The day has arrived for you to sign the contract or the consent form for your IUI, IVF, egg freezing, donor eggs, donor sperm, donor embryo or other treatment. It might have been a long time coming to get to this milestone. It’s something to take seriously, and also be gentle with yourself around what emotions bubble to the surface. You probably didn’t expect to be having these heavy decisions at this point in your life.
This puts you in a vulnerable position in an already vulnerable position because you’re going through fertility treatment and then have these extra considerations.
For example, I had to redo my whole legal will because of mine and Emanuel’s frozen embryos. We weren’t anticipating having that conversation at that tender time on our fertility journey. We knew something we could change later, but we needed to think through in case anything happened.
My aim in writing this article is to provide you with tips to empower you, take back any control you can get and lead to you having fewer regrets later. But I first wanted to acknowledge that emotional elephant in the room.
What to look out for in your contract
1. Check out the detailed cancellation policy due to reaction to medication, a new diagnosis that prohibits you from carrying on with treatment or any way your body medically prevents treatment. Check if anything like a personal emergency or other need to stop from your perspective needs to end or reschedule treatment and any money back at any date. Check if the policy if they have an issue on their, side like staff shortage, or something else like weather conditions (think massive snow storm), and if they refund at any point and how much. What is the cut-off day? It might be before specific medication starts, such as the stimulation injections or once you’ve received the donor eggs or sperm.
Check if there’s a down payment to reserve your spot and if that’s refundable.
There might be a graded cancellation it might mean that, for example, 30% is refunded if you cancel on day 10, 50% by day 3, 80% on day 1 and so on for IUI or an egg retrieval cycler you or your donor or surrogate.
2. Related, check the policy for if you contract Covid-19 or another illness. Check in detail about at what point you contract an illness and type of illness and at which stage in your treatment would it be cancelled and when would it resume. Will it require you to stop the cycle and how long to test negative before resuming your cycle?
3. Check to see if you’re required to purchase your medication through their clinic and if they use a dispensing fee, and how they dispense. Preferably, they dispense as you go so that you don’t buy more than you may end up needing. These meds can be expensive and every bit helps. It’s illegal to buy or take free prescription medication from others and there is a black market on Craigslist or Kijiji for these kinds of things, but it’s not legal. There are companies that you can buy cheaper medication shipped to you but beware of any that need to cross a country border and risk of confiscation and risk if there’s a delay in getting the medication and consequence for your cycle.
4. What is included in the treatment fee, providing the breakdown of all the potential add-ons like PGT-A, embryo glue, sperm wash, ICSI or FET. Often in an IVF cycle the cost includes a fresh transfer. Ask for any unforeseeable costs like placing an IV, if a nurse does an injection, or additional ultrasounds or bloodwork.
5. Check if they include testing progesterone after a monitored cycle, IUI or embryo transfer. This isn’t always included and if you know you want that, get the cost upfront if it’s not automatically included in your cycle fees.
6. Additional paperwork
- If you’re in Canada: you might find it more paperwork than you’ve ever encountered in a largely public system and working with a private clinic or a combination if you’re in Ontario or Quebec. There will be more detail about side effects and harms.Talk to your doctor for more information about research behind any claims such as health of the future baby or babies, risks in pregnancy due to this treatment and any other claim and book a call with me for any further clarity.
- If you’re in the US, this is more standard but it still might be shocking how there’s even less room to sue or less retaliation if the clinic makes a medical mistake.
7. What happens if you don’t have any eggs at retrieval and does the clinic assume any responsibility (probably not)? If it’s for egg retrieval then usually the full amount must be paid if you go ahead with the retrieval even if there aren’t eggs in the end, although it’s very rare. Or, if you’re creating embryos and no embryos in the end then usually you won’t get money back either. These are all really tough pills to swallow and it happens. I wish it never did and it’s good to know this ahead of time, just in case.
8. Double check that the cost is the same as the cost that was advertised or originally shared with you. Get it in writing whenever possible. If they have a cost change, ask to have the price that it was when you first reached out to the clinic, especially if there was any kind of internal delays from the clinic. Sometimes you can pay upfront before a projected treatment fee increase is put in place. Ask ahead of time.
9. If one or both of you die, what happens to any of the potential leftover embryo(s), eggs, or sperm. Things got real quickly, didn’t it? These kinds of contracts force you to face questions that get into ethics and even existential reflection. If you (and/or your partner) die, usually they would be discarded. If you abandon your embryo or other genetic material, then what happens? What about if you divorce? Check the laws in your jurisdiction to see even if your contract holds up because laws can override these contracts. If you plan to have eggs or embryos frozen then add it to your estate planning if you’re creating or recreating your will. This has different implications if you use donor embryos and if you need to return any unused embryos to the original person or people who donated them. Every jurisdiction has different laws. To be prudent, do the will with the estate lawyer who should work with the laws in your jurisdiction; it gets complicated if you’re working with a clinic outside your legal jurisdiction. Have a fertility specialized lawyer look it over if you’re really concerned.
10. If you’re doing PGT-A, PGT-M or PGT-SR, then you want to consider these questions.
- Do you have to pay even if you end up with zero embryos to test in the end?
- Is it the same price regardless of how many embryos are tested or is the price per embryo?
- When can you back out of doing PGT-A or request to do it?
- At what point in the cycle does the clinic need to know?
- Ensure it includes the possibility of what to do with mosaic embryos. Some clinics classify them as abnormal and others do not. What do they do with abnormal embryos?
- Are there any limits to how many attempted embryos are created?
- What is the clinic’s policy around using or discarding an embryo if it doesn’t meet the usable criteria?
- If you have more than one embryo, can you test only some but not all of your embryos?
11. If you have any embryos, donor eggs or donor sperm left over, check what you’re able to do with it or them:
- keep them frozen and pay an annual storage fee (often the first year is covered).
- take them home (it’s an option usually!),
- donate it or them to another person or family,
- donate it or them to science – if so, what are the specifics of that research or potential research
- donate to embryologists in training.
- If you do, this is the time to start thinking of putting this in your will too.
12. If you’re going to procedures alone, do they require that someone be there to pick you up such as after egg retrieval or hysterscopy, or Testicular Sperm Aspiration (TESA) or can you drive home or take a taxi or Uber on your own?
13. Check if the contract is with the individual doctor or with the clinic or hospital. Often if the contract is with a hospital it can change a lot about your experience such as more strict policies, as well as open up opportunities if you need additional specialists or procedures that you hadn’t intended.
14. Risks of the treatment. This can be a bit overwhelming and sometimes it’s difficult to tell how much of a risk. Ask your doctor about the chances of each happening to you such as having an ectopic pregnancy, multiples (twins etc.) with a single embryo transfer, needing to access egg retrieval through your belly and not your vagina, risks in embryo transfer conceived pregnancy, risks to a future IVF or IUI conceived child’s health. Get the updated information about your case and with your clinic and doctor.
15. What happens if you ovulate before the IUI. They should be monitoring you and if you’re on a medicated IUI you can still ovulate through medication in some cases, so check on what happens in these situations. Usually you still have a chance because there’s a window of opportunity once the egg is or eggs are released, but time is sensitive.
16. Get the name of the lab that they use and check details. They might include that information in the contract and about liability of eggs, sperm and/or embryos in the event an error occurs. Sometimes the lab is outsourced. other times it is in-house.
17. If you are purchasing donor sperm or eggs then check their policies in the event that you have any leftover and what your choices are (see # 11 above). You’ll need to check the source too, but seeing what your clinic or doctor’s corporate policy is would be important. Also, double check when annual storage starts, whether it’s when you receive the eggs or sperm or once the first transfer happens. If there’s a delay, which happens all too often unfortunately, it could save you months of payment to have this worked out ahead of time.
18. Talk to a fertility lawyer if you have concerns or the law have been changing in your jurisdiction. Get intel from your support group for your clinic or in your jurisdiction. They may have tips to point out about your specific clinic. I can suggest fertility lawyers in some areas.
19. Can you do blood tests or other monitoring elsewhere or just within their clinic? If so, check to see if there are additional fees.
20. Can they write you a doctor’s note to send to your employer or for insurance or do they have stipulations in the contract?
21. Check if there’s a maximum to the number of embryos or eggs they attempt to harvest or create. Some clinics or doctors limit the number for those who have a lot of follicles so that the risk of OHSS is lowered. Some clinics try to get as many as possible. It depends in part on your diagnosis and what they expect your egg counter might be. This might be in the contract but it might just be part of choosing your clinic or doctor.
If you want more personalized support, I’m here.