An all-inclusive vacation, but self-served? Welcome to fertility care where you have all the expenses but none of the white glove service.

On the latest episode of my podcast, Let’s Be Heard (LBH), I was chatting about fertility care in the US with Traci Keen, founder and CEO of Onto Health. During our conversation, Traci shared how frustrated she and her wife felt when going through IVF, and she used an analogy that stuck with me.

And that’s another thing that my wife and I found really frustrating – it was always us driving the process forward, which makes you feel like, I'm paying you the better part of 25 or 30 grand. Why am I the driver here? Not to be preposterous, but if you pay $25,000 for a vacation, you're going to expect some level of white glove service. And there's just this huge gap where the patient's driving the process forward, and that's got to shift.

I had never thought about fertility care that way. But Traci is absolutely right. The vacation example shows just how absurd fertility care feels today, placing all the weight on the patient. 

So, picture this. You book a luxury vacation. You pay top dollar. You arrive at the hotel expecting a seamless experience. Instead, there is no valet. The parking lot is crammed, and the only open spots are a long, hot walk away. You drag your bags through the humidity, finally reach the front desk, and find no one there. You ring the bell. Nothing. You wait, frustrated, before hunting down a staff member yourself. 

When you finally get your room key, you learn the hotel has no elevators. You climb five flights of stairs, sweaty and exhausted, only to open your door and find the bed unmade. The sheets and comforter are just sitting there. You call for towels, but all you get is bad hold music and no help. So, you climb back down the stairs, search again for someone at the front desk, and after a long wait someone finally hands you two hand towels. 

You collapse on the bed and wonder: why did I pay so much for this? Why am I doing everything myself? 

This is how couples feel going through fertility care. It is a fragmented, clunky experience because fertility clinics operate in a liminal space within healthcare. They sit outside traditional insurance-driven models and follow a consumer cash-pay structure. Patients are forced to navigate care pathways both inside and outside the healthcare system. For something as emotionally charged as fertility care, that burden is heavy.  

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Take Traci as an example. She is more knowledgeable about the complexities around fertility care than most people, yet she still struggled with going through the process as a patient. She and her wife started out with Intrauterine Insemination (IUI) treatment, which involves using a device to place sperm directly into the uterus during ovulation (i.e., when the ovary releases an egg). You can think of it as similar to a shower head with high pressure versus one with rain style. 

The first IUI treatment failed. Then came the second one, which also failed. After that, Traci and her wife shifted to in vitro fertilization (IVF), which involves an egg being fertilized by sperm in a lab setting rather than inside the body. For this process, Traci and her wife needed to retrieve their frozen eggs from the storage facility and take them to a fertility clinic to make embryos with the donor sperm. Now, you would think that should be simple right? Yes, but no. Far from it actually. 

They could not get an address for the clinic. Traci called over and over, until finally giving up and moving her wife’s frozen eggs to a different fertility clinic. The whole process took them seven months, which is precious time you can’t get back as a woman.  Traci’s wife, who plans to carry out the pregnancy, is 40 years old.  

In terms of costs, the couple had to pay for the initial egg freezing, storage fees, donor tissue, transport expenses, and a surprising $1,500 "processing fee" simply to access / process out eggs that were already theirs. 

Overall, the lack of timely responses, unclear expectations, seeming forgetfulness, and apparent indifference to Traci and her wife’s urgency created both emotional distress and practical delays.    

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So, how did we get here? Infertility was not widely discussed as a medical issue until the 1970s. Research on infertility is still relatively new, and like any new field in medicine, it was met with skepticism. After the first successful IVF birth in 1978, many religious institutions called it immoral and much of society saw it as unnatural, even frightening. Fertility care was treated like medicine’s scarlet letter. Over time, this created a deep divide between fertility care and the rest of healthcare. 

The result is what we see today: all the costs with none of the support.  

With fertility care, people have accepted this as normal. But if you compare it to any other high-cost experience, it is absurd. You would never spend $30,000 on a vacation and accept poor service. Why do we accept that in fertility care?