The Doctor is IN! The Financial Reality Behind Fertility Treatments
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- This whole process that Dr. Yoder and I just outlined was $20,000 roughly. The medication pack, we had gone directly through spring. It would have been like $4,000. We went through our insurance. It showed me the top number was six grand. I was like six Gs for medicine. - Yeah.

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Hey besties, welcome back to another episode of Net Worth and Chill with me, your host Vivian Tu, aka Your Rich BFF and your favorite Wall Street girly. Today's episode is a hotly requested one. I have finally gotten all of the details, all of the information organized, and we are going to be talking about my egg freezing journey. Yes, this was a very personal and frankly,

vulnerable moment in my life. Not only am I usually someone who is relatively healthy, I try to stay away from doctor's offices, but this was something that made me reconsider a lot of the decisions that I'd made in my personal life.

So today we are going to cover things like what does the actual egg freezing process look like? How much does it cost at every single step? What every single step means scientifically? And we are going to also just go over the emotional aspects of this process and if it might make sense for you. First and foremost, I chose to freeze my eggs, in particular freeze my embryos with my now husband

because I'm 30, but I knew for a fact that I did not want to have kids this year, next year, or probably even the year after that. I also recognized that because of how my career is set up, I wasn't necessarily going to be able to have PTO in the way that someone who works for a corporation does. I wanted to give myself essentially an insurance policy in the case that I waited for a

Boo and I were having trouble having a child, I would potentially have an insurance policy essentially to fall back on. It doesn't necessarily mean that I would use my eggs. It doesn't necessarily mean this makes sense for everybody, but it felt like the right choice for me at the time. In particular, I had a girlfriend who contacted me and she shared that she was going through the process and

At first, it kind of surprised me because she was actually six months younger than I was. And I asked her, you know, without being too probing, why are you doing this? And she

She shared that her older sister had fertility issues when she was trying to have a child. And because she's her sister and they share 99% of their DNA, it made her worried about her fertility as well. When she went in to go have her initial consultation and to double check her ovarian reserves, she found out that she had a low egg count.

and that time was of the essence and that she was going to want to take advantage of her younger age and get some eggs frozen, that transparently really scared me because I had never even thought about my ovarian reserves. I frankly took for granted that I was always going to be able to have kids even though my mom at my age was already pregnant.

And I did not really foresee myself having kids in the near future, whether it be through the foods we eat, whether it be through the environment, you know, how modern life has changed. A lot of us are delaying our family planning and starting to have kids.

So I just wanted to make sure that I had every option available to me. That said, I am not a medical expert. And as such, I have invited a medical expert to join us today. She is a board certified OBGYN. She is a fertility specialist at Spring Fertility who's bringing her incredible expertise from Yale, NYU, and Cornell to help

People build their families. And what actually makes her so special isn't just the fact that she's an incredible doctor. She was my incredible doctor, and she helped me freeze my eggs. Everyone, please welcome Dr. Nicole Yoder to Net Worth and Chill.

Hi, thank you so much for having me. It's good to see you again in a little different context. So good. This time I have my pants on. I'm not wearing a paper skirt. Yes, this time in your domain. Yes. Oh my gosh. Thank goodness. Yes, you look great though. Thank you so much. I am so excited for us to dive into this conversation. But before we get started, can you roll back the clock and just give us like a rough 30 second timeline of like, how did fertility treatments start?

Yeah, it's actually interesting that fertility as a specialty and like a medical subspecialty is not that old when you think about it in terms of like all the other medical subspecialties that we have. Right.

Really, they were only starting to figure out like what estrogen and progesterone were about 100 years ago. So when you think of like the grand scheme of things, like that's not that long ago. Yeah, no. And then the first IVF pregnancies, really the original data started coming from like animal studies and it crept into human studies. Got it. But the first IVF baby was only born in 1978. Oh.

Oh. So, yeah. Like younger than my parents. Yeah, younger than your parents. So in the whole grand scheme of things, this is actually not – it's a very like new-ish field and always rapidly evolving. So technology definitely has gotten much better since that 1978 first baby, and it's getting better and better all the time. But it's definitely something that is like kind of a new hot field from my perspective anyway just because it's actually relatively young. That's really interesting. Yeah.

Could you share with us just like a couple things that people should consider when they're on their fertility journey? Like what are the key health moments that we should be looking out for and tracking? And at what age do we really start thinking about fertility? Yeah. It's good, I think, for anybody who potentially wants to have a biologic family to like

kind of at least map out what their ideal life would look like and always be, I hate saying this because it's sort of a burden on the female, but always be aware of like the age and sort of what your overall health situation is because so much of fertility really comes down to age at the end of the day.

So things to be kind of cognizant of are, I always tell people, always think of not only when you might want to start trying to have a baby or create a family, but when you might also have that last baby. I can't tell you how many times people are like,

Oh, I'm going to start. I'm like, I'm 30. I'm start trying like two, three years. So I'm good. And it's like, well, yeah, probably for baby number one. Most people that age have success. Some don't. But how many kids do you want? How far apart you envision them being? Yeah.

is baby, do you want two babies, three babies? Is baby number three going to be like closer to 40 than 30? Yeah. Then a lot of times it's a different picture when you're a little bit older. So good to keep in mind sort of the overall trajectory and just like the ages where you, in your ideal world, might see those things happening. Yeah. And you mentioned like the specific timeline and it feels like there's this big shift between 30 and 40. And

Fun fact, you guys. So I did my egg freezing at Spring Fertility. And before you go in for your first appointment, they assign you homework. There's a 30 minute video that, you know, I had to watch with my husband and we went through the whole thing and it kind of

demonstrated to us that like at 35 for women, like there's like a little bit of a shift. Like what happens at that point that it makes it so much harder to have kids? It really comes down to egg quality. And the interesting thing about that 35 number, the way we talk about it, it would seem like, oh, you get to 35, like you fall off a cliff, you're immediately infertile. It's not quite that stark, but there is some truth behind that number. So when we look at studies of

natural fertility rates across different generations, across different countries, pretty much any population that's been studied in terms of their fertility, there's a very consistent decline in fertility rates that starts around 35. Really what that comes back to is the quality of the egg itself. Now, why biologically we are set up to sort of

you know, start to lose the quality of the egg around 35. I don't know that any of us will know. Same reason, like, why do we go through menopause around 50? Like, not sure. That's the way we're set up. But it's a very consistent thing that we see, like, time after time, like, study after study, where around 35, those eggs just aren't performing their job as well as they used to be. So that's why that 35 number gets thrown around a lot. And it is kind of a good line in the sand as a check-in point of, like,

you know, am I before 35? Am I after 35? Where in the spectrum am I fertility wise? This might be a stupid question, but like if 35 is kind of when egg health starts to really deteriorate, like what is the best age to get pregnant technically? I would say peak fertility is really like mid to late twenties. Okay. That's kind of the sweet spot in terms of like maximum fertility rates. It's still pretty good in the early thirties. Fertility rates in like

the 20s are probably about 25% chance per month for people who are actively trying to get pregnant. In your early 30s, it drops down a little bit to about 20% chance per month. But then by the time you're 40, it's about 5% chance per month.

Oh, wow. Most of that, yes. Most of that change is driven by the ages 35 to 40. So a lot of decline. There's just a lot of changes with the ovaries and egg quality that happens from 35 to 40. And then even more so beyond 40, decline is even more rapid. I don't think I understood...

how hard it was to get pregnant because when you go through like sex ed in high school or you know even just like when you're in college and like having a good time you have this constant fear that you're like I can't get pregnant I can't get pregnant like 100% but then all of a sudden it goes from I can't get pregnant to I must get pregnant and as soon as that flip switches like

it feels like it's really challenging. Like there's only a couple days per month that you in theory could get pregnant, right? Right. Peak fertility time is really the five days leading up to ovulation, which is one of the reasons why fertility rates aren't like 100% every month. There's a narrow window for it.

But then also, as you very appropriately said, so many people spend so much time trying to not become pregnant. And then all of a sudden you're like, okay, now I'm ready to have a baby. Like, boom, it's going to happen. And it doesn't. For most people, if they're like, oh, I've been trying for three or four months and nothing happened, I'm like,

sounds about right, you know, like, unfortunately, just because fertility rates are not as high as we really think they are. I mean, very appropriately, we do talk about a lot about preventing unwanted pregnancies, which is also very important. But one thing that's really lacking from our just like reproductive education, at least in the US, is infertility. Those rates of infertility, actually, the estimates are going up

all the time. So they used to estimate it as about one in eight couples that needed some sort of assistance to conceive, which in itself is not low. I think it was last year or the year before that they actually increased it to it's like one in six couples now. Oh, wow. Okay. That's a lot. Which is pretty common. Yeah. It's like when you think about one in six, like-

Most people I talk to these days have some sort of friend who needed to do IVF or had trouble getting pregnant. It's more and more common, especially in places like New York City where people delay having kids. They don't start their families until like after 30. A little later. I know. When people have kids in their 20s now, I'm like, oh, that feels like a teen pregnancy in New York. I know. I'm like, whoa, whoa, whoa. What is this? Yeah. But it definitely has shifted later. Yeah.

But unfortunately, our bodies have not also, like, evolved in the same sort of, like, social way that we have evolved. Like, the pilgrims died at 30. Yeah, exactly. You're done. Like, you didn't need it. It's like, what do we need them for after this? Like, you're toast. Yeah. Yeah, but now people are having babies, like, 30s, late 30s, 40s, and that's pretty common. Yeah. But unfortunately, a lot of people don't have that background information of, like,

It's actually kind of hard to get pregnant at those ages for some people. And Net Worth and Chill, obviously, is a finance podcast. So I want to talk a little bit about this bigger philosophical question that I want you to weigh in on for me. I don't think you're going to have a perfect answer, but...

When it comes to the fertility journey, it really feels like when you're younger and have these healthier eggs, you may not be able to afford some of these really key treatments that would help you essentially get insurance. But once you get to the point where you can afford them, your eggs are probably a little less viable than they would have been younger. Right.

How do we as smart consumers and smart people make sense of that? Yeah. This is, again, where I say it's always good to at least have a check-in with either your GYN or fertility specialist or somebody if you want to keep the doors open for biologic children. Even in your 20s, just to say like, hey, are there any red flags in my medical history or

or any medical conditions that might make it harder for me to get pregnant, but also what does my ovarian reserve look like? So you can have people who are young with a low reserve or older and have a high reserve, and it kind of matters where you stand in

age and quantity-wise, whether or not it makes sense to do something more proactive. It's not, you're right, I don't have a perfect answer for this, but it's always good to at least get a sense of like, okay, here's where I stand now. What does my timeline look like? And do I have wiggle room in like delaying this and putting this off further? You know, sometimes people will come in and they're in like, you know, 26, 27. It's like, oh, it seems kind of young, but

But sometimes you find that they have a really low reserve and like you never would have known unless you had a checkup. Yeah. And then they're at least empowered to act on that. And like move quickly. And move quickly. Yeah. Or sometimes people come in and they're like 28, no medical problems, just checking it out. They're like –

You have very robust ovarian reserve. And they say, you know what? Like, I'm going to wait a year or two. From my perspective, I'd say, like, that's probably totally fine. Yeah. Like, you're going to do – if you need to do some sort of intervention, I foresee that you would have good success rates this year versus next year versus following year. But if you come in my office and you're 42 – Yeah.

I'm probably going to say even if like time is of the essence, like we don't really have the luxury of time. Like we got to get started next month. Exactly. So the two things that can kind of like make things a little more pressing are one, age. Anyone over 35, it's kind of like, you know, we know the quality is starting to go down. But then, you know, age and the quantity, just like your medical situation as well. So both of those will play into whether or not it makes sense and how much like leeway we have with the timing. Got it.

And I want to walk through really quick kind of like my process just so that if anybody who's considering this like understands and then kind of on each step, I'd love your POV of why we do these things. Yeah. Yeah, absolutely. First step, came in for a consultation. We sat down with you.

you walked us through what I can only describe as like a bio class PowerPoint, which I loved. So like I understood exactly what was happening, but you know, nothing was really done at that point. I also really loved that at spring,

After we had our meeting, we did a full financial meeting. I had a full financial meeting. You went and saw a different client. Yes, I go somewhere else. But you guys get all the deets on the finances because it's a real thing. It's very expensive. It's expensive for anybody. But we got our finances sorted out. They checked our insurance. I remember you telling me, you were like, you have really good insurance. You know that, right? Yes, I know. I was like, oh, you got the catalog of insurance going here. I was like, this is lovely. Which is nice because it gives you the liberty to do whatever is medically necessary.

Necessary. Necessary and appropriate. Yes. Yes. So we have the consult. And then after that, we decide to move forward. I can't remember what the medication was, but you put me on a medication that I had to take for seven days. Yes. Probably Agestin. Yes. Yes. I hated this medication. This was the worst part. I had a weird side effect in that it made it really hard for me to sleep. Yes.

That's miserable. But the purpose of that medication was to just like time up my cycle, right? It has a couple purposes. Basically, it goes in the category of priming medications. There are some different forms of it. Sometimes we'll use like birth control pills, like the one that most people are familiar with. Sometimes we use something like estrogen, just the estrogen component, or what you took was just the progesterone component of a birth control pill. But basically, the idea behind it is...

We want all of your eggs or follicles to grow as a group together. And doing some sort of priming medication tends to help that process happen a little bit more naturally. There's more of a spread of sizes of eggs.

at the end when you don't do priming. So it's just to sort of like get the best cohort that we can during your cycle. Make them as uniform and healthy as possible. In an ideal world, every egg would be the same size on the same day.

And when you're triggered, they'd all be mature at the same time. Got you. That doesn't really ever happen in reality. But as close as we can get to that is ideal. So that's why we give you that medication. I will say some people feel nothing with it. And some people are like, I hate adjusted. Don't ever make me do that again. So I'm so sorry you felt that way. No. Oh, my God. Please. Please.

As soon as I was off of it, after seven days, I went back to sleeping like normal. That's good. But then we moved into phase two, the most fun, the shots. Yes. And when people talk about egg freezing shots, I heard shots with the S at the end, plural, meaning multiple days. Yes.

I did not realize it was also multiple shots per day. Yes, multiple shots, multiple days. Yeah, it was. So for about a week, I did two shots at night, one of which was not too bad, Follistim, and then one of which burned. It was the most horrible thing. Menoper, you and I have beef. I mean, listen, these are all medically necessary drugs, but I'm taking those. And essentially, you guys are just trying to like,

blimp up my eggs. Yeah. The point of those two medications is to get as many eggs from that month's cohort to grow as we can. So each month your body actually recruits a group of eggs and

to initially be, if you have a chance at pregnancy, in a normal cycle, your body will grow just one of those with like a tincture of that hormone you took from your brain. What we do is we give you a higher dose of the same hormone your brain would make to hopefully grow a whole group of them. All of them. Yeah. So those two that you start with in the evening, those are for growing the follicles or growing the eggs. Gotcha. And I think a big misconception is also that like

When you do an egg freezing round, you're like borrowing from the future and all the eggs you're harvesting mean you're going to have less eggs overall. No, no, no. Like every single month, your body in theory could have like 20 plus eggs, but like only one of them becomes like the viable one. Yeah. Yeah. But now we're just harvesting all of them. Exactly. Yes, exactly. Exactly.

It's good to like understand how like our actual like natural cycle works in order to understand like how the egg freezing process works. But exactly as you said, each month we actually have a whole group of eggs that initially gets recruited. In a normal cycle, what happens is one ovulates. The rest of them just die off. So it's actually a very, in my opinion, inefficient way that we are set up. Yeah.

And so when you do like egg freezing or an egg retrieval for IVF, essentially we want to get all of the eggs from that month to grow. But if you hadn't done an egg retrieval, those would have died off anyway. Hence exactly what you said. So you're no worse off. Yeah, you're not worse off. We didn't steal from eggs that you would have had in the future.

It's not decreasing your future fertility and you're not going to run out of eggs sooner. So you're not going to go through menopause earlier because you did it. Yeah. Oh, I love that. Yeah. All good things. So seven days, agestin, my least favorite medication, seven days of two shots per night. And all the while I'm seeing Dr. Yoder every like two, three days. Like I'm coming into the office every other day. And we're getting a very fun,

ultrasound, you're looking at my ovaries, what have you. I'm getting blood work done. I mean, I was just being jabbed every single day. Then the last week is the most fun because not only do you get to continue the two shots you were taking at night, you get to add one in the morning and you have to take it at a very specific time from the other two. So it will also impact when you can take meetings. This is true. Yes, yes, yes. 100% true. And that medication is...

It's pretty important that you take it at the right time because that's someone that prevents you from ovulating on your own. Oh. So when you're growing follicles, once it gets to a certain size, your brain will get the memo like, hey, there's a good juicy follicle. You should ovulate. We don't want that to happen. Got it. Because we want entire control over when –

that process starts so that we can retrieve the eggs. So that one is pretty time sensitive because if you miss it and you take it way later, then your brain might think, oh, hey, I should, yeah. And then it's sort of like all your hard work is for naught if, you know, if you ovulate. So that's why we're a little bit pickier about the timing of that one. And we say you probably want to ruin your meeting for this. Yes. So you don't like waste the whole two weeks. And by the way, I don't know if this is how it is at all fertility centers, but like

through my entire process, you were the only doctor I saw with one exception. There was one Saturday, it was like right before, right as I was ready to start retrieving, I saw another doctor. But I just felt like really safe.

That it was always you. Yeah. And that's one of the things that, you know, we try to do our best to like have a lot of continuity with our patients. Yeah. We know that a lot of times this is not anyone's plan A to like walk into my office. I get that. I totally appreciate that. And it's also really like sort of vulnerable space. You're doing something very intimate. It's for your like your family building purposes. Some people have like, you know, anxieties around it.

Some people have it easier than others, but like the more that we can have a relationship with our patients and see them and scan them ourselves, we try to the best we can. Now we're not there like 24 seven. So yeah, she probably saw someone else at some point, but usually that's what we're trying. Yeah. Only once. That sounds about right.

But usually we're trying to like keep you updated on how things are going. Does this look good? Does it look better than we thought? Worse than we thought? Because then at least you don't get any surprises at the end. Yeah. And you'll kind of know what's coming. Yeah. And so I do my three weeks of medications and shots. And we get to the end. You do the final look at my ovaries. You're like, oh, these look plump and juicy. Yep. It's time. And then I took what everybody calls a trigger shot. Yeah.

To be clear, I cannot remember what any of these medications are called, but I take this big, scary trigger shot. The needle was literally the size of my arm. Not to scare anybody, but it was really nervous for me. Listen, I never injected myself before this. It's a weird concept for people who don't do injections or don't regularly take injectables. Yeah. And so I did this trigger shot, and then I believe it was the 24th. Two days later. Yeah. 48 hours later.

I show up to Spring Fertility. We go to the floor above the floor that I normally saw you on. And it is so funny because the office looks like a one hotel. Yeah, it kind of does. It's got the grass wall. Yeah, yeah, yeah. The same vibe. It has organic vibes in there. It was very soothing, but I got in the full hospital garb. We went in and it wasn't too bad, but all I can remember is

right before I went under you were trying to like distract me or something because it's like a little uh humiliating when you walk into the operating room and you have no pants on and there are five six people standing directly you know looking at where the sun doesn't shine and you're like oh I saw you posted an Instagram story about these snacks you were eating this past weekend and I was like

why is she talking to me about these snacks right now? And it's so funny. We were having this mid-conversation and all of a sudden I go, oh, I'm getting a little, and then I woke up. Yeah, yeah. That's the usual like trajectory of it. It's like mid-sentence like, oh, and she's out. And I'm gone. Yeah, and she's gone. And then you wake up and it's like, did we start yet? Yeah. And it's so funny. I think the only like real like,

or like real like negative thing I felt was I was really cold after the procedure. Yeah. But no pain. Didn't feel anything negative. So yeah. That's good. I consider it a really good outcome. That's not bad. Yeah.

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Yeah, and a lot of times we're giving you like IV fluids, which are cold, and you've, you know, you've been in the procedure room with not a lot of clothes on. So that kind of tracks. But usually people that day, it's like crampiness. It's usually not severe pain, but like you just feel crampy. I think the best description, honestly, is that someone's like, you know, I just feel gross. Yeah. I'm like, what?

Yeah, that tracks. Like you just feel a little like not your best self. But usually it's not severe pain. It's like crampiness and a little discomfort. And for me, it was more so just like horrific, like bloating. Like I felt like I had to, like before the procedure, I felt like I had to pee every 30 minutes. And like I was like waddling. I was like, what is going on? Yep, yep. Towards the end, your ovaries just physically take up so much more space in your pelvis. Yeah.

that you just feel so bloated. And there's also fluid retention from the hormones. So the waddle is pretty typical when you get to like day 10, 11, where people are like, oh, I can't even like walk around normally. But yeah, those all sound like pretty common experience. Okay. So now, you know, I got the retrieval done. This is the final step. And this is what you have dubbed for me, egg math. Because not only did I freeze my eggs, in particular, you know,

We wanted to freeze embryos. And when I walked out of, well, I walked out of, when I awoke, I immediately grabbed the nurse and I was like, how many eggs did you get? And I'm going to share some numbers. I want to say, first and foremost, like, I almost didn't want to share this because I felt bad.

bad that my process had gone so well. I didn't think that I would feel guilt about it going well. I think I would have been like really scared to share having it not gone well. But like even knowing that I had girlfriends who said, oh, I got the results you got after doing two or three cycles. Yeah.

It, you know, it upset me. It like, you know, felt like. Yeah. They're like. Why did I get lucky and they didn't? Yeah. They're like emotions that are attached to the numbers. Yeah. Inherently. So I ended up getting 30 eggs. 24 were mature. Like fully mature. Yeah. Fully mature. Yeah. Of the 24, we inseminated all of them. And remind me, I believe it was 19. Yeah. I believe 19 like fertilized normally. Yeah.

By the end of the fertilization process, 14 of them turned into blastocysts. Yes. Sounds like blastosaur, some Pokemon. And then we also opted into doing genetic testing to make sure that our embryos were chromosomally normal. And of the 14, 13 were normal. Yeah. And you always told me that for every human kid that I wanted, that...

I would need roughly two embryos. - Yeah, ideally you have like two normal embryos for every baby desired.

So I can have a basketball team. You could have an entire team of, yes. I think you have made it very clear to me through this process that, like, I had a really incredible result. Yeah. But is not normal, quote unquote. You're definitely on, like, the higher end of the spectrum. Can you give us context of, like, what is average for someone who's maybe 30 versus someone who's 40? Yeah. So...

As you very appropriately said, your numbers were fantastic. You have a great reserve. You did great during the whole cycle. Sometimes that's the way it goes, and sometimes we're expecting that it's way less. Part of my job is to at least counsel people on what the expectations are. But just to give you ballpark averages, if you're in your 30s, an average number of eggs to have retrieved, I'd say if you get between 10 to 15, I'm like, yeah, that's pretty common. But once you're closer to 40...

Anything like five to 10, that's pretty like, I'd say normal. And that's just the starting number. Now you kind of very nicely walked through all of those steps that happen in the lab. So first thing we do is we see how many are mature. And that's where that priming medication can help more be mature at the same time. But that will be a certain percentage for people. Usually it's about 75% are mature. Then we have to fertilize them. Typically about 75, 80% will fertilize normally.

And then we let them turn into embryos. We let them grow in the lab. Now, you had a very good result on that portion of things. Like 19 fertilized eggs turning into 14 embryos is way higher than I would expect. Usually that's about like 40 to 50 percent will turn into embryos. Do you think it's just because like I'm 30, like I'm younger? Yeah. Yeah. Not to sugarcoat it, but yeah, you're young, you're healthy. There is no apparent like egg or sperm quality issue. So you crushed it. You did great. Yeah.

And then we see how many of those embryos are chromosomally normal. And again, when you're young, 13 out of 14, like, yeah, that tracks. Now, if we fast forward and you're doing this when you're like,

late 30s, 40s, something like that, well then maybe the numbers are looking like we get 10 that are retrieved, maybe eight are mature, six fertilized normally, maybe three make it into an embryo, and then we're happy if we get one or two normal embryos out of that. So each step along the way, we expect there will be cutoff, and some of those cutoffs are more or less severe depending on age or just any medical history. I'm not going to lie, this whole process...

even though I knew I was healthy, even though I knew I was like young on the grand scheme of things, like I felt a lot of guilt. Like when I started like doing this process, I was like,

should I have drinking so much in my early 20s? Like, God forbid I had that one cigarette outside of that bar one time. Like, why did I have all of those burgers and cheese fries in college? Like, why didn't I eat healthier? And like, every little decision I've ever made kind of came to the forefront of my mind to be like, you're an idiot. And like, what if that is the reason why this doesn't work? Yeah. A lot of people get to, they have sort of like epiphanal moments in my office or like,

oh my gosh, like has everything I've been doing, like it made it impossible or like it had its major effect. The real answer is like, we don't know. We're all trying to do the best we can. But it brings up a good point. Like for people with ovaries and eggs, like you're born with all the eggs you'll ever have. They stay with you your entire life until you ovulate them. So when you're like 30, your eggs are 30 years old. When you're 40, your eggs are 40 years old. They've been kind of exposed to like all the elements you've been exposed to. Now, most people who are doing the things that you described

are just fine. Yeah. But, you know, there are cases where certain lifestyle choices can, you know, take a hit on your overall health and fertility health. Yeah. Oh, man. I know. That's a heavy one. And to take this gamble and do this

We have to talk about the cost. To break down kind of my process in rough ballpark numbers, like I mentioned, I went to Spring Fertility in New York City. Keep in mind, this is a major metro. Prices will fluctuate upwards or downwards depending on where you go. But this whole process that Dr. Yoder and I just outlined was $20,000 roughly. The medication pack was $1,000.

I believe if we had gone directly through spring, it would have been like $4,000-ish. We went through our insurance. It showed me the top number was $6,000. I was like, six Gs for medicine. Yeah. Fortunately, we had opted for the really, really expensive PPO that year knowing we wanted to do this. Right.

I spent $180 on that medication. I was like, hell yeah, $180. That's a win. Yeah, that seems like nothing compared to six grand. And then, you know, just in the forms that you guys have shared with me, to actually then take those embryos that we currently have frozen that cost about $1,000 each year to keep on ice, it's another $10,000, sometimes $15,000 to then put them back inside the

Correct. My body. Yes. Making them is the first part. Yeah. If you use them, that's a whole separate procedure with a whole separate associated cost. Oh my gosh. Yeah. Just like point blank. Why is this so expensive? Part of it is that...

In the lab with the embryologist, literally everything is being done by hand. Yeah. Like one by one. One by one. Like when you have an egg, we're trying to turn it into an embryo. There is an actual human that's making all of that happen in the lab by hand. So it's a very technically challenging procedure and requires just a lot of technology to sort of create this like fake environment. Yeah. You know, that the egg can thrive in to turn into an embryo. So part of it is just there's a lot that like...

in like the infrastructure that goes into it. Like having a lab is expensive. Yeah. It requires a lot of upkeep. There's a lot of personnel. Like it's kind of amazing to think of like how many people go into like one person's journey on all of this. It's like there's actually so many people that are a part of it. Like I know you saw me a lot of times, but like there's a whole team of people behind me making all of this happen. Right next to the actual like surgical procedure room, there was like the

lab and you just see like a dozen people in white coats, like all with their little pipettes and stuff. I'm like, wait, what are they doing? Yeah. That's all the oncologists. Yeah. They're back there making babies. And honestly, like they are the unsung heroes of all of IVF in my opinion. Yeah. What you can have like the best doctor, the best ovaries, the best protocol, all of those things. If your lab is not

Like none of that matters. And so a lot of it is just the lab expertise is you want it to be top notch. And that unfortunately will come with some cost. Yeah. Broadly speaking, like I shared exactly like kind of what my costs were. Yeah. What should people expect to spend on average? So.

Really great question and really good to have, I think, a little insight at the beginning of how many rounds you might need to go through. Oh, yeah, yeah, yeah. So you were in a great position. You were young. You had a good reserve. One and done. Great. Have everything that you're hoping for. Yeah.

In that scenario I described earlier, it's like, oh, maybe we get 10 eggs and end up with like one or two normal embryos. Well, if you want more than one baby, you're probably doing this again. And that's a whole separate cost. So it's really important. And there are no cost savings if you go a second go. There is –

At spring, there's like a slight discount on like repeat cycle for like egg freezing. But generally, it's almost the full cost. Like the medications is the full cost again. So it's really good to have a very honest conversation about, you know, with your physician about like realistically how many rounds do you think I need? Now, some people get lucky and, you know, only do it once and be good. But for some people, like I fully expect for their goals and their ideal family size, like

You're going to need to do this two, three times. And then if it's out of pocket and there's no insurance coverage, it's that 20K times three, the medications. Times three. Times three. And then if you use them. Insemination times three. Yes, on the back end. Then it's like all of those things. Yeah. Times three each time you do a transfer. So it's very, I think, important to just really grasp what, like best case scenario and worst case scenario.

Yeah. In terms of like how many rounds you might need to go through. Is there any way to like somehow squeeze out some cost savings here just so that more people can get access to this like in their younger years? So at Spring we actually have a payment plan for egg freezing, which part of the goal is exactly as you said, just to help make it more accessible to people. Because usually the people who would probably benefit from it the most are

are the ones who are like, I'd really like to, but it's just not attainable for me. So with the payment plan that we have, it's basically $250 a month, interest-free, for 40 months.

Interest-free is like a really, really nice offer. Yeah, which is really nice. But basically it's like about the cost of an Equinox membership or something like that. The medications are their own thing up front, but at least then it's not like the big up front fee initially. Yeah, of course. Of course. So that's one of the things to look into. And I always tell people like –

look into your insurance, look into like your HR department, specifically ask them, do I have fertility benefits? I can't tell you the number of times I've had people who are like, oh, I didn't realize I had this benefit for like the first two years I worked there. It's as if they're like not advertising it somehow. Well, no, they're not advertising it because it's expensive. They actually are not advertising it. But then they find out like, oh, well, I should do this because I have the benefits. But it's just,

kind of crazy to me that you're like, wow, you have this really great benefit and you had no idea. So always ask. And if you don't have benefits, it's really one of the things that a lot of people have been able to push for as a, like, you know, for their employers because this day and age, especially in like the tech sector, like,

A lot of companies are starting to offer fertility benefits because they're realizing it's really important to people, especially if they're putting off their family in order to work more up front. Yeah. People are like, hey, XYZ company is going to pay for me to do an egg freezing cycle. Like,

What do you got to help me out? Which you should 100% like push for that. I've had people who have told me like, you know what? I don't have benefits now, but I'll be back in a year with benefits. And they've done it. Just by like going to their HR and being like, this is important. If you don't give us, you know, like if you don't factor this into our lives, like.

It's an important selling point for staying at that job. Yeah. I mean, what was it that people were picking up random shifts at Starbucks because Starbucks as a corporation was offering fertility benefits to anyone who worked over a certain number of hours? Yeah. I mean – Yeah. I've seen people switch jobs. I've seen – Yeah. Because if that is your most important goal, to have a family, and you can't afford it out of pocket –

That's oftentimes like the only route people have to go is like they have to switch their job to get a job that has fertility benefits so that they can go through the process. I want your POV also on medical tourism. So I think there's...

the good and bad case. Like I know some people who are, you know, big time celebrities, they're practicing medical tourism in places that may just have like more advanced technology, whether that be going to the UK or something. But then there's also people who are like, hey, I went and got like a BBL somewhere that's like a little sketchy. Like, do you think medical tourism is a viable option, one, for fertility, but also like, is it a smart one?

It's a pretty big question, but not necessarily like one straightforward answer. I'd say it's not all bad, but you really have to do your research and know what you're getting into and really have to think about what all of the like hidden costs that will add up down the road will actually be. So sure, you can go to a different country, freeze your eggs for a cheaper price, but you really need to factor in like,

What if I'm someone who needs to do multiple rounds? What if I have a low reserve? Do I travel back there like three times? Or when I need to use these eggs or embryos, what does that cost? And then like five years down the road, are we also having to go back to this place

What are their success rates? What does their regulatory body look like? What is the support system that you might have there if something goes wrong? Most of the time, this is a fairly safe, straightforward, low-risk procedure. But any medical procedure has some sort of complications that can be associated with it.

And who's going to be there to help you out? I mean, I went under. Yeah. Yeah. You have like anesthesia. You're under. And most of the time, it's straightforward, no complications. But heaven forbid something happened, like what hospital are you going to go to? Like who are you going to be able to communicate with there? So definitely more feasible if you have connections in some way, shape, or form to wherever that location is. Yeah.

Or like know people who have used them and who can vouch for their success rates. Yeah. Because in the U.S., everything is very heavily regulated. So it's kind of a matter of like seeing is this other place up to snuff on their regulations and safety data and all of that. I love that. So also I wanted to get kind of into –

what folks can do in their everyday lives aside from just fertility treatments right away. Like, are there smart choices that people can be making in their 20s that'll set them up for success in their 30s and 40s to do this? Yeah. So a couple things. I think it's really good to be in tune with like just your normal cycle and what is going on with your body. So

For people who are, like, not on birth control, I say track your periods. See, are they regular? As gynecologists, we consider it, like, you know, another vital sign as, like, how often do you get your periods? There's a lot of people who, like, don't pay attention to it or maybe it's, like, very irregular and they, like, never really thought about it until they're actually trying to get pregnant. But it's good to sort of, like, touch base with yourself and be like –

Do I actually get regular periods? Are they extremely heavy or painful? Is there something else that might be going on? The earlier you can know about things that might affect your fertility, the better because you can act on them. So things like fibroids, things like polyps or endometriosis, the sooner you can know those things, the better. Another thing is knowing your family history. Do you have a family history of early menopause? Nobody talks about fertility.

It's not in families that I know of, but sometimes people will be like, oh, yeah, I actually went to try to get – I'm having difficulty conceiving. I finally talked to my parents about it. They're like, oh, yeah, like X, Y, Z. There's all this family history of it. So it's good to be aware of those types of things. I think you touched upon this a little bit already, but there is so much like processed foods, processed materials, like plastics everywhere. Yeah.

I'd be a fool to say like, avoid all of those things because you can't. But I think being cognizant of what you're putting in your body is really important. You know, try to eat real food. Try not to have it be like, you know,

In a bag. Yes, exactly. Exactly. There have definitely been these like declining fertility rates in the last few decades that are a little bit baffling of why this is happening. And I can't help but think like some of it has to be like we're just around so much more. The PFAS. Yeah. They're getting us. I swear. I swear. And when you look at sperm counts too, like globally, they're just on this downward trajectory. And it's like, why is that happening? Wait, can I tell you? I...

I made Boo swap out his underwear

Because he had these like athletic weave, like not cotton underpants. And I, for some reason or other, I was served this fun little video on TikTok that was like, if your man has polyester underpants, it's zapping his sperm. I went and threw out all his underpants the next day. I was like, we're getting cotton underwear. I don't care if you're sweating them. Like, it doesn't matter. You have to wear these undies. And he was like,

oh my God, like why? And I was like, we're going to be prepared for this. And it worked out okay. So I have no idea if the underwear had anything to do with- It didn't hurt the cause, obviously. The other thing that I find very interesting, I had no idea about, was how many men in New York City use saunas. Oh, you're not supposed to sauna if you're a guy? Yeah.

It can definitely affect your sperm counts. I've had, I cannot tell you how many cases where like they come in for a semen analysis, looks totally normal, good. Come back a little bit later. I'm like, where did it all go? What's happening? And they're like, oh yeah, I use the sauna like three, four times a week. If you're trying to get pregnant, really like tell your guy, reel back on the saunas because it definitely can affect sperm counts. They're like getting cooked. Yes. They're basically like cooking themselves. Yeah.

- Yeah, yeah. - Oh my gosh. - Yeah, so other lifestyle things. - And these are all things that you can do for low to relatively low cost that can help the case out so you hopefully don't need that third round of this. - Exactly, exactly. - If you can get it done in two, that's great. - Exactly, and I always tell people too, anything a cardiologist would tell you is good for your cardiac health

Also good for your reproductive health. It's like moderate exercise, eating, you know, a healthy, well-balanced diet with like fruits and veggies. Now, there's no one diet that has been proven to like definitely increase or decrease fertility. But generally, it's like common sense things like don't eat greasy, fatty foods, like limit red meat consumption to like three times or less per week, I would say. And then, you know, antioxidants.

And exercise. So anything cardiologists would say is good. I would also bless that as they generally can only help your reproductive health. I love that. Thank you so much for all of your wisdom. Kind of final question for you is just, is there any sort of fertility financial takeaway that you want to remind all of our listeners of? I would say...

Knowledge is power. Knowing, do you have benefits? Knowing how to use them in their most optimal way. There are definitely smart ways you can use your insurance and not so efficient ways you can use it. And then also taking a step back and looking at your own health. That's the other part of information that knowledge is power. Do I have a low reserve? Do I have medical conditions that might raise the chances you might need fertility treatments? And what are my goals?

It's really important to have just an honest conversation about like, here's what I would like with my life. And here's I'm going to best set myself up to possibly do everything I can to achieve that goal. And that's wonderful advice. Like not even so much just for fertility, but for life. Yeah, life advice. Everyone's like, you just got to take a beat and like check in with yourself and be like, what?

What do I want? How do I get there? Yeah. Thank you so much for being here. Of course. This is great. Thanks for tuning into this week's episode of Net Worth and Chill, part of the Vox Media Podcast Network. If you liked the episode, make sure to leave a rating and review and subscribe so you never miss an episode.

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