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Networth and Chill with Your Rich BFF
The Doctor is IN! The Financial Reality Behind Fertility Treatments
00:49:08
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- [00:00]
Vivian Tu
This whole process that Dr. Yoder and I just outlined was $20,000 roughly. The medication pack we had gone directly through spring, it would have been like 4,000 ish dollars. We went through our insurance. It showed me the top number was six grand. I was like six G's for medicine.
- [00:18]
Dr. Nicole Yoder
Yeah.
- [00:19]
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- [00:52]
Vivian Tu
Hey, besties. Welcome back to another episode of Net Worth and Chill with me, your host, Vivian Tu, AKA your rich BFF and your favorite Wall street girly. Today's episode is a hot requested one. I have finally gotten all of the details, all of the information organized, and we are going to be talking about my egg freezing journey. Yes, this was a very personal and frankly, vulnerable moment in my life. Not only am I usually someone who is relatively healthy, I try to stay away from doctor's offices. But this was something that made me reconsider a lot of the decisions that I'd made in my personal life. So today we are going to cover things like what does the actual egg freezing process look like, how much does it cost at every single step, what every single step means scientifically, and we are going to also just go over the emotional aspects of this process and if it might make sense for you. First and foremost, I chose to freeze my eggs, in particular freeze my embryos with my now husband because. Because I'm 30. But I knew for a fact that I did not want to have kids this year, next year, or probably even the year after that. I also recognized that because of how my career is set up, I wasn't necessarily going to be able to have PTO in the way that someone who works for a corporation does. I wanted to give myself essentially an insurance policy in the case that I waited for a certain amount of time. And then if Boo and I were having trouble having a child, I would potentially have an insurance policy essentially to fall back on. It doesn't necessarily mean that I would use my eggs. It doesn't necessarily mean this makes sense for everybody. But it felt like the right choice for me at the time. In particular, I had a girlfriend who contacted me and she shared that she was going through the process and at first, it kind of surprised me because she was actually six months younger than I was. And I asked her, you know, without being too probing, why are you doing this? And she shared that her older sister had fertility issues when she was trying to have a child. And because she's her sister and they share 99% of their DNA, it made her worried about her fertility as well. When she went in to go have her initial consultation and to double check her ovarian reserves, she found out that she had a low egg count and that time was of the essence and that she was going to want to take advantage of her younger age and get some eggs frozen. That transparently really scared me because I had never even thought about my ovarian reserves. I frankly took for granted that I was always going to be able to have kids, even though my mom at my age was already pregnant. And I did not really foresee myself having kids in the near future, whether it be through the foods we eat, whether it be through the environment. You know how modern life has changed. A lot of us are delaying our family planning and starting to have kids. So I just wanted to make sure that I had every option available to me. That said, I am not a medical expert, and as such, I have invited a medical expert to join us today. She is a board certified obgyn. She is a fertility specialist at Spring Fertility who's bringing her incredible expertise from Yale, NYU and Cornell to help people build their families. And what actually makes her so special isn't just the fact that she's an incredible doctor. She was my incredible doctor and she helped me freeze my eggs. Everyone, please welcome Dr. Nicole Yoder to Net Worth and Chill.
- [04:34]
Dr. Nicole Yoder
Hi. Thank you so much for having me. It's good to see you again in a little different context.
- [04:38]
Vivian Tu
So good. This time I have my pants on. I'm not wearing a paper skirt.
- [04:42]
Dr. Nicole Yoder
Yes. This time in your domain. Yes.
- [04:44]
Vivian Tu
Oh, my gosh. Thank goodness.
- [04:46]
Dr. Nicole Yoder
Yes. You look great, though.
- [04:47]
Vivian Tu
Thank you so much. I am so excited for us to dive into this conversation. But before we get started, can you roll back the clock and just give us, like, a rough 30 second timeline of, like, how did fertility treatments start?
- [05:01]
Dr. Nicole Yoder
Yeah. It's actually interesting that fertility as a specialty and like a medical subspecialty, it's not that old when you think about it in terms of, like, all the other medical subspecialties that we have. Really, they were only starting to figure out, like, what estrogen and progesterone were about 100 years ago. So when you think of, like, the grand scheme of things, like, that's not that long ago.
- [05:22]
Vivian Tu
Yeah. No.
- [05:22]
Dr. Nicole Yoder
And then the first IVF pregnancies, really, the original data started coming from, like, animal studies, and it crept into the human studies. But the first IVF baby was only born in 1978.
- [05:33]
Vivian Tu
Oh.
- [05:33]
Dr. Nicole Yoder
So. Yeah.
- [05:34]
Vivian Tu
Like, younger than my parents.
- [05:35]
Dr. Nicole Yoder
Yeah, younger than your parents. So in the whole grand scheme of things, this is actually not. It's a very, like, newish field and always rapidly evolving. So technology definitely has gotten much better since that 1978 first baby. And it's getting better and better all the time. But it's definitely something that is kind of a new hot field from my perspective anyway, just because it's actually relatively young.
- [05:59]
Vivian Tu
That's really interesting. And could you share with us just a couple things that people should consider when they're on their fertility journey? Like, what are the key health moments that we should be looking out for and tracking? And at what age do we really start thinking about fertility? Fertility, yeah.
- [06:15]
Dr. Nicole Yoder
It's good, I think, for anybody who potentially wants to have a biologic family to, like, kind of at least map out what their ideal life would look like and always be. I hate saying this because it's sort of a burden on the female, but always be aware of, like, the age and sort of what your overall health situation is, because so much of fertility really comes down to age at the end of the day. So things to be kind of cognizant of are. I always tell people, always think of not only when you might want to start trying to have a baby or create a family, but when you might also have that last baby. I can't tell you how many times people are like, oh, I'm gonna start. I'm like, I'm 30. I'm gonna start trying in, like, two, three years. So I'm good. And it's like, well, yeah, probably for baby number one, most people that age have success, some don't. But how many kids do you want? How far apart do you envision them being? Do you want two babies, three babies? Is baby number three going to be, like, closer to 40 than 30 then? A lot of times it's a different picture when you're a little bit older. So good to keep in mind sort of the overall trajectory and just like, the ages where you in your ideal world might see those things happening.
- [07:27]
Vivian Tu
Yeah. And you mentioned, like, the specific timeline, and it feels like there's this big shift between 30 and 40 and. Fun fact, you guys. So I did my egg freezing at spring fertility, and before you go in for your first appointment, they assign you homework. There's a 30 minute video that I had to watch with my husband. And we went through the whole thing and it kind of demonstrated to us that, like, at 35 for women, like, there's like a little bit of a shift, like what happens at that point that it makes it so much harder to have kids.
- [07:58]
Dr. Nicole Yoder
It really comes down to egg quality. And the interesting thing about that 35 number, the way we talk about it, it would seem like, oh, you get to 35, like you fall off a cliff, you're immediately infertile. It's not quite that stark, but there is some truth behind that number. So when we look at studies of natural fertility rates across different generations, across different countries, pretty much any population that's been studied in terms of their fertility, there's a very consistent decline in fertility rates. That starts around 35. Really what that comes back to is the quality of the egg itself. Now why, Biologically we are set up to sort of, you know, start to lose the quality of the egg around 35. I don't know that any of us will know. Same reason, like, why do we go through menopause around 50? Like, not sure that's the way we're set up. But it's a very consistent thing that we see like time after time, like study after study, where around 35, those eggs just aren't performing their job as well as they used to be. So that's why that 35 number gets thrown, is kind of a good line in the sand as a check in point of like, you know, am I before 35? Am I after 35? Where in the spectrum am I, fertility wise?
- [09:11]
Vivian Tu
This might be a stupid question, but, like, if 35 is kind of when egg health starts to really deteriorate, like, what is the best age to get pregnant?
- [09:20]
Dr. Nicole Yoder
Technically, I would say peak fertility is really like mid to late 20s.
- [09:26]
Vivian Tu
Okay.
- [09:27]
Dr. Nicole Yoder
That's kind of the sweet spot in terms of like maximum fertility rates, it's still pretty good in the early 30s. Fertility rates in like the 20s are probably about 25% chance per month. For people who are actively trying to get pregnant in your early 30s, it drops down a little bit to about 20% chance per month. But then by the time you're 40, it's about 5% chance per month. Oh, wow. Most of that, yes, most of that change is driven by the ages 35 to 40. So a lot of decline. There's just a lot of changes with the ovaries and egg quality that happens from 35 to 40, and then even more so beyond 40, decline is even more rapid.
- [10:05]
Vivian Tu
I don't think I understood how hard it was to get pregnant. Because when you go through, like, sex ed in high school or, you know, even just like, when you're in college and, like, having a good time, you have this constant fear that you're like, I can't get pregnant. I can't get pregnant, like, 100%. But then all of a sudden, it goes from I can't get pregnant to I must get pregnant. And as soon as that flip switches, like, it feels like it's really challenging. Like, there's only a couple days per month that you, in theory, could get pregnant.
- [10:34]
Dr. Nicole Yoder
Right, right. Peak fertility time is really the five days leading up to ovulation, which is one of the reasons why fertility rates aren't like 100% every month. There's a narrow window for it. But then also, as you very appropriately said, so many people spend so much time trying to not become pregnant, and then all of a sudden you're like, okay, now I'm ready to have a baby. Like, boom, it's going to happen. And it doesn't for most people, if they're like, I've been trying for three or four months and nothing happened, I'm like, that sounds about right. Unfortunately, just because fertility rates are not as high as we really think they are, I mean, very appropriately, we do talk about a lot about preventing unwanted pregnancies, which is also very important. But one thing that's really lacking from our just like, reproductive education, at least in the US Is infertility. Those rates of infertility. Actually, the estimates are going up all the time. So they used to estimate it was about one in eight couples that needed some sort of assistance to conceive, which in itself is not low. I think it was last year or the year before that, they actually increased it to, it's like one in six couples now.
- [11:37]
Vivian Tu
Oh, wow.
- [11:38]
Dr. Nicole Yoder
Which is pretty common. Yeah. It's like when you think about 1 in 6, like most people I talk to these days have some sort of friend who needed to do IVF or had trouble getting pregnant. You know, it's more and more common, especially in places like New York City where people delay having kids. They don't start their families until, like, a little later. I know when people have kids in their 20s now, I'm like, oh, that feels like a teen pregnancy in New York. I know. Like, whoa, whoa, whoa, what is this? Yeah, but. But it definitely has shifted later. Yeah, but unfortunately, Our bodies have not also, like, evolved in the same sort of, like, social way that we have evolved.
- [12:10]
Vivian Tu
Like, the pilgrims died at 30, so.
- [12:12]
Dr. Nicole Yoder
Exactly. You're done. Like, you didn't need it. It's like, what do we need them for after this? Like, you're toast. Like, yeah, yeah. But now people are having babies, like, 30s, late 30s, 40s, and that's. And that's pretty common. But unfortunately, a lot of people don't have that background information of, like, it's actually kind of hard to get pregnant at those ages for some people.
- [12:30]
Vivian Tu
Yeah. And Net Worth and Chill, obviously, is a finance podcast. So I want to talk a little bit about this bigger philosophical question that I want you to weigh in on for me. I don't think you're going to have a perfect answer, but when it comes to the fertility journey, it really feels like when you're younger and have these healthier eggs, you may not be able to afford some of these really key treatments that would help you essentially get insurance. But once you get to the point where you can afford them, your eggs are probably a little less viable than they would have been younger. How do we, as smart consumers and smart people, make sense of that?
- [13:10]
Dr. Nicole Yoder
Yeah. This is, again, where I say it's always good to at least have a check in with either your GYN or fertility specialist or somebody if you want to keep the doors open for biologic children, even in your 20s. Just to say, like, hey, are there any red flags in my medical history or any medical conditions that might make it harder for me to get pregnant? But also, what does my ovarian reserve look like? So you can have, you know, people who are young with a low reserve or older and have a high reserve. And it kind of matters, like, where you stand, age and quantity wise, whether or not it makes sense to do something more proactive. Yeah, it's not. You're right. I don't have a perfect answer for this, but it's always good to at least get a sense of, like, okay, here's where I stand now. What does my timeline look like? And do I have wiggle room in, like, delaying this and putting this off further? You know, sometimes people will come in and they're in, like, you know, 26, 27. It's like, oh, it seems kind of young, but sometimes you find that they have a really low reserve, and, like, you never would have known unless you had a checkup.
- [14:20]
Vivian Tu
Yeah.
- [14:20]
Dr. Nicole Yoder
And then they're at least empowered to act on that and, like, move quickly and move quickly. Or sometimes people Come in and they're like, 28, no medical problems, just checking it out. They're like, very robust ovarian reserve. And they say, you know what? Like, I'm gonna wait a year or two. From my perspective, I'd say, like, that's probably totally fine. You know, like you're going to do. If you need to do some sort of intervention, I foresee that you'd have good success rates this year versus next year versus following year. But if you come in my office and you're 42, I'm probably gonna say, even if, like, time is of the essence, like, we don't really have the.
- [14:53]
Vivian Tu
Luxury of life, like, we gotta get started next month.
- [14:55]
Dr. Nicole Yoder
Exactly. So the two things that can kind of like, make things a little more pressing are, one, age. Anyone over 35. It's kind of like, you know, we know the quality's starting to go down, but then, you know, age and the quantity, just like your medical situation as well. So both of those will play into whether or not it makes sense and how much, like, leeway we have with the timing.
- [15:16]
Vivian Tu
Got it. And I wanna walk through really quick, kind of, like my process, just so that if anybody who's considering this, like, understands and then kind of on each step. I'd love your POV of why we do these.
- [15:29]
Dr. Nicole Yoder
Yeah, absolutely.
- [15:31]
Vivian Tu
First up, came in for a consultation. We sat down with you. You walked us through what I can only describe as, like, a bio class PowerPoint, which I love. So, like, I understood exactly what was happening, but, you know, nothing was really done at that point. Yeah, I also really loved that at spring, after we had our meeting, we did a full financial meeting. I had a full financial meeting. You once saw a different client, but.
- [15:57]
Dr. Nicole Yoder
I go somewhere else. But you guys get all the deets on the finances because it's a real thing.
- [16:00]
Vivian Tu
It's very expensive. It's expensive for anybody. But we got our finances sorted out. They checked our insurance. I remember you telling me, you were like, you have really good insurance. You know that, right?
- [16:11]
Dr. Nicole Yoder
Yes, I know. I was like, insurance, like, oh, you got, like, the catalog of insurance going here. I was like, this is lovely. Which is nice because it gives you the liberty to do whatever's medically necessary.
- [16:19]
Vivian Tu
And, like, makes the most inappropriate. Yeah. Yes. So we have the consult, and then after that we decide to move forward. I can't remember what the medication was, but you put me on a medication that I had to take for seven days.
- [16:30]
Dr. Nicole Yoder
Yes. Probably a Jestin.
- [16:32]
Vivian Tu
Yes. I hated this medication. This was the worst part I had a weird side effect in that it made it really hard for me to sleep.
- [16:42]
Dr. Nicole Yoder
That's miserable.
- [16:43]
Vivian Tu
But the purpose of that medication was to just time up my cycle. Right.
- [16:47]
Dr. Nicole Yoder
It has a couple purposes. Basically, it goes in the category of priming medications. There are some different forms of it. Sometimes we'll use, like, birth control pills, like the one that most people are familiar with. Sometimes we use something like estrogen. Just the estrogen component, or what you took was just the progesterone component of a birth control pill. But basically, the idea behind it is we want all of your eggs or follicles to grow as a group together.
- [17:12]
Vivian Tu
Yeah.
- [17:13]
Dr. Nicole Yoder
And doing some sort of priming medication tends to help that process happen a little bit more naturally. There's more of a spread of sizes of eggs at the end when you don't do priming. So it's just to sort of, like, get the best cohort that we can during your cycle.
- [17:31]
Vivian Tu
Make them as uniform and healthy as possible.
- [17:33]
Dr. Nicole Yoder
In an ideal world, every egg would be the same size on the same day. And when you triggered, they'd all be mature at the same time.
- [17:40]
Vivian Tu
Gotcha.
- [17:40]
Dr. Nicole Yoder
That doesn't really ever happen in reality, but as close as we can get to that is ideal. So that's why we give you that medication. I will say some people feel nothing with it, and some people are like, I hate. Hey, Justin, don't ever make me do that again.
- [17:53]
Vivian Tu
So.
- [17:53]
Dr. Nicole Yoder
I'm so sorry you felt that.
- [17:54]
Vivian Tu
No. Oh, my God, please. As soon as I was off of it after seven days, I went back to sleeping like normal. That's good. But then we moved into phase two, the most fun, the shots. And when people talk about egg freezing. Shots. I heard shots with the S at the end, plural, meaning multiple days. I did not realize it was also multiple shots per day.
- [18:18]
Dr. Nicole Yoder
Yes, multiple shots. Multiple days.
- [18:20]
Vivian Tu
Yeah, it was. So for about a week, I did two shots at night, one of which was not too bad. Fall a stim. And then one of which burned. It was the most horrible thing. Menopur. You and I have beef. I mean, listen, these are all medically necessary drugs, but I'm taking those. And essentially, you guys are just trying to, like, blimp up my eggs.
- [18:45]
Dr. Nicole Yoder
Yeah.
- [18:46]
Vivian Tu
Right.
- [18:46]
Dr. Nicole Yoder
Yeah. The point of those two medications is to get as many eggs from that month's cohort to grow as we can. So each month, your body actually recruits a group of eggs to initially have a chance of pregnancy. In a normal cycle, your body will grow just one of those with, like, a tincture of that Hormone you took.
- [19:06]
Vivian Tu
Gotcha.
- [19:07]
Dr. Nicole Yoder
From your brain.
- [19:07]
Vivian Tu
Yeah.
- [19:08]
Dr. Nicole Yoder
What we do is we give you a higher dose that of the same hormone your brain would make to hopefully grow a whole group of them.
- [19:14]
Vivian Tu
All of them.
- [19:14]
Dr. Nicole Yoder
Yeah. So those two that you start out with in the evening, those are for growing the follicles or growing the eggs.
- [19:20]
Vivian Tu
Gotcha. And I think a big misconception is also that, like, when you do an egg freezing round, you're, like, borrowing from the future and all the eggs you're harvesting mean you're gonna have less eggs overall. No, no. Like every single month, your body, in theory could have, like 20 plus eggs, but, like, only one of them becomes, like, the viable one.
- [19:42]
Dr. Nicole Yoder
Yeah, yeah.
- [19:43]
Vivian Tu
But now we're just harvesting all of them.
- [19:44]
Dr. Nicole Yoder
Exactly. Yes, exactly. It's good to, like, understand how, like, our actual, like, natural cycle works in order to understand, like, how the egg freezing process works. But exactly as you said, each month we actually have a whole group of eggs that initially gets recruited in a normal cycle. What happens is one ovulates, the rest of them just die off. So it's actually a very, in my opinion, inefficient way that we are set up. And so when you do, like, egg freezing or an egg retrieval for ivf, essentially we want to get all of the eggs from that month to grow. But if you hadn't done an egg retrieval, those would have died off anyway. Hence exactly what you said.
- [20:23]
Vivian Tu
So you're not worse off.
- [20:24]
Dr. Nicole Yoder
Yeah, you're not worse off. We didn't steal from eggs that you would have had in the future. It's not decreasing your future fertility and you're not going to run out of eggs sooner. So you're not going to go through menopause early, earlier. Because you did it.
- [20:34]
Vivian Tu
Yeah. Oh, I love that.
- [20:36]
Dr. Nicole Yoder
Yeah. All good things.
- [20:37]
Vivian Tu
So seven days ago, my least favorite medication. Seven days of two shots per night. And all the while I'm seeing Dr. Yoder every, like, two, three days. Like, I'm coming into the office.
- [20:49]
Dr. Nicole Yoder
Yes, yes.
- [20:49]
Vivian Tu
Every other day. And we're getting a very fun ultrasound. You're looking at my ovaries, what have you. Yeah, I'm getting blood work done. I mean, I was just being jabbed every single day. Then the last week is the most fun because not only do you get to continue the two shots you are taking at night, you get to add one in the morning and you have to take it at a very specific time from the other two. So it will also impact when you can take meetings.
- [21:17]
Dr. Nicole Yoder
This is true. Yes, yes, yes. 100%. True. And that medication is pretty important that you take it at the right time, because that's the one that prevents you from ovulating on your own.
- [21:27]
Vivian Tu
Oh.
- [21:28]
Dr. Nicole Yoder
So when you're growing follicles, once it gets to a certain size, your brain will get the memo like, hey, there's a good, juicy follicle. You should ovulate. We don't want that to happen.
- [21:38]
Vivian Tu
Got it.
- [21:38]
Dr. Nicole Yoder
Because we want entire control over when that process starts so that we can retrieve the eggs. So that one is pretty time sensitive, because if you miss it and you take it way later, then your brain might think, oh, hey, I should ovulate. Yeah. And then it's sort of like all your hard work is for naught if you ovulate. So that's why we're a little bit pickier about the timing of that one. And we say, you probably want to ruin your meeting for this.
- [22:02]
Vivian Tu
Yes.
- [22:03]
Dr. Nicole Yoder
So you don't, like, waste the whole two weeks.
- [22:06]
Vivian Tu
And by the way, I don't know if this is how it is at all fertility centers, but, like, through my entire process, you were the only doctor I saw, with one exception. There was one Saturday. It was, like, right before. Right as I was ready to start retrieving, I saw another doctor. But I just felt really safe that it was always you.
- [22:26]
Dr. Nicole Yoder
Yeah. And that's one of the things that, you know, we try to do our best to, like, have a lot of continuity with our patients.
- [22:32]
Vivian Tu
Yeah.
- [22:33]
Dr. Nicole Yoder
We know that a lot of times this is not anyone's plan A to, like, walk into my office. I get that. I totally appreciate that. And it's also really, like, sort of vulnerable space. You're doing something very intimate. It's for your, like, your family building purposes. Some people have, like, you know, anxieties around it. Some people have it easier than others, but, like, the more that we can have a relationship with our patients and see them and scan them ourselves, we try to the best we can. Now we're not there, like, 24 7. So, yes, you probably saw someone else at some point. But usually that's what we're trying. Yeah. Only once. That sounds about right. But usually we're trying to, like, keep you updated on how things are going. Does this look good? Does it look better than we thought? Worse than we thought? Because then at least you don't get any surprises at the end. And you'll kind of know what's coming.
- [23:14]
Vivian Tu
Yeah. And so I do my three weeks of medications and shots, and we get to the end. You do the final look at my Ovaries. You're like, ooh, these look plump and juicy. It's time. And then I took what everybody calls a trigger shot. To be clear, I cannot remember what any of these medications are called, but I take this big, scary trigger shot. The needle was literally the size of my arm. Not to scare anybody, but it was really. It was nervous for me. Listen, I never injected myself before this. Yeah.
- [23:42]
Dr. Nicole Yoder
It's a weird concept for people who don't do injections or. Yeah. Don't regularly take injectables.
- [23:49]
Vivian Tu
Yeah. And so I did this trigger shot, and then I believe it was the 24. Yeah, yeah. 48 hours later, I show up to Spring Fertility. We go to the floor above, the floor that I normally saw you on. And it is so funny because the office looks like a one hotel.
- [24:08]
Dr. Nicole Yoder
Yeah. It kind of looks like it's got, like, the grassy. Yeah, yeah, yeah.
- [24:10]
Vivian Tu
The same vibe.
- [24:10]
Dr. Nicole Yoder
It has, like, organic vibes in there.
- [24:12]
Vivian Tu
It was very soothing. But I got in the full hospital garbage. Like, we went in, and it wasn't too bad. But all I can remember is right before I went under, you were trying to, like, distract me or something because it's, like, a little humiliating when you walk into the operating room and you have no pants on and there are five, six people standing directly, you know, looking at where the sun doesn't shine. And you're like, oh, I saw you post an Instagram story about these snacks you were eating this past weekend. And I was like, why is she talking to me about these snacks right now? And it's so funny. We were having this mid conversation, and all of a sudden I go, oh, I'm getting a little D. And then I woke up.
- [24:57]
Dr. Nicole Yoder
Yep. Yep. That's the usual, like, trajectory of it. It's like, mid sentence, like, yep. And she's out and she's gone. And then you wake up and it's like, did we start yet?
- [25:06]
Vivian Tu
Yeah. And it's so funny. I think the only, like, real, like, pain or, like, real, like, negative thing I felt was I was really cold after the procedure, but no pain. Didn't feel anything negative. So, yeah, I consider it a really good outcome.
- [25:23]
Dr. Nicole Yoder
That's not bad.
- [25:24]
Political Commentator
The Republicans have been saying lots of things. Just yesterday, their leader said he wants to own Gaza.
- [25:32]
Dr. Nicole Yoder
The US Will take over the Gaza Strip, and we will do a job with it, too. We'll own it.
- [25:38]
Political Commentator
On Monday, the Secretary of State said an entire federal agency was insubordinate.
- [25:43]
Dr. Nicole Yoder
USAID in particular, they refused to tell us anything. We won't tell you what the money's going to where the money's for, who has it.
- [25:49]
Political Commentator
Over the weekend, Vice President Elon Musk, the richest man on earth, tweeted about the same agency that, you know, gives money to the poorest people on earth.
- [25:58]
Dr. Nicole Yoder
We spent the weekend feeding USAID into the wood chipper. Could gone to some great parties, did that instead.
- [26:06]
Political Commentator
But what if the Democrats been saying people are aroused?
- [26:10]
Dr. Nicole Yoder
I haven't seen people so aroused in.
- [26:12]
Vivian Tu
A very, very long time.
- [26:14]
Political Commentator
Huh. That's a weird way to put it. Senator, we're gonna ask, what exactly is the Democrats strategy to push back on? Republicans on Today explained.
- [26:24]
Dr. Nicole Yoder
Yeah, and a lot of times we're giving you, like, IV fluids, which are cold. And you've, you know, you've been in the procedure room with not a lot of clothes on. So that. That kind of tracks. But usually people that dates. It's like crampiness. It's usually not severe pain, but, like, you just feel crampy. I think the best description, honestly, is that someone's like, you know, I just feel gross. Yeah, that. That tracks. Like, you just feel a little like, not your best self, but. But usually it's not severe pain. It's like crampiness and a little discomfort.
- [26:51]
Vivian Tu
And for me, it was more so just like horrific, like, bloating. Like, I felt like I had to, like, before the procedure, I felt like I had to pee every 30 minutes. And, like, I was, like, waddling. I was like, what is going on?
- [27:02]
Dr. Nicole Yoder
Yep, yep. Towards the end, your ovaries just physically take up so much more space in your pelvis that you just feel so bloated. And there's also fluid retention from the hormones. So the waddle is pretty typical once you get to, like, day 10, 11, where people are like, oh, I can't even, like, walk around normally. But, yeah, those all sound like pretty common experience.
- [27:22]
Vivian Tu
Okay, so now, you know, I get the retrieval done. This is the final step, and this is what you have dubbed for me, egg math. Because not only did I freeze my eggs, in particular, you know, we wanted to freeze embryos. And when I walked out of. Well, I walked out of. When I awoke, yes, I immediately grabbed the nurse and I was like, how many eggs did you get? And I'm gonna share some numbers. I wanna say first and foremost. Like, I almost didn't wanna share this because I felt bad that my process had gone so well. I didn't think that I would feel guilt about it going well. I think I would have been, like, really scared to share having it not Gone well. But, like, even knowing that I had girlfriends who said, oh, I got the results you got after doing two or three cycles, it upset me. It like, you know, felt like they're like, why did I get lucky? And they didn't.
- [28:21]
Dr. Nicole Yoder
Yeah. They're like emotions that are attached to the numbers.
- [28:23]
Vivian Tu
Yeah.
- [28:23]
Dr. Nicole Yoder
Inherently.
- [28:24]
Vivian Tu
So I ended up getting 30 eggs. 24 were, like, fully mature. Fully mature. Of the 24 we inseminated all of them. And remind me, I believe it was 19.
- [28:40]
Dr. Nicole Yoder
Yeah, I believe 19, like, fertilized normally.
- [28:43]
Vivian Tu
Yeah. By the end of the fertilization process, 14 of them turned into blastocysts.
- [28:49]
Dr. Nicole Yoder
Yes.
- [28:50]
Vivian Tu
Sounds like Blastosaur or some Pokemon. And then we also opted into doing genetic testing to make sure that our embryos were chromosomally normal. And of the 14, 13 were normal. And you always told me that for every human kid that I wanted, that I would need roughly two embryos.
- [29:15]
Dr. Nicole Yoder
Yeah. Ideally, you have two normal embryos for every baby desired. Yeah.
- [29:21]
Vivian Tu
So I can have a basketball team?
- [29:23]
Dr. Nicole Yoder
You could have an entire team of. Yes.
- [29:26]
Vivian Tu
I think you have made it very clear to me through this process that, like, I had a really incredible result, but is not normal, quote, unquote.
- [29:34]
Dr. Nicole Yoder
You're definitely on, like, the higher end of the spectrum.
- [29:38]
Vivian Tu
Can you give us context? Like, what is average for someone who's maybe 30 and versus someone who's 40?
- [29:44]
Dr. Nicole Yoder
Yeah. So, as you very appropriately said, your numbers were fantastic. You have a great reserve. You did great during the whole cycle. Sometimes that's the way it goes. And sometimes we're expecting that it's way less. Part of my job is at least counsel people on what the expectations are. But for like, an. Just to give you, like, ballpark averages, if you're in your 30s, like, an average number of eggs to have retrieved, I'd say if you get between 10 to 15, I'm like, yeah, that's pretty common. But once you're closer to 40, anything like 5 to 10, that's pretty. I'd say, normal. And that's just the starting number. Now, you kind of very nicely walked through all of those steps that happen in the lab. So first thing we do is we see how many are mature, and that's where that priming medication can help more be mature at the same time. But that will be a certain percentage for people. Usually it's about 75% are mature. Then we have to fertilize them. Typically, about 75, 80% will fertilize normally. And then we let them turn into embryos. We let them Grow in the lab. Now, you had a very good result on that portion of things. Like 19 fertilized eggs turning into 14 embryos is way higher than I would expect. Usually that's about, like, 40 to 50% will turn into embryos.
- [31:01]
Vivian Tu
Do you think it's just. Cause, like, I'm 30, like, I'm younger.
- [31:03]
Dr. Nicole Yoder
Yeah, yeah. Not to sugarcoat it, but, yeah, you're young, you're healthy. There is no apparent, like, egg or sperm quality issue. So you crushed it. You did great. And then we see how many of those embryos are chromosomally normal. And again, when you're young, 13 out of 14. Like, yeah, that tracks.
- [31:21]
Vivian Tu
Yeah.
- [31:22]
Dr. Nicole Yoder
Now, if we fast forward and you're doing this when you're, like, late 30s, 40s, something like that, well, then maybe the numbers are looking like we get 10 that are retrieved, maybe 8 are mature, 6 fertilize normally, maybe 3 make it into an embryo, and then we're happy if we get one or two normal embryos out of that.
- [31:40]
Vivian Tu
Yeah.
- [31:41]
Dr. Nicole Yoder
So each step along the way, we expect there will be cutoff. And some of those cutoffs are more or less severe, depending on age or just any, like, medical history.
- [31:51]
Vivian Tu
I'm not going to lie. This whole process, even though I knew I was healthy, even though I knew I was, like, young on the grand scheme of things, like, yeah, I felt a lot of guilt, like, when I started, like, doing this process. I was like, should I have drinking so much in my early 20s? Like, God forbid I had that one cigarette outside of that bar one time. Like, why did I have all of those burgers and cheese fries in college? Like, why didn't I eat healthier? And like, every little decision I've ever made.
- [32:19]
Dr. Nicole Yoder
Yeah, yeah.
- [32:20]
Vivian Tu
Kind of came to the forefront of my mind to be like, you're an idiot. And, like, what if that is the reason why this doesn't work?
- [32:25]
Dr. Nicole Yoder
Yeah. A lot of people get to. They have sort of, like, epiphany moments in my office, or like, oh, my gosh. Like, has everything I've been doing like. Like, it made it impossible or like, it had its major effect? The real answer is, like, we don't know. We're all trying to do the best we can. But it brings up a good point. Like, for people with ovaries and eggs, like, you're born with all the eggs you'll ever have. They stay with you your entire life until you ovulate them. So when you're, like, 30, your eggs are 30 years old. When you're 40, your eggs are 40 years old. They've been kind of exposed to, like, all the elements you've been exposed to. Now, most people who are doing the things that you described are just fine.
- [33:00]
Vivian Tu
Yeah.
- [33:00]
Dr. Nicole Yoder
But, you know, there are cases where certain lifestyle choices can, you know, take a hit on your overall health and fertility health.
- [33:08]
Vivian Tu
Yeah. Oh, man.
- [33:11]
Dr. Nicole Yoder
I know that's a heavy one out there.
- [33:14]
Vivian Tu
And to take this gamble and do this, we have to talk about the cost to break down. Kind of my process in rough ballpark numbers. Like I mentioned, I went to Spring Fertility in New York City. Keep in mind, this is a major metro. Prices will fluctuate upwards or downwards depending on where you go. But this whole process that Dr. Yoda and I just outlined was $20,000 roughly. The medication pack was, I believe if we had gone directly through spring, it would have been like 4000 ish. We went through our insurance. It showed me the top number was six grand. I was like, six GS for medicine.
- [33:55]
Dr. Nicole Yoder
Yeah.
- [33:56]
Vivian Tu
Fortunately, we had opted for the really, really expensive PPO that year, knowing we wanted to do this right. I spent 180 bucks on that medication. I was like, hell, yeah, 180 bucks.
- [34:06]
Dr. Nicole Yoder
That's a win.
- [34:07]
Vivian Tu
Yeah. That seems like nothing compared to six grand.
- [34:09]
Dr. Nicole Yoder
Yeah.
- [34:10]
Vivian Tu
And then, you know, just in the forms that you guys have shared with me, to actually then take those embryos that we currently have frozen, that cost about a thousand dollars each year to keep on ice.
- [34:19]
Dr. Nicole Yoder
Yeah.
- [34:19]
Vivian Tu
It's another 10, sometimes $15,000 to then put them back inside.
- [34:24]
Dr. Nicole Yoder
Correct.
- [34:25]
Vivian Tu
My body. Correct.
- [34:26]
Dr. Nicole Yoder
Yes. Making them is the first part. If you use them, that's a whole separate procedure with a whole separate associated cost.
- [34:34]
Vivian Tu
Oh, my gosh. Like, just like point blank. Why is this so expensive?
- [34:39]
Dr. Nicole Yoder
Part of it is that in the lab with the embryologist, literally everything is being done by hand. It is a very one by one, one by one. Like, when you have an egg we're trying to turn into an embryo, there is an actual human that's making all of that happen in the lab by hand. So it's a very technically challenging procedure, and it requires just a lot of technology to sort of create this fake environment that the egg can thrive in to turn into an embryo. So part of it is just there's a lot that both in the infrastructure that goes into it. Having a lab is expensive. It requires a lot of upkeep. There's a lot of personnel. Like, it's kind of amazing when you think of, like, how many people go into, like, one person's journey on all of this. It's like there's actually so many people that are a part of it. Like, I know you saw me a lot of times, but, like, there's a whole team of people behind me making all of this happen.
- [35:31]
Vivian Tu
Right next to the actual, like, surgical procedure room, there was like, the lab.
- [35:35]
Dr. Nicole Yoder
Oh, yes.
- [35:36]
Vivian Tu
And you just see like, a dozen people in white coats, all with their little pipettes and stuff. I'm like, wait, what are they doing?
- [35:41]
Dr. Nicole Yoder
Yeah. And you're like, all the younger babies. Yeah, yeah. They're back there making babies. And honestly, like, they are the unsung heroes of all of ivf, in my opinion.
- [35:48]
Vivian Tu
Yeah.
- [35:49]
Dr. Nicole Yoder
What you can have, like, the best doctor, the best ovary, is the best protocol, all of those things. If your lab is not amazing, like, it does, none of that matters. And so a lot of it is just the lab expertise is. You want it to be top notch. And that, unfortunately, will come with some cost.
- [36:04]
Vivian Tu
Yeah. Broadly speaking, like, I shared exactly, like, kind of what my costs were, but, like, yeah, what is. What should people expect to spend on average?
- [36:13]
Dr. Nicole Yoder
So really great question and really good to have, I think, a little insight at the beginning of how many rounds you might need to go through. So you were in a great position. You were young, you had a good reserve one and done great. Have everything that you're hoping for. In that scenario I described earlier, it's like, oh, Maybe we had 10 eggs and end up with, like, one or two normal embryos. Well, if you want more than one baby, you're probably doing this again. And that's a whole separate cost. So it's really important.
- [36:43]
Vivian Tu
And there are no cost savings if you go a second go.
- [36:45]
Dr. Nicole Yoder
There is at spring, there's like, a slight discount on, like, yeah, repeat cycle for like, egg freezing. But. But generally it's almost the full cost. Like, the medications is the full cost again. So it's really good to have a very honest conversation about, you know, with your physician about, like, realistically, how many rounds do you think I need? Now, some people get lucky and, you know, only do it once and be good. But for some people, like, I fully expect for their goals and their ideal family size, like, you're gonna need to do this two, three times. And then if it's out of pocket and there's no insurance coverage, it's that 20K times three, the medications times three times three.
- [37:24]
Vivian Tu
And then if you use them, insemination times three.
- [37:27]
Dr. Nicole Yoder
Yes. On the back end, then it's like all of those things times three. Each time you do a transfer so it's very, I think, important to just really grasp what, like, best case scenario and worst case scenario in terms of how many rounds you might need to go through.
- [37:44]
Vivian Tu
Is there any way to somehow squeeze out some cost savings here just so that more people can get access to this in their younger years?
- [37:52]
Dr. Nicole Yoder
So at spring, we actually have a payment plan for egg freezing. Which part of the goal is exactly as you said, just to help make it more accessible to people? Because usually the people who would probably benefit from it the most are the ones who are like, I really like to, but, like, it's just not attainable for me. So with the payment plan that we have, it's basically 250amonth, interest free for 40 months.
- [38:18]
Vivian Tu
Interest free is a really, really nice one.
- [38:20]
Dr. Nicole Yoder
Yeah. Which is really nice. But basically it's like about the cost of an Equinox membership or something like that. The medications are their own thing up front, but at least then it's not like the big upfront fee initially, of course, that's one of the things to look into. And I always tell people, like, look into your insurance. Look into like your HR department specifically. Ask them, do I have fertility benefits? I can't tell you the number of times I've had people who are like, oh, I didn't realize I had this benefit for like the first two years I worked there. It's as if they're like, not advertising it somehow, but.
- [38:54]
Vivian Tu
Well, no, they're not advertising it because it's expensive.
- [38:56]
Dr. Nicole Yoder
Exactly. They actually are not advertising it. But then they find out, they're like, oh, well, I should do this because I have the benefits. But it's just kind of crazy to me that you're like, wow, you have this really great benefit and you had no idea. So always ask. And if you don't have benefits, it's really one of the things that a lot of people have been able to push for as a. Like, you know, for their employers. Because this day and age, especially in, like the tech sector, like, a lot of companies are starting to offer fertility benefits because they're realizing it's really important to people, especially if they're putting off their family in order to work more up front, people are like, hey, XYZ company is gonna pay for me to do an egg freezing cycle. Like, what do you got to help me out? Which you should 100% push for that. I've had people who have told me, you know what, I don't have benefits now, but I'll be back in a year with benefits. And They've done it just by going to their HR and being like, this is important. If you don't give us. If you don't factor this into our lives, it's an important selling point for staying at that job.
- [39:54]
Vivian Tu
Yeah, I mean, what was it that people were picking up random shifts at Starbucks because Starbucks as a corporation was offering fertility benefits to anyone who worked over a certain number of hours?
- [40:06]
Dr. Nicole Yoder
Yeah, I've seen people switch jobs. I've seen people. Because if that is your most important goal, to have a family and you can't afford it out of pocket, that's oftentimes like the only route people have to go is like, they have to switch their job to get a job that has fertility benefits so that they can, you know, go through the process.
- [40:24]
Vivian Tu
I want your POV also on medical tourism. So I think there's the good and bad case. Like, I know some people who are, you know, big time celebrities. They're practicing medical tourism in places that may just have like more advanced technology, whether that be going to the UK or something. But then there's also people who are like, hey, I went and got like a BBL somewhere that's like a little sketchy. Like, do you think medical tourism is a viable option, one for fertility, but also like, is it a smart one?
- [40:57]
Dr. Nicole Yoder
It's a pretty big question, but not necessarily like one straightforward answer. I'd say it's not all bad, but you really have to do your research and know what you're getting into and really have to think about what all of the, like, hidden costs that will add up down the road will actually be. So sure, you can go to a different country, freeze your eggs for a cheaper price. But you really need to factor in, like, what if I'm someone who needs to do multiple rounds? What if I have a low reserve? Do I, you know, travel back there like three times? Or when I need to use these eggs or embryos, what does that cost? And then, you know, like five years down the road, are we also having to go back to this place? What are their success rates? What does the regulatory body look like? What is the support system that you might have there if something goes wrong? Most of the time this is a fairly like, safe, straightforward, low risk procedure. But any, like, medical procedure has some sort of complications that can be associated with it. And who's going to be there to help you out?
- [41:58]
Vivian Tu
You know, I mean, I went under.
- [41:59]
Dr. Nicole Yoder
Yeah, yeah, yeah. You have like anesthesia, you're like, you're under. And most of the time it's straightforward, no complications. But heaven forbid something happened, like, what hospital are you going to go to? Like, who are you going to be able to communicate with there? So definitely more feasible if you have connections in some way, shape or form to wherever that location is. Or like, know people who have used them and who can vouch for their success rates. Because in the US Everything is very heavily regulated. So it's kind of a matter of like, seeing is this other place up to snuff on their regulations and safety data and all of that.
- [42:35]
Vivian Tu
Oh, I love that. So also, I wanted to get kind of into what folks can do in their everyday lives aside from just fertility treatments right away. Like, are there smart choices that people can be making in their 20s that'll set them up for success in their 30s and 40s to do this?
- [42:55]
Dr. Nicole Yoder
Yeah. So couple things. I think it's really good to be in tune with like, just your normal cycle and what is going on with your body. So for people who are like, not on birth control, I say track your periods. See, are they regular? As gynecologists, we consider it like, you know, another vital sign as like, how often do you get your periods? There's a lot of people who like, don't pay attention to it, or maybe it's like very irregular and they like, never really thought about it until they're actually trying to get pregnant. But it's good to sort of like touch base with yourself and be like, do I actually get regular periods? Are they extremely heavy or painful? Is there something else that might be going on? The earlier you can know about things that might affect your fertility, the better because you can act on them. So things like fibroids, things like polyps or endometriosis, the sooner you can know those things, the better. Another thing is knowing your family history. Do you have a family history of early menopause? Nobody talks about fertility, at least not in families that I know of. But like, sometimes people be like, oh, yeah, I actually went to try to get. I'm having difficulty conceiving. I finally talked to my parents about it and they're like, oh yeah, like xyz. There's all this family history of it. So it's good to be like, aware of those types of things. I think you touched upon this a little bit already. But there is so much like processed foods, processed materials, like plastics, everywhere. I'd be a fool to say, like, avoid all of those things. Cause you can't. But I think being cognizant of what you're putting in Your body is really important, you know, Try to eat real food. Try not to have it be, like, in a bag. Yes, exactly. Exactly. There's definitely been these, like, declining fertility rates in the last few decades that are a little bit baffling of why this is happening. And I can't help but think, like, some of it has to be like, we're just around so much the loss. Yeah.
- [44:48]
Vivian Tu
They're getting us.
- [44:49]
Dr. Nicole Yoder
I swear. I swear. And when you look at sperm counts, too, like, globally, they're just on this downward trajectory, and it's like, why is that happening?
- [44:57]
Vivian Tu
Wait, can I tell you? I made Boo swap out his underwear because he had these, like. Like, athletic weave, like, not cotton underpants. And I. For some reason or other, I was served this fun little video on TikTok that was like, if your man has polyester underpants, it's zapping his sperm. I went and threw out all his underpants the next day. I was like, we're getting cotton underw. I don't care if you sweat in them. Like, it doesn't matter. You have to wear these undies. And he was like, oh, my God. Like, why? And I was like, we're gonna be prepared for this. And it worked out okay. So I have no idea if the underwear had anything to do with it.
- [45:37]
Dr. Nicole Yoder
Didn't hurt the cause, obviously. Obviously. The other thing that I find very interesting, I had no idea about was how many men in New York City use saunas, so.
- [45:48]
Vivian Tu
Oh, you're not supposed to sauna. If you're a guy.
- [45:50]
Dr. Nicole Yoder
It can definitely affect your sperm counts. I've had. I cannot tell you how many cases where, like, they come in for a semen analysis. Looks totally normal. Good. Come back a little bit later. I'm like, where did it all go? What's happening? And they're like, oh, yeah, I use the sauna, like, three, four times a week. If you're trying to get pregnant, really, like, tell your guy, reel back on the saunas. Cause it definitely can affect your sauce.
- [46:10]
Vivian Tu
They're, like, getting cooked.
- [46:11]
Dr. Nicole Yoder
Yes. They're basically, like, cooking themselves. Yeah, yeah.
- [46:15]
Vivian Tu
Oh, my gosh.
- [46:17]
Dr. Nicole Yoder
Yeah. Yeah. So other, like, lifestyle things, like, you.
- [46:20]
Vivian Tu
Know, and these are all things that you can do for low to relatively low cost that, you know, can help the case out. So you hopefully don't need that third round of this and.
- [46:32]
Dr. Nicole Yoder
Exactly, exactly.
- [46:32]
Vivian Tu
You can get it done in two weeks. That's great.
- [46:34]
Dr. Nicole Yoder
Exactly. And I always tell people, too, anything a cardiologist would tell you is good for, like, your cardiac health. Also good for your Reproductive health. It's like moderate exercise eating, you know, a healthy, well balanced diet with like fruits and veggies. Now there's no one diet that has been proven to definitely increase or decrease fertility, but generally it's common sense things. Don't eat greasy fatty foods, limit red meat consumption to three times or less per week, I would say, and then antioxidants and exercise. So anything cardiologists would say is good. I would also bless that as a generally can only help your reproductive health.
- [47:11]
Vivian Tu
I love that. Thank you so much for all of your wisdom. Kind of final question for you is just is there any sort of fertility financial takeaway that you want to remind all of our listeners of?
- [47:26]
Dr. Nicole Yoder
I would say knowledge is power. Knowing do you have benefits, knowing how to use them in their most optimal way. There are definitely smart ways you can use your insurance and not so efficient ways you can use it. And then also taking a step back and looking at your own health, that's the other part of information that you know, knowledge is power. Do I have a low reserve? Do I have medical conditions that might raise, you know, the chances you might need fertility treatments? And what are my goals? It's really important to like have just an honest conversation about, like, here's what I would like with my life and here's how I'm gonna best set myself up to possibly do everything I can to achieve that goal.
- [48:07]
Vivian Tu
And that's wonderful advice. Like not even so much just for.
- [48:10]
Dr. Nicole Yoder
Fertility, but life advice. I know every once in a while you just gotta take a beat and like check in with yourself and be like, where am I? What do I want? How do I get there?
- [48:17]
Vivian Tu
Yeah. Thank you so much for being here.
- [48:19]
Dr. Nicole Yoder
Of course. This is great.
- [48:21]
Vivian Tu
Thanks for tuning into this week's episode of Net Worth and Chill, part of the Vox Media podcast network. If you like the episode, make sure to leave a rating and review and subscribe so you never miss an episode. Got a burning financial question that you want covered in a future episode? Write to us via podcastorrichbff.com follow Net Worth and Chillpod on Instagram to stay up to date on all podcast related news and you can follow me at YourRichBFF for even more financial know how. See you next week.
- [48:47]
Dr. Nicole Yoder
Bye.