I no longer thought of myself as an IVF patient and began to consider myself an IVF consumer.
I lay flat on my back on the table, my feet in the stirrups, when he plunged the ultrasound wand inside me. It was a routine event after each failed IVF cycle and I had just racked up my fourth.
If the ultrasound revealed cysts on my ovaries (a common side effect of fertility drugs), I would have to wait on the IVF "time out" bench until they disappeared. If it revealed none, I could get right back on the IVF roller coaster and -- up, up and away -- try once again.
The verdict was good. No cysts.
With the wand still inside me the doctor said, "Let's talk about our next cycle."
The implication: We were in this struggle together. It was our IVF cycle. The assumption: He was my one and only. But he did not yet know my plan. I was leaving him.
I wanted a doctor/patient divorce. And never one to end a relationship without setting my sights on another, I had already selected my new doctor. As I gently broke the news, his face turned crimson. And although I lay there in my little blue hospital gown, desperately yearning for a child, he stood over me in his starched white coat and tried to talk me out of leaving him.
"Do you really believe this new fertility doctor has something more to offer you than I do?" he asked.
Damn right I do. I let him talk, but he didn't have a hope in hell of swaying me.
The woman on the table that day, confident and in control, was not the same woman who, almost 35 and just shy of a year into her marriage, first walked through the doors of a fertility clinic.
I was a corporate lawyer who had spent a decade toiling in the testosterone filled world of elite law firms, but I had always been certain that my family rather than my career would have the greatest power to fulfill me. Faced with infertility, the first medical crisis of my life, my heartache and despair were immeasurable.
Despite my education and professional training, I did not research how best to navigate the world of assisted reproduction. Instead, using only word-of-mouth as my guide, I took a blind leap of faith and passively surrendered to medical authority.
"He seems like a nice enough guy and he sounds like he knows what he's doing." That was the full extent of my analysis when my husband and I met with our first fertility doctor.
Following several weeks of injections, ultrasounds and blood draws, we were swollen with hope on the day of our first embryo transfer. After our doctor loaded our embryos into the catheter, he discovered that I had a curved cervix that would be difficult to negotiate. He managed to get our embryos inside me after a 10 minute struggle, sweat dripping from his brow, but they were traumatized in the process and did not implant.
I left him when I discovered that it was standard practice in many fertility clinics to do a "mock transfer" with an empty catheter long before the actual embryo transfer to avoid this kind of fiasco.
"She seems more thorough and I think she really cares about helping us get pregnant." This was the sum total of my thought process after we met with our second fertility doctor.
We went through the same rigamarole; injections, ultrasounds, blood draws. As I recovered from my egg retrieval, I waited for my doctor to report the number of eggs retrieved, hoping it would be high. She approached me silently holding her index finger to her thumb. ZERO! Not a single egg retrieved.
"Something probably went wrong when the nurse injected you with the medication that triggers the eggs to mature," she explained.
I left her when I discovered that to avoid this kind of gut-wrenching scenario, it was standard practice in many fertility clinics to test the patient's blood the next morning following the trigger shot to confirm its absorption.
On the night of our big fat ZERO, I lay in bed with my husband and tearfully asked a question I knew he could not answer.
"We are trying to have a baby. How can they take such a casual approach to something that means so much to us and has caused us so much emotional and financial strain?"
We soldiered on and experienced two additional IVF failures. It was then that a realization that had been slowly creeping into my consciousness became a full blown epiphany.
"We can't continue to rely exclusively on fertility doctors to guide us," I told my husband. "They won't tell us that we would be better off spending our money at their more successful competitors."
"But what about the Hippocratic Oath?" he asked. "Aren't they ethically bound to pursue the best care for us even if it means making a referral to a fertility clinic that is better qualified?"
"That's just it," I replied. "We've been naive. It doesn't work that way in IVF. We have to own the process and became our own best advocates."
I finally understood that the world of assisted reproduction, one of the most lucrative industries in medical history, was as much about entrepreneurship as it was about medicine, and that medical entrepreneurship and patient vulnerability were a dangerous combination.
Fertility clinics with low or average success rates, and those not in step with the most recent scientific advances, faced a conflict of interest. Their patients would be more likely to become pregnant with the help of their more competent and cutting-edge competitors, but the clinics would be more profitable if they did not direct them there.
With this new found insight, I no longer thought of myself as an IVF patient and began to consider myself an IVF consumer. I realized there wasn't a fertility clinic on earth that could offer me a 100 per cent guarantee that I would have a baby, but I became determined to select a superior clinic capable of offering me my best chance of falling on the right side of the statistics.
I applied the strong critical analysis skills I had developed as a lawyer as I sat in the medical school library devouring the scientific literature with gusto. It soon became clear to me that fertility clinics did not provide IVF treatment in one consistent manner and that some were taking an outdated approach that had been eclipsed by new techniques.
And although there were close to 500 fertility clinics in the United States, few were at the forefront making significant strides in propelling IVF technology forward. I then used the Society for Assisted Reproductive Technology's Registry of fertility clinic success rates to assess their performance, and learned how to do so with an understanding of the nuances and subtleties that only savvy insiders pick up on.
It became immediately apparent that the playing field was not level -- there was a wide disparity in the quality of fertility clinics. I developed a short list of clinics, and consulted with physicians at each one. The clinics each had their own distinct cultures and differed, often dramatically, in their opinions on subjects about which I had been expecting consistency.
I asked penetrating questions to understand the rationale for their conflicting views, as I was determined to reconcile them in a meaningful way.
The fertility clinic at which we did our fifth IVF cycle was the first one we selected in this methodical and discerning way. We were attracted to its exceptional laboratory, which was capable of cultivating our embryos to their maximum potential to implant and would not squander them by allowing them to spiral into despair.
The center appealed to us also because of its philosophy that an obsessively careful approach must be taken beyond the laboratory, including with respect to the stimulation of a woman's ovaries and the transfer of embryos to her uterus.
That cycle resulted in the birth of the loves of our lives, our twin sons, Max and Lorne. Now 18 and at university, they are thriving in every possible way. Had our first IVF cycle been at the world class fertility clinic where our sons were finally created, we would have needed only one IVF cycle, not five.
Max & Lorne's 18th birthday, October 2014
I would not wish five IVF cycles on anyone, but I do not wish my story was different in even the slightest way.
Although it felt like a curse at the time, my IVF odyssey was ultimately a gift, one of my life's greatest blessings. Not only did it deepen my appreciation for what is most important in life, it also lit a fire inside me, inspiring a dramatic and immensely fulfilling career shift, for which I am tremendously grateful.
Now an expert in the IVF landscape in the United States and Canada. I left the practice of law to devote my life to helping others navigate the world of assisted reproductive technology as informed consumers with a sophisticated understanding of the full range of their best options.
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