Transcription
Hello, beautiful friends. We gather on the lands of the Aboriginal people. We thank, acknowledge and respect the Aboriginal people’s land that we’re gathering on today. Take pleasure in all the land and respect all that you see. She’s on the Money podcast acknowledges culture, country, community and connections, bringing you the tools, knowledge and resources for you to thrive.
She’s on the Money introduction
Victoria: Hello and welcome to She’s on the Money, the podcast where we discuss all issues affecting your personal wealth goals, so that you can feel more in control of your financial future. I’m Victoria Devine and today we’ll be covering a topic that’s top of mind for many of you in our community.
I’m talking IVF, including what’s involved and what you should know about financing this life-changing decision. Joining me is a friend of the podcast, Dr Nicole Hope, who you might remember from our webinar on IVF and egg freezing. The Medical Director at Newlife IVF, Dr Nicole, is a sought-after fertility specialist helping people have and grow their families for almost 20 years.
Passionate about supporting people to conceive, Dr Nicole is here to help you make sure that you have all of the information that you need before choosing the right fertility outcome for you.
And just a little preface on this conversation, this one is quite a sensitive one. Whether you’re unsure about having kids, you’re planning to start a family or you’re experiencing complex fertility issues of your own, it can be all too hard to talk about sometimes, and that is okay.
Personally, I’ve had my own issues with fertility and I’ve had moments where I had to tap out of conversations like this. So please do exactly what is right for you. Just know that we get it and we encourage you to take your time and listen when you’re ready. Otherwise, my friends, let’s get into it.
Understanding your fertility treatment options
Victoria: Dr Nicole, welcome back to the show. It is so good to have you in an official studio. Last time we were just – were you at your house or were you at your office?
Nicole: We were at the office.
Victoria: Yeah, I was in my house.
Nicole: But it was a very small office, lots of equipment around. So, it was a tight space.
Victoria: It was a really special conversation. And I obviously went in having this conversation about fertility because the community had so many questions. But it was just so nice talking to you. Not only are you incredibly intelligent, but I was also like, ‘Oh, this woman is a weapon.’ I was like, ‘She makes me so comfortable.’ Like, you’re a friend of the show. Please come back.
I have been deep in the DMs on Instagram of the She’s on the Money community, and I’ve been gathering all of your pressing questions for our friend, Dr Nicole, the Medical Director at Newlife IVF.
So, when we’re thinking about IVF and egg freezing, what is actually the difference there? Can you explain, I guess, the purpose and then the process of each? Because some of our listeners have gone down a rabbit hole, are confused. Or they haven’t gone down the rabbit hole, and they’ve been avoiding it because everything is kind of like analysis paralysis.
Nicole: Sure. So, they’re actually very similar processes, but the crux of it is when we do egg freezing, we are just freezing eggs. But when we are doing IVF, we are actually putting the eggs and sperm together to make embryos.
But in terms of the actual preparation for egg freezing and IVF, women are doing injections to try and get multiple eggs to grow. They’re having some blood tests and ultrasounds during that treatment to assess how they are progressing and how many eggs are likely to be collected at an egg collection. And, usually, they are on injections for about 10 days and most women are ready to have their egg collection around day 14 in their cycle.
If someone is doing egg freezing on that day that the eggs are collected, that is when we will freeze the eggs. And the eggs then can remain frozen until the woman is ready to use those eggs. Now, that may be that she comes back in a few years with a partner who she wants to conceive with, or it could be she is single and wants to do this on her own and access donor sperm and inseminate those eggs. But by freezing eggs, we can preserve a woman’s fertility at the age she was when she froze the eggs.
If a woman is having IVF, then that means we need sperm available on the day and we will inseminate the eggs. And rather than just freezing the eggs, we then grow or culture the embryos in the lab for up to five or six days. And we only freeze the embryos that have continued to grow and progress and reach a certain stage of development.
And so mostly in terms of freezing embryos, people are usually doing IVF when they have a partner who they are trying to conceive with and maybe they have not had any success. Or if they are actually have decided they want to do this on their own and access donor sperm, then they might be doing IVF and creating embryos with sperm.
Victoria: It’s crazy to me that you can freeze. Like just the idea that you can preserve someone’s fertility at that age is just so cool.
Nicole: When I started out in IVF, we did have egg freezing, but our freezing and thawing techniques were not very good. And really it was something that was just sort of put aside for women, for example, maybe who had cancer and they needed to start chemotherapy, and we wanted to freeze eggs, because chemotherapy can damage the egg supply. But it was more of an emergency kind of situation, and the success rates were not that great. But over the years, freezing and thawing techniques have really improved. And now egg freezing is a really viable option. And ultimately, until we come up with a way to reverse the ageing process, it’s the best way to preserve fertility.
Victoria: It is very cool. Like just the whole concept of it. When you became a doctor, was that something that you were like, ‘I really want to go down this route of kind of, you know, helping create life, helping create babies?’ Or was this something you discovered during the process? I’m just so pervy because it’s just so special.
Nicole: I think I did always have an interest in this. And when I was studying medicine, when I first applied and started doing my training in obstetrics and gynaecology, I was thinking, I really hope I like this because I actually can’t imagine anything else that I want to do.
Victoria: I’ve actually worked it up in my head.
Nicole: Yes, this is where I want to go. And look, I was lucky enough during my training that I did get exposed to working with fertility patients. And so, once I had that exposure and it just confirmed that this is something that I was really interested in. And yeah, it was easy to pursue my passion.
Victoria: 100%. And I was saying this to you off camera. We did our webinar, and for those who haven’t listened to it I’ll put a link in the show notes so that you can go back because I’ve made sure that we haven’t doubled up on questions because I was like if I have her in front of me I’m not going to be asking the same things over and over. But I just feel like you’re the right person for this role like you are so warm and so friendly and I can imagine if I was going through a process of IVF, you’re the type of person I would want holding my hand.
But that’s a really big decision to make, right? So, for couples who have been trying to conceive for a little while and it’s been a little bit challenging, when do you recommend that they actually start looking into IVF? Because I remember when it was hard for me, I remember saying to my husband, ‘Are we meant to talk to someone about this? Or like, do we just try for a few more months? Or like, what does this look like? Or are we meant to do preliminary fertility testing? What do we do?’
Nicole: Yeah. Well, look, to be honest, I think if you are worried and it’s creating anxiety, it’s quite reasonable to see your GP, get a referral to see a fertility specialist. And when you see the fertility specialist, they should be ordering some baseline investigations. That could include like hormone tests to confirm that you’re ovulating, a pelvic ultrasound to check that there’s nothing physical that might be interfering with getting pregnant. If you’re in a heterosexual relationship, checking your partner’s sperm to make sure that’s okay.
Just because you make an appointment with a fertility specialist, it doesn’t mean that you’re necessarily going to be doing IVF next month. They would initially organise all these tests and sometimes there may actually be something that you can treat without doing IVF.
So, for example, if someone does have an issue with ovulation, there are hormone medications to assist with that. And so, for some women, if you can just get them to ovulate, they will get pregnant.
Victoria: Yeah. And that’s quite cool too.
Nicole: Exactly. So, I would say even though I do have a lot of patients doing IVF, I also have a lot of patients who are doing what we call ovulation induction and getting pregnant naturally.
Victoria: How cool.
Nicole: So not everyone has to go to IVF.
Victoria: Yeah, but it’s nice to know that there are lots of different options and it’s not just, ‘Okay, I’m going to go down this route and it’s going to get really serious really quickly,’ because that can be overwhelming.
Nicole: Yes.
Victoria: I have a question, because whenever I’ve needed to go to the GP to get a referral to a specialist, I haven’t necessarily known who I needed to see. I’ve always gone, ‘Oh, I need to see a doctor for this more complex issue and my GP says, I’ll refer you out. Barry down the road has a good reputation.’
But I feel like with fertility, I maybe have a different experience to other people. So, I’m only talking from my, I guess, my own experiences here. But before I even spoke to a GP, and thankfully I didn’t need to go down this route, I Googled everything. I was looking at all the different clinics. I was looking at what other people were doing and how they were doing it. How do you, or do you have a list of things that people could look out for when looking for a clinic. Because, for me, it didn’t feel like something where I would go to my GP and just go, ‘Hey, could you just give me a random referral?’ Like, it’s so important to pick the right clinic.
Nicole: Yeah, absolutely. And I think it’s really difficult for patients to navigate the information that’s out there. If you are looking at an IVF clinic, most IVF clinics on their website, they will advertise, for example, the cost of their treatment. But unfortunately, for some clinics, there are lots of additional costs that maybe are not always on their website.
At Newlife IVF, where I work, our costs are generally quite inclusive. And what I mean by inclusive is they include the fees of the doctor during an IVF cycle. They include actually freezing the eggs or freezing embryos during your treatment. They include extra lab techniques that we consider best practice, like using an embryoscope or using embryo glue when we do an embryo transfer.
Victoria: Embryo glue?
Nicole: Yes.
Victoria: That’s a thing?
Nicole: It is a thing. There is evidence that it can help improve the chance of an embryo implanting. How cool. And with some clinics, they may actually charge an extra fee for using that glue. And that may not be actually included in the fees that they advertise.
Victoria: And that’s disheartening because you go to someone and yes, there’s a very big financial side, but there’s also an even bigger emotional side.
Nicole: That’s exactly right.
Victoria: And to then be slapping on additional costs and feeling like, ‘Oh, I didn’t see that coming. Oh, I didn’t see that coming,’ I think it shakes the trust you have with your provider.
Nicole: It really does. And you know, one of the things when I heard that some clinics were doing this, it just blew my mind because some clinics you go through a whole IVF cycle and then they’ll say, ‘Well, if you want to freeze your excess embryos, there’s an extra cost you have to pay.’ And we have always just routinely included freezing embryos as part of the treatment.
Victoria: Because that makes sense.
Nicole: That’s part of the treatment. And then obviously if someone’s got a lot of embryos to freeze, then having to sort of make a decision about, ‘Oh, can I actually afford to freeze the embryos I’ve made? Or can I afford to freeze all of them?’ So, these are things that are not going to be advertised on the website that you do have to look at.
I think as well, like what you were saying about the emotional cost, IVF definitely is a bit of a rollercoaster ride. And for some women, it’s really straightforward, especially if they get pregnant on a first attempt or quite quickly.
Victoria: Such a win, both emotionally and also financially.
Nicole: This is exactly right. And so, one of the things that I do suggest people do is look at the success rates of the clinic that they’re looking at. So, there is a website called yourivfsuccess.com.au. This website is funded by the Australian government and all IVF clinics in Australia are invited to provide their results. You can go through, and there’s IVF success rate calculated. So you can enter your details and it will give you some idea about the overall average chance of getting pregnant per IVF cycle. But it will also show you each individual clinic and you can look at their success rates.
Victoria: That’s so good.
Nicole: And this is really important because if a clinic may advertise cheaper costs, but if their success rates are lower…
Victoria: You’re going to be paying for round after round.
Nicole: Exactly. And then there’s the emotional costs that go with that because obviously the longer it takes to get pregnant, it’s a difficult process. And so ideally you want to get pregnant as soon as you can from an emotional point of view and also from a financial point of view.
Victoria: Yeah, and we’re trying to balance both of these things as well. My goodness, I didn’t know that website existed and it makes me so happy it does because when I was looking for things like this, you’re relying on Google reviews.
Nicole: Yes.
Victoria: And people are incredibly emotional. So, you can’t really rely on that when it comes down to like the bad stuff versus the good stuff. Obviously, fantastic. But just the idea that you can look at success rates and have more of a tangible measure of, ‘Okay, well. I’m going to a place that is really good at what they do, and I feel quite validated in that and spending money there.’ What kind of cost are we actually looking at when it comes to IVF?
Nicole: So, every clinic, as I said, is different and looking at what they include per cycle is also, as I said, very important to consider. At Newlife IVF, the out-of-pocket cost for if we’re doing an IVF cycle for a first cycle, that can be around $5,000 to $6,000 for the first round. That will, though, include hopefully freezing of embryos. Unfortunately, with IVF, no clinic has 100% success rates.
And so, while some women do conceive first time, for most women they are having to do more than one round. And so hopefully even though the first round, that’s when we do the egg collection and make embryos and hopefully freeze extra embryos. If a woman is not pregnant, then potentially the next round instead of having to go through all the injections and the egg collection, we can just take an embryo out of the freezer and put that back into them, the cost of that treatment is a lot less.
Victoria: Yeah. Wow. And I feel like that’s actually, I won’t say reasonable for what it is because I’ve got absolutely no idea what makes that cost up. But I’ve got friends who are paying $10,000, $12,000 for rounds. So that feels a lot more accessible. Is that something that you’ve…
Nicole: Well, what I will say is there is an upfront fee and that is in that range. Around $10,000 to $12,000. But there are Medicare rebates. So that sort of $5,000 or $6,000 is more that out-of-pocket cost.
The other thing which isn’t at all covered by Medicare but is something to consider is pre-implantation genetic testing. Have you heard of that?
Victoria: I have not done that, but I have done all of the genetic testing. So I was that crazy lady. I don’t know if crazy is it. I think it’s smart. But I was that crazy lady who said to her husband, ‘Right, if we’re going to have babies in a couple of years, I want to do all of our genetic testing and make sure that nothing’s awry.’ So, is it similar to doing all of the blood work?
Nicole: It’s actually a bit more similar to, did you do when you were sort of 10 and a half weeks pregnant, did you do the NIPT?
Victoria: Yep, I did the NIPT.
Nicole: So, it’s more like having the NIPT done on the embryo before we put it back.
Victoria: What a peace of mind because that NIPT test, like it’s happening at 10 weeks, at which point that’s a very, very hard decision to make.
Nicole: That’s exactly right. So, with this PGT, as I said, it is an extra cost, and not all clinics offer it. But for all women, especially as we are in our mid-30s or older.
Victoria: Especially if we’re looking at IVF.
Nicole: Yes. We do just naturally start to produce more abnormal eggs. And unfortunately, these will result in abnormal embryos. And we can’t tell if an embryo is abnormal just by looking under the microscope. So, if we put back an embryo and it is abnormal, a lot of the time it just won’t ‘stick’ and you won’t be pregnant. But if it does ‘stick’, sometimes it can result in an early miscarriage or sometimes you can get to that time of doing the NIPT test and find out there’s an abnormal pregnancy and then there are some really difficult decisions to make.
So, if we do this NIPT test on an embryo, we can’t make an embryo normal if it’s not normal. But we can select to put back the embryos that have normal results and have the best chance of pregnancy. And so, with that, when we put back an embryo that’s been tested, not only are the pregnancy rates higher, but also the miscarriage rates are much lower.
So, it is an extra cost to do this testing on embryos. But it might save you money in having transfers that will ultimately not result in an ongoing pregnancy. It will also save time by identifying the best embryos up front and also helping with emotional cost of treatment by going through not being pregnant or miscarrying.
Victoria: I was about to say, you are arguably paying an insurance costs to lower your trauma.
Nicole: Correct.
Victoria: And I just think that as somebody who has been there – take all of my money. Like I would love to be able to lower the cost of miscarriage and stuff like that. What type of cost are we looking at if Medicare isn’t going to supplement that?
Nicole: Again, it is a varying cost per clinic. At Newlife IVF, the cost per embryo that you test is $780. By comparison, if you had a frozen embryo transfer, the out-of-pocket cost for that can be something like just under $3,000. And so, if there was an abnormal embryo and you avoid putting that back, you have actually saved outlying on a frozen embryo transfer that was never going to work anyway.
Victoria: And not only are you kind of saving that trauma and stuff, it’s also time. Especially if you’re in that process, like having held a lot of friends’ hands through this process, you don’t want to muck around with doing around and then having to go through the waiting process again and it not working and then it just, it sounds like a lot.
Nicole: Yes.
Victoria: Is that something that is going to be added to Medicare at some point? Because I feel like this space is so fickle because there’s changes and developments all the time. So, have they caught up or are they not planning to?
Nicole: So, there is some support from Medicare for people who are doing PGT to look for specific genetic conditions. So, you mentioned you had all the genetic testing when you were trying to get pregnant. And so, when we do have couples where they are at risk of having a child with a genetic condition, then Medicare does provide some funding for that. But not yet for the general chromosome testing, which, as I said, is an issue for all women, especially as we get older.
Victoria: Yeah, and I’m hoping that as time goes on, they add more and more things.
Nicole: Yeah, and look, it is a little bit of a slow process with Medicare. In the last year, we have embraced a new definition of infertility, which does allow more people to access treatment and have Medicare support. So, it used to, like the traditional definition of infertility.
Victoria: I was about to ask like. What’s the new definition?
Nicole: Well, the traditional definition was a heterosexual couple having sex every month for a year and not conceiving.
Victoria: That’s what I was told it was.
Nicole: Yes.
Victoria: You’ve got to try for a year and then you can talk to a fertility expert, but that’s not true.
Nicole: No, because our society is different than it was 30 years ago. We now have people who have issues with fertility for a variety of reasons. Maybe they are single, no matter. How much you try on your own, you’re not getting pregnant. Maybe you’re in a same-sex relationship.
Victoria: And you can try all you might. It’s just not going to happen.
Nicole: It’s not going to happen. And so, the new definition encompasses a variety of both strictly medical causes, but also other circumstantial reasons that would explain infertility.
Victoria: That’s really cool.
Nicole: So that’s definitely made treatment more accessible.
Victoria: I love that. You mentioned before, ovulation treatment. And one of my girlfriends has gone through IUI and that was successful. Can we just touch on what that is and financially what that costs? Because from my understanding, IUI is like a step down from IVF. Is that how we would categorise it?
Nicole: Yes. So, with IUI, what it stands for is intrauterine insemination. And that’s where we prepare sperm. We monitor the woman to see when she’s ovulating. And then we will insert some sperm into the uterus at the time of ovulation.
Victoria: Direct delivery. It’s express post.
Nicole: Correct.
Victoria: Perfect.
Nicole: Now, with insemination, there are certain circumstances where there’s a real benefit. So, for some couples, there are actual issues with intercourse. They’re not able to have intercourse and that can be due to pain with intercourse, erection, ejaculation disorders, or it can also be, again, a same-sex couple or a single woman where they need to use donor sperm and then we need to get the sperm into them for them to get pregnant. So, there are definite indications like that.
There are other indications. For example, if the sperm parameters are a little bit below normal. By doing the insemination process, we wash and prepare the sperm to get a smaller volume but highly concentrated swimming sperm that we can deliver directly to the top of the uterus where it needs to go.
In couples where they are having regular sex and they are ovulating and the sperm is normal, the insemination doesn’t offer as much of a benefit. So sometimes when I have couples who have what is called unexplained infertility. So that means we’ve done all their tests and they’re all normal and we don’t know why they’re not getting pregnant.
Victoria: That would be so frustrating.
Nicole: It’s very frustrating.
Victoria: Hearing like, there’s no good reason. I’m such a reason person.
Nicole: Yes. It doesn’t mean there’s not a reason. It just means our tests haven’t shown what the reason is yet. And unfortunately, it’s about 10% of the patients that we do see have unexplained infertility. So, for someone under 35 with unexplained infertility, I would be saying to them, ‘ Look, if you keep trying naturally, you’ve got about an 8% chance of getting pregnant every month.’
Victoria: That’s much lower than I thought it would be.
Nicole: Well, unexplained infertility means you’ve already been, say, trying for a year and it hasn’t happened. Yeah. If we do insemination, that might boost it up to 12%.
Victoria: Oh, that’s not as good as I thought it might be.
Nicole: And if you then do IVF in someone under 35, the pregnancy rate per cycle with IVF is more like 50%.
Victoria: Yeah, okay.
Nicole: So, as I said, I do have some patients who really want to try insemination first, and that can be just because they’re not quite ready to go down the IVF pathway and they feel like they want to try everything first before they embark on the IVF journey.
But a lot of patients do ask about insemination. And when we talk about the actual success rates, then a lot of them do actually bypass insemination and go straight to IVF.
But as I said, in certain circumstances, as I said, if you actually haven’t been managing to have intercourse at all, then there really could be a benefit from having insemination.
Victoria: And that’s where you want a good clinic and a doctor that you can sit down with and be like, ‘Here’s all my cards on the table. Here’s what we’ve tried,’ and you’ve got to be so comfortable opening up and being like, ‘So we did this and we tried this and this is how life is looking for us right now.’ And that’s a big conversation to have.
Nicole, I feel like, just getting into the thick of it. But there is a lot more to come right after a very quick break.
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The financial side of fertility treatment
Victoria: All right, we are back with Dr Nicole from Newlife IVF, and we’re discussing all things finance when it comes to your fertility and family planning. Now, we’ve covered the process of IVF and what egg freezing looks like, and you’d mentioned costs relating to other medications and stuff on your price charts, but they’re ranging from like $200 to $400. And I just don’t know what I’m talking about when I look at that. So, can you tell me a little bit more about them and like what the medications are for and when they’re introduced?
Nicole: Yes. So, in an IVF cycle, usually there are three main medications or maybe actually four, three to four main medications, depending on what treatment you’re having. The first medication is one to try and make multiple eggs.
Victoria: Right.
Nicole: So naturally as women, we tend to just produce one egg every month. While it’s possible to do IVF in the natural cycle and just get one egg every month, they don’t all fertilise. They don’t all form embryos. And so, the more eggs we can get, the better the chance we have not only of getting a good embryo to put back on the day, but also getting extra embryos that we can freeze. And again, talking about cost of treatment, the more embryos you can freeze, the less egg collections you have to go through and therefore the cost of treatment is less.
Usually someone is on one injection every day to try and make multiple eggs grow. After a few days, they may start a second injection, which is to make sure you don’t ovulate too early. So, when you have multiple eggs growing, your hormone levels are higher than normal and the brain thinks that you’re ready to ovulate. And we don’t want you to ovulate because obviously we want to get all the eggs.
Victoria: So like, no, save them for us.
Nicole: Exactly. And then usually women are on injections for about 10 days in total. And as I mentioned earlier, prior to having an egg collection, a woman will usually be having some blood tests and scans to see when’s going to be the best time to do the egg collection. And once we make that decision, there’s a final injection we call the trigger injection. And that trigger injection actually starts the ovulation process. And what we want to do is then collect the eggs before ovulation actually occurs. So, the ovulation process is really important for helping to mature the egg and make it ready.
Victoria: So, it’s ready.
Nicole: Ready to be inseminated or ready to freeze.
Victoria: Yeah, cool.
Nicole: Then for women having egg freezing, that will be the end of their treatment. But if a woman is doing IVF and she’s having what we call a fresh embryo transfer – so that’s usually putting the embryo back five days after the egg collection – then often she will be starting some progesterone to support the lining of the uterus and make sure the period doesn’t come too early. And with that progesterone, often they are vaginal progesterone pessaries.
Victoria: As somebody who had to take progesterone to support my pregnancies, they suck. I’m sorry, Nicole.
Nicole: Yeah, they’re not pleasant. There are some injectable options.
Victoria: No. I’d prefer the pessary, thank you!
Nicole: Yeah, so there are injections for around 10 days and then progesterone for two weeks from the egg collection until the pregnancy.
Victoria: Two weeks. I’m not going to lie. That sounds good as someone who had to be on it for 16 weeks. One out of 10, do not recommend!
Nicole: No, that’s a long time.
Victoria: It was a while.
Nicole: Yeah, yeah. Look, if we have someone who is pregnant, I do often continue the progesterone for a few more weeks until the pregnancy is established. Yeah, 16 weeks is a long time.
Victoria: Yeah, and I should preface that for those of you who maybe are going, ‘What the hell, Victoria, what’s going on?’ I had recurrent miscarriage and so that’s something that they do to hopefully make sure that the pregnancy stays and sticks, because there was no good reason for my miscarriages. And I’m happy to talk about it for those of you who maybe haven’t seen my social media. There’s a pinned post on my Instagram talking about it, but I think it’s something that is really important to be open and honest about. Because it’s not just me going through these things.
And I didn’t know, Nicole, that I would have to take pessaries for 14 weeks.
Nicole: And they’re not cheap either.
Victoria: Oh, they are like $90 a box. And a lot of people in my DMs, when I started talking about IVF and the costs associated, I feel like a lot of us in our heads, we go, ‘Okay, cool, a round is going to be $10,000 to $12,000 and we’ll get a rebate. So we can anticipate about six grand, right?’ And there’s lots of different, you know, levers there.
But some of our listeners have asked, what are some other out-of-pocket costs that might come up during the process?
Nicole: With the medications, if your cycle is covered by Medicare and if you were a Medicare cardholder, I would say a majority of IVF treatment is covered by Medicare. So, the actual medications are covered by Medicare, but Medicare do have what they call a script fee. So, I was talking about the two injections, the trigger injection and the progesterone. So that’s four different medications. So, Medicare will charge $60 per medication. So, you don’t actually get charged for the medication.
Victoria: But you’re getting the script fee to get access to it.
Nicole: And unfortunately, that’s a Medicare thing. It’s not your IVF clinic charging that. During your treatment, any blood tests and scans you have for monitoring, they should be covered by your IVF clinic fee. But the IVF cycle does only go until the pregnancy test. And so, when you are pregnant, most clinics will do some monitoring for a few weeks to make sure the pregnancy has established itself.
Victoria: I was going to ask, when do we get to graduate?
Nicole: Yes. So, what we usually do at our clinic is some blood tests. So, when you find out you’re pregnant, you’re four weeks pregnant, we usually do a blood test at four weeks, five weeks and six weeks. And then we will get patients to have an ultrasound at seven weeks. And at that point in time, we are hoping to see a baby and a heart rate. And that’s usually when you are graduating.
Victoria: You get to graduate.
Nicole: You get to go.
Victoria: Which is exciting.
Nicole: So, with the IVF cycle, those tests once you are pregnant are no longer covered by the IVF cycle fees. So yes, there can be a cost for the scan with the blood test. If you are lucky, your clinic may bulk bill those one’s for you.
Victoria: So, when we graduate, and this may be a naive question, is our pregnancy then considered a vanilla pregnancy, and I can just go through the public healthcare system? Or do I need another, like private OBGYN that I can work with to support it in a different way? Like what does that look like?
Nicole: Yeah, I would say, I mean, IVF is so common at the moment. We sort of estimate around 10% of kids are born through IVF. So as long as the pregnancy itself is like there’s a single pregnancy and you don’t have any previous obstetric complications or any severe medical issues yourself, we would actually treat it just like a normal pregnancy. I do often say to patients, we’re really lucky. We have a really good public hospital system, especially for obstetrics. Unlike other areas in medicine, you need a knee joint replacement, you go on a waiting list for however many months. You can’t put pregnant women on waiting lists.
Victoria: Could you actually have your baby next year, not this year? Because we’ve got a wait list. That’s not going to happen.
Nicole: It’s not going to happen. So look, one thing with the public hospital system is they do work on a sort of triage pattern. So basically, I have heard of cases where someone was going to get induced on a certain day, but then there were some other more urgent cases that came up, and so their induction was pushed to the next day or the day after. But at the same time, if you’re the person who does need urgent care, you are going to get looked after straight away because, as I said, you can’t postpone or delay obstetric.
Victoria: Yeah, absolutely. Absolutely. And stuff like that can go so awry so quickly. I feel like it’s nice to know that the public system is well equipped. And it’s a funny conversation because like I had private OBGYNs when I had both of my children and they were like, ‘Victoria, like the public system at the end of the day is where you’ll be transferred if things go awry.’ And that gave me a lot of peace to go ‘We are in exactly the right place we need to be in.’
Can I just say that it has been so good to have all of this information, I guess, presented to you up front. Like, to be able to have this conversation and have someone, I don’t know, in their car or on their morning walk, be able to listen to a conversation between two women talking about a topic that maybe they haven’t opened their mouths about yet. Or maybe they’re not ready to reach out to their GP for their referral yet, especially because I know that so many people in our audience are already invested but feeling really overwhelmed.
It’s just been really, really cool to feel, from my perspective, safe to ask these questions, but from my community’s perspective, knowing that I’ve got somebody who’s so well – I guess – equipped in this space to be like, ‘Nope, this is what that looks like. This is what that looks like. Here are the medications.’ I just know that if I went into the process now, I’d be like, ‘Okay, I’ve got a little bit of background.’ And I always say, you need to know enough to be dangerous. You don’t need to know the whole thing. You just need to know enough that you can ask the right questions and feel empowered.
But I do feel like the financial commitment should be a very big part of this as well.
Nicole: Absolutely.
Victoria: Do you have to have these conversations with people?
Nicole: Yeah, all the time. I think in all areas of medicine, there should be financial consent that’s obtained. But I do have patients where because of their financial circumstances, I will refer them to public IVF options if they’re available, because it’s just not possible for them to afford treatment in the private setting. But obviously if you can do IVF in the private setting, there are so many options. And you do really need to sort of get an itemised costing to know what you’re going to be up for. You do need to look at the success rates to sort of give you an idea about how many treatment cycles you’re going to need. And you do need to look at what’s included with your treatment, even things like counselling.
So, at Newlife, we have counsellors and we provide counselling to patients if they are struggling during treatment. And that can be women, that can be their partners or the couples together. And this is just part of our routine treatment and care that we offer.
And I have heard that some clinics offer counselling, but only in a group session. Or only online and I think that that’s quite confronting especially as you mentioned it is so personal. And I’m always amazed at what some clinics are doing and, usually, I’m actually relying on my patients to say ‘Hey, I’ve come to you because I went to this other clinic and this is what they were doing.’ Or I meet people who’ve come from elsewhere and I say ‘Okay these are the costs and we’re doing this and this,’ And they say ‘Oh I don’t have to pay extra for that.’ And I’m like, ‘No’, that’s included.
Victoria: No, of course not. Because I’m not taking advantage of you. I feel like you are being much kinder about this than you could be because it’s like financial advice. So as someone who used to be a financial advisor, I’d have clients come to me and be like, ‘This is what another practice has done.’ And I’d be like, ‘Oh, my goodness,’ and fly absolutely off the chain. Because it’s crazy to me how different industries and obviously your space and my space could not be further from different. But I just look at it and go, ‘My goodness,’ in every aspect, there’s always someone who is willing to take advantage of a situation and milk it for what it’s worth. And that breaks my heart, especially when it’s such an emotional filled journey. And that’s where I want to add a little bit more of a caveat, I suppose, because this space is filled with fertility or IVF specific loans.
And please – I’m not saying they’re bad – but please, please, please do your research because you might just be better off getting a standard personal loan rather than an IVF branded one if you’re going down that route. And that’s the financial decision that you’ve made because these options exist and there are lots of different options. You could even potentially access your superannuation to help you fund your IVF journey. Is that something that you’ve seen a lot of your patients use?
Nicole: Yeah, a few patients do that. Obviously, I would say where possible, look at other options because your super is really important.
Victoria: Thank you. But also, it’s so nice to know it’s an option, but let’s preserve it.
Nicole: One of the things is there is a special application form, and it does need to be completed by someone other than your IVF specialist or doctor. And as part of that form, one of the things is there are only certain situations where you can access your super. And for patients doing IVF, the main indication is mental health issues. So, what you need to be prepared for is the doctor completing the form has to state how your infertility has impacted on your mental health and or contributed to deterioration in your mental health.
Some super companies do require you to actually see a psychiatrist. Other companies, if you’ve had your GP managing your mental health issues, the GP can sometimes complete that form. So that can take a little bit of time to organise, especially if you are required to see a psychiatrist. I’ve had patients where they’ve had to wait several months to get an appointment with a psychiatrist. So, if you do have a GP who supported you and seen you before for mental health issues, that’s what the form is. You can’t just say, ‘I want to do IVF, give me my super to pay for that.’ There does have to be this application on mental health grounds.
Victoria: Yeah, and that makes sense. And I’ve had a lot of people say that’s not fair. It’s my super, I should be able to spend it in line with whatever I would like. But ultimately, superannuation exists to provide for you in retirement. And quite bluntly, it’s the government’s priority to make sure that you’re financially sound. And you’re not going to be destitute. And as much as it is your money and you do have control over it, it has been allocated for that. And so, I get why it’s such a serious process. It just breaks my heart a little bit knowing that it could be the reason you’re being held up. Like, you know that’s the only way you’re going to access it, but you can’t get your fertility treatment until you get a psychiatry appointment. And it’s just a circus that I wish people didn’t have to be involved in.
Nicole: But having said that, sometimes I have patients and they are not on any psychiatric medications or antidepressants or anything like that. But nonetheless, most of my patients, by the time they are getting to do IVF, they already do have a degree of anxiety, maybe some depression as well relating to their infertility.
Victoria: Oh, absolutely.
Nicole: So even someone might say, ‘Well, look, I’ve never seen my GP before for mental health issues,’ it doesn’t actually mean that it’s a ‘No.’ Because even if you don’t need to be medicated, you will probably still have those feelings, because that’s normal when you’ve been trying to get pregnant and it’s not happening.
Victoria: And I cannot imagine that a doctor exists where they don’t understand that the IVF process is inherently emotionally draining. So, I just can’t imagine you going to a doctor and going, ‘I think I need to access my super.’ And they go, ‘No, no, no.’ Like they’re not financial advisors. I’m sure that they would recommend, ‘Oh, maybe you should chat to an advisor and see what your options are. But here’s the process and I can help you go down it.’ Am I right in saying that?
Nicole: Yes.
Victoria: Okay. Very cool. Now, I shared a poll on our Instagram stories because I was like, ‘All right, guys, I’ve got Dr Nicole in – what are your rapid-fire questions?’ And I’ve taken some screenshots. Would it be okay if I ask a few questions and we can rapid fire through them? Because I know that I’m running out of time with you and I’m trying very hard to make the most of it. I’m not going to use names. I’m just going to ask the questions.
Someone said, ‘I’m three months into trying. Should I be looking at IVF? I’m 32 years old. Is there a process I’m supposed to be following?’
Nicole: So that’s that perfect example. See your GP. Get a referral to see a specialist and just start the investigation process. It doesn’t mean you have to do IVF, but you can get the ball rolling. And it takes time to do tests, so you can still be trying in the meantime.
Victoria: Very cool. The next person has said, ‘I’m thinking about freezing my eggs, but I have a partner. What are the chances of successful outcomes from egg freezing versus freezing an embryo?’
Nicole: Well, what I would say is there is more certainty with freezing embryos. So, with eggs, we have to make assumptions. Like we have to assume that of the eggs, this many will fertilise and this many will form embryos. And so, we can give you an estimate when we are freezing embryos, they have already fertilised and made embryos. So, our estimation is a lot clearer or precise.
So, I think when I’m talking to people about freezing eggs or embryos, I have a lot of patients who do come and say, ‘I’m in an early relationship. I’m not quite sure.’ The main advantage of freezing eggs is that they’re your eggs.
Victoria: You could pick a different partner.
Nicole: Exactly. Or if your relationship breaks down, you’re not tied to that. So, when you freeze embryos, you are actually then tied to the person who you created embryos with. And if you meet another partner down the track, obviously you’re not going to use those embryos. But sometimes I have people who are in committed relationships and they will say, ‘I’m 37 now, but we’ve got these various things happening over the next 12 to 24 months and I won’t be ready to get pregnant till I’m 39. And so, therefore, I’d rather be making embryos now when I’m 37.’ In that situation, if you are in a committed relationship, then definitely freezing embryos gives you a much better idea about what you’ve got frozen.
Victoria: And it to me is kind of magic, the idea that you could freeze embryos, have a baby and still have an embryo that was made at the same time. But then all of a sudden, your babies have a three- or four-year age difference or even more.
Nicole: I have heard the term is ‘twibblings.’ So, twins, but siblings.
Victoria: That’s really cute. Another person has said, ‘How does egg freezing and Medicare work if you have endo?’
Nicole: As I said, the definitions for infertility have become a lot more inclusive. If I have a patient who is doing egg freezing and they have endometriosis, I would be putting them through under Medicare.
Victoria: Very cool. I have a question and I have not heard this term. Someone said, ‘What is a mosaic embryo, and do you know more about the outcomes?’
Nicole: So, what a mosaic embryo refers to is this pre-implantation genetic testing I was talking about. So, most embryos are either normal or not normal. But some embryos come back with a mosaic result. And what that means is of the cells we test, some are normal and some are abnormal. So, it’s a combination of normal and abnormal cells. We know that human embryos have the capacity to repair themselves. And so there is actually quite a lot of evidence now that when putting back a mosaic embryo, they do have quite decent pregnancy rates and live birth rates. We would always recommend putting, obviously, normal embryos back first. But there are some women who never get normal embryos, especially as they get older. And maybe their best embryo is a mosaic embryo.
So, when putting back a mosaic embryo, something that’s really important is having good genetic counselling beforehand. And again, this could be another extra cost through an IVF clinic. So, at Newlife, our genetic counselling is again included in the payments that patients are making. It’s not an extra cost.
But patients do just need to be aware that an embryo can correct itself, but it may not correct itself. If we do put back a mosaic embryo when someone gets pregnant, we would often suggest, for example, having an amniocentesis to just confirm that result.
I’ve definitely had quite a few patients who’ve put back mosaic embryos and have healthy children born from that. So, as I said, it’s not our first line go-to option, but it is an option. And with appropriate genetic counselling, we can proceed.
Victoria: That’s very cool that those options exist. Now I have two more questions for you. The second last is, ‘How much does it cost to use donor sperm?’
Nicole: That is quite complicated.
Victoria: Sorry. I thought you’d be like, ‘It’s X.’ And I’d be like, ‘Cool, moving on.’
Nicole: So, with donor sperm, there is clinic-recruited donor sperm and then some clinics also offer overseas donor sperm as well. The issue is it’s very difficult to recruit sperm donors. The transport’s fine. There are very specialised couriers who are experienced at moving eggs and sperm.
Victoria: You never know what’s under in the cargo hold, you know?
Nicole: No, you do not. There are specialised couriers and specialised containers and packaging to keep them frozen.
Victoria: But you can just import it.
Nicole: Well, no, you can’t just import. It is a process. And ultimately, any sperm that we import does need to comply with our local laws and legislation. But invariably, with the overseas sperm, there’s additional costs. But with the sperm, there are often fees to secure a sperm donor. And then there are fees to use sperm each time. So, part of the securing a donor is, for example, in Victoria, a sperm donor can donate to up to nine different women. So, by securing your spot, you’ve got that one spot out of nine.
We always do genetic testing, and we do an extended panel to make sure there are no issues with the sperm donor that you’re using. And there is a cost for that genetic testing.
And then every time you use the sperm, you will pay a fee per use. So, for example, someone doing insemination with donor sperm, each time they have insemination, they will pay a fee to use the donor sperm. Whereas someone else, if they are doing IVF, they will pay a fee in their first round of IVF when we’re using the sperm. But when we do a frozen embryo transfer, because the embryo is already created, they don’t pay anything using the sperm again.
Victoria: Wow! I had literally no idea this space – it’s like equal parts magic and mystery to me.
And the last question, which I think a lot of people especially if they’re listening to this episode are going to resonate with, is ‘How do I get over the anxiety of just starting the process? I’m really scared that I might end up paying for a loss.’
Nicole: What I would say is, as you said, just sort of trying to work out who is someone you can see and who you can trust. As I was mentioning earlier, about 10% of kids are born through IVF. Actually, I think if people do start talking to friends and family, they will find someone who has done IVF. And so, I think, talking with friends and family, seeing who they’ve used – were they happy with them. So, word of mouth is really good.
And I must say, I have a lot of patients where they’ll say, ‘You treated my sister, you treated my friend at work.’ And so sometimes it’s not necessarily the GP who’s referred them to me, but they’ve gone to their GP saying, ‘I want to see this doctor’ because they’ve spoken with their friends.
Victoria: That’s the best.
Nicole: If you have like a good GP, especially a GP who is sort of more focused on younger people and fertility, they will often have other patients and patients will speak to their GP and say, ‘I saw this person, I didn’t like them.’ And so, if you really don’t have any contacts, speaking to your GP is good.
And then I think as well, in this day and age, there are lots of webinars and podcasts and other things. And so sometimes you can access an IVF clinic’s website and there will be videos or links to videos, and you can get a feel if someone’s going to be a good fit for you.
And obviously, sometimes even location’s an important thing. I mean, fertility treatment’s hard enough. You don’t want to be, you know, having to…
Victoria: Lug it two hours to get there when you’re already tired and pumped full of hormones.
Nicole: Exactly, but at the same time – and I guess this is one good thing from COVID – that Telehealth appointments are now very common, almost the norm. So while I do like to meet my patients at least once in the flesh, I do have a lot of patients who we do Telehealth appointments just because it is really hard to, when you’re working full time, actually get out in the middle of the day and go to an appointment when the petrol costs however much it costs and you can’t find a car park.
Victoria: Hospital parking is as astronomical, as the fuel crisis is. Oh, my goodness. Can I just say how grateful I am to have finally gotten you on the podcast? I got to do a webinar with you and I was like, ‘It’s going to happen.’ And we finally have made that a reality. I just know that so many people within our community have had their questions answered, finally.
So, thanks for hanging out. Thanks for your wisdom. Thank you for discussing all things fertility. And I’m sure this is not the last time that I get to share you with our community.
My friends. I’m going to share all of the important links that Nicole has mentioned in the show notes so that you can continue learning about your fertility options and everything that is available to you.
And if you have loved this conversation just as much as I have, please share it with somebody, because I promise it’s not as overwhelming as it feels once you dive in and start listening to conversations. Because these people, especially people like Nicole, are just here to support you and they are wildly passionate about doing so.
Please subscribe to make sure that you never miss an episode. And my friends, I will see you on Friday for Friday Drinks.
