On The Cutting Edge

LFM_On_the_Cutting_EdgeIn 2009 when I started Lane Fertility Institute, I had little idea of what would be in store for me or my patients. I was determined that a better environment for fertility care could exist. I believed that costs could be contained if only by accepting insurance – a concept that was novel in my local private practice environment. I wanted women to feel that they were not a part of a medical mill – a challenge that we keep fighting every year with growth. And I knew that awareness about fertility timelines and reproductive options had to be improved.

That last concept resulted in Lane Fertility Magazine. At first it was just an annual effort with contributors from local practices and my editing efforts. But this year I am launching a monthly magazine with a broader scope focused on survey results from our patients. My hope is that conversations will be initiated between women and their friends, families and children.

We will feature articles on understanding embryo freezing techniques, the latest data on the benefits of frozen embryo transfers and understanding the interaction of some common medications with your fertility.

Here is what I have learned from my years in practice. Amazingly talented and successful women walk through my door every day. And for all of their successes in life, we have still not adequately prepared them for one of their biggest challenges – their own fertility.

Please help us to help you by suggesting topics and letting us know when you read something that you like. Pass our Lane Fertility Magazine link on to your friends and colleagues so that more women can have an educational resource as they experience their own fertility journey!

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Fertility Story

LFI_Fertility_StoryBy: Joelle

My name is Joelle and this is my story of overcoming infertility. For several years, my husband and I unsuccessfully tried getting pregnant. We finally agreed that something must be wrong and decided to take action. My OBGYN referred us to Lane Fertility Institute (LFI). I was scared, nervous and excited all at the same time, but was willing to do whatever it took to get pregnant.

Our first meeting with Dr. Lane was extremely positive. She was excited and determined to get us pregnant. Dr. Lane’s enthusiasm was contagious. Her positivity carried me through many low days and I will forever be grateful to her for that. We explored several options during the consultation. Since we were young and had no known health problems, Intrauterine Insemination (IUI) was the best option to begin our path to parenthood.

The idea of an intrauterine insemination was personally a terrifying option for me. I had to give myself a shot prior to the IUI procedure. Unfortunately, my husband works nights so this was something I would have to do on my own. Thankfully, I was not alone. My clinical coordinator, Stephanie, provided detailed instructions, which gave me the confidence needed to administer the shot. To my surprise, it was quick and painless. Thank God!

We waited two long weeks to get the results. Each time I did an IUI and went in for my pregnancy test blood work I was told the sad news that I was not pregnant. The disappointment hit me hard each time that I received my test results. I cried, thinking I would never get pregnant, but remained optimistic. Tears turned into stronger determination. I quickly pulled myself together and immediately asked what we do next.

Dr. Lane decided injectable medications with IUI wasn’t the best for us because of the risk of having too many babies at once. So for us, In Vitro Fertilization (IVF) was the next step and boy, was that a process.

Once again, the team at Lane Fertility made the IVF process as easy as possible. The office staff ordered my medication and gave me a calendar of what to take every day – that was very helpful. On the day of the retrieval Dr. Lane retrieved 18 eggs, 11 matured and 8 were frozen. My husband and I went back and forth on transferring 2 embryo’s and after giving it some thought, we decided to transfer 1 embryo the first time around and thought that if it didn’t work we would transfer 2 embryos the second time. I was beyond excited the day of my transfer and felt good about the process.

Dr. Lane put me on strict bed rest after my transfer and I was happy to oblige. I decided I wasn’t going to do a home pregnancy test in fear of getting a false positive or the dreaded “Not Pregnant”, so I waited until I was scheduled for my blood work. That was the longest day of my life. I will never forget the moment Stephanie called with my results. My stomach was in knots and for a moment I couldn’t breathe. I was so used to getting bad news during this call that for a brief moment I thought she was going to say my results came back negative. With excitement in her voice Stephanie gave me the news I have been waiting for. I was Pregnant!!! I broke down crying and thanked her for the amazing news.

The fear of “what if” was always in my mind, but all I could do was be happy in that moment knowing I was able to get pregnant and prayed all would work out. I’m happy to report all is well and I am five months pregnant with a boy. My husband and I couldn’t be happier and are so grateful to Dr. Lane and her team for all their hard work and support.

Joelles-baby-boyMy fertility journey was quite a long road but I believe this process made me a stronger more supportive friend, wife and sister. I only hope my story will give someone hope in knowing it’s possible. It just might take a little bit longer with a little help to get your miracle baby.

Sincerely,

Joelle

 

Inspired by Joelle’s Fertility Story? Help us help others by sharing your path to Lane Fertility Magazine. (connectwithus@lanefertility.com)

 

International Fertility Tourism

LFM_International_Fertility_TourismBy: Lee Kao MD, PhD

Infertility knows no political boundaries. In many countries, however, cultural norms, laws and, cost limit access to cutting-edge fertility treatments Fortunately, prospective parents are not easily discouraged, and as a result, many will travel around the globe across national borders to obtain care. This practice is commonly referred to as International Fertility Tourism or cross-border reproductive care (IFT/CBRC).

In 2010, researchers estimate that in Europe, 24,000-30,000 cycles of cross-border treatment occurred per year, representing approximately 5% of all European fertility care. Similar survey data from the United States indicates that 4% of all fertility treatment provided in the county is delivered to non-US residents. Amongst patients traveling to the US, the largest groups of patients are from Latin America (39%) and Europe (25%). Additionally, the number of patients leaving the U.S to travel abroad for fertility care is estimated to be far lower than the rate of patients coming into the United States.

The factors that motivate patients to travel beyond the country border for fertility care (IFT/CBRC) typically fall into four basic categories: 1) access to broader and higher quality care, 2) avoidance of local regulations, 3) reduction in cost, and 4) privacy.

Travel to Access Broader and Higher Quality Care

In many countries, the availability of fertility care is extremely limited. Typically, limitations to care are due to an inadequate number of fertility providers, and fertility clinics. As a result, patients are required to wait a significant amount of time prior to receiving care and in some cases this decreases their chances of success. Surveys suggest that this issue of access is particularly relevant in the Middle East, Southeast Asia, and Latin America.

There is also a lack of egg or sperm donors and gestational carriers in countries where payments for these services are forbidden. Thus patients with this need will frequently travel abroad. This represents a large reason for International Fertility Travel amongst Canadian women. Additionally, many national policies require that egg and sperm donors’ identity be disclosed to the recipient couple. Comparatively, it is estimated that in the United States, 70% of donor cycles are performed anonymously. Thus, in countries such as Sweden, the United Kingdom, and Norway, patients indicate that the desire for anonymous egg donation is a cause for international fertility travel.

A patient’s desire to access higher quality care also figures prominently into international fertility travel. The majority of patients who travel abroad for care have already received treatment in their home country. Treatment failures, along with a perception that clinics abroad employ more highly trained personnel, utilize more up-to-date equipment, and offer more specialized services, encourage these experienced patients to seek treatment abroad. In countries that infertility care is part of their national health service, patients have higher tendency to travel to avoid long wait times.

Travel to Circumvent Fertility Treatment Law

Legal regulation of fertility treatment worldwide occurs on a country-by-country basis, with no overarching international treaties or formal laws in place. Fertility regulations that motivate international fertility travel fall into two broad categories: 1) restrictions on who can access fertility care and 2) restrictions on what fertility care can be accessed. In many countries, there are laws addressing ‘‘who’’ may access care based on patient demographics such as patient age, marital status, and sexual orientation. As a result, often older, single, and gay/lesbian patients are forced to travel across borders to access care. Conversely, in the United States, strict nondiscrimination laws prohibit ART clinics from denying care on the basis of a host of demographic factors, including race, ethnicity, marital status, and sexual orientation. Recently, the ability to biopsy embryos and demonstrate genetic normalcy has revolutionized the field of fertility. However, legal restrictions on access to this service in states such as Massachusetts and various countries around the world have been a cause for fertility travel. Other restricted services in certain international jurisdictions include limits on sex selection, compensated egg/sperm donation, and embryo cryopreservation.

Travel to Reduce the Cost of Fertility Care

High cost involved in fertility care is a well-described barrier for many patients. Even patients who start out able to afford the expensive care often incur financial hardship in their quest for parenthood. Globally the price of different fertility services varies widely, with the average price of an IVF cycle in the United States as high as $10,000 and as low as $690 in India. Surveys of patients who travel to access third-party reproductive services indicate cost as a significant factor in their decision to leave home country. For example, the media reports India as being a popular destination country for gestational surrogacy services, with fees to carriers averaging $8,000 compared with $25,000 typically for a US surrogate. Fees to egg donors also vary considerably from country to country.

Travel for Privacy and Cultural Comfort

“Infertility” can engender sociological, emotional, psychological, physical, and financial burdens in many patients and lead them to seek treatment abroad for privacy and cultural comfort. Often these patients seek out a country in which they have extended family or possess a degree of cultural familiarity. Family connections, cultural comfort, and access to racial and ethnic-matched donor gametes can be a reason for choosing international fertility services.

Why the San Francisco Bay Area?

San Francisco is an internationally known tourism hub, with easy international travel access and extremely tolerant cultural diversity. In addition, the San Francisco Bay area is composed of a unique ethnically diverse society, including Asians, Hispanics, Europeans, Pacific Islanders, living in a harmonious yet high tech affluent environment. Paired with client friendly/protective reproductive laws, non-discriminatory social fabric, diversified oocyte donor/gestational surrogate pool, high caliber fertility services, and advanced fertility technology, the San Francisco Bay Area easily and uniquely becomes a hub for international fertility tourism.

How to initiate international fertility care at Lane Fertility Institute

At Lane Fertility Institute, we have designed an experience that specifically meets the needs of our long-distance and international patients. Initial consultations may be conducted by telephone, email or skype. Pre-testing and some evaluation may be done locally prior to travel. Travel to the international facility is required for laboratory procedures including egg retrievals and embryo transfers. Translation services are available to assist in the care of our diverse group of patients.

 

ABOUT THE AUTHOR

Lee Kao, MD, PhD, Reproductive Endocrinology and Infertility specialist.  Dr. Kao joined Lane Fertility Institute in 2012.  Educated at Taipei Medical College in Taiwan, Dr. Kao came to the United States for the remainder of his training.  He completed residency at Georgetown University Hospital and fellowship at the University of Pennsylvania Medical Center.  After completing tenures as faculty at UCLA and Stanford University, Dr. Kao brings tremendous expertise to his patients at Lane Fertility.  Dr. Kao specializes in international fertility care.

How To Optimize Your Body Mass Index

LFM_Body_Mass_indexBy: Danielle E. Lane, M.D.

For our family it begins on November 1st – the day after Halloween. Armed with candy, my family, friends and I slowly begin our plunge into the holiday eating binge. There will be turkeys and stuffing, gravy, mashed potatoes, candied yams, apple pies, pumpkin pies, holiday cookies, fruitcakes and every other weight-gaining food known to woman. And by the time it’s over, the food saddled with travel and decreased exercise rarely results in less than 10 pounds of weight-gain.

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So here’s the good news! Now it’s over. The family, friends and food were great, but 2015 has arrived! You are back in your own home, with your normal routine. This means that with a little focus and consistency you will be back in fighting shape.

Weight is a simple equation. It is the balance between calories in (food) and calories out (exercise). So decreasing the caloric intake and the type of calories (lowering carbohydrates) and or increasing the exercise regimen will get your body back to its normal weight.

Carbohydrates can be tricky. The easy things are easy to recognize: pastas, potatoes, rice and breads. Everyone knows about the cookies and cakes, but what about the more subtle carbohydrates. Here’s a hint: if it tastes sweet, there are carbohydrates involved! Table 1 provides a comprehensive list of low-carbohydrate options to be considering in your diet.

 

If all of these carbohydrates have to be used in severe moderation, what does that leave? Weight gain will be most easily curbed by a diet containing a predominance of lean meats and vegetables. Snacks must be minimized, and water should be drunk in abundance. And yes, you will be a little hungry at first. Depending on the level of carbohydrates that you are eating, exercise may be an adjunct to a strict dietary regimen.

weight-factsWhen I was in my fellowship, I used to argue with my division director that weight loss was very hard, and that the reason it worked in clinical trials was because the food was often given to patients, and a study coordinator would call patients weekly or sometimes daily to check in and see how they were doing. In this setting, it was hard to fail. The good news, is that study-like conditions are now easily obtained by the general public. In the last decade multiple physician-supervised weight-loss clinics have developed. Some are integrated into health plans such as Kaiser Permanente and Sutter Health, others are commercial endeavors that may or may not take your insurance (JumpstartMD, Nutraworks). All have the ability to help you manage the diet and exercise regimen necessary to reach your goals.

Fast Facts About Your Weight Loss contains a few known weight related outcomes to consider. So, as we enter 2015, take the time to optimize your health and achieve a body mass index that will help with your goal of creating your family. Here’s to a happy and healthy 2015!

References:

1 Falsetti L, Pasinetti E, Mazzani MD and Gastaldi A (1992) Weight loss and menstrual cycle: clinical and endocrinological evaluation. Gynecol Endocrinol 6,49–56.

2 Kumar A, Mittal S, Buckshee K and Farooq A (1993) Reproductive functions in obese women. Prog Food Nutr Sci 17,89–98.

3 Clark AM, Ledger W, Galletly C, Tomlinson L, Blaney F, Wang X and Norman RJ (1995) Weight loss results in significant improvement in pregnancy and ovulation rates in anovulatory obese women. Hum Reprod 10,2705–2712.

4 Galletly C, Clark A, Tomlinson L and Blaney F (1996) Improved pregnancy rates for obese, infertile women following a group treatment program. An open pilot study. Gen Hosp Psychiat 18,192–195.

5 Norman RJ and Clark AM (1998) Obesity & reproductive disorders: a review. Reprod Fertil Dev 10,55–63.

6 Bellver J et al (2010) Female obesity impairs in vitro fertilization outcome without affecting embryo quality. Fert Ster 93, 447-454.

 

ABOUT THE AUTHOR

Danielle E Lane, MD, Reproductive Endocrinology and Infertility specialist. Dr. Lane attended McGill University before completing her medical training at the University of Pittsburgh school of medicine, her residency at Yale-New Haven Hospital and her fellowship at the University of California, San Francisco. She opened the Center for Reproductive Health at Kaiser Permanente in Napa-Sola-no in 2005. In 2009 she founded Lane Fertility Institute. The Institute has grown to a four physician, multi location practice with a state of the art embryology laboratory. She is committed to providing education for women about preservation of their fertility and developing lower cost models to improve access to care.

Understanding Your Health Insurance Plan

LFM_understanding_insuranceBy: David Jaramillo
Lane Fertility Institute Financial Specialist

When accessing coverage under your insurance Plan, at the beginning of a new year, understanding the plan terms or descriptions of provisions and coverage can be difficult. Below is a list of common health insurance coverage terms to help everyone understand more about their individual Plan:

Deductible: The deductible refers to the amount of money that the insured individual will need to pay annually before any benefits from the health insurance policy can be used. This is usually a yearly amount so when the policy starts again such as 01/01/15, the deductible would be in effect again and would therefore have to be met. Some services such as a physician visit may be allowed under the copay only. However, as the insured individual, you should contact your Plan to understand whether the visit is applied to the deductible or is only subject to your copayment, if applicable.

Co-pay: The co-payment is a fixed amount that the insured is required to pay at the time service is rendered. It is usually required for basic physician visits.

Co-insurance: This is usually a percentage amount that is the insured’s responsibility. A common coinsurance split is 80/20. This means that the insurance company will pay 80% of the procedure and the insured is required to pay the other 20%

Out-of-pocket: This is the cost one would pay out of their own pocket. An out-of-pocket expense can refer to how much the co-payment, co-insurance, or deductible is. Also, when the term “annual out-of-pocket maximum” is used, that is referring to how much the insured would have to pay for the calendar year, excluding policy premiums, if applicable.

Lifetime Maximum: This is the most amount of money the health insurance policy will pay towards certain services (i.e. Infertility treatment not to exceed $2,000.00 per lifetime to include or exclude medications).

Exclusions: The exclusions are the things/services that the insurance policy will not cover.

Coordination of Benefits: If the insured has available two or more Plans that provide coverage for certain conditions, both plans are then billed and will coordinate payment between the primary and secondary Plan but will never pay above the billed amount.

Provider Networks: Most health Plans have health care service providers that have made a deal with the health plan to provide services at discounted rates. Together, these health care service providers are known as the health plan’s Provider Networks. It is important to understand whether your Health Care Provider is considered In-network or Out-of-Network. Even if you have benefits Out-of-Network, in all likelihood, you will have a higher co-insurance due by you along with a higher deductible and any payment made on services that doesn’t pay the charge in full is then your responsibility. For example, if your PPO plan requires a $45.00 copayment to see an in-network specialty physician, but 50% coinsurance if you see an out-of-network specialist, instead of paying only $45.00 to see an in-network specialist, you could end up paying $200-$300 to see an out-of-network specialist, depending on the amount of the bill. HMO plans and some EPO plans will not allow you to use an Out of Network provider.

Prior Authorization: Most health plans won’t allow you to get whatever health care services you wish, whenever or where ever you wish. Since your health plan is paying for at least part of the bill, it will want to make sure you actually need the health care you’re receiving and that you’re getting it in a reasonably economic manner. One mechanism used is a pre-authorization and HMO plans all require this. Some other plans as well (i.e. PPO, POS, EPO) require review/authorization for Specialist services (i.e. Infertility services). Authorization if required must then be obtained before the service is rendered or it will be denied and you could be then liable for the cost.

These are just some of the basic tenets of understanding your Plan coverage. As a patient in a fertility practice, it is particularly helpful to understand these terms to maximize your coverage and minimize unexpected costs.

Please visit Lane Fertility Institute for a list of Accepted Insurance Plans

 

ABOUT THE AUTHOR

David Jaramillo. Financial Specialist for Lane Fertility Institute.  Mr. Jaramillo brings over 30 years of experience working in health care finance.  He spent a decade as the financial specialist at the UCSF Center for Reproductive Health where he pioneered novel systems that are still used today to assist patients in navigating the complexities of their fertility benefits.