I had an ultrasound last week. The front desk staff was friendly, and the nurse practitioner warmly chatted with me before we got started. We talked about a ring I was wearing, she asked about my toddler daughter, we laughed at some joke. It was standard medical appointment small talk — nothing out of the ordinary at all — but it stood in stark contrast to the care I’d been receiving in the previous four months.
Since December, I’d been going to a private fertility clinic trying to get pregnant. Now that I’d succeeded in doing so, I was at a local hospital for my first prenatal appointment. Putting the two experiences side by side, I was struck by how different they were: here, I felt like a patient; there, I felt like a customer.
Right off the bat, a caveat: not all fertility clinics are bad. Some are great — I loved the treatment team that helped me get pregnant with my daughter back when I lived on the other side of the country — and some prenatal departments at hospitals are horrible. Plus, people tend to rate their experience at a clinic more poorly if they don’t end up with a baby, which means that some good clinics are judged through an unfairly harsh lens.
But make no mistake: the fertility industry is very much an industry, and often, that’s apparent.
There’s a lot of evidence that fertility clinics prioritize the bottom line above patient outcomes. For instance, fertility doctors will commonly transfer multiple embryos during IVF cycles, a practice that results in unwanted multiples for mothers but helps the clinic juice their success rate to get more people through the door. What’s more, clinics sometimes refer patients to loan companies to finance their treatment, and then get hefty referral fees from the companies. There are also sketchy “baby-or-your-money-back” setups, which almost always work out with the clinic as the financial winner. Though some of this is new, it’s been this way for a while: back in 1999, Dr. Sam Thatcher, a reproductive endocrinologist and pioneer of fertility technology, wrote a scathing indictment of the industry, raising concerns over the lack of regulation and clinics’ tendency to put profits first.
Patients can feel this. “All these clinics are after is your money,” declared one woman in a BBC article. “I’ve never received a phone call or letter after a failed cycle.” Another from the same article said she found “very little compassion” and felt like she was “on a conveyor belt.” On the Yelp page for the clinic that I went to, one woman’s review reads: “This clinic is all about the bottom line. If you want someone to hold your hand and care for you, I’d seek it elsewhere.”
I understand where all of these women are coming from. Every time I walked into the clinic for an appointment, the receptionist would ask for my last name — despite the fact that she saw me almost every week, often several times a week — and then immediately tell me how many hundreds of dollars I’d be paying that day. After my ultrasounds, I’d meet with the doctor standing up in an open hallway to talk about my treatment plan and address any questions I had — a startling adjustment after the closed-door, sit-down meetings I’d had with my wonderful doctor back in New York. I never got a solid answer on why we were doing a different treatment protocol than the one that worked for me before; my questions were waved away. At one point, I asked a question that led to a medication change, a change that I’m quite sure is the reason I’m pregnant today. If I had not asked that question, I would likely still be throwing thousands of dollars at the clinic each week, becoming increasingly desperate and hopeless.
The last time I went to the clinic was on March 17, for the IUI that ultimately resulted in pregnancy. Since then, I’ve not been contacted once. There is not even a gesture toward follow-up, a charade of caring how I am and what the outcome was.
I have a few theories about why fertility care can be so much colder and more transactional than prenatal care. For one thing, fertility treatment is considered elective, in the same category as plastic surgery, so doctors may be inclined to treat patients more casually (though as anyone who’s gone through it knows, it is anything but casual). For another, fertility treatment is often not covered by insurance, so if you feel more like a paying customer, it’s because you are. There’s also, of course, the omnipresent influence of the patriarchy: We value pregnant women more than non-pregnant women because expectant women are fulfilling their moral obligation to reproduce. What worth does a woman’s body without a baby inside it have in our deeply sexist society?
I’m on the other side of things now. Looking back at my fertility treatment, I can even find it funny; every few days I’ll say to my husband, “They still haven’t called me,” and we’ll both laugh. I’m grateful that I’ve made it here, and that for the next seven months or so, I can look forward to compassionate care, care that lets me know that me and my baby are in good hands.
But my experience, and the experiences of others, shows that this industry needs to change, needs more transparency, needs a greater emphasis on not just outcomes and bottom lines, but the experience of real people giving it their all to become parents. Would I go through all of this again to be where I am now? Absolutely. Does that make it okay? Not one bit.
Kate Willsky is a freelance writer based in California by way of Brooklyn. She covers a range of topics, including health, culture, food, and parenting. Her bylines include The Washington Post, VICE, SELF, Glamour, and Eater, and you can find more on her website.