I Didn't See THAT Coming! One Woman's Struggle with Infertility and How it Changed Her Life

By Lyneda Lincoln

How did I get here?! I have NO idea how I got here!

As a little girl dreaming about the life I aspired to have – a high powered career, a doting husband, two beautiful children – it never crossed my mind that I might not be able to have one of those things. From a young age I was told that if I wanted something, I just had to work hard enough, and it could be mine; something about the world being my oyster – you know the saying. So, that’s what I did. I worked hard. I was dedicated. I crushed high school. I sailed through college. I landed an amazing job with a Fortune 100 company right out of college at the ripe age of 22. And finally, that sexy guy that I had kept on my arm for the past four years - my best friend turned love of my life - finally asked me to marry him! I was getting everything I ever wanted. But, why shouldn’t I? I followed the recipe of life that had been handed to me – I worked hard and maintained focus. For that, I deserved everything I ever wanted. Crack that oyster open y’all! I want my pearl!!

My husband and I had decided before we got married that we wanted to spend the first two years of our marriage just enjoying each other and settling into adult life. After that, we’d start the next part of our journey together and have that first child we had been fantasizing about. It was the perfect plan. But, this was the first time I would find that life doesn’t always quite go as planned. A year after we got married, I was unwillingly saddled with this burdensome feeling that I wanted to be a mother sooner. As exciting as the prospect of being a mother was, I was a bit annoyed that my mind and my heart didn’t get the memo that I needed another year of blissful married life before I started thinking about children. I tried to push the feeling aside, but pregnant bellies popped up everywhere and babies had these cute, googly eyes that caused my heart to palpitate uncontrollably. The baby aisles suddenly had this alarming power to pull me towards them and then it happened… the mirror whispered to me to look down at my hand cupping my belly and picture that oyster pearl finally cradled within my grasp in the form of tiny hands and toes. I told my husband about how I was feeling. He was kind hesitant because he didn’t want the pressure of trying yet. But, he was willing to let me stop my birth control pills and with an, “if it happens it happens” attitude, he began toying with the idea of a surprise pregnancy that would whisk him into fatherhood. So, Christmas 2013 was an exciting time because we had it in our minds that within the next few months we would make the exciting announcement that Baby Lincoln was on the way!

Oh… but its 6 months later and we haven’t even seen a shadow of a line on any of those little pesky tests that we had stocked up on. What was going on?? Well, duh! I wasn’t following the recipe. I was expecting it to just happen without any hard work. No worries – challenge accepted!!! I began rigorous research – I found articles, books, Facebook support groups. I downloaded more apps for tracking my cycles to compare against the My Calendar app I had already been using. I started my Rainbow Lite Prenatal Vitamins. I purchased Wondfo OPKs. I booked a pre-conception check-up appointment for myself and my husband. By this time my husband also felt we should be more pro-active and start actively trying to conceive so we just knew that the pre-conception check-up would give us the ammo we needed to make this baby. Much to my surprise, because we were only 24 years old at the time and too young to be worried about fertility issues, the pre-conception visit consisted of a standard physical and a metaphorical pat on the head with a, “have fun!” on the way out the door.

Christmas 2014 had now come and gone. Still no baby. How could this be?? I clearly wasn’t working hard enough… I wasn’t praying hard enough. Time to add in monitoring my Basal Body Temperature and get down on those knees a bit more so my Heavenly Father could hear me better. But despite my hard work, my heart was still in shambles as with each month Aunt Flo showed up like clockwork. By early 2015 I was tired of waiting around. Friends and family had been telling me to stop stressing and just let it happen. Our doctors had told us it just takes time and that we are young so there was nothing to worry about. Yet, each month, someone else was making a pregnancy announcement or posting photos of their new baby and here I was with an empty womb. My oyster shell was closing… and fast. I was in despair. The emotional toll began to affect me physically as well in many ways. My husband didn’t know how to console me. Aside from dealing with what I presumed to be an undiagnosed fertility issue, I was also trying to cope with grief and loss of several family members. By June 2015 I had a more positive outlook on life and decided to go in for fertility testing. Once again, we were told that we were too young to be worried about fertility issue, but I was persistent.

After fertility testing with our local doctor, we were diagnosed with severe Male Factor Infertility and were hesitantly advised that we had a 1% chance of ever being able to conceive naturally. So, a referral was made to a local fertility clinic and urologist who would help us going forward. After a few months, my husband was prescribed Clomid to start his treatment, but before we could get the prescription filled, we found out that we were miraculously pregnant!! At 8 weeks, my OB had trouble believing we were pregnant and asked that she be able to check via ultrasound before my dad and my husband came back into the room to prevent any harsh surprises. But, sure enough our little pearl was there - strong and healthy.

I went on to have a perfect pregnancy filled with awe and a blissful unmedicated home water birth where we met our precious baby girl. However, I never lost sight of the fact that we were one of the few lucky ones. Most go on to do years of treatment and endure IVF before they ever get to meet their long-awaited miracle(s).

Being a spiritual person, I believe that everything happens for a reason and at the perfect time. But, I also can’t help but feel as though we may have had our miracle that much sooner had our medical professionals not been so blinded by our age. Infertility doesn’t just happen to those in their mid-30’s and 40’s. We were a stable, otherwise healthy married African American couple in our mid-20s who had an explainable fertility issue that could have been addressed early on during our pre-conception checkup and could have saved us a lot of heartache, time, and money.

Although our infertility journey was admittedly long and painful (longer than some, shorter than others), it did make me more appreciative of the privilege it is to be a mother. My husband and I spend every day extremely thankful for our daughter and we cherish every small moment with her. But, what I didn’t anticipate was that the feelings of infertility don’t just go away after you “beat it”. You look around at the other women who are still standing in the mirror cupping an empty womb. Their pain continues. You watch women complain about how easy it is for them to get pregnant with children they don’t want. You get angry. In my case, you change your life plans and decide that you don’t need two children – one is good enough – because you don’t want to experience the pain and longing all over again. So, then what DOES come after infertility?

In our case, I realized that our burden could be used as someone else’s blessing. I wasn’t ready to give up the fight against infertility just yet. From this, I made the decision that I was going to become a surrogate to help other couples complete their forever family. My husband was completely supportive, and we went through the laborious process of screening, testing, matching, fertility medications, and embryo transfer. It gave me the chance to understand all we could have gone through, so I could appreciate my blessing that much more. It also gave me the chance to meet a beautiful couple in their mid-40s who is now eagerly awaiting their fraternal boy/girl twins from our first successful FET in December 2017 after years of their own infertility struggle which included failed transfers, pregnancy loss, and financial sacrifice. This journey has presented its own set of challenges but is equally rewarding and fulfilling for me knowing that I did my part to help eliminate the fertility struggles of another couple.

I honestly can’t say how I go here – how I became this 28-year-old mama discussing and spreading awareness about infertility. But, I am so honored to be a part of this movement and to have been given a platform to tell my story. I hope as you’ve read through some of these stories this week, you gain a better understanding of the struggles about infertility and how it can affect just about anyone around you. I hope you choose to speak out and do your part to bring more awareness to this topic so that people don’t have to continue suffering alone… It really can happen to anyone.

Lyneda is a 28-year-old aspiring entrepreneur and mama of one. Several years ago, in the midst of her pain, she took to Instagram as a way to express her frustrations of eagerly awaiting a child and to find other women who might be experiencing the same thing. Since then, she has continued the unfiltered documentation her life on her Instagram profile @WeAreTheLincolns in the hope to spread awareness about infertility, motherhood, and surrogacy. In between Instagram blog posts, Lyneda enjoys reading, working her new endeavor as a home-based travel agent, and spending time with her family.

Our Story of Infertility

By Owen Davis

My name is Owen and I am so excited to share my story with you guys today. I am a part time orthopedic Physician Assistant and a full-time mommy. I still get butterflies when I call myself a mom… I will never get used to hearing that and I will never take it for granted. Unless you have personally struggled with infertility, you probably have no idea that this week is National Infertility Awareness Week. A week dedicated to bringing awareness to a topic that is under discussed and over prevalent. I'm sharing our story in hopes of removing the stigma surrounding infertility and to help at least one person feel less alone.

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Our infertility story began when we were just dating when a doctor delivered the heartbreaking news that it would be hard for us to get pregnant naturally in the future. At that point we knew we would one day get married and want babies so we decided to proceed with surgery, knowing that it may or may not help our chances. These are some scary decisions to make for your future when you are just dating. After surgery it was just a waiting game... we wouldn't know whether it was successful until we started trying to conceive. Fast forward about 4 years. We were married and it was (finally!) time to start trying to get pregnant.

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This is where God stepped in, as He always does. I was in PA school and I chose to do one of my elective clinical rotations in infertility medicine. Ever since our infertility journey began it had become so intriguing to me both medically and personally. I told the reproductive endocrinologist I worked with all about our story and asked his personal opinion. He told me that we should go back to our previous doctor for more testing since we had not successfully gotten pregnant yet. So back to the doctor we went where more tests were done which showed that 1) the surgery had not worked and 2) they were concerned my husband may have a benign brain tumor that could also be affecting fertility. An MRI was done which did, in fact, show that he has a benign brain tumor also affecting fertility. With all of these factors, they told us our only option was IVF.

We were referred to UNC Fertility where we met our absolutely amazing doctor for a consultation and more testing and he agreed that IVF was our only option. That was a really low point in my life. I was overwhelmed, ashamed, heartbroken, scared and lonely. I decided that I could either keep it a secret from everyone or I could bravely share our story with the world which is what we decided to do. I am not a sharer by nature so this was a huge leap of faith for me! But I knew that if I stepped out of my comfort zone I could bring awareness to infertility and break the stigma behind it. I prayed that I could help at least one woman not feel so alone by sharing our journey.

Now it was go time! From there we began shots in preparation for egg retrieval. Egg retrieval went amazing and we got 44 eggs, 28 of which became healthy, day 5 embryos! This was such amazing news and a huge relief. I then suffered from ovarian hyperstimulation syndrome (OHSS) so our fresh embryo transfer was canceled while my body recovered. Six weeks later I was feeling great and ready to proceed with a frozen embryo transfer! We started medications again and on June 24, 2016 we transferred one grade 4AA embryo. It was the most amazing experience watching it on the screen and I will never forget my doctor saying, "You should be cautiously optimistic!"

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Five days later I did what any Type-A person would and peed on a stick... there was no way I could wait 4 more days for my blood test. A faint line appeared immediately and I was in shock! The rest of my pregnancy flew by and at 37 weeks I delivered our perfect baby girl via urgent C-section after 50 hours of labor.

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Struggling with infertility was a huge blessing in disguise. While I would never wish it on my worst enemy, it taught me so much about myself and about life in general. The three things that infertility has taught me are:

1) Never ask someone when they are going to have kids. You don't know what they may be going through. They could be going through IVF, IUI, just had a miscarriage, been trying for years unsuccessfully, you name it. Everyone's story is different and 1 in 8 people are struggling to get pregnant. Words can hurt so badly when you are in the midst of infertility heartbreak. Think before asking someone such personal information.

2) Ask how she is doing. If someone you know has shared that they are going through infertility, always say something. I was so hurt by the things that people didn't say when we were struggling. Some of the people I am closest to never said a word to me about it. I know that they felt uncomfortable and at a loss for what to say, but I will never forget feeling so alone and forgotten by some of my closest friends. Even if you don't know what to say, a simple "I'm thinking about you and praying for you" goes such a long way.

3) Never take a single moment for granted. I am one of the lucky ones who got my miracle baby on this side of Heaven. Not everyone is that lucky and I will never take that for granted. Even the most boring, mundane days with her are the best days ever. At least once a day I think to myself, "I still remember the days I prayed for the things I have now". Infertility has made me so much more patient and grateful. Our battle with infertility wasn't easy but the fact that it resulted in our baby girl made it so worth it. I would take every injection, procedure, tears and heartache all over again to be her mommy.

Owen lives with her husband and their 14-month-old baby girl in eastern North Carolina. She is a beach bum at heart and loves a good cup of coffee and cold glass of prosecco. She began blogging in 2014 to document their lives as she navigated PA school, marriage, and traveling. She quickly realized that she would be doing the world a disservice if she wasn’t transparent about their struggles with infertility and their journey through IVF which led to their miracle baby. 

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Flip the Script - Tia Gendusa

By Tia Gendusa

Hello and welcome lovely readers! I am so, so happy you took a few minutes out of your busy day to connect with me here at Fertility Bridge! My name is Tia and I am a former IVF warrior that writes over at ForeverOrchard.

My path to motherhood closed in late 2017, after unsuccessfully going through four egg retrievals, three transfers, and suffering two miscarriages. We fought and failed for five years, and I spoke frankly about our lives and our decision moving forward in THISPOST

I wouldn’t wish infertility on my worst enemy, but I am here, standing and thriving, even though life is shaping up a bit differently than I had planned.

These days I speak to spread awareness about the ups and downs of infertility, not only in the thick of treatments an uncertainty, but for everything that comes afterward, whether you find success or not.

I hope by cultivating happiness through my Blog, YouTube Channel, and Instagram, we all learn to give ourselves more grace and practice positive thinking no matter what life throws at us.

One of the top issues about fertility treatments for our family included our finances and insurance coverage. Did you know that only 15 states currently offer some formof infertility coverage? I live in IL, one of the covered states, but even I work for a company that was exempt from this type of coverage, forcing me to branch out and buy my own individual insurance. I thank my lucky stars every day that we had the coverage we had. Even so, we spent roughly $30,000 out of pocket, and while that number may be shocking to see, it fell somewhere in the middle of the (very wide) spectrum of financial woes associated with these types of treatments.

This year, Resolve’s theme is Flip the Script, and it’s offering a chance for people like me to level the playing field when it comes to breaking down barriers with family-building.  This week in particular is NIAW, or National Infertility Awareness Week. It’s our week to band together and fight for the justice we deserve. We deserve better insurance coverage, more affordable treatment options, less discrimination, more empathy and more education for the masses.

Infertility doesn’t just affect the person or people trying to grow their family. All facets of their lives take a hit. Our friends and family may not know about our struggles, and if they do, they don’t know what to say when faced with such a heavy topic. Our careers are constantly taking a back seat to appointments and procedures. Financial woes hit heavy on our emotions and our wallets. To think that it takes the equivalent of the child’s college fund just to have a child in the first place, is daunting. A complete lack of infertility insurance coverage or state-to-state exemptions leave us scraping money together via loans or fundraisers for something that comes so easily to others.

There are MILLIONS of us. Don’t believe me? Start a conversation with your friends and I could bet good money (maybe enough for another round of IVF?) that you know at least one other person who has, or is, struggling to conceive and resorted to fertility treatments.

Our goal is simple. To fulfill our lives in the best way we know how. We want to nurture and raise little miracles of our own that will eventually be thriving adults. The love we have for these babies that don’t exist yet is paramount. And yet, so many of us are bashed for our way of thinking or forced to close this chapter of our lives because we simply cannot afford it.

I urge you to use your voice. I urge you to use your social media platforms. Write the letters. Send the emails. Speak up and help lift up this community. It’s time to Flip the Script.

Thank you for reading. Please feel free to email me with any questions or comments that are on your mind. Let’s do better together.

Tia is a Vlogger and Writer at Forever Orchard. She lives in the suburbs of Chicago with her husband and English Bulldog. She started her journey to parenthood in 2012 and quickly realized it wasn’t as easy as her Health teacher once told her. She and her husband are both autosomal recessive carriers of a genetic condition called MCAD, therefore, IVF was the only option to eliminate this disease from their future children. After four egg retrievals, three transfers, and suffering through two miscarriages, she closed the door to motherhood in late 2017. These days she speaks openly about her struggles with grief and cultivating happiness no matter what life has to offer.  

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A New Vision and Different Strategy for IVF Centers to Thrive Beyond 2018

By Griffin Jones

Part 2 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

We might criticize REI fellows for not wanting to take over existing IVF practices, but they are making the same decision that current practice owners have made for decades. They are deciding to be doctors and not CEOs. At the time, starting an independent practice didn’t mean launching a commercial enterprise. The difference is that new doctors know they can’t get away with that today.

 Organizational leadership is an issue at many fertility practices

Organizational leadership is an issue at many fertility practices

In Part 1 of our series on the contemporary fertility practice’s shift from “small, independent healthcare practice”, to “entrepreneurial venture”, we discussed the traditional model’s outdated business structure. Now, in Part 2, let’s talk about how the leadership atop that structure dramatically affects a fertility center’s ability to do business today, leave alone tomorrow. We’ll discuss eight critical elements of vision and strategy, and we’ll deeply explore those with which IVF centers tend to have the most trouble.

A new vision and different strategy needed for fertility centers

We mentioned that the Practice Director is in charge of an IVF clinic, where the CEO is tasked with the overall responsibility of creating, planning, implementing and integrating the strategic direction of an organization. But what happens when infertility clinics don’t have a clear vision in place? Here are some real life examples:

  • One partner wants to sell his share of the practice to a private equity firm but his partner wants to remain independent.
  • The practice principal wants to increase fertility preservation, bur the rest of her team knows very little about this initiative.
  • Practices jump from one marketing venture to the next, wasting time and money because they aren’t making their advertising work toward their vision.
  • Business development projects are started and abandoned because practices have few benchmarks in place and consequently don’t accurately measure if they’re moving toward their goal.

“Hope is not a strategy,”—Rick Page

Do any of these problems resonate with your practice? We’ve accepted that the head of our company, Principal, Founder, CEO, President, or whatever we choose to call it, has responsibilities that extend far beyond the role of physician and even that of Medical Director and Practice Director. Now visionaries can lead their practices in ways that allow us to super-serve their patients and grow. The leader of a company identifies, articulates, and plans its

  • Core Values
  • Core Focus
  • 10-year target
  • High Level marketing strategy
  • 3-year picture
  • 1-year plan
  • Quarterly Priorities
  • Issues

All of these tenets are essential, with the priority starting at the top of the list. Some we will link to external sources for further reading, because we need to spend more time with the most common principals with which fertility clinics struggle.

1). Core Values

I’ll wager that your values are far more compelling than those of the average business. After all, you’ve devoted a career to helping loving parents create life. But how do you articulate your values to your team, to patients, and to the public? We work in a field that is both being changed by society, and changing society…rapidly. How do we stay true to who we are and what we believe while being able to adapt? When core values are true and defined, leaders make hiring decisions that allow them to unload responsibilities and feel comfortable that their practice is in good hands.

2). Core Focus

Your Why and Your What. Purpose, passion, and cause combined with your niche. The more closely aligned employees are with Core Focus and Core Values, the more prepared they are to make decisions in the best interest of the practice, and the less practice owners need to micromanage.

3). 10 Year Target

Where one wants to be in ten years is the destination from which the rest of the roadmap is drawn. This is where fertility centers frequently fall off track. Do you want to open more offices or labs? Do you want to attract patients from overseas? Do you want to pilot a technological solution? You may notice that we can’t move to the next core tenet of Vision and Planning, the High Level Marketing Strategy, until we have solid long term goals.

 Original fertility marketing consultant, Yogi Berra, on strategic growth

Original fertility marketing consultant, Yogi Berra, on strategic growth

In the same week, I received two calls from two different fertility doctors who had the same question, “how much money should I spend on marketing?”

A million dollars. A couple thousand dollars. My answers to each of them were starkly different.

The first doctor was in his early sixties. He works for a larger practice group and does a little bit of marketing for himself. He’d like to perform seven or eight more egg retrievals per month. He plans to retire in the next two years.

The second physician just completed his REI board certification in the United States. He’s in his early thirties. He wants to move back to Latin America to start a large IVF center that draws patients from the United States, Canada, and Europe.

These are two vastly different long-term targets that dramatically impact who they will hire, how they will build from patient feedback, and how they will market. The 10 Year Target could be the most measurable differentiator between visionary entrepreneurs and independent physicians. Fertility practice groups without a defined long-term target are finding themselves directed by the demands of the day instead of concentrating their resources on becoming who they want to be. Entrepreneurial Operating System (EOS) founder, Gino Wickman, says that the 10 Year Target is not the time to be conservative. Dream big for the best version of yourself and your practice.

4). High Level Marketing Strategy

Do we know who we want to serve and what we mean to them? Is our 10 Year Target defined? Great. Our High Level Marketing Strategy involves doing whatever it takes to get there, within our core values and core focus. It details our

  • Goals (obtained from 10 Year Target, 3 Year Picture, and 1 Year Plan)
  • Benchmarks
  • Unique Marketing Position (obtained from Core Values and Core Focus)
  • Practice Brand
  • Content Strategy
  • Distribution Strategy (advertising)

Benchmarks

Many practices want to jump right into marketing without having reliable benchmarks or key performance indicators (KPI) to plan their strategy. Without them, money and effort may be wasted.  If you’ve ever spent money on advertising and aren’t sure of the results, revisit your KPIs. Do you have access to all or any of these Indispensable Indicators?

  • New Patient to IVF Conversion
  • Phone Call to New Patient Conversion
  • Online Contact Forms to New Patient
  •  Cost Per New Patient
  •  Patient Life Time Value
  • Cost Per Lead

We are data-driven marketers. Results must be measured as accurately as they can be. If you need help calculating your Indispensable Indicators, read Chapter 2 of The Ultimate Guide to Fertility Marketing.

Brand

If you feel like you can’t trust your employees or marketing partners with your message, you may need to document your practice's brand. At the Midwest Reproductive Symposium international (MRSi) in June 2018, I will be giving a branding workshop for fertility centers with branding expert, Mara Lucato. Here’s a glimpse of my thesis.

Brand is being known to the people we serve: how and why we help them with their problems. Logos, color schemes, and slogans, are relevant, or not, in so far as they help us achieve that end.

In our case, we have a community of people that desperately needs our help. In many cases, they don’t know who we are or how we can help them. Our brand and our high level marketing strategy involve providing them with as much value as we can, and then making it as easy as possible for them to do business with us. It includes

  • Connecting them with peer and professional support
  • Educating them
  • Encouraging them
  • Standing up for them

We are charged with making sure that everyone in our region knows that infertility is a common medical issue. That people struggling with infertility are human and their problem is human.
They need to know that we are the ones who will help them. That is a fertility center’s brand.

Content and Advertising Strategy

A fertility practice’s High Level Marketing Strategy activates its brand by delivering its message across the platforms on which patients spend their time and attention. The platforms, and consequently the methods, change. 15 years ago, creating an infertility support blog was a game-changer. 10 years ago, having a Facebook page was a tremendous way to reach new people. Three years ago, Instagram stories and Facebook Live didn’t exist. Today, they are among the best ways to connect with prospective patients. Four years from now, there will be new tactics, and some of our current marketing efforts will be less relevant. A High Level Marketing Strategy allows us to adapt our marketing efforts to the tactics that are relevant to the attention of the people we serve.

5). 3 Year Picture

The 3 year picture and the 1 Year Plan zoom in on the 10 year target. Where are we going to be in three years? What is our revenue? How many IVF cycles are we doing? How many physicians are on staff? In the same way that practices often lack a 10 year target, the three year picture serves the same importance, just getting closer to bridging Vision and Traction.

6). 1 Year Plan

Long term planning for fertility centers

Often fertility centers have annual volume goals, but are they committed before the start of the year? Are they realistic?

7). Quarterly Priorities

Again, fertility practices frequently fall off track here. Do we have three to seven quarterly priorities that must be accomplished this quarter? Are we accomplishing priorities that move our business toward its one year plan, its three year picture, and its ten year target? Or are we drowning in the issues of the day-to-day?

8). Issues

 Just another REI practice manager

Just another REI practice manager

The image of Sisyphus pushing the rock up the hill for all of eternity resonates with many practice managers. Fertility centers’ staffs frequently burn out because they are working on the same issues with no resolution. Care teams spend so much time working on issues that are urgent, they may have precious little time to focus on important, big picture issues. Take a look at the Eisenhower Decision Matrix. 

 The Eisenhower Decision Matrix applied to fertility clinics

The Eisenhower Decision Matrix applied to fertility clinics

As a fertility specialist, or a practice manager, you never have to deal with matters in Quadrant 1, do you? Yeah right. Fertility centers live in Quadrant 1. Employers that make their employees and managers work in quadrant 4 ought to go to jail, (joking…or am I?). Work of little importance and urgency robs human beings of their energy and happiness. Most of the responsibilities in Quadrant 4, by definition, can be eliminated. Let software do the rest.

Now we’re left with Quadrants 2 and 3. As the owner or manager of your practice, with your very limited time remaining from Quadrant 1, which do you prioritize between “urgent and non-important” and “important and not urgent”? It’s Quadrant 3, isn’t it? We often worry about issues that are not important but they have to be attended to right away. This isn’t to say that issues in Quadrant 3 don’t need to be addressed, but that’s exactly what we do, address them. By prioritizing issues in Quadrant 2, we solve them. Visionaries that focus their companies in Quadrant 2 make Quadrant 3 less relevant, and Quadrant 1 less overwhelming.

Paint the picture, chart the course

With a clear vision and strategy, fertility centers know exactly what their goals are and how to achieve them. Without them, practices frustrate their team members, exhaust resources, and find themselves losing market share to competitive IVF centers. Whether one wants to be the largest fertility preservation company in the world, or happily perform 150 egg retrievals per year and super-serve their patients, there’s no right or wrong answer. Their Core Values, Core Focus, and 10 year target inform their High Level Marketing Strategy, 3 Year Picture, 1 Year Plan, Quarterly Priorities, and resolution of Issues. When practices follow a strategy to a committed vision, they are prepared for the powerful competitors and challenges that pursue them. And just in the nick of time, because there are plenty. We’ll talk more about them in Part 3 of our series on the tectonic shift from medical clinic to entrepreneurial enterprise.

If you would like help building your practice’s High level Marketing Strategy, learn more about the Fertility Marketing Blueprint below.

Set Up to Fail: Fertility Clinics Not Structured for 2018

By Griffin Jones

Part 1 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

“Young doctors aren’t willing to work long hours,”

“Fellows today don’t have entrepreneurial chops,”

“New REIs don’t want to pay their dues.”

 Millennial fertility doctors may sometimes be perceived this way

Millennial fertility doctors may sometimes be perceived this way

Have you ever made any of these comments or heard them said about your peers? It’s common to razz new subspecialists coming out of their Reproductive Endocrinology and Infertility (REI) fellowship. I often hear from recruiting physicians, that new REIs are not entrepreneurial. That they have no desire to take over a retiring doctor’s fertility center and run their own practice. It is said that fellows and new specialists want to work for someone else, clock their hours, and go home.

There may be valid points in this general perspective, but I see a much more comprehensive picture. Would you like to see what I observe from my semi-outsider’s vantage point? The radical statement to follow is the thesis behind the core business challenges with which so many fertility centers battle today.

The Tectonic Shift from "SMALL CLINIC" to "ENTREPRENEURIAL ENDEAVOR"

I don’t believe that many practice owners wanted to be entrepreneurs either. I suppose many physicians wanted to run their own fertility center and practice medicine the way they prefer. Is that unfair? Twenty to twenty five years ago, that may have been a tenable position. At that time, fertility specialists opened and operated small medical practices. Today, whether they like it or not, independent practices are entrepreneurial enterprises. We have sailed away from our calm cottage lakes, and onto the ocean of commercial venture. Here, our competitive threats come not only from other fertility centers, but from Wall Street, Silicon Valley, and a dynamically changing society. Canadian and European friends, this includes you too.

In this series, we’ll identify the main threats and challenges that fertility doctors, now accidental entrepreneurs, face in this new, unforgiving landscape.

  • Practice Business Structure
  • Vision and Strategy
  • Fierce Competition
  • Rapidly Changing Technology and Society

And we will force ourselves to answer the question we can no longer afford to avoid:

What is the plan?

Part 1: PRACTICE BUSINESS STRUCTURE

Independent fertility centers’ competitive challenges begin long before we even begin to think about marketing. Typically, they are inherent to the structure of the practice. If you own an IVF center run by fourteen employees, it may be tempting to ignore corporate structure. On the contrary, it is lack of structure that frequently keeps small practices from competing with large firms. Here we see the first differences between an REI practice, and a commercial endeavor.

A fertility clinic is run by a

  • Medical Director
  • Practice Director
  • Lab Director
  • Practice Administrator

Who runs the large corporations that are buying and operating fertility clinics across North America? Did you know that your new competitors are led by a C-Suite? They have a

  • Chief Executive Officer (CEO)
  • Chief Operating Officer (COO)
  • Chief Marketing Officer (CMO)
  • Chief Technology Officer (CTO)
  • Chief Financial Officer (CFO)
  • Chief Information Officer (CIO)
  • Chief Human Resources Officer (CHRO)
 Entrepreneurial Operating System (EOS) Accountability Chart applied to fertility clinics

Entrepreneurial Operating System (EOS) Accountability Chart applied to fertility clinics

This isn’t to suggest that a four physician, twenty five employee IVF clinic needs to have the same corporate structure as their large competitors. They don’t. They need to run their company on a business operating system (BOS) if they want to articulate a vision, agree upon a strategy, and enable their entire team to achieve their collective goals. Fertility Bridge is run on an operating system called the Entrepreneurial Operating System (EOS). To clarify, I am not an EOS consultant, nor do I sell their services at this time. You can find another BOS or you can build your own, though I have no idea why anyone would want to start from scratch.

One of the strongest arguments of EOS is that there are three core functions in any business. In our field, we might split Operations into Medical and Lab, or even Compliance, but the three core functions are

  • Operations
  • Finance
  • Sales and Marketing

In most independent IVF centers, instead of planning for the three core business functions for which someone must execute, they are often bundled into “other” and dropped in the lap of the practice administrator. Is she or he expected to run the operations of the practice, account for the finances, recruit and manage team members and write and execute a complete marketing plan? Is she or he an expert on digital media, law, technology, workforce development, and corporate strategy? Is that fair? Is that realistic?

How many seats are you in?

Rather than hire someone for each of these roles right away, which most fertility centers cannot do, EOS helps with the concept of “one person, one seat”. One person can hold more than one seat, but one seat cannot be occupied by more than one person. This helps small practices flush out capacity related issues and step out of roles as they grow.

Take a look at an example accountability chart below. How many seats are you in? How many seats are unclear as to who is accountable for them?

Example Accountability Chart for fertility clinics.png

As an REI physician, in just one very busy seat, you probably have to perform

  • 150+ egg retrievals,
  • Several dozen intrauterine inseminations (IUI),
  • All other surgeries

Oh, and you still have to spend time with and respond to your patients.

While infertility doctors at corporate-run clinics can devote all of their working time to their "REI seat", you’re the Medical Director or Practice Director of your IVF center and you have many other roles. As the head of an entrepreneurial venture, you now have additional responsibilities to properly delegate or do yourself.

  • Implement the vision of your company
  • Hire and interview every employee
  • Execute the marketing strategy
  • Account for the finances
  • Run the operations of the office
  • Manage every member of every team

Simply delegating each of these responsibilities can be a full time job, let alone sitting in each individual seat. Again, independent practices don’t necessarily need dozens of employees to run the business side. If they want to maintain or grow their practice, they need to eliminate, automate, and delegate. [A wink to those practice principals that are still signing paper checks].

Is "control" hindering your practice's growth?

Something stops fertility centers’ teams from taking ownership of each of these responsibilities and taking them off of the practice owner’s lap. As one writer says, “Want to drive your employees absolutely crazy? Give them responsibility without authority”.

If we hire a Human Resources Manager, but she doesn’t have the authority to choose the payroll company, negotiate salaries, or make the final decision on hires, then the responsibility of Human Resources continues to consume our time and energy.

If we hire a finance officer, but this person isn’t able to choose the bookkeeping software, set pay dates, and decide the terms of Accounts Payable and Accounts Receivable, then we haven’t delegated finance.

If a practice hires a marketing director, but the marketing director doesn’t have creative control and isn’t given a budget and goals for which they are responsible, then the load of marketing remains in our lap.

How does it impact the growth of your practice if you and your partners deal in every facet of the business without clearly defined roles in an operating system? How does it affect the way you practice medicine? How does it weigh on your relationships with your patients, your team members, and your loved ones?

SHIFTING from "practice owner" to "visionary"

If this describes you or your partners, is it because you're reluctant to pass on control? When practice owners feel that that they need to manage every movement in the practice, it may be because there is not a cohesive culture behind a clear vision. By acknowledging the tectonic shift that has happened in the field of reproductive health, that independent fertility practices are in fact commercial enterprises, practice principals can step into the role of visionary. In the next part of our series on the difference between fertility practices and entrepreneurial ventures, we’ll see when a company follows an operating system, practice principals are able to chart a vision and plan that allows them to pass responsibility to their team and adapt their practices to our changing world.

5 Tips for Fertility Clinics Who Want a 5 Star Reputation

Guest post by Garrett Smith

Fertility clinics help patients through one of the most difficult times of their lives: growing a family. Given the sensitivity and life altering nature of infertility, finding a high-quality fertility clinic is the number one priority for patients.

Today, most patients head online to find their fertility doctor. Even if they’ve received a referral from another doctor, friend, or family member, there’s little chance of them NOT checking you out online. What will they see?

That’s where online reputation management comes into play. Ensuring that the offline realities of the great care you provide are properly reflected online should be one of the main priorities of your marketing. In fact, your online reputation could be the main reason you get - or lose - a potential new patient to another fertility clinic.

 

5 Online Reputation Management Tips for Fertility Clinics

If you have used Google to search for restaurants near you, or for a mechanic that is trustworthy, chances are you have encounter online reviews of those businesses prominently displayed in the search results. After all, Google and other prominent websites want to show patients the best results for their particular search.

It makes sense to prominently show those businesses that customers (and patients) have rated the best. After all, who wants to work with a 2 star plumber? Your fertility clinic is no different.

So what can you do to better manage and improve the online reputation of your fertility clinic? Here’s 5 easy to implement tips to help your fertility clinic with their online reputation!

 

  1. Do Some Research

When you’re trying to piece together exactly where you’re starting from when it comes to managing your fertility clinic’s online reputation, the first step you’ll need to take is doing some research.

It’s important to know what your online reputation currently is before creating a strategy and implementing a workflow to manage what information about your clinic is online.

This means Googling “Fertility Clinics in (your city),” ‘Best Fertility Doctors Near Me,” and other important terms. Does your clinic appear on any of these searches? If so, what information is appearing – and is it good or bad?

You can also search for the direct name of your clinic and the names of providers who work there. Get a good look at the reputation of everyone associated with the practice and you’ll know just how big of a project this will be.

 

  1. Claim Your Online Profiles

Getting your profiles all claimed is one of the most proactive steps you’ll take. This means you’ll want to make a list of all the profiles your fertility clinic has online. Keep in mind that this list doesn’t just include profiles you’ve purposefully made – businesses often have dozens of profiles on professional websites that were generated by users or automatically.

If you have a login and password for a profile, make sure to test it and confirm that you have actually claimed that business and are the only ones who can control the information that is listed.

If you don’t know the login for a specific profile, you can move forward with the steps provided by that specific website that will lead to you claiming that profile. Often, this requires you to create an account with the profile and use an auto-calling feature to confirm that you are the owner.

 

  1. Make An Online Reputation Management Strategy

Once you have finished claiming your profiles, you can move on to creating a reputation management strategy for your fertility clinic. RepCheckup has written extensively on the topic of creating good management strategies, including this blog written exclusively to help business owners create their own reputation management plan in 2018.

Overall, your strategy should include constant outreach for reviews, like asking clients, customers, and patients to leave a review on a specific website (to help minimize the work that they need to do) before they leave your building.

 

  1. Set Your Schedule to Stay Consistent

Once you have a plan in place, make sure its upkeep is built into your schedule! This means that you should appoint a specific person to manage your profiles, check in on and respond to new reviews across your different profiles, and making sure that no fake reviews have been posted publicly without some investigation.

 

  1. Use a Reputation Management Tool

Many business owners have schedules that are too packed to go through this entire process. For most fertility clinic managers and practitioners, there isn’t enough time in the day to cross off some simple “to do” items, which is why using a reputation management tool is the preferred method of many clinics.

Tools like RepCheckup will centralize all of your profiles onto one dashboard, saving you the time and energy of keeping a log of all the profiles you need to check and logging in/out of each website. You can also solicit reviews directly to clients en masse by sending out texts and emails asking for them to leave you a review.


 

7 trigger points that infuriate fertility patients and lead to bad reviews for doctors

By Griffin Jones

What should fertility doctors say or not say, do or not do, to avoid angry reactions from patients on the internet?

observation, not advice

This is tricky. I can help practices increase their positive reviews, but I will not tell physicians how they should talk to their patients, because I am not a physician. I write prescriptions only to medicine I’ve swallowed myself. The reason I feel comfortable telling clinics to invest in Facebook ads, is because I have had success reaching new patients through Facebook ads. I’m comfortable telling fertility specialists how to respond to negative reviews online because I have improved doctors’ online reputations from the way I respond to reviewers.

I have never delivered a fertility diagnosis inside a consult room. I’ve never told a couple that their prospective IVF cycle has a 10% chance of success or called someone to tell them that their 3rd IUI was not successful. I have an idea of how I think I would communicate with patients, but I have little tolerance for arm chair quarterbacks. 

navigating the mine field with compassion

Frank-Luntz-Quote-It-s-not-what-you-say-it-s-what-people-hear.jpg

What I can show you, however, are patterns that I’ve observed from upset patients: what I call “landmines” or “trigger points”. These are common themes that, when received a certain way, tend to send patients’ thumbs into a blaze of fury to light up their IVF center on the internet. By being aware of how patients recount certain interactions, you may better prepare for them.

“It’s not what we say, it’s what people hear.”—Frank Luntz, PhD

1). Body Mass Index
When a patient visits an IVF center, her initial testing may reveal that her body mass index (BMI) is too high for a fair probability of IVF success. Patients may first be referred elsewhere to help decrease their BMI. While I cannot tell you how to deliver this news, I can show you how it is sometimes received. Comments like, “he called me fat” or “they refused to even see me because I’m too fat,” are common on social media and review sites. I wouldn’t suppose that the physician used those words, but in a very difficult moment, this is what the patient may hear. 

fertility doctor called me fat.jpg

2). Age and Diminished Ovarian Reserve
“She told me I was too old to ever get pregnant”. The quality or quantity of a patient’s eggs may be low, and a physician may issue caution about the probability of successful treatment. What could be a very honest move, certainly in patients’ best interest that they not spend money and energy on unwise surgery, can send patients to their keyboards in anger when received the wrong way.

fertility doctor said i was too old.jpg

3). Low probability diagnoses
Patients occasionally feel that their doctor is rooting against them, or shows no compassion for them when going over their diagnosis. Reviews commonly include boasting that the patient got pregnant, even though their doctor said they would not. This article articulates what patients sometimes write about their doctor after they have seen more than one specialist. 

4). Contact availability
“The two week wait” (#2ww) is one of the most notorious chapters of fertility treatment and it is only one of many anxious periods patients have to face. When one doesn't receive a call when she or he was told to expect one, more stress is added to the patient experience.  Failing to call with test results, not responding quickly enough to patient calls or e-mails, and not being available via the media which patients use to communicate are all landmines for patient reaction.

In fact, I would be very curious to know what percentage of negative fertility center reviews come during moments when the patient is waiting for correspondence from the provider. When worries about treatment monopolize a person's mental bandwidth, the wait for answers turns seconds into hours. It is a feeling of helplessness and desperation in which lashing out against the provider online may be an attempt to regain a sense of control.

5). Face time with doctor
Smaller fertility practices frequently claim that individualized care is their edge over larger practice groups. It is an advantage, if in fact, the patient gets to spend more time with the provider. Rarely seeing one’s physician is a very common pain point that leads patients to say things like “baby factory”, “only in it for the money”, and “looked at me as a dollar sign”.

Face time.jpg

6). Punctuality and preparation
Doctors are very busy people. So are patients. With high demand from patients, and a nearly infinite number of scenarios that can arise at any moment, the need for providers to maximize their time can make timeliness impractical. Still, patients feel slighted when they are not seen on time because their time is valuable too. The same goes for when they feel the doctor has not read their chart, not taken the time to thoroughly answer their questions, or rushes through their appointment. 

fertility doctor in it for the Money.jpg

7). Absolutely anything to do with billing
If these scenarios are landmines for fertility center reviews, the billing department is a minefield in and of itself. Billing issues might account for 1/3 to ½ of your negative reviews. In short, the billing department is arguably the greatest liability to a fertility practice’s online reputation. Patients often feel ambushed by the costs that they incur during the course of treatment. Insurance coverage (or lack thereof), reimbursements, deductible requirements, and variability in medication costs are pain-points unique to healthcare. Patients may lash out against their practice in a public forum because they do not experience these annoyances in most other consumer categories.

Hate the billing dept of fertility clinic.jpg

To make matters worse, prospective patients receive very little education about IVF costs prior to treatment. In fact, some practices refuse to detail any cost information on their websites because they are afraid that it will dissuade people in need from seeking a consultation or that it will give a competitive advantage to other IVF centers. Many fertility clinics would rather bury their heads in the sand and hope for the best, than properly use digital media to educate patients about the headaches of insurance and billing.

Setting the stage

As a fertility specialist, you are walking into a minefield of patient anxiety and frustration. I don’t think it would be possible to tip-toe around every possible pressure point. Instead, what may be more prudent, is to disarm the tension as much as possible from the very beginning. Of course, I can’t tell you what to say to patients. From what I observe from their accounts, however, is that many patients do not hear their concerns addressed in this way:

“What you are going through is extremely difficult at times, and that is perfectly normal. You’re not alone because we’re here to help you with everything we can and connect you with resources for those things we can't control. We wish we could wave a magic wand and make everything better right now, but there will likely be parts of this process that are very frustrating.

"Billing, medication costs, and insurance can be a big headache. You may see a charge for a service and think what the heck is this? Just ask, we're here to help you through it.

"There may be times when we don’t call you back as quickly as we want to because our nurses are helping other patients in the same way we want to help you.

"We always try to be on time for our appointments, but every now and again, a patient needs a little extra time with her doctor, and we want to extend that same level of care to you.

"We often have to be the bearers of very delicate news. We balance optimism and our eagerness to help you have a healthy, beautiful baby with our duty to inform you of the implications and realistic outcomes of your different options.

"You don't have it easy and neither do we, but the plus side is that we’re working together. We hope you’ll tell us if we are falling short at all during this process because we need your help to do our best for you".

Satisfaction equals experience minus expectation

By setting expectations abundantly clear ahead of time, you may be able to prevent negative reactions when, not if, issues arise. Some patients develop their own expectations, regardless of what you do to help set them. It’s okay if some people are not satisfied with your practice and staff as long as the dissatisfied number is the lowest it can be. There are certain pressure points that must be approached with empathy during the already tense fertility journey. By setting the stage and disarming the mine field, you can reduce the number of complaints about your practice and doctors, and increase patient satisfaction.

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If it's too late and you need examples on how to respond to negative reviews, read chapter 4 of the Ultimate Guide to Fertility Marketing

A Stern Warning for Fertility Clinics Who Complain About Patient Review Sites

By Griffin Jones

"Change is not painful. resistance to change is painful."

Consider this a gentle "love tap" from a friend. 

A direct warning from me is far milder than what the market has in store. If I don't speak up about this single issue now, then I am neglectful in my duty to help protect the field of reproductive health from cultural and technological shock, because the internet-led market has proven to be unforgiving.

easy part.jpg

When I entered the fertility world, I accepted the responsibility of preparing those inside the field from the disruption coming from outside. I built a company to help bridge the gap between the status quo of reproductive health and what's happening in the rest of the tech revolution. So that we're not dealing with contemporary business buzzwords, allow me to give this definition to what entrepreneurs and venture capitalists call "disruption":

  • Major enterprises losing double-digit market share or going out of business within 36 months due to brand new players who come from outside of their field. 

ONline reputation is hardly the tip of the iceberg

This article does not come in reference to any one particular conversation I've had (perhaps even with you) in the last few months...because I've had several. Some have been with clients, some with vendors, some with strategic partners; it's a recurring theme.

When I first started creating content for fertility practices, the topic of "online reputation" is what really piqued the interest of fertility doctors. Many of us are concerned with what people say about us online. We often find the comments to be unfair, untrue, or at the very least, unkind. As we explore, however, you may agree that the root of the issue has less to do with the comments of others and more to do with a strategically flawed grasp for control.

Technological and cultural change are sweeping through nearly every facet of society. We are dissecting online reputation in this instance, simply because it happens to be a very common pain-point. In this deep-dive, we closely examine

  • The cause behind the information shift of the last twenty years
  • Why patients have embraced it
  • The four principal reasons that practices have NOT embraced it
  • Why patients rely on social proof to make decisions
  • The real threat to a fertility center's online reputation
  • What to do once we've stopped resisting 

Many doctors tell me that negative reviews upset them to the point where they can't sleep. You've done everything you could, and if you could wave a magic wand, you would wish for nothing less than for your upset patient to have a healthy baby and a happy family. Before we separate your perspective from the patient's right to have and share a completely different perspective, let's first examine the informational shift that has happened over the last two decades.

the human need to move away from information ASYMMETRY

For any patient to think that she or he is more qualified to review her or his case after a few hours (or even hundreds) of internet research, must be insulting. If you're a fertility doctor, you've gone through four years of undergraduate studies, four years of medical school, four years of residency, and three years of REI fellowship. That's fifteen years of higher education, followed by some of the most demanding board exams in medicine. If you've grown accustomed to this legacy of information control, it's because you've worked extremely hard to do so. 

Information asymmetry, wherein the seller (provider) almost always has an information advantage over the buyer (patient) is wonderful...when you're the seller. Recall other pre-internet situations in which you have been the buyer. Call back to a time when you had to buy a car when only the car dealer knew the manufacturer's suggested retail price (MSRP) or its pre-owned history. Think of buying a house when only the realtor knew the last sale price, its home improvements, and recent sales in the neighborhood.  How did that feel? The best real estate agent in your market has a lot more experience buying and selling homes than you do. She may also be a very authentic and trustworthy professional. Does that mean she should expect you not to use Zillow and Trulia? You don't need me to explain the deep-seated human need to shift from information asymmetry to information parity. As consumers, we do it every day.

For over a century, virtually the only way for someone to obtain in-depth knowledge about any given medical condition was to attend medical school. Like our example of home-buying, patients had a scarcity of information, few provider choices, and no means to talk back. Contrast that with our very different world today.

The drive toward information parity

change coming for ivf centers

When I was a kid in the early 1990s, I wanted a million dollars so I could buy my own video game arcade. Now I have one on my phone (that I have never used). Every one of our patients walks around with a super computer in his or her pocket at all times. Within sixty seconds of being diagnosed with infertility, one can

  • Read various definitions of infertility
  • Study the most common causes
  • Research potential treatments
  • Compare providers
  • Watch video explanations from medical doctors from around the world
  • Find humor and relief from satirical and artistic content
  • Connect with thousands of other patients via social media

Information asymmetry is over. Forever.

patients often need to rely on each other 

Some of us are frustrated that just because our patients have access to virtually limitless information, that does not qualify them to make any diagnoses or prognoses. Correct; they are not medical doctors. They don't have to be. They are human beings with opinions and emotions and they have a right to share their experiences with each other. They frequently have to turn to one another for social proof to help them assess this information.

Also known as informational social influence, social proof is the psychological phenomenon where people rely on the actions and opinions of others to determine the appropriate behavior for a given situation. Talk about ambiguous social situations! What is the appropriate mode of behavior when someone learns that they've been diagnosed with infertility? When they've paid $18,000 of their life savings for two failed IVF cycles?

Social proof may be even more necessary for those dealing with infertility because of the tremendous social pressure to have children. When so few people in one's social network can relate to what they're going through, our patients frequently have to turn to the internet to find those who can empathize with their emotions and relate to their experience. 

information parity meets social proof meets technology

Imagine having to spend thousands of dollars of your own money on fertility treatment, and having no way of knowing which doctor or clinic could be the best fit for you. Along comes a fantastic user experience (UX), with sleek design and fields of search deeply relevant to those struggling with infertility. 

I don't own any equity in or have any commercial partnership with Fertility IQ at this time. Yet when I set myself free from my own desire to have perfect control over my paying clients' online ratings, and put myself in the position of the patient, it's easy to understand why they are using the platform in the hundreds of thousands. Instead of comparing apples to oranges on Google reviews, RateMDs, ZocDoc, Vitals, HealthGrades, or even Yelp, people with infertility read verified experiences from patients by their

  • Age
  • Diagnosis
  • Type of treatment(s)
  • Number of treatments
  • Success or failure of each treatment
  • Income level
  • Number of doctors seen

Complaining about Fertility IQ or any other review site is not as trivial as disliking a website. It's partaking in the exhausting struggle against what patients desperately seek. It is the hubris attempt to fight the human drive to move away from information asymmetry toward information parity. The market, whether through Facebook, Instagram, FIQ, Google, or any other platform will find a way to give it to them. It does not give a damn if we are inconvenienced.

the four main reasons for resisting patient reviews

Tech disruption in infertility field

I won't tell you to let go of control because we can't let go of something we don't have. If Muammar Gaddafi, the despot who antagonized western powers for decades, couldn't suppress social media, how could we? Why would we want to?

Well, after hundreds of conversations with fertility doctors, nurses, and practice managers, I've identified four principal reasons that we yearn to have control over what people say about us online, leading us down the path of most resistance.

  1. What we do is so hard and complicated. People don't have a right to criticize what they don't understand
    Consider the phenomenon of flight. What a magical experience. Distances that would have taken us weeks to travel a century ago, now take us a few hours. Instead of physical exertion, we're served snacks and alcohol while we enjoy unlimited entertainment on our personal supercomputers. The logistics, expertise, and technology required to provide this luxury to us are overwhelming.

    Left to my own devices, I would be lucky to mount a camel for a few miles. I still hate United Airlines, and so do you, and so do millions of our peers. Could we do a better job piloting, procuring maintenance for tens of thousands of aircraft, and maintaining schedules for tens of millions of travelers? Absolutely not. Should we have any right to complain when we're inconvenienced by what is still a tremendous luxury compared to the alternatives? Should is irrelevant; we do have the right, and we frequently exercise it. We are citizens of countries where free speech is (meant to be) protected by our constitutions. 

  2.  These reviews are fake
    Of the four reasons for resistance, this is the most legitimate, if the review is in fact illegitimate. False reviews are a real problem. Up to 15% of online reviews may be fake. If you are certain that a review is not from a patient at all, but from a competitor or an internet troll, flag it for review. I recommend flagging the review from more than one user account. At Fertility Bridge, we see fake reviews rear their ugly heads, and aren't always able to get them taken down. It's unfair and it pisses me off too. Because at least 85% of our reviews are authentic, let's focus on what we can control.

  3. Only unhappy people leave reviews
    A widely held assumption among fertility doctors is that IVF center reviews are overwhelmingly negative. This simply isn't true. In an analysis of 504 fertility clinic reviews, conducted by Fertility Bridge in 2015, 63% of reviews were positive and 37% were negative. Yes, there are reasons that people are motivated to leave negative and positive reviews about their practices. Someone may not have been able to become pregnant and want to take it out on you. Others may sing your praises because they were pregnant. Still, some centers are able to minimize their negative comments and maximize their positive ratings; that is our goal.

  4. Negative reviews use libel and slander
    If you'd like a good laugh with your morning coffee, read RateMDs' FAQs for doctors. In 12 paragraphs, they tell you how you can go pound sand if you think you're going to sue them. Vitals and HealthGrades do too, but RateMDs is the most humorous.
    Sometimes reviews violate the platform's terms of agreement by using hateful or vulgar language, and the site will remove them. Most of the time they do not.

the greatest threat to the accuracy of your reputation

Once we've moved beyond our four cardinal motives for resisting public feedback, we can focus on the real liability to the accuracy of our online reputations.

Last summer, in a summary of fertility doctors' responses to their online reviews, I corrected the old adage, "the customer is always right," to "the patients (plural, meaning the market) are always right". I'll use my own company as an example. Fertility Bridge served eight IVF clinics in 2016. If two of them were dissatisfied, one held a neutral opinion, and five were delighted with the service they received, I might be able to identify a few patterns. But what I would really want to do, is increase the volume of evaluation. Eight sources of feedback? Better than three, I guess. Thirty would be a heck of a lot better. 

The same is true for an IVF center's online reputation. When a fertility doctor has two scathingly negative reviews, one luke-warm review, and one glowing review, the public doesn't have enough information to accurately judge this physician. Very often, fertility doctors have unfavorable online profiles because they simply don't have a high enough volume of reviews on that particular platform. Forget these four motives for distrusting online review platforms; lack of volume is our worst enemy. The higher a clinic's volume, the more likely their reviews are to be positive. Period.

what to do now

Okay, Griffin. We've stopped resisting. We have a high volume of reviews but our ratings are still low. We still hate this. Make it go away.

disrupting the fertility field

If we've truly made it thus far, then we have the best road map for operational/personnel adjustments that we could ever ask for.  We have data to identify the most common problem areas in our practices and fix them. That's right, the same platforms that take control away from us give it right back...if we choose to act on it.

In my opinion, no review site makes it easier to evaluate customer service patterns than Fertility IQ. Clinics are rated by 

  • Operations
  • Scheduling
  • Billing department
  • Nursing Team

Physicians are rated by

  • Whether they treated their patient like a person or a number
  • Communication
  • How often they saw their patients at appointments
  • Response time

When we can measure how patients adore our nursing staff, and their disappointment in when their calls are returned, it's a lot easier to smoke out capacity-related issues that hinder the excellence of our practice experience. Of course we don't have to wait until patients leave our practice to listen to their stories. We can use tools like Press Ganey or Rep Check Up to solicit patient feedback, in-house. Public ratings are the final word, however, and in the eyes of the public, perception is reality.

a new review site is barely a baby serving of disruption

We've hardly seen the tip of the iceberg, my friends. If we cannot adapt to the reality of how patients use the internet to share their experiences, we are not long for what is to come. Regulation has sheltered healthcare from many of the market effects that have impacted other areas, but it won't hold forever. The executives of Zoc Doc, Vitals, and Health Grades are not worried about awkward run-ins at ASRM with physicians who subscribe to their premium offerings. They are interested in being the marketplace where patients find their providers.

FertilityIQ was started in the birthplace of many other innovative tech companies, the San Francisco Bay Area. It was started in the way most disruptive tech companies are, from outside. FertilityIQ doesn't receive funding from IVF clinics. They didn't need our permission to build their company and patients don't need our permission to share their experiences on their platform. This is what disruption looks like. Thousands of entrepreneurs are chomping at the bit to change healthcare in their own way. If we stay in the habit of yearning for control that we don't have, we will wistfully long for the days of unfavorable online profiles being our biggest pain in the neck.

Blockbuster Video chose to be nostalgic about the adventure of going to the video store. Netflix didn't. Marriott could have invented the world's most used lodging app; AirBnb was happy to do it instead. The largest taxi companies balked at the idea of hundreds of millions of passengers choosing to ride in a strangers' car; Uber bet the pot on it and became a multi-billion dollar company.

We are presented with an incredible moment in time to use new market opportunities to build the most successful versions of our practices. I started a company inside of our field, rather than outside, because it is far more agreeable to strategically adapt to technological and cultural change than to be rocked by the market. This is just advice, you certainly don't have to take it. Before you decide anything though, you might ask yourself if what you do now will make you right or wrong in the context of history.

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To learn more about how to improve your fertility practice's online reputation, and to adapt to new patient behavior, download your free copy of the Ultimate Guide to Fertility Marketing

Why did these 9 patients just leave word-of-mouth referrals for their fertility doctors on Instagram?

By Griffin Jones

**Fertility Bridge does not endorse any of the programs or doctors mentioned. They come from responses from our Instagram community**

"The only thing that matters is the lab"

That's what a board-certified reproductive endocrinologist (RE) told me over lunch at the 2016 American Society for Reproductive Medicine (ASRM) annual scientific congress. "The patient experience doesn't matter. The only thing that matters is if they get a baby or not." My efforts to show him all of the evidence to the contrary were fruitless. That was the end of the conversation. Why try to convince the inconvincible?

In some perverse way, it excites me when people are so neglectful of what our patient population demands. Meritocracy might be a lofty ideal, but I love working with fertility clinics who take IVF cycles from people who think like that. A slop-eating grin came over my face as I stared at his plate and thought of the perfect metaphor:

I'm going to eat your lunch.  

 Who are they and what did people say?

Who are they and what did people say?

Satisfied don't mean delighted

A 2014 study by Software Advice states that 61% of patients evaluate their new doctor before their first appointment. Over 40% of new patients of Fertility Bridge clients confirm having read online reviews before scheduling their first visit. Nearly 30% say they were referred by a friend.

Bain's Net Promoter System suggests that patients can be divided into three categories across a satisfaction scale from 0 to 10. The single question is, "how likely are you to recommend our practice to a friend or family member?" Those who answer between 0 and 6 are called detractors. They actively discourage others from coming to your practice. Those who respond with a 7 or 8, are labeled passive, because their referral rates are less than 50% of those who respond with a 9 or 10. Finally, those who respond with 9 or 10 are promoters, people who sing the practice's praises to anyone who will listen. You can read more about using your practice culture to turn patients into promoters in Chapter 2 of the free e-book, The Ultimate Guide to Fertility Marketing.

I know many of these promoters very well. They brought me into the field of reproductive health in the first place. After all, people don't get so fired up after they buy a power washer from the Home Depot. So, among thousands of people in the trying-to-conceive (#ttc) community on Instagram, who are actively undergoing or pursuing fertility treatment I asked them the question. Would you recommend your fertility clinic, and why?

1). By Name in New England

Absolutely and I actually have. The first place we went to was terrible and I've shared that with people who have asked for recommendations. I wish I had done some thorough research beforehand but I wasn't aware how common infertility is and how many clinics were out there. The second place was beyond anything I could have hoped for! We saw Dr. Gargiulo at the Center For Reproductive Care (CRC) in Stratham, NH. We are less than an hour away from Boston which is home to some of the top hospitals in the country so we fortunately have a large number of places to choose from. The entire staff at CRC was absolutely fantastic.

I was greeted by name every single time I walked into the office and the nurses were amazing when it came to making the entire process less stressful and knowing when to crack a joke to lighten the mood. The thing that really set CRC apart was the welcome packet. In addition to the typical insurance forms they included an illustrated book that talked about how to talk to all of the different people in your life from co workers to your spouse. Also, they make sure to include that due to the sensitivity of this journey, no one under the age of 18 is allowed into the office for any reason. Reading that one policy was the moment I knew we had finally found the place that truly focuses on their patients and not their numbers.

2). Memorable in Montana

I totally would! I should mention, my RE and her partner are the only ones in the state. Even if she wasn't, I would still recommend her. Her name is Dr. Stacy Shomento with Billings Clinic. Dr. Shomento is in Bozeman, and that is the staff I know and love! She has a pile of patients, but always gives you lots of time and takes a personal interest in you. She also has a stellar, amazing, outgoing staff. Infertility is very personal and invasive. Having a comfortable relationship with the medical staff is a must for me.

She took the time to make personal connections and remembered us, not just our chart. Really, because RE's are so busy, you end up dealing a lot with your nurse, so they really need to be awesome.

3). Compassion in California

I totally would!!!! Coastal Fertility in Irvine, CA is the best! So compassionate. Dr. Werlin rocks!!! He's amazing!!!

4). Knowledge in New Jersey

I would. More specifically, I would recommend my doctor, even though all the doctors are great. Dr. Marcus Jurema from Reproductive Medicine Associates of New Jersey (RMANJ) is what every reproductive endocrinologist should be. I'm thankful I have him in my corner. My doctor is part of RMANJ and was originally with IVFNJ before the merge. I've had several issues with several staff members with both practices.

There's very little communication within the company within different departments (billing, nurses, etc). I'm sure that's because the company is just so big. With that being said, RMA has the best labs in the state, maybe the East Coast. Because of that, I can't leave. Plus, my doctor is amazing.

He teaches as he goes. He knows I need technical info, good or bad. I can't have anything sugar coated. I'm a medical assistant so I research everything. He knows that and will give it to me straight, while also holding my hand through the bad stuff. He's been with me from day one, with every cycle and every loss.

5). Benign in Boston

We switched doctors for our last round of IVF, but we stayed at the same clinic, IVF New England. The nurses are magnificent and since that's who you're interacting with the most, it's invaluable. I never felt like a number there, even though they're a bigger clinic. I always knew I was in good hands, even after 4 failures with my first doctor. It took me a long time to decide to switch. It broke my heart to try someone new, because I trusted him implicitly.

My new RE, Dr. Pauli is amazing. I don't regret not going to him sooner but I'm so glad I did. We were successful on our first round with him and I'm currently 11 weeks pregnant. I love that both doctors called with results of the bigger tests (pgd, era etc) and called to check in on us. Dr. P. called me once with results while he was on vacation.

I have nothing but good things to say about IVFNE. They're not perfect, and some of their methods aren't for everyone. But they are perfect for us. Even if we never got pregnant, I wouldn't feel any differently.

6). Education in the OC

Yep!!!! HRC Fertility in Newport Beach!! I think the best thing about HRC is the coordinator is amazing financing and they can do preimplantation genetic screening (PGS) with a fresh transfer. My doctor was very, very busy all the time, but he did give me pregnant the first time. He never did an ultrasound which I thought was odd but I love the girl who did my ultrasounds.

My doctor was always kind, and answered all my questions but the relationship was definitely not personal. I don't care about that; I want results, and he provides results.

My tech was wonderful because she would walk me through exactly what she was doing. During stims, she would explain what she was counting, what she was looking for, and what she saw. Same after I became pregnant. They followed me for 11 weeks.

7). Making changes in Maryland

Our first one, absolutely not. We were a paycheck at [a very large fertility practice group] and never felt like patients. Our RE told me that our son "must have been a lucky egg and I wanted to go cry in the car, go ahead". It was the worst year of my life. My new doctor, Dr. Mary Ann Sorra with Natural Fertility, actually held my hand when I was put under for a laparoscopy. It feels so nice to finally be cared about.

8). Looked After in Louisiana

Definitely. Arklatex Fertility and Reproductive Health with Dr. Vandermolen. I just felt like they're all so patient. Any time I had questions, I could call the nurse and she would call me right back. They knew me by name. The success rate for the doctor is pretty high, which is always a plus. When I first went to him, he told me what was going on. I felt like I had options instead of having him tell me what I was going to do.

9). Genial in Jersey

Absolutely! RMANJ, because of their lab. I was told I was going to be treated as a number, but on the contrary, I got to talk with my RE personally. He even called me right before my egg retrieval to know how I was doing. The nurse was always on top of things and answered me right away.

The transfer was very detailed oriented. They addressed yeast infections and progesterone levels while my previous clinic always dismissed my concerns.

"A great lab is necessary, but not sufficient"--Jake Anderson-Bialis

While I chose not to include the names of these volunteer promoters, they are perfectly willing to share their experiences with thousands of other people in the infertility community on Instagram. We often believe that people only recommend their IVF center online if they become pregnant or have a baby. We're told that they'll leave negative comments if they have a failed cycle, but research from Fertility Bridge and Fertility IQ show that that's not exactly true.

 True for almost every fertility clinic review we read.

True for almost every fertility clinic review we read.

"No question, if a patient has a good result, they're more likely to recommend their fertility doctor/clinic," says Fertility IQ co-founder, Jake Anderson. "With that said, when we look at patients who had failed cycles, it's very clear who is likely to recommend the doctor, and who definitely won't."

It seems that the contrapositive is also valid; when we look at patients who've had successful cycles, it's clear who will be the source of future patients in the form of word-of-mouth referrals. Many people have success at their fertility centers and are "satisfied", but we see in these recommendations that it's compassion and personal connection that turn former IVF patients into zealous promoters of their practices. So the next time a competing fertility doctor tries to convince you that the patient experience is meaningless, and clinical outcomes are all that matter, don't feel disappointed when you can't change his mind. Eat his f'ing lunch.

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For strategy on improving the patient experience, read chapter 2 of my free e-book, The Ultimate Guide to Fertility Marketing, by clicking the button below.