This is the twelfth installment of Barren Advice. You can ask questions that are fertility or non-fertility related.

Barren Advice is posted each Tuesday. If you have your own question for Barren Advice, click here to learn how to submit. Please weigh in with your own thoughts in the comment section and indicate which question you’re addressing if there are multiple questions in the post.

Dear Mel:

My husband and I are in the early stages of preparing for IVF treatment. We are doing the tests required by the fertility clinic. I have been searching everywhere for information about the payment process, specifically regarding paying for multiple cycles. When I spoke with the clinic’s billing office, they stated that you do not get a refund if you become pregnant on the first cycle, even if you paid for 2-3 cycles. At this particular clinic, it costs $6,900 for the first cycle and about $11,000 if you pay for 2 cycles. So, you save money if it takes you 2 cycles to get pregnant but you lose a big chunk of money if you get pregnant on one. This doesn’t include medication costs of course.

Is this standard procedure for most clinics? I understand that you are happy just to get pregnant but it seems like they are taking advantage of desperate people. I can understand if they don’t refund you the entire amount but what is the reasoning for not refunding any money at all? Do you know of anyone who has successfully fought back against this policy?

–Anonymous

Shared risk is a great plan for those without insurance coverage with the emphasis on the word “shared.” You are sharing the risk with the clinic; meaning, if you don’t get pregnant, they ate a lot of the cost and if you do get pregnant, you may have eaten an extra portion of the cost. But the risk is shared by both parties.

With a single payment plan, the risk isn’t shared at all. It’s solely on you. Therefore, if you get pregnant, great–it will cost $6900. And if you don’t get pregnant, we’re sorry–but it will cost you $6900. And it sounds from the question that you’d like the risk to be solely on them. And it would be nice if they were willing to work with that, but since you have the option to apply for the program or the option to pay per cycle, it isn’t really feasible for the person requesting the service to also have the service pay them to use them essentially. In other words, you need them. They don’t need you (though they do need customers and they have set up these plans in order to make IVF more accessible to a larger population. Though, “more” is an relative word when you’re talking about thousands of dollars).

Here’s the thing with shared risk: because the clinic is deciding who qualifies for the plan, they are not taking anyone they see outright as a risk. Because that isn’t in their best interests and they are a business and not an altruistic organization. Which sucks to think about because they are doctors, but you can’t think of them in the same way you think of your local emergency room staff. It is simply a different kind of medical service. So if you qualify for the plan, it means they think that you have a greater chance of getting pregnant in one IVF cycle than you do taking two or more cycles to get pregnant.

You can do what you wish with that information.

Some people see if they qualify for shared risk and then decide that they’d rather take the gamble and pay per cycle. If they get pregnant on the first try, they saved a lot of money. If they get pregnant on the second try, they lost a little bit of money. But if they get pregnant on the third try, they lost a lot of money.

Here are the pros and cons to a shared risk plan and who should or shouldn’t use the plan if they qualify:

Should:

• If you are worried about the financial side of things and would rather know a flat end price than pay little bits at a time, never knowing fully how much you’ll spend in the end.
• If you have a lot of stress in your relationship about financial matters and want to argue about cost one time.
• If you want to remove some of the stress inherent in a cycle.
• If you want to have options to try different protocols.
• If you have unexplained infertility or no clear diagnosis.

Shouldn’t:

• If you are doing it to save money (because you might or you might not and you’ll be right pissed if you lose money and this was your reason for entering into the plan).
• If you think you will get pregnant in one try.
• If you have a clear diagnosis with a clear solution.

See which list you fall in and what you should do. I have seen both sides of this fence: one friend entered into shared risk because she thought she would save money. She got pregnant on the first try and is still bitter to this day that she paid more for IVF than she would have if she had paid per cycle. She really didn’t enter into shared risk for the right reasons. I also have a friend who just left a shared risk program having a large portion of her money returned because they couldn’t get her pregnant. She is obviously thankful that she is getting a portion of her money back because if she hadn’t done shared risk, she would have paid for numerous fresh cycles and had nothing for it in the end. She can now apply that money to a different path to parenthood.

And that’s the beauty of how these programs work. The plans are not actually for paying for IVF. They are simply insurance for when things don’t go according to plan. And you need to decide whether or not you need insurance simply because it is offered.

No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely. I would love people to add their feelings if they used (or didn’t use) a shared risk plan.

Leave a comment in the reaction box below–only keep in mind that conflicting advice is embraced and rudeness is not. Want to ask your own question? Click here to see what you need to send in order to be included in a future Tuesday’s installment of Barren Advice.

I am very good at asking questions. I ask a lot of questions, a lot of what ifs.

I am not quite as good at waiting for the answer. I don’t mean that I’m not interested in hearing the answer and jump straight into the next question as if I hadn’t asked the first one. What I mean is that I’m not very good with that period of time between asking the question and getting the answer.

That lag time is the emotional equivalent to radio’s dead air.

I don’t know where my impatience stems: if I think that the silence means that it won’t ever be answered (and what is the worst that comes from that?), or if we’re just accustomed to a “now” culture, or if I’m imbuing meaning from the fact that I have been given an answer.

Let’s just say that Eat, Pray, Love has been raising many internal questions about why I do what I do and why I worry where I worry. And I’ve been closely considering the time between the question asked and the question answered.

What do you do in that space? Forget you even asked the question? Wait impatiently for the answer?

Gaaaaaaaaaaaaah! Tell me now!

Any while you think I’m being facetious, it’s really just feigned facetiousness so I don’t appear to be a complete freak. But I truly am wondering if I am the only person who has trouble waiting for answers. I am the type who prompts the person to keep talking when their voice trails off as they’re thinking.

On a completely unrelated side note, we were watching Food Network last night and Duff was on an episode of another show. He told the host that he had been a chef for over 20 years and Josh looked at me dryly and said, “did you know that? That in the free moments when you weren’t making out with him during that middle school trip that he was cooking? Damn you frittered that.”

And this is biting me in the ass ten-fold this week because I’m making a cake for a shower and using fondant. And, as I’ve said before, I skipped the fondant classes when I was study cake decorating because of the girl who would yammer on and on about her fan-fucking-tastic pregnancy (why bother showing up to class when I’m going to spend the bulk of it in the bathroom crying?). I could use some advice. Some colouring fondant advice. And, as Josh says, I frittered that away. In more ways than one.

Welcome back to Show and Tell. Everyone is welcome to join, even if you have never posted before and just found out about Show and Tell for the first time today. In fact, we hope you do go back to your blog and post your own Show and Tell item and then return with the link to your post. Details on how to participate are located at the bottom of this post.

Let’s begin.

A week or two ago, in the middle of a massive, gulping-while-crying meltdown, I wailed, “and I’ve never owned a business card.” It is simply just one of a long stream of things I would like and do not have. I have never had a job that warranted a business card (teaching just isn’t a business card-like profession) and while I still do not have a job that warrants a business card, I cannot help coveting them and what they mean.

Josh admitted that he could not fix many of my problems, but he could have business cards made. We hopped onto the computer and went through a few design choices and finally settled on the one below. It took a long time to decide what information to place on the card because…well…when it comes down to it, I still don’t have a job with an office that warrants a business card. Therefore, we were stretching a bit to find things to stick on the front.

I have crossed out my last name in the photograph (with so many spammers constantly goading me to change my penis size, it seemed circumspect to not pass out my last name here so the spam emails could be tailored to me any further), but this is the business card that I will have few chances in life to actually pass out to anyone. Perhaps, if we meet at BlogHer, you will walk away with one in your pocket.

What are you showing today?

Want to bring something to Show and Tell?

• If you would like to join circle time and show something to the class, simply post each Sunday (or earlier in the weekend or on Monday if you can’t do Sunday), hopefully including a picture if possible, and telling us about your item. It can be anything–a photo from a trip, a picture of the dress you bought this week, a random image from an old yearbook showing a person you miss. It doesn’t need to contain a picture if you can’t get a picture–you can simply tell a story about a single item.
• Label your post “Show and Tell” each week and then come back here and add the permalink in the comments section below (make sure you don’t just comment that you participated: add a link to your blog in your comment so people can click over). I post a new Show a
  nd Tell post every Saturday night or Sunday. I usually move people up into the body of the post every few hours.
• Oh, and then the point is that you click through all of your classmates and see what they are showing this week.
• If you want it…
  I’ve now placed a Show and Tell archive on the sidebar that will be updated each week in case you miss it. And click here for the icon code if you wish to have it for your blog. It links to the archives.

I have already admitted to being dumber than a napkin, so it probably shouldn’t surprise you to learn that it took many months into the game to finally figure out Twitter. I was getting ready for bed and had an epiphany–it’s micro-blogging. It’s a blog entry in two sentences. And it’s like an enormous blogging IM conversation. The people you follow–you watch their thoughts unfold in two sentence chunks and then people respond (sort of like a comment) and you follow their thoughts and build off of that…

I get it.

I think I get it a little more than Facebook. I certainly get it more than social bookmarking. In the long continuum of things I need to understand on the computer, this is how I would rank my knowledge:

Cross-posted with BlogHer because I’m a cheater, cheater, pumpkin-eater. Unless it’s pie. I don’t do pumpkin pie.

Your blood doesn’t clot properly thereby making it impossible for the embryos created out of your sub-par eggs (coming out of your prematurely failing ovaries) to remain implanted in the uterus, thereby necessitating conception attempts to move from the bedroom to a sterile doctor’s office (and pay thousands monthly for the experience) with a cast of six male doctors staring at your vagina while attempting to manipulate the catheter on any given visit. No one can tell you how long this will take or how much money you will spend or what your body will endure.

But, of course, despite all of that, we’re going to have to ask you to just relax if you want this to work.

Stress reduction has long been held up as the panacea for a host of ailments including infertility. In last weekend’s New York Times magazine, Peggy Orenstein had an article titled “Stress Test” that points out the missing threads in this line of thinking:

It’s not that I think the mind-body connection is a total sham. But even where it would seem most established, say in the relationship between stress and heart disease, the mechanism is unclear. Is stress an independent risk factor or does it merely influence others, raising blood pressure or encouraging over-eating? Either way, popular mythology both simplifies and generalizes the potential harm, applying it to everything that ails us. After all, it feels true: I’m more at peace with my frenetic life after a few rounds of sun salutations. Yet, what does that prove?

I would take it a step further to say that even if the mind-body connection exists and stress levels affect hormone production, pointing out how stress affects the body and asking those in a health crisis to relax through therapy, yoga, and meditation is reductive (and, in turn, raises stress levels when you hit that brick wall). If it were truly a solution, the infertility crisis would be moving towards resolution rather than chaos as technology improves and stress reducing outlets increase.

In the end, it’s a prescription that moves in a circuitous route rather than forward towards a solution. It is an empty prescription–one that states the problem without stating a true solution. It is like this: we can say that overeating leads to obesity. And we can point out ways to curb overeating including portion control, drinking a lot of water, and exercising instead of consuming food. But if these solutions were implementable, many more people would do it. No one consciously chooses to be unhealthy. Yet sometimes we truly cannot help our unhealthy tendencies, no matter how much the head battles the heart.

The reality is that we’re talking about some major emotional rewiring.

It is too hard to stop overeating simply by having someone tell you to stop overeating. It is too hard to stop overeating simply because you are attending therapy or drinking two liters of water a day or even exercising with a personal trainer while eating with a personal chef. Can we do it for short periods of time–even months or years? Of course. When other factors are aligning themselves in the outside world, we can muster amazing willpower to override our natural tendencies. But we can’t sustain this level of self-control indefinitely. We all have a way of moving back towards the way we deal with our stress: overeating, obsessing, consuming mind-altering substances.

Because, what all of these things have in common is the control we are desperately trying to grasp in the face of having a lack of control.

We all have our ways that were either taught or intuited that help us process life. I’m not saying that our methods are healthy. Many times, like stress or overeating, it can be detrimental to our health or push us even farther from the goal. But pointing it out doesn’t make the problem disappear.

Worrying, not deep breathing, is the anxious girl’s way of dealing with stress. Because what is worrying other than emotional preparation? Running through the what ifs, feeling the intensity of the emotion ahead of time, falling apart and having a long cry–these are the ways we exercise our hearts to deal with the crisis when it actually occurs. How many times does the anxious girl say that she’s great in a crisis? Preparation–it’s the motto of anxious ladies and girl scouts.

And that, I would say, is a more feasible goal. Someone needs to invent a therapy that doesn’t go against the natural tendencies of the worrier but instead embraces them. Oh…wait…it does exist. It’s called blogging. And I’d love to see a study where blogging, writing the what ifs out to their limit, sitting in front of the computer and having a good cry, falling apart completely is shown to have the same success rate as those who go against their body and unnaturally force it to relax.

Once they do that study, I’ll go back to visualizing my happy space and shoving all of my infertility worries into their alloted daily hour.

Orenstein finishes the article with this thought: “Stress is our burden, our bogyman, and reducing it is the latest all-purpose talisman against adversity’s randomness.” In the end, aren’t we all simply searching for an answer; an explanation; the secret door that lets us out of here? And can we blame researchers for holding out this idea even if being told that unattainable relaxation will help only brings on more stress?