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Fertility Loans: When Hypothetical Meets Reality

There was an article on fertility loans in Slate a few days ago, and I barely paid any attention to it because my feeling was that loans are loans.  There is a long line of people making their money off of my medical situation, and most of the time, it doesn’t bother me.  I make my money off another person’s inability or lack of desire to string sentences together.  They hire me to write for them, and I don’t see this as very different from paying my doctor to utilize his skills and medical equipment.  And in regards to fertility loans, they are just one more fork in the pie.  My body doesn’t work properly, and they’re willing to underwrite the possible solution so I can deal with the problem.  And in exchange, I will pay them back for fronting the money now, and I will pay them extra for doing this for me.

Then I actually took the time this morning to read the Slate article and realized that it was slightly shadier than I thought on the surface.  Some fertility doctors are taking kickbacks from fertility loan companies to send patients their way.  I’ve heard of this happening with drug companies.  I’m giving all my doctors the benefit of the doubt that they’re prescribing the best medication for my particular situation, and I have no problem with medicine representatives giving doctors samples and explaining how their medication works.  After all, they are like a walking advertisement for the medication, and doctors may not know about a new medication or a new use for an old medication if they are not provided with the information.  So visits from a drug company representative = potentially good.  Kickback from a drug company so the doctor will prescribe their drug instead of the competitor even if the competitor is the better drug for that particular patient = abuse of the system.

And then it stopped being hypothetical, and the article got very very personal.

My doctor, who I think is an amazing physician — caring, kind, thoughtful, funny, intelligent — owns a stake in a fertility loan company.  The one I was pointed towards when we returned to treatments and no longer had any insurance coverage for treatments.  (We had decent insurance that paid for a few things the first time around, and we covered the rest of the bills with our savings.)  So he was recommending that I take out a loan to cover my medical bills, and he owns a stake in that company and additionally makes money when I take out a loan with that company.  In the article, he doesn’t see this as a conflict of interest, though I don’t recall him disclosing his connection to the company when he recommended it.

The option was presented to us to do with as we wished — we certainly weren’t pressured to use the loan company — but I wish that as the pamphlet was being handed to me, I was told, “I have to admit that I have a stake in this company, but I think they’re an upstanding lender and you may want to consider them.”  Would my doctor still buy a stake in that company if he didn’t know that it was doing well?  And knowing that he only collects back from his equity ownership if the company does well, does he have a vested interest to make the lender do well in order to make back his money?  While this isn’t the same as him investing in a company that bets against me to lose, this feels a little bit too much like insider information.

We took a break from treatments a few years ago and have never returned.  We took a break because our friends were losing their jobs left and right in the recession, and we were worried that we’d be next.  When we were trying the first time around, we were willing to take on any debt.  But now our financial decisions would affect the twins we had from our first round of treatments, and it didn’t seem financially sound to take money away from them for a chance to have a third child.  It was an impossibly hard decision to make, and there were a lot of tears over the idea that while we had the means to support a third child once they were here, we didn’t have the means to create said third child, even though other people on earth create their children for free.

When it felt like the job world stabilized, that same mentality followed us into the stability.  I didn’t have a great chance of conceiving with my own eggs years ago; and fertility only declines with age.  We could try with my own gametes, but when the money ran out, the money ran out.  We could pay for the more expensive shared risk program with donor egg, but part of my problem was the clotting disorder, and that seemed like a gamble with our money as well.  And then we became deer in headlights, unable to move forward and unable to step back.  We’ve been living in a non-decision for a few years now, batting around different ideas.  Most of the time, it’s just something we don’t deal with, like that pile of papers in the corner of the room.  We know it’s there, we want to deal with it, but then we can’t wrap our mind around the best way to proceed so the clutter just sits there, in our line of vision.  We think about it all the time.

I read an article like this, and on one hand, I don’t care.  In the end, all I want is my third child, and when I have that, I close the door on the clinic.  They will not be part of my life forever, they’re just the vessel to bring our family together.  I don’t need them to treat me nice; I just need them to do things ethically and in my best interests since they have my overall health in their hands.  I don’t really care if they see me not as a human being but as a pile of money.  Again, I’m not there to make friends; I’m just there to have a family.  But I do need to state that I never got the sense that my doctor saw me as a pile of money.  My doctor sat on the phone with me and gave me a pep talk when I was falling apart one afternoon at work.  He treated me as an intelligent, important member of the team.  So there’s the quote in the article, but there’s also the other side: that he was incredibly caring, never dismissed my feelings, and ultimately helped me conceive the twins.

The other reality is that if we went back, I wouldn’t have to take the loan; in fact, now that I know this, I could opt to use a competitive loan company.  I can educate myself (actually, I think we’d all agree considering I wrote a book about infertility, that I’m pretty well-educated), and if my doctor’s recommendations for treatment don’t mesh with my comfort zone or he can’t explain why he is making these choices, I have the right to walk and find a clinic that will make the best choices for my body.

It’s easier not to deal with that clutter in the corner of the room; the corner of my life.  I look at the situation, and I become so overwhelmed over the idea that I need to be this on-guard.  I look at the twins and think about how I don’t want to miss out on one second of their lives in order to chase a third child.  I don’t want to take anything away from them in order to put it into the possibility of someone else, even if I know that if that someone else were here, I would equally say that I can’t believe I ever thought about not doing everything in my power to bring them into our family.

Which leaves us still in the exact same place.  Because articles like this Slate article don’t push us forward or back.  They just leave us in the exact same place that we started.


1 gwinne { 07.18.12 at 11:26 am }

This is, I realize a small bit of a large (and wonderful) post: “I don’t want to miss out on one second of their lives in order to chase a third child.”

You know, I think I said point blank on my blog, when it got started, that if fertility treatments for #2 in affected my relationship with #1, I’d stop. Yeah, could not have been more wrong. She was affected in all sorts of daily practical ways, not to mention emotional ways. But that girl wanted a sibling–oh, she wanted a sibling–and in the end everything was worth it, I think, even for her. She dotes on her brother.

In terms of the bigger issue: wow, I’d be icked out if I ever found out something like that about my doctor. I might have spent tens of thousands conceiving my children, but she also gave me a freebie IUI every now and again.

2 Jendeis { 07.18.12 at 11:41 am }

Great post – nodding all the way. Particularly agree with you about the doc being upfront about his interest in the loan company. If he does not believe that there’s a conflict of interest, why not say so? For me, it’s like the difference between following the letter of the law and following the spirit of the law.

As for becoming well educated about all your options, yes, I agree that each person needs to educate themselves, but isn’t your doctor supposed to be part of that? Someone who may advocate one choice over another, but someone who allows you to make an INFORMED choice? This just leaves a bad taste in my mouth.

3 Sharon { 07.18.12 at 11:44 am }

One thing I found particularly troubling about loans for fertility treatment is that they seemed to be lumped together with elective procedures like breast enhancement, liposuction and cosmetic dentistry. While I will concede that fertility treatment is “elective” in the sense that almost no one dies from infertility, I don’t think I would put the desire to be a parent in the same category as wanting to have prettier teeth, a smaller butt or bigger breasts.

Also, why is it that insurance companies pay for drugs like Viagra and Cialis but not for fertility treatment? Not being able to get an erection is a medical condition, but not being able to procreate is not? Hmmm.

4 loribeth { 07.18.12 at 12:12 pm }

Ugh indeed. Seems to me like taking advantage of someone when they’re at their most vulnerable.

Debt was one reason why we made the decision to stop when we did. We saw couples all around us going tens of thousands of dollars into debt. We’d worked hard to build up the savings we had and, much as we wanted a child, I just couldn’t stomach the idea of gambling it all away on what was a very long shot at parenthood, with odds that were decidedly not in our favour. I think the odds would have been better in Vegas, quite frankly.

I found out (via a message board), about five years after we left treatment, that my RE was cited for misconduct the local college of physicians & surgeons. He was fined and his registration was suspended for three months, pending completion of an ethics course (big deal, right?). I had had mixed feelings about him all along, but when I heard the stories (not sure I should repeat them here), I was very glad that we hadn’t pursued treatment further, and certainly not with him. :p He is still practicing & still gets rave reviews on local “rate your dr” forums.

5 Bea { 07.18.12 at 12:15 pm }

Yeah, so, I read that article and I thought, um, hello, unethical conflict of interest. How can the doctor not see that? I mean, maybe he means it doesn’t change his clinical practice. Hopefully that is the case. But really, the temptation should just be made unavailable (at the very least, disclosure, but I really think made unavailable).

On the more personal note, though – it’s always tempting to leave a difficult pile of clutter. I know you’ll clear it eventually, and hope you feel comfortable with things when you do. Whatever happens.


6 Mud Hut Mama { 07.18.12 at 12:55 pm }

That is very shady. Even though you had a great experience with your doctor, I really think he should have disclosed what his stake in the loan company was when he gave you that information. There are certainly excellent fertility doctors out there, but there are also many who only see dollar signs. I appreciate that this is how they are making their living and don’t begrudge them their fee when they are honest with their patients but I think there are too many that are only looking at how much they can make off each patient instead of what is in that patient’s best interest.

I still get angry when I think about the first RE we saw. He took advantage of us and set us back rather than than helping us move forward. We were heartbroken by the infertility and then devastated to find out that the person we had turned to for help had taken us for a ride in order to make a lot of money out of us.

While having a share in a loan company he recommends may not be the same thing as strongly recommending an unnecessary surgery, I think there is still a conflict of interest. Yes we have to be educated consumers but it would be really nice if we could take our doctors’ recommendations – for treatment, for loans, and for referrals – at face value and not have to question if the recommendation is for our best interest or for their personal financial gain.

7 Kristin { 07.18.12 at 1:14 pm }

I think regulations on this issue vary by state. I live in California and I do believe that medical professionals are legally required to disclose financial stakes in complementary services. For example, my first RE had a financial stake in a health clinic next door to his office, which provided out-patient services. All of his forms indicated this information. To not disclose, whether they are legally required to or not, is incredibly shady!

8 a { 07.18.12 at 2:23 pm }

I think the non-disclosure is a little shady. I don’t mind about the idea of loans, but if doctors have a stake in a company they’re recommending…well, that is certainly a potential conflict of interest. The point of conflict of interest is not whether the parties involved believe there is one…the point is whether an outsider would be likely to believe that there is one.

Good luck wading your way through that clutter. If you sit it out long enough, it will take care of itself, but that may not be the result you’re looking for.

9 Denver Laura { 07.18.12 at 3:10 pm }

My RE offered links to a few loan services. I did contemplate getting the shared risk IVF loan but ultimately decided against it. I did get a personal loan for the last IUI. I could have put it on my credit card but since I was already paying for the first IUI out of pocket my cash reserve was a bit low. Plus the personal loan % was lower than my credit card so it made sense. I don’t think I would have thought of getting one if it had not been for the RE. Him getting a kickback would not have made any difference to me whatsoever.

10 jjiraffe { 07.18.12 at 4:16 pm }

“I look at the twins and think about how I don’t want to miss out on one second of their lives in order to chase a third child. I don’t want to take anything away from them in order to put it into the possibility of someone else, even if I know that if that someone else were here, I would equally say that I can’t believe I ever thought about not doing everything in my power to bring them into our family.”

This is exactly how I feel now. And I feel stuck, too.

11 Cristy { 07.18.12 at 8:28 pm }

The Slate article scares me. The idea that doctors have a vested interest in pushing certain types of treatment on couples who are so desperate for a child. This already is happening in other areas of medicine (http://www.npr.org/blogs/health/2012/04/04/149978690/doctors-urge-their-colleagues-to-quit-doing-worthless-tests), which is already unethical. The difference here is that it’s targeting a specific population who generally do not have any medical coverage. What’s to stop a doctor from pushing another round of IVF simply because they know they can milk a couple who longs for a family?

One of the main reasons we decided to stop treatments is because we couldn’t justify spending thousands of dollars on “bad luck.” Yes, I get that IVF is a numbers game, but I can’t justify the cost (financially and emotionally) of continuing based on such uncertainty. The thing is, I completely understand why others would chose to continue with treatment. The longing I have for a child has not lessened since we made this decision and it’s something that haunts me daily. Based on this, I think it is a violation of patient trust for a physician to own stakes in a product that they are pushing. At the very minimum, they should at least be disclosing their financial interests to their patients.

12 Chickenpig { 07.18.12 at 9:02 pm }

Stuck in the same place where we started, you and me both, my friend. I’m wishing you the clarity and strength to get un-stuck.

13 Lori Lavender Luz { 07.18.12 at 9:04 pm }

If the FTC is concerned that we bloggers offer our readers full disclosure over a bottle of shampoo or a package of Bic shavers, I can’t understand why practices that involve thousands of dollars and human life are not held to the same standard.

Sending you a hug, too, Mel. XOXO

14 Io { 07.18.12 at 10:26 pm }

When Al had his MESA the doctor by law had to have us sign something acknowledging that we knew he had a financial stake in the surgery center where it was done. Of course, what I know now is that if you are doing IVF with my RE he will let that exact same doctor use his facilities for free. so it would have been like $1300 or so less. Not that we had the money for IVF too at that time, but it would have been nice to hear that was an option.

15 Io { 07.18.12 at 10:28 pm }

Ack. I meant to add that when you are so overwhelmed with such a bad diagnosis you aren’t necessarily asking the questions. I grew up assuming the doctor would never mislead me.

16 Queenie { 07.19.12 at 5:14 pm }

If the ethical standards governing lawyers and politicians don’t allow this type of behaviour, why do we tolerate it in doctors?

I’m struggling with the question of how you decide to be done family building. I always thought I’d just know, but I don’t. At least, clarity hasn’t yet arrived.

17 Esperanza { 07.20.12 at 1:09 am }

Wow, I think that is kind of shady that a doctor would own a stake in a loan company that people use to pay for his services. That feels very unethical to me, though I can’t articulate why in quite the way I want to.

Thank you for sharing your family building story. I had always wondered if you’d continued treatments to have another kid or if you were still doing so. I appreciate hearing the thought process you used to get where you are today. Thank you for sharing that. And I’m sorry finances came between you and your third child.

We will probably be in a similar situation, though I guess it’s reversed. While we can afford to bring a third child into the world (because as far as we know we wouldn’t need to use ART) we won’t be able to afford a third child over his or her lifetime. And that is going to be really hard for me to face some day. I think my partner will be totally fine with it though. Maybe I should worry to much about that until I manage to have a second child. I’m always getting ahead of myself.

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