Culture Study Podcast - The Heartbreaking (and Largely Unregulated) Business of IVF

00:00:00.000 Hey, everyone. So let me fill you in on the recordings we have coming up so that you can submit your questions. For starters, we have two authors who are coming on that had me texting Melody in all caps when she told me that she got them to come on the show. It's amazing. We're going to talk to R.F. Kwong, author of The Poppy Trilogy, Babel, Yellowface, and Katabasis. I want to get into the popularity of dark academia, but of course you can ask her anything you'd like.

00:00:24.200 I'll also be talking to Culture Study fave Kat Sebastian, author of one of this month's

00:00:29.060 romance book club picks about queer historical romance.

00:00:32.440 So submit your questions for her as well.

00:00:34.920 Okay, here's what else we've got cooking.

00:00:37.000 An episode about adults, specifically ladies and non-binary people getting into video games.

00:00:42.400 An episode about car culture and more specifically the death of car culture, like what does life

00:00:47.720 after cars look like?

00:00:48.940 an episode about how to prepare for and or handle all the bureaucracy and paperwork around your

00:00:55.000 parents dying. This is with a death duel. It's going to be really good. So you can submit all

00:01:00.720 of your questions for these and for our Ask N Anything segment at tinyurl.com slash culture

00:01:07.300 Study Pod. Can't wait to hear from you. This is the Culture Study Podcast, and I'm Anne Helen

00:01:20.140 Peterson. And I'm Jackie DeVallos. I'm the host of IVF Disrupted, The Kind Body Story. It's a

00:01:26.420 podcast about the fertility industry and a startup that grew a little too quickly. Okay, I'll just

00:01:33.420 quickly set the scene here. Kind Body is a fertility clinic startup with dozens of locations 0.73

00:01:38.380 across the U.S. If you live in a major city, you might have walked past one. It started in 2018

00:01:44.020 and is backed by a ton of venture capital and private equity. Obviously, people should listen

00:01:50.200 to the podcast, but just to tick through some of the things that you found out in your reporting

00:01:55.700 and talking to patients and staff members. So again, according to your reporting, understaff

00:02:00.820 clinics, a culture of upselling products and procedures to meet internal financial targets,

00:02:06.000 infrastructure issues in the buildings, embryos that were mislabeled or stored in improper

00:02:10.160 conditions or accidentally destroyed. So tell me how you even started looking at KindBody and all

00:02:17.740 of this. It was, I wasn't even looking for a story in the fertility world. I was a tech reporter at

00:02:25.820 the time. And KindBody came onto my radar because they started kind of spamming me with a lot of

00:02:33.180 ads on TikTok and Instagram. And at the time I was 30, 31 years old. So right in its ideal

00:02:42.140 demographic for targeting women who might be seeking egg freezing services or IVF. And just

00:02:49.620 the concept of how much I was getting these ads and it looked really beautiful. I mean,

00:02:55.480 when I think about fertility services, I didn't really know what to expect, but this looked like

00:03:00.760 the kind of place that I would see in New York City where I lived. And that concept of something

00:03:07.660 feeling like a spa, this wellness brand, I'm a millennial, so naturally I tend to gravitate

00:03:14.860 toward those kind of startups anyway. And I got super curious. And, you know, as a journalist,

00:03:20.500 you just start making a couple calls. And fairly soon after that, you know, I started to get the

00:03:27.100 sense that things were not as the company was portraying them to be. What year was this about?

00:03:34.220 This was the beginning of 2023. I also feel like this is a time when a lot of these startups,

00:03:40.100 Like people were like, there's something rotten at the core, right?

00:03:44.060 Like it started happening a little bit before, but I do think that this was part and parcel

00:03:49.620 of that larger movement.

00:03:51.840 100%.

00:03:52.280 I had actually done some reporting on other health tech companies the year before in 2022

00:03:58.200 when, you know, if you're not familiar with what was going on in the tech world, just

00:04:03.200 a lot of startups got a reality check that you can't be spending this much money.

00:04:07.380 And, you know, a lot of companies started struggling to raise money and some started going out of business. And I had done reporting around this one startup called Cerebral, which was doing a lot of prescriptions for controlled substances. And they got in trouble for that along with other startups.

00:04:22.840 So naturally, I was already kind of skeptical about health tech working, especially when like the stakes are so high. And when I saw that this was a venture backed company, my spidey senses always go off like when these sorts of startups are tackling something this sensitive and then take on kind of the Silicon Valley vibe to it. You know, as a reporter, I wanted to dig in a little more.

00:04:47.880 And we'll talk about this as we go through this episode a little bit more.

00:04:50.680 But the thing about Kind Body specifically is they were trying to be almost like a one-stop

00:04:55.660 shop, like a convenience store for fertility, as in they were trying to market to you for

00:05:02.020 egg freezing, but then they also were trying to provide the services for people who were

00:05:06.440 going through IVF later down the road.

00:05:09.020 Yes, they were undertaking something that no other company in the fertility industry

00:05:15.700 had ever done. This idea of a one-stop shop was really new because it is so hard to do. I mean,

00:05:22.920 they wanted to do gynecology, egg freezing, IVF, but also if you need some counseling. And then

00:05:30.800 they were later on going to do stuff for surrogacy. And so it was just kind of really ambitious,

00:05:38.540 but it was also really exciting. We have to give them a little credit for seizing on that

00:05:45.620 moment where, you know, women were really curious about taking control and wanting to take control 0.75

00:05:51.920 of their health. And women's health is already a really kind of under-invested, under-covered area. 0.97

00:05:59.460 And so I think their audience and their ideal customer was hungry for something like that.

00:06:07.340 Totally. And I think like a lot of it is so opaque that when you're in your 30s and you

00:06:13.060 see something that's promising to leak, like so many other services, especially startups that are

00:06:17.880 like, well, if you just press this button, then things will work. Like the promise is alluring.

00:06:23.340 But I also think this is something that so many startups have encountered. Like there's a reason

00:06:27.900 why these services have not been bundled together. There's a reason why things are difficult,

00:06:32.800 because it is a difficult process. And you can't just be like, oh, we're just going to do this.

00:06:38.400 we're just going to offer this and it's going to work. Yes. And what makes fertility even harder

00:06:44.400 is that like, it's only been around since really the nineties. I mean, in the, in the seventies and

00:06:51.120 eighties, it was like, you know, the kind of thing that like only veterinarians really had

00:06:56.620 experience with because they were doing this stuff with animals, like literal, like farm animals.

00:07:02.220 And so a lot of the experts that I spoke to who've been in the industry for decades were like,

00:07:06.720 oh, this was like, you know, this wasn't a thing until really the 90s when it started becoming

00:07:12.900 like a far more commercial venture, much more mainstream, more clinics started cropping up.

00:07:18.600 And so because of that, you know, it's kind of been stuck in its ways. And so to have this

00:07:24.700 really flashy, buzzy, millennial-friendly, aesthetic, vibey startup disrupting it,

00:07:31.120 I think you had its skeptics, but for the most part, people were really eager to hear them out.

00:07:37.700 Yeah. You know, it's so hard for me because like, I absolutely understand that. And then it also

00:07:41.860 just grosses me out when people are like, yeah, having babies, like that's a profit center,

00:07:46.940 right? Like, it's just, whenever like there are things like this that are so complicated,

00:07:53.320 so emotional, so weighted with all of this stuff, and then to have it turn into a profit

00:08:00.700 center just makes all of the problems, I think, even worse. 100%. I mean, it's like a lot of

00:08:07.900 areas in American healthcare, it's a business. But what makes fertility, I think, even more

00:08:15.040 complicated is the fact that there is no ceiling, virtually no ceiling, to how much people will pay.

00:08:23.280 And when you're dealing with such a vulnerable population, I mean, women will go through

00:08:28.480 anything. I heard heartbreaking stories of not just the money that they pay, but their bodies

00:08:35.520 and what they go through with the hormones and the disappointment. I mean, they will do anything 0.68

00:08:42.780 to have a baby. You know, I hear a lot about it, both in my friend group, also in the comments on

00:08:48.740 culture study, like this is such a vulnerable area. And there's a lot of reporting and a lot

00:08:54.800 of personal essays, collections, all sorts of stuff. Like there are so many directions that

00:08:59.220 you could take an episode on this larger topic of IVF. We are specifically focusing on the industry

00:09:05.460 because I actually think this is something that is under understood, misunderstood. Like people

00:09:12.200 do not have, there is not enough transparency about how it functions as an industry and a lot

00:09:17.560 of the bureaucracy. I think people who have been through it will talk about it, but it's not

00:09:22.180 something that you necessarily know about if you haven't been through. So that's our focus for

00:09:26.800 today. And we have a lot of questions that we've chosen that are going to allow us to drill down

00:09:30.280 more on that. So this first question comes from Andrea. As a person with unexplained secondary

00:09:35.740 infertility who did not want to undergo IVF, I found it quite frustrating the lack of alternative

00:09:41.400 options that were available to me and my partner when we were trying for a second child. We did

00:09:46.980 all the tests and everything came back quote-unquote normal for your age for both of us.

00:09:52.180 We were told we should just jump straight into IVF to avoid wasting more time and money with

00:09:57.300 less effective options like IUI. It seems that IVF provides an expensive, invasive, and time-consuming

00:10:04.800 yet effective solution to infertility. Is this the main reason for the lack of research into other

00:10:10.000 treatments? Or is it just a symptom of a lack of research in women's health in general? Where does 0.88

00:10:15.660 male fertility fit into this? So we should define some terms here first. So secondary infertility

00:10:23.320 is when you have a baby without any problems, and then the second baby, it's just more difficult.

00:10:31.560 And then the other thing that we should define is IUI, which I understand is like,

00:10:36.880 it's interuterine insemination. So it's when they take concentrated sperm and they put it

00:10:42.720 directly into the uterus it's like an assist in a slightly different way than ivf um and less

00:10:48.580 invasive totally less invasive doesn't require any egg retrieval yeah yeah so the her question

00:10:56.320 is about like why is there this jump it's almost like people like the jump right now in women's

00:11:02.920 health there's like i've seen a bunch of different a bunch of reporting about like the jump to always

00:11:06.980 go to cesarean when that's not necessarily the best solution. Why is there this jump to go to

00:11:14.000 IVF? Well, she kind of hit one of the problems on the head there with the fact that there's

00:11:21.900 very little research into the causes of infertility. And I'm not just talking about

00:11:28.760 infertility for women. I mean, male factor infertility is also something that is

00:11:33.980 really not well understood. And so when you think about the menu of options to work with,

00:11:42.240 it really depends on the person that walks in the door, but IVF works. I mean, it is a very

00:11:48.540 effective treatment. And so one of the things that doctors told me as I was reporting was,

00:11:56.640 why would I have a woman waste her time, especially if she's older? Let's say she was 1.00

00:12:02.580 in her late 30s, early 40s, the other stuff might not work for you as well as IVF. And if you want

00:12:08.920 to have a baby this year, like, let's just jump right to it. However, there is an incentive as

00:12:16.040 well to resort to IVF because it is by far the most lucrative type of treatment in the fertility

00:12:24.000 world. And so when I was doing reporting on KindBody, I got to look at documents that listed

00:12:30.060 out how much the clinics were making when you charge for IUI versus IVF. And because IVF requires

00:12:39.440 an egg retrieval, that's the most expensive part. And if you're the patient walking in the door,

00:12:46.000 it's not just the egg retrieval I'm paying for. It's genetic testing. It's the medications,

00:12:50.600 which usually are not covered by insurance. Most people are self-pay. And so there's a lot of ways

00:12:58.140 that the clinic can also make money off of IVF, whereas you can't really collect on those

00:13:04.460 certain add-on services like embryo glue or neupogen wash or some of these other things that

00:13:11.720 some clinics will say will help your chances to get pregnant. But the science really does not

00:13:17.360 back that up. So I understand the skepticism that people have when the first option that they're

00:13:24.620 given is IVF. Again, doctors will tell you this is such a tailored thing. It really depends on so

00:13:30.960 many things about your history, if you have hormonal issues, PCOS. And so what women told

00:13:42.000 me when their spidey sentences went off, it was like they didn't even ask. It was just kind of

00:13:48.740 this was the only option. Yeah. Yeah. Gosh. Well, and it also, there's something about like that

00:13:55.400 description of a doctor being like, well, if you want to have a baby on this timeline and you're

00:13:59.920 getting older, like you've got to do this right now, why quote unquote waste your time? And I

00:14:04.780 understand that, but it also feels like optimization culture in this kind of icky way that I could feel

00:14:11.760 someone who is going through this process and doesn't want to go through the like invasive and

00:14:16.520 expensive and time-consuming process of IVF, they want to be like, well, let's try this little step

00:14:22.160 first. And if you're thrown directly into IVF, that's when you're like, oh, is this because this

00:14:28.280 is the best deal for you? Totally. I mean, it's a cash cow. I don't know how else to put it. IVF

00:14:38.260 is extremely lucrative. And certain clinics kind of take it to another level because there are so

00:14:45.620 many other ways to profit off of this. But also because there is so much demand, they can, you

00:14:52.540 know, put this out as the only option. And people really trust their doctors when I think more so

00:14:58.140 than any other kind of patient I've seen in the health world, fertility patients have so much

00:15:05.200 trust in their doctors because it is this like very nebulous world. It's super opaque. And so

00:15:12.160 if a doctor tells you that this is the best option, you're just going to go with it. Yeah.

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00:19:07.200 Okay, next question builds on this. It comes from Stephanie.

00:19:11.240 In IVF, desperation is a business model. Clinics know it and patients feel it at every turn.

00:19:17.840 especially when you're encouraged to try just one more round before giving up.

00:19:22.660 For context, I'm a two-time IVF mom.

00:19:25.600 Is there any way to talk openly about the financial incentives and upselling in fertility care

00:19:31.360 without making patients feel judged for doing what they can to build a family,

00:19:36.580 all while calling the system out for what it is?

00:19:39.900 I like that Stephanie called attention to this tension,

00:19:43.200 because i do think like there is a a gentleness with which we should approach this subject because

00:19:50.900 at the one time yes like kind body was exploiting people's desperation and like screwed up a lot of

00:19:57.640 people's lives and you hear that in the reporting that you've done and like this is what you get i

00:20:02.560 think in a podcast you get to hear those voices and you get to hear that desperation and what

00:20:06.920 people were driven to and like i don't blame them for taking that route but also like we have to

00:20:13.040 talk very plainly about how that desperation is taken advantage of at the same time I mean I think

00:20:19.780 about Lacey Mickelson's story the woman who eventually was able to conceive but it's almost

00:20:28.240 like this shame that they carry um like I should have known I should have asked I um you know I

00:20:35.460 put myself through this I put my family through this I think there's a lot of guilt that these

00:20:41.460 women carry, but you don't know what you don't know. And until they went through that, many people

00:20:48.800 just didn't know what to ask or what was normal. And so absolutely, I think both things can exist.

00:20:56.240 We can hold space for their experience and give credit to this great treatment, but also call out

00:21:04.060 the fact that the incentives currently in place in this industry take advantage of people's

00:21:11.640 vulnerability and exploit what they're able to put up with. Do you think some of it is that

00:21:16.460 I think as a society, we are much more open about talking about IVF, but it's still like the details

00:21:25.020 of it are not something that is discussed as much. Like people will be like, there used to be

00:21:29.720 embarrassment about even saying like, we're doing IVF. That to me seems to be disappearing

00:21:34.000 within many contexts. At the same time, the like, we're doing that, like anything over a couple

00:21:41.380 rounds, I think sometimes there does become this like, kind of, we don't want to talk about it

00:21:46.500 publicly. Yeah, I think, I mean, I heard this a lot. Some women didn't want to share their full

00:21:54.800 names because they hadn't told their families. There is somewhat of a, you know, like a religious

00:22:00.220 component. One of the women that I interviewed was from a very religious community who, you know,

00:22:09.400 she was terrified. I mean, the emotion in her voice when she was like, you cannot tell anybody.

00:22:16.480 And eventually she agreed to be on background at least. But it was really important to her because

00:22:23.640 of her beliefs. And a lot of people don't realize that IVF gets caught up in the abortion politics

00:22:32.300 debate. And I don't have to go into it too much for this particular question, but there is a lot

00:22:38.000 of that. There is kind of the same critics and skeptics that will say, if you have an abortion,

00:22:46.520 you're killing a potential child. There's some of that wrapped up in IVF because in the process

00:22:52.800 of creating embryos, you sometimes have to discard some and to some that's tantamount to murder.

00:22:59.160 And so depending on where you are, for example, Tennessee, I spoke to some patients for the

00:23:07.080 reporting generally, Kind Body doesn't have a clinic there, but they were really reticent to

00:23:11.700 talk about this stuff in comparison to like a couple from New York or Chicago. Yeah. Yeah. No,

00:23:18.100 that's such a good point. What about the upselling part too? Like, how does that work?

00:23:24.580 So upselling, I mean, the add-on services in IVF are some of the, it's a racket. It's a complete

00:23:36.440 racket. I have not had one doctor tell me that these things actually work. So for example,

00:23:43.020 neupogen wash, embryo glue, you know, allegedly helps like the embryos stick to your uterine

00:23:50.760 lining better. Sometimes you're sold supplements that will help you, you know, along the process.

00:23:58.740 There's a lot of these things. Genetic testing, there's a little bit of a debate as to whether

00:24:05.360 you need it or not. It's somehow now become the standard of care when many doctors tell me

00:24:11.820 not everybody needs it, yet many clinics sell it as if everybody does. And so that doesn't just add

00:24:19.900 hundreds of dollars, it has thousands of dollars. Genetic testing is upwards of like four to five

00:24:24.600 thousand dollars. And, you know, when you're paying already, you know, an average of twenty

00:24:29.440 three thousand dollars per cycle, you're like, all right, what's another thousand bucks, you know,

00:24:34.400 to improve my chances this is not a perfect metaphor but it reminds me of like if you take

00:24:42.680 your car in to get fixed and you don't know a lot about cars and someone who seems to know a lot

00:24:48.960 about cars comes in and says these are all the things that you need to do to your car and you're

00:24:54.380 like well I don't know what like what's bullshit and what's not right and so of course like you

00:25:01.180 don't want your car to break down on you and you also don't want to jeopardize in any way 0.82

00:25:05.940 the the possibility of conception and i think that people just get stuck in that like well

00:25:11.760 like you said at the very beginning of the episode you don't know what you don't know

00:25:14.780 yes and so you're vulnerable to like that sort of okay we haven't even said too like

00:25:20.180 is there any regulation like who is regulating these clinics who is saying like maybe you should

00:25:24.760 you have to clarify that this is not necessary or like no one there's you know i actually spoke

00:25:32.400 to a lawmaker um last december actually for a different story um related to just kind of what

00:25:40.860 regulations do exist yeah or what consume what consumer protections because there is no

00:25:47.800 regulation. Effectively, it's like you have state health agencies sometimes going in and making sure

00:25:56.540 that like the blood testing and urine analysis that certain things in a lab go right. But when

00:26:02.520 it comes to the embryology lab, that's like the beating heart of an IVF clinic. That's completely

00:26:09.920 untouched by the government. And there's a reason for that. It is so touchy politically. The lawmaker

00:26:16.800 I spoke to last year was a Democrat, Senator Wyden from Oregon. He had put in some of the most,

00:26:25.620 I think, well-intentioned consumer protections back in the 90s when IVF was still super new.

00:26:33.380 And what that did was make sure that doctors couldn't falsely advertise their success rates.

00:26:41.240 You had doctors back then saying, oh, I can get you pregnant in two cycles. I have 100% success rate. And people go through with it and then they realize the guy was a con artist. So what that law put in place was now you have to report your success rates. And that still exists today, but that doesn't protect people from upselling. That also doesn't regulate what goes on in the embryology lab.

00:27:09.280 I mean, it doesn't track errors. So when something goes wrong, no one knows about it.

00:27:16.600 Yeah. God.

00:27:18.420 Okay, we'll get into more of that too as we keep going. But let's get to our next question,

00:27:21.900 which is from Anna.

00:27:23.640 We went through IVF this summer for known male factor infertility due to a genetic condition.

00:27:29.400 The economy of the industry seems so intentional and predatory that even though I love my team,

00:27:34.980 I still feel yucky. Anything related to the male factor infertility side was self-pay,

00:27:41.000 and while we were lucky to have fertility coverage through our insurance and to have a doctor in our

00:27:46.180 area that accepts it, the lab we had to use, because it's attached to our clinic, only accepted

00:27:52.180 the one insurance the doctor didn't take, so all our lab fees were self-pay. Is this the norm across

00:27:58.440 the industry, or is it just slow to catch up to insurance covering fertility treatments?

00:28:03.060 Sadly, it's typical. And I think it reveals something else about how the industry has kind of evolved. It's really around women's bodies. The male factor infertility accounts for like a pretty big chunk of all infertility cases.

00:28:24.160 So it's not like it's all women's fault. Like many times, you know, the male partner has a lot to do with that, but a lot is not known about what causes it. And because of that, you don't know how to treat it.

00:28:37.980 And what you do know how to do is work with like the woman's reproductive system that we know pretty well. And it's a far more studied and area that like has had practice versus like treating the male side.

00:28:54.300 But the insurance aspect of this as well, I mean, insurance is barely catching up. This idea that insurance covers IVF is really only something that's happened within the last decade or so.

00:29:11.000 There's some states that actually mandate insurance companies cover fertility treatments like Illinois.

00:29:19.800 Illinois is like, you know, you can get a certain number of cycles or a certain dollar amount covered.

00:29:25.380 But many states don't do that. And there's a lot of lobbying to like have other states cover it.

00:29:31.460 But even when it is covered, there's just like a lot of, you know, red tape that comes in between that as well.

00:29:39.020 like, you know, medication ends up being in the tens of thousands of dollars because sometimes

00:29:44.280 it's not covered by. Because it's not part of the procedure. It's like, does it separate between

00:29:50.280 procedure and medical, like the medications you have to take in order to prep for the procedure? 1.00

00:29:55.900 That's so dumb. I'm sorry. So one of the things that really struck me about the reporting 0.97

00:30:00.800 is how kind body partnered with different employers and employers thought like oh well

00:30:10.260 we're partnering with this company like what a great deal like we're going to be able to like

00:30:13.940 get the egg freezing and then later ivf like it's just like and the employer also pushes this as a

00:30:19.880 benefit can you talk a little bit about that component oh yeah um kind body had an interesting

00:30:26.200 business model from like the employer benefit side and then having people come in and pay out

00:30:33.860 of pocket. They really pushed this employer benefit thing because it was starting to catch

00:30:41.120 on in the industry and more companies wanted to offer that benefit. But not every fertility clinic

00:30:50.960 does that. And they were pretty unique in that they were partnering with companies in that way,

00:30:56.680 kind of on the scale that they were. And look, it gave people the additional option. But what I did

00:31:05.000 also realize, if you did not have a good experience, you were kind of stuck. I remember

00:31:09.920 interviewing people from... There was one woman whose husband worked at Tesla and they had this

00:31:16.680 great benefit, but like their care was terrible. They were so unhappy and they were like, what are

00:31:20.960 we going to do? We're stuck with this benefit and either we pay out of pocket or we just, you know,

00:31:26.100 put up with it. Well, and it's so striking to me the ways in which like these tech companies

00:31:31.320 partner with other tech companies, right? Like, or like venture capital funded companies. So when

00:31:37.180 I was at BuzzFeed, the company partnered with this like on demand, urgent care, right? That like,

00:31:43.840 oh you just like put in your thing and then you get an appointment anywhere in the city

00:31:47.260 it was so bad but you couldn't do anything and they were like look at how we're giving you good

00:31:52.220 health care and we're like like they want to look cool right and they like came to the office and

00:31:58.200 like did a cool presentation like everything about it was so icky but you can't like they're trying

00:32:04.640 to say like look at this cool benefit that we are giving to all employees and then it sucks and you

00:32:10.020 can't do anything about it. I mean, the way Kindbody pitched it, and to their credit,

00:32:16.040 they were wanting to expand access. So they were like, if you live in a state and you don't have

00:32:22.080 mandated insurance by the state, then if you work at one of these companies, look, now you have this

00:32:28.800 additional benefit. In their eyes, this was like leveling the playing field a little bit. And

00:32:35.220 expanding access seems like the top priority I heard about the most from everyone in the industry.

00:32:42.020 Like, there are not enough doctors. This stuff is too expensive. We need to get fertility care in,

00:32:50.240 you know, make it accessible to as many people as possible. And this was like one of the strategies.

00:32:56.660 Now, was it totally effective? That's a different story.

00:32:59.560 Right. Okay, next question actually is a very good segue into this. This is about why the service is bad, essentially, which there is a lot of conversation in your reporting about this. This question comes from Rebecca.

00:33:12.440 I have two questions. First, why do so many IVF clinics have such terrible customer service when

00:33:20.020 they are getting paid so much money, often out of pocket? Is it because they may not have a huge

00:33:26.280 amount of competition? Is it because they're dealing with desperate people who just keep

00:33:30.800 coming back even though they are sometimes dealing with really poor communication and service?

00:33:35.700 What is up? Second question, what are your thoughts on the lower cost clinics that are

00:33:41.360 popping up. CNY Fertility is a big name, but I hear of others too. Are they good for patients?

00:33:47.260 Do you think they will push down costs overall as people get more options?

00:33:51.620 So let's deal with number one first. And the reason I was thinking about this is like

00:33:56.960 thinking about your reporting and the amount of turnover that's happening.

00:34:00.940 People are trying to do a good job, but when you are in an organization that has as much turnover

00:34:06.920 as KindBody had, and is also trying to cut costs and trying to have hockey stick growth,

00:34:13.760 you're just going to oftentimes get poor experiences and people are locked into them

00:34:17.860 as we were just discussing. So can we talk a little bit about the customer service and then

00:34:21.240 we'll get into the second question? So this problem is not just unique to KindBody.

00:34:29.140 Broadly in the industry, we see this because the demand for fertility services has completely

00:34:36.500 skyrocketed over the last five to 10 years. And because of that, there's just not enough

00:34:43.540 doctors and also like nurses with this very specific fertility experience. Like it takes a

00:34:50.240 very specific skillset and there's just not enough people out there. When you look at the funnel of

00:34:56.340 doctors coming into this field, like you have to go through a very specific residency and fellowship

00:35:03.120 And then this other like layer of experience that takes time to, to train these professionals

00:35:10.260 and doctors tell me like, there's just not enough of us.

00:35:13.440 And so because of that, you end up having doctors take on so many IVF cases and patients

00:35:22.920 that some of the perhaps bedside manners, some of like the care, the softer stuff kind

00:35:31.300 of goes by the wayside.

00:35:33.120 Um, further down the funnel with nurses and clinic coordinators, I mean, these clinics 0.92

00:35:38.860 are just overwhelmed.

00:35:40.560 So with so many patients coming in, um, you don't really have the nurses and other kind

00:35:48.540 of lower level clinic workers making as much money as fertility doctors who they make a

00:35:54.140 lot of money, but that was a big complaint that I, that I had, um, coming from the people

00:35:59.780 I spoke to that like the hours you're putting in, the amount of emotional care that you're giving

00:36:04.740 these people, like these nurses would get so invested as well. And they burned out really

00:36:09.580 quickly. Same goes for embryologists. It's a field that really burns you out. And so

00:36:16.780 the word that kept coming up when I would speak to people who had just like left the industry

00:36:23.460 entirely were like factories. Like some of these clinics were like factories, just churning through

00:36:28.680 patients. And then when it came to like the very more kind body specific problems that you also

00:36:36.000 see with other private equity backed clinics is the push to cut costs. You don't need as many

00:36:45.000 nurses. You don't need as many embryologists. All of that puts additional pressure on fewer people 0.90

00:36:51.000 who have to take care of all this overwhelming amount of cases to begin with. And private

00:36:57.620 equity's presence in fertility is only growing. So it's not a problem that's going to get any

00:37:02.420 better. And we should say too that, you know, if this leads to burnout, it also leads to mistakes.

00:37:08.060 Yes. Yes. Especially when it comes to people that work in the embryology lab. I mean,

00:37:14.400 those are the people with like the pipettes and the peachy dishes, and they're the ones that are 0.99

00:37:19.220 actually creating embryos. The amount of stress that they have on their shoulders, the, I mean,

00:37:28.500 anxiety that they carry, I've never, I've never spoken to like anyone in the medical field that

00:37:35.320 kind of had this, this kind of pressure on them because they all, they don't interact with the

00:37:41.840 patients as much as the doctors do. They're not super face-to-face or kind of in the back room,

00:37:46.580 But they know the stakes. And so when you make the tiniest mistake, they really carry it. But there is no regulation that, you know, limits the number of cases a certain embryologist you should have.

00:38:00.280 There are guidelines that are set by this industry group that say, maybe you should do, you know, this number of cases per person. This is how you should staff. But no one is actually going in there and making sure that clinics are adhering to those guidelines.

00:38:17.620 Yeah. And like, if you're looking for a clinic, you're not looking to see if it adheres to these guidelines.

00:38:22.740 No, you don't even know that they exist.

00:38:24.320 They can't, they're not like broadcasting it.

00:38:28.420 It's not like at the bottom, like a smoking advertisement or something.

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00:42:40.580 What about these low-cost ones?

00:42:42.420 Are most of them also private equity-backed?

00:42:44.500 So some of the lower-cost ones.

00:42:46.560 So CNY is interesting because they really pride themselves in making this so much more affordable.

00:42:54.200 in turn I think that gets patients talking to other clinics and they start asking more questions

00:43:01.480 so there is a benefit to having this kind of player in the market and I've had other doctors

00:43:06.100 from like competitors be like look I appreciate what they're doing but our advantage is that you

00:43:14.060 know we offer more tailored care and like some of this is you know clinics bad-mouthing each other

00:43:22.580 But on the whole, many doctors agree that like, you know what, it's nice that they offer a cheaper option when, you know, if they can do it, great.

00:43:35.200 Is the owner of CNY making as much money as a doctor that, you know, owns one by private equity?

00:43:42.560 I don't know.

00:43:44.720 But at the end of the day, you are going to have some tradeoffs.

00:43:49.460 I'm not sure if CNY does this specifically, but I do know that there are fertility clinics I researched that offer IVF at a lower price by not having the fertility doctor, a reproductive endocrinologist, do all the work, and instead having OBGYNs, which are different from these more specialized fertility doctors, to do some of the other stuff.

00:44:15.740 Now, the pros of that is, okay, great. You get care that's cheaper and you still get to see a doctor, not a nurse or a nurse practitioner. But the downside to that is OBGYNs are not always trained with the same level of detail that fertility specialists are.

00:44:35.140 And so, you know, Kind Body actually tried to do this, but it never really got off the ground. They tried to have their OBGYNs do egg retrievals, which is not something that they typically do, to bring down costs and to, you know, be able to manage more of that volume. And doctors, like, really weren't having it. I mean, some of the OBGYNs I spoke to were like, we're not doing this. We're not trained to do this.

00:45:00.000 So there are ways to cut corners that can eventually, you know, really affect the patient in the end.

00:45:06.160 And there's no regulation of that.

00:45:08.040 Like, you could just have an OBGYN and do it.

00:45:11.400 Yeah.

00:45:12.020 And the only person pushing back would be the doctors themselves.

00:45:15.940 Yeah.

00:45:16.320 And, you know, there's some OBGYNs out there who also told me, like, hey, look, I've had some, like, really good on-the-job training.

00:45:23.880 I, you know, but, but it's not by, it's not like accredited by the board that, you know,

00:45:33.180 certifies doctors.

00:45:34.480 I think it's called, um, I mean, I'm not, I think it's called ACOG, but I don't want

00:45:39.080 to get it wrong, but basically there's like a board certification that every doctor has

00:45:43.260 to have.

00:45:44.040 There's no such thing.

00:45:45.380 Like you can kind of get this bootcamp style training and it's perfectly legal and patients

00:45:52.860 really don't know the difference because they're just going to see Dr. So-and-so, and they're not

00:45:57.500 going to question what kind of fertility, you know, reproductive endocrinology training they've had.

00:46:03.160 And we should say in many cases, that's fine. Like if you don't have a complicated case or

00:46:07.720 something like that, but then it becomes not fine. When it becomes not fine, this is the problem,

00:46:13.540 I think. And why like relying on the individual to really have to ask these questions and to try

00:46:20.140 to find this information, not only does it lead us into our current like healthcare moment where

00:46:25.500 everyone is essentially like just asking questions, figuring out healthcare for themselves, like

00:46:30.100 that's a crisis on all in all ways. But the only fix is a much more systemic one, which

00:46:37.280 as we've talked about, our current government is not willing or any government has not been

00:46:43.660 willing to figure out how to legislate, how to govern this in a way that would make sense for

00:46:47.780 more people. No, I think it's too touchy because it's so intertwined with abortion politics and

00:46:57.400 Republicans and Democrats alike don't want to wade into that thorny mess. It's complicated,

00:47:06.780 but there are easy ways to do this that wouldn't require a system overhaul. I bring up air tracking

00:47:15.380 as a really easy thing to do because we've seen it happen in Europe. And it's a basic thing that

00:47:24.400 you would, I mean, it's almost like a very simple consumer protection that allows you to hold a

00:47:32.080 clinic accountable or at least kind of have the assurance that someone is making sure that they're

00:47:40.740 following the guidelines that they're supposed to be following and what trends look like over time.

00:47:45.940 Does this clinic have more instances of errors? It's complicated because then, you know, would

00:47:52.560 that mean it restricts access because then you have some clinics shutting down? That's one of

00:47:58.260 the concerns. But at the end of the day, these are people's hopes and dreams of having children

00:48:05.020 that are kind of also stuck in the fray.

00:48:10.200 I just, I don't see the demand for it ever.

00:48:14.400 I don't see it decreasing.

00:48:16.980 Although, you know, Melody just pointed this out to me

00:48:19.940 that the Speaker of the House just stripped IVF coverage

00:48:22.380 from members of the military with the defense policy bill

00:48:25.480 that was unveiled in December.

00:48:27.080 And oftentimes, whether or not government employees

00:48:31.800 have a coverage that drives...

00:48:34.080 a lot demand for a lot. What do you think? Like, do you think of it as something that's going

00:48:39.800 to continue to expand only in this privatized way? Or do you think that it's going to

00:48:44.220 become just like a larger component of American culture?

00:48:48.540 It's really a toss up because IVF is incredibly popular. In 2024, there were a flurry of surveys

00:48:56.160 that were looking at how popular it was or what Americans thought about fertility care

00:49:02.560 in the wake of the Alabama Supreme Court ruling. 0.90

00:49:06.620 Right.

00:49:07.640 And then at the time, obviously, you had Biden and Trump running, and everyone was kind of

00:49:15.480 coming out with their, you know, we're going to do this for IVF.

00:49:18.380 And Trump at one point called himself the father of IVF because he knows that this is

00:49:24.120 a really-

00:49:24.880 It's a popular position.

00:49:26.320 Yeah.

00:49:26.660 Yes.

00:49:26.980 And I mean, I remember doing some reporting around what this administration was doing

00:49:34.900 back in February when they announced that they were going to expand IVF access with

00:49:40.360 an executive order, but the executive order literally said nothing of use.

00:49:44.460 It was like, we're going to come up with a plan in X amount of months.

00:49:49.120 And then that deadline came in May and then nothing happened.

00:49:53.660 And so it just kind of seems like we're going backwards or maybe they're

00:49:56.960 backtracking a little bit. But I do think that this industry is already kind of like the flywheel

00:50:03.460 has been set in motion. And even if there is not kind of the government backup, it hasn't stopped

00:50:09.440 the industry from expanding, particularly because you have these deep pocketed investors coming in

00:50:15.460 and propping it up with like a lot of cash to like invest and then molding it in the way that

00:50:22.420 they wanted to work. And when that happens, you know, you're just going to end up with a field

00:50:30.100 that is skewed toward profit. Whereas if you had government as a bigger participant, it would

00:50:38.540 balance it out a bit. You know, if you don't want to call it socialist, you know, level kind of

00:50:44.620 Europe-style care, fine. But right now, it's really one-sided. And I just don't think that's

00:50:54.220 boding well for patient care. I mean, there's studies out there as well that kind of show

00:50:58.180 people get upsold more when you go to a private equity-backed clinic.

00:51:02.340 Yeah. Well, I'm going to get the link from you for that because I think that that's like a very

00:51:07.520 strong piece of evidence. And also, this is a nice segue into our last question, which is about

00:51:12.680 trying to figure out how you actually find a doctor with integrity. So this question comes

00:51:18.720 from Jessica. For people entering the world of fertility doctors, what are the protections in

00:51:23.280 place to ensure that you find an honorable doctor? Our first infertility doc, the only one in a small

00:51:28.960 town, made so many errors along the way. It was hard not to feel taken advantage of for the sake

00:51:33.780 of more money in a largely self-pay adventure. So you are not the expert of all experts, and I

00:51:41.160 don't think anyone expects you to be. But based on your reporting, what sort of questions would

00:51:45.340 you tell people to ask when they start looking for doctors or clinics? Well, I know I just

00:51:54.600 pooh-poohed it a few minutes earlier, but the CDC does track success rates. And that is at least

00:52:03.400 one data point that patients can be sure is legit. It will tell you how successful they've been

00:52:12.900 in with live births, with, you know, using frozen embryos, using fresh embryos, all these different

00:52:20.240 kind of ways. You can rest easy that if a doctor says you have a 50 whatever percent chance that

00:52:27.300 they're telling the truth because they have numbers reported to the government backing that up.

00:52:33.000 However, when you go into a clinic, you're relying a lot on a doctor telling you what

00:52:40.740 your chances, kind of giving you an assessment of this is kind of what your baseline chances

00:52:46.880 are.

00:52:47.960 And be really honest.

00:52:51.020 They should be really honest about what they can afford, about the timing, about is it

00:52:57.800 make or break for you to have a child in a year or two years? Do you have other children that you

00:53:04.580 need to take care of? Kind of like what's your bandwidth to be able to like undergo

00:53:08.860 egg retrievals? Like being really open with a doctor and upfront about what you can handle

00:53:14.260 financially and otherwise. And, you know, really taking reviews seriously. I think

00:53:21.860 when people look at a negative review online, you can kind of maybe downplay it because no one

00:53:31.200 posts a nice review. It's always the bad ones. Or there's so much emotion. There's so much

00:53:35.420 emotion wrapped up in this, right? Yeah. Exactly. But there are some good websites out there that

00:53:40.800 just specialize in fertility reviews. They vet it. They provide like really good summaries of

00:53:46.960 you know, the offerings and prices and comparisons city by city. Fertility IQ was an amazing resource

00:53:54.680 for me as I was going through this because, you know, it's not like Yelp, but it does have like

00:54:00.680 specific doctor names and it has specific clinics and that's one resource. But, you know, pay

00:54:09.220 attention to kind of what the vibe of the clinic is. Do the people working there seem really

00:54:15.800 stressed out. When you were given instructions, are they clear? Do they make little mistakes?

00:54:23.200 You know, like take your medication on a Thursday, but it was really like take it on Wednesday.

00:54:28.800 Those sorts of things add up. Listen to your gut. You know, so many women told me,

00:54:34.780 I knew that the little mistakes were red flags, but I didn't really, you know,

00:54:42.520 take them seriously because I just thought they're not that important. When you're in

00:54:48.120 a fertility clinic and getting this care, everything is important. It doesn't really

00:54:52.620 matter how small. It's hard. I'm not sure if that answers her question, but.

00:54:59.980 Is there a way to, like, I'm thinking specifically of the, like, upsells on the things that don't

00:55:05.260 necessarily work. Like, how do you, is there a question that people can ask about, like, efficacy

00:55:12.100 like how can you pose that question give me the studies because when you ask them i mean i i when

00:55:19.780 i was trying to figure out does neupogen actually neupogen wash or embryo glue does that actually

00:55:24.360 work um doctors very quickly gave me the link to several studies like it took 30 seconds to find

00:55:32.340 these studies that show yes these maybe increased chances in like a couple people but on the whole

00:55:40.140 this is not something that should be sold as a slam dunk. And it was, if you ask them for a study,

00:55:49.340 you know, they're going to have to explain that to you. And don't be afraid of like diving into

00:55:55.380 some of these studies yourself. I would say also ask for their protocols, like give me my array

00:56:06.520 of options before you just kind of give me this one. Ask them, you know, can I do IUI? Can I do

00:56:14.780 this Clomid treatment? I've heard of this. Doctors are used to that. Actually, one woman told me that

00:56:21.560 she would go in equipped with what her friends had done, and it actually provided a really good

00:56:28.300 baseline for the doctor to then explain and then kind of backtrack, well, then maybe you can also

00:56:33.860 try, you know, IUI before IVF. Explaining kind of what other people have gone through

00:56:40.500 is an entry point for doctors to kind of explain themselves because this is expensive stuff. Like

00:56:46.580 if you're being pushed into it, you should know why.

00:56:49.300 Yeah. Can you call a clinic and say, are you backed by private equity?

00:56:55.020 Because I think sometimes for me, like when I'm trying to figure out

00:56:58.180 if a company is backed by private equity, oftentimes you'll like Google it and it'll

00:57:03.460 be some sort of like venture, right? And then maybe actually that venture is owned by the

00:57:09.020 larger private equity firm. You know, like there's just this trail because they're trying to erase

00:57:13.440 any sign that says like, we are private equity because that word has taken on a certain

00:57:18.660 connotation, especially to certain people. So any advice on figuring out if a particular clinic

00:57:24.840 is private equity backed? One, ask them. Yeah. They can't lie to you. I mean, all the big names,

00:57:31.220 I mean, are now owned by PE, Boston IVF, CCRM, Shady Grove. You know, all of them are kind of

00:57:39.300 under this like PE umbrella these days. But also, you will find pretty quickly that the ones that

00:57:46.540 are private equity backed are typically the ones that are getting a ton of bad reviews because of

00:57:52.400 just how, um, how much like the customer service aspect ends up outweighing like the outcome

00:58:00.760 itself. Even women who like did get pregnant, they're like, but I should not have had to go 0.99

00:58:04.940 through this, you know, rigmarole with billing. Oh my God. Billing was like one of the chief

00:58:10.600 complaints. Um, typically the PE backed clinics will have that trend that, you know, those type

00:58:18.300 of complaints, um, like a trail behind them. Yeah. And a discrepancy too, between like what's

00:58:24.540 quoted and what's actually charged, which is like, what has been the reception since

00:58:34.700 your reporting came out, since the show came out?

00:58:39.000 I mean, this part makes me emotional because I still get messages. Um,

00:58:46.040 it's been amazing i mean it patients have like i posted one tiktok one day like terribly edited

00:58:56.940 like rambling and the comments were like oh my god i thought i was the only one

00:59:03.420 this happened to me too and not just with kind body people were like you know spewing listing

00:59:09.620 off naming names of their clinics, their doctors, and it unleashed this wave of support. And people

00:59:19.000 from Kindbody, I mean, employees who were still there, emailing me and reaching out saying,

00:59:26.060 oh, wow, yeah, everything that you said has been happening. It's getting worse. The company's

00:59:32.100 going to go under. I wish I could talk to you, but I know I need this job. So much

00:59:39.300 validation that the company was not doing right by patients. And also, even some of my fiercest

00:59:47.220 skeptics from the industry who thought that I was fear-mongering and talking bad about fertility

00:59:53.920 care when it's already coming under fire from detractors and Republicans and conservatives,

01:00:00.980 I got a lot of heat from them. But they said, you know what? If you have to highlight a bad apple,

01:00:08.280 so be it, because it's going to make us all stronger. And I think even those people,

01:00:14.540 doctors and embryologists were saying that it's stories like these that erode trust in the

01:00:19.760 treatment itself. And that by being so defensive about it or denying it, the industry is just kind

01:00:26.080 of shooting themselves in the foot. And so I actually saw a lot of people, you know, some

01:00:31.060 doctors saying, how can I help get this message out? Thank you for this reporting. Some lawmakers

01:00:37.040 reached out and said, you know, we really want to do something around this. We're going to keep

01:00:42.400 fighting for it. A lot of support. The company, of course, um, said that it was all false and that

01:00:50.220 like it was inaccurate, um, and that I'm wrong. Um, but the facts speak for themselves and

01:00:58.040 yeah. Yeah. So this is the part of the show where usually I ask people where they could

01:01:04.280 find you on the internet. But since the show came out, you've had a big life change. Can you give us

01:01:09.940 some context for what you're doing now? Yes, I am actually in France right now,

01:01:16.040 in a tiny little country town outside of Lyon in pastry school. And it's been a lifelong dream of

01:01:22.820 mine to open a bakery. And I just always thought I was going to do it when I'm older, I'm going to

01:01:27.280 get to it. But if there's anything that this reporting taught me is that life is way too

01:01:33.280 short and that you got to just go chase your dreams while you can, while you're alive and

01:01:39.300 kicking and cute. And you just, yeah, I, I really, you know, I was so, um, emotionally invested in

01:01:49.100 this reporting because, um, of how many women I spoke to that just never really felt heard

01:01:56.360 by anybody. And that left such an impression on me that like, you know, if and when I have

01:02:03.980 kids, I don't know that it's in my plan. But I kind of want to be the sort of person that my

01:02:11.140 nieces and nephews are proud of chasing their dream. So here I am. It's amazing. And we will

01:02:17.680 link to your Instagram, which is fantastic. You can see all your pastry creations, everything.

01:02:21.640 So thank you so much for coming on the show to talk about this.

01:02:25.140 Like I, we have had a lot of people who wanted an episode and this felt like a really great

01:02:31.680 way for us to talk about IVFs in a way that people will understand the larger culture

01:02:36.240 around it and also hopefully be able to ask better questions in their own, their own journeys.

01:02:41.760 So thank you again.

01:02:43.280 Thank you guys.

01:02:49.360 Thanks for listening to the Culture Study Podcast.

01:02:51.640 Today, paid subscribers got a bonus conversation about the origin story for Melody and me,

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01:03:47.340 The Culture Study Podcast is produced by me,

01:03:49.440 Anne Helen Peterson, and Melody Rowell.

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01:03:58.160 and the show at Culture Study Pod.

01:04:16.680 You

Culture Study Podcast - February 04, 2026

The Heartbreaking (and Largely Unregulated) Business of IVF

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