Learn how to build, train, and tune your BS detector to ensure you’re getting the best care at your fertility clinic. Dr Alan Thornhill, Fertility Expert & Coach, Founder of The Fertility Guy, discussed how to evaluate clinic information critically, identify red flags, and ask the right questions to make informed decisions about your fertility journey.
Trust is crucial but very easy to lose. The vast majority of clinics and their staff can be trusted, and they genuinely want the best for you. They are honest and want to help. However, the fertility journey creates a lot of stress, vulnerability, and a loss of control, making trust even more important than in simpler transactions. Infertility and its treatment are very personal, and the stakes are high, which increases the need for trust. The treatment is financially, physically, and emotionally demanding, putting you at a disadvantage in many situations. The relationship between the healthcare provider (the clinic or doctor) and you, the patient, is based on trust. It should be more than a simple transaction. Common ways trust is broken include:
You need a BS detector because IVF is not 100% successful. If it were always successful, you might overlook minor issues. Since success is not guaranteed, the process needs to be as straightforward, honest, and transparent as possible. IVF is not standardized; there are many differences between clinics and countries, including various add-ons and drug regimes. Due to these differences, you need a mental tool to assess whether things sound right. It’s important to question whether you’re being told the truth about IVF costs. The actual cost of IVF often differs significantly from the initial estimate.
Clinics today are more commercial than ever before and are under pressure to deliver profits. This means there might be more misleading information, so it’s important to be vigilant. For example, if a clinic offers an add-on for £5,000 with uncertain outcomes, that’s at least an honest offer. However, if they claim that the add-on works for everyone or that it’s a fraction of the cost of multiple cycles, that’s when you should be cautious. Challenging the plan and asking the right questions will almost certainly save you time, money, and energy.
When it comes to transparency and honesty in IVF, it’s crucial to understand it should reffer to both the clinic staff and you, the patient. It’s essential to be as honest as possible with your clinicians. Provide a full and detailed description of your medical and reproductive history to receive the best help. Communicate clearly about what you want and what you don’t want. This was also highlighted in my previous webinar on boundaries, which you can catch up on.
During consultations, patients often express concerns about treatments they are reluctant to pursue. It’s crucial to communicate these concerns to your clinical team. Always ask about the costs, limitations, risks, complications, and side effects of any treatment. These questions form the foundation for assessing whether a treatment is right for you. Keeping this list in mind will help you navigate various treatments, drugs, and medications effectively. Proper information sharing leads to a more efficient process and hopefully the best outcomes. Additionally, it builds mutual trust, which is essential in any relationship.
Emotionally, lacking or vague information often leads to anxiety, distress, and confusion. These are common issues I discuss with people. Financially, hidden, unexpected, or extra costs can cause shock and stress, and sometimes even result in the stopping of treatment. Studies show that people who understand costs are better prepared and experience less stress. Managing expectations and being informed can reduce stress and anxiety during your fertility journey.
To ensure transparency, you should:
These tips involve using your eyes, ears, and the letter “I” to help you assess information critically.
By applying these tips and remaining vigilant, you can better navigate the complexities of IVF and make informed decisions about your treatment.
Have an ally with you at critical times. It could be family, friends, or a buddy. A clinic advocate, counselor, or nurse can also be good advocates. External support creates independence. Communication is key. Good communication is clear, specific, and transparent. Remember, the clinic is not a mind reader. Their opinions may not be the same as yours or your friends and family’s. Be clear about what you want and don’t want. Be assertive and communicate issues and problems quickly. It’s easier to deal with them when they’re fresh.
Put things in writing. Do that by email, then you’ve got a record. It really helps when it comes to that “he said, she said” part of any disputes, and it allows you to be in control of your story.
First of all, let’s go backwards and address how you can avoid offending your current provider. It isn’t your job to avoid offending them. But I’m pleased you’re considering it because you care about not upsetting them, which shows you’re a good person. There’s also a practical aspect to consider—people often worry that if they complain or aren’t fully compliant, they might be looked down upon or their future treatment might suffer. While I’d like to think that’s not the case, it’s understandable to feel that way.
If you’re paying, or even if you’re not, you have every right to question what’s happening and seek a second opinion. Here are some layers to consider:
You could ask if the case has been discussed at a multidisciplinary meeting. Many clinics will consult their team for difficult cases. A good doctor will discuss challenging cases with their team and then report back to you on the team’s opinion. If a doctor says they consulted the team, you should be able to trust that they did, though it’s possible they might not say they didn’t.
You can also stay at the same clinic and ask for another doctor’s opinion. Often, the response you get can provide insights. If they dismiss your request or say they don’t normally do something without listening to you, it might push you to seek an opinion outside the clinic.
Another layer is communication. When asking for a second opinion, being specific helps. Otherwise, you might end up going through a full consultation again, which is almost like saying you’re so disturbed by what you’ve been told that you’re considering starting the whole process over. For example, if you’re asking about IVF or ICSI based on sperm parameters, this is something you can get a clear answer on from a second opinion.
The final point is if you’re truly unhappy, especially if the stakes are very high. In such cases, it’s worth getting a second opinion. If you don’t and are unhappy with the outcome, you might regret not seeking a second opinion. There’s no set rule for when to seek a second opinion—it’s very personal and specific to each case and condition. For instance, if the treatment plan involves a minor tweak and the initial treatment was mostly okay, it might not warrant a second opinion. It’s all about the specifics of your situation and how you feel about it.
What I would say is to watch my other webinars about costs. I’ve done a whole webinar on that. I’m not saying it will answer your specific questions, but it will certainly give you things to look for and questions to ask. However, I’ll give you a summarized version now.
In the UK, which you may not be in, the principle is the same, it is a requirement for the clinic to state the treatment options that are suitable for you and the associated costs. Then you need to use a kind of hidden cost detector, which is part of the BS detector, to ensure you understand the full costs.
For example, if they give you a list of costs that include embryo freezing, you need to ask if storage is included or not. If your question is about whether they are transparent about your treatment options, that is a slightly different question. If it is really about costs, then you should ask for a detailed treatment plan, which in the UK is called a costed treatment plan. This plan should include all the things you are likely to need, and the actual costs associated with them, possibly with a range. For instance, if they charge per embryo for freezing, they might say it ranges from 200 to 1000, so you get an idea of the costs involved.
I recommend watching the webinar on this topic because there is a lot to consider, such as hidden costs and add-ons. Hidden costs are one of the major complaints people have. I will repeat the importance of communication: if you get in writing that you will only pay X for this treatment, and then you end up being charged more, you should use that email to address the issue. Go back to them and say, “You said I was going to be charged X, but now I’ve been charged X plus Y.”
I’ve worked with clients who had issues with unclear charges, and when they went back with written documentation, they often got a refund or clarification. Most clinics will not fight hard against written documentation that suggests they haven’t done their job properly. However, if you’re unclear about it from the beginning and say you didn’t understand, that’s usually not sufficient for them to issue refunds, in my experience.
So, yes, that’s the approach for dealing with billing and transparency issues.
It depends on what the red flag is. I’m not trying to push you to say what it is at all, but I’ll give some examples.
If the red flag is getting inconsistent information, you should address it directly. For example, you might say, “This doctor said this, and this nurse said that,” and write it down. Send an email saying, “This is causing me frustration and confusion.” You don’t need to get angry; just clearly express how you feel. Don’t assign blame, just state how it affects you. This helps them understand your perspective and the stakes involved.
For a more serious red flag, like reading an inspection report that shows numerous incidents or a warning that the clinic might be shut down, you should confront them differently. You might say, “I’ve read this report, and I need assurance that it’s safe to continue here. What can you tell me to reassure me?” In such cases, go to the top person responsible, like the medical director, and express that this situation has shaken your confidence.
If you have the option of going elsewhere, you can have the same conversation but add, “Unless you can convince me to stay, I might need to move elsewhere.” While this is inconvenient, you might not have the luxury of time or resources to delay, so you may need to make the best decision for yourself as quickly as possible.
I know this is a bit of a vague answer, but red flags come in many forms. If you want to discuss specifics privately, feel free to reach out. It’s good that you’re recognizing these issues as red flags, indicating that something is troubling you and needs to be addressed. I certainly wouldn’t ignore it.
