over weeks earlier. She started talking to me like I was going to do more rounds of IUI and I was like, no, I’m ready for IVF, and she was like, well you could do up to six rounds of IUI (which, from what I understand, you’re basically wasting your money after the third or fourth round). She then started to go into her spiel about the IVF process and I was like, we can skip this, I’ve heard it three times already and she was like, “But you haven’t gotten MY spiel” and soldiered on. After we spoke, she said her nurse would follow up which never happened so I never even had to tell them I was going with a different clinic.
I have talked to other people who used Austin Fertility and it is generally agreed that their front desk is a shitshow.
Austin Fertility Institute
This is the one clinic I didn’t talk to because 1) no female doctors 2) I heard the one male doctor is “an asshole but knows what he’s doing” — from someone who had success with him. I figured I did not need more stress or assholes in my life ¯\_(ツ)_/¯
Aspire Fertility
I cannot overemphasize that by the time I talked to Aspire, I was fucking losing it. I was so frustrated by Fora and in the middle of a very stressful period at work but still dealing with this every day and on meds that were making me sick and generally feeling like I was doing everything wrong.
I had my initial consult with Dr. Kelley, who showed me the difference between being fine with your doctor and LOVING your doctor. She treated me like an adult and calmly answered my questions without overexplaining. At Fora, my initial appointment was held up because the counselor I’d seen was slow to send over records, and I was stressed about going through that process again to send another copy to send to Aspire. Dr. Kelley told me she believed me when I said I had done counseling, but that was an optional step anyway and she didn’t need the records. She made me feel calm and hopeful, and gave me a clear timeline since it was obvious I was ready to go.
I was concerned that the other doctor in the practice is a guy, given my bad experiences with TFC, but I also LOVE Dr. Prokai. He’s super friendly, positive, and fun to talk to. He also told me my ovaries were doing a great job, and who doesn’t want to hear that?
At Aspire, I never have to wait for my appointments, am always seen right away, and everyone I’ve interacted with has been pleasant and remembers who I am. I don’t feel like I’m just a number, like I did at TFC.
I had actually contacted Aspire at the same time that I contacted Fora, and Aspire returned my call but not my call back, so I had written them off. However, other than that one snafu, all communication with Aspire has been super clear and prompt. They also message through the portal (which admittedly has the interface of a message board from 2003) but I generally get answers same-day (you can also call as well). Their financial process was clear and included line items for what they were charging me for.
Switching to Aspire has made such a difference in my mental health about this whole process. I love them so much.
That said, all of this is my experience. The important thing is to find your version of Aspire, even if that is one of the clinics I just talked shit about. So, do some research, visit multiple clinics to see what your options are, and don’t be afraid to make a switch if things don’t feel right.
Part One: The Lead-up and the Tests
Part Two: Choosing a Sperm Donor
Part Three: The IUIs
Part Five: Insurance Hell and IVF Costs
Part Six: Egg Retrieval and Needles Galore
Part Seven: Creating Embryos and the Numbers Game
Part Eight: ~*fEEliNgS*~