The Hope Business: Step Aside Plastic Surgery, “Fertility” Beckons



The young woman sitting across the airplane aisle looked to be no older than 16 years old. I would not have given her more than a passing glance had it not been for what she said.  Her words left an impression, and led to this post. Apparently she will soon be someone’s reproductive endocrinologist, embryologist, or to use her word “fertility” doctor.

I couldn’t believe my ears. I was aghast and intrigued.  Had this woman-child really told the flight attendant that she was pursuing a medical school degree in “fertility?” Clearly she was being programmed early and well in the lingo of medical marketing spin.

I was also put off by her use of the word “fertility” because it seems to be the term of art used most readily in advertising by enterprising doctors who have banded together to sell services aimed at delivering what their “customers” want: babies.

Since I work in marketing, I’m naturally suspicious of anything that sounds too slick or contrived. A classic example of how marketing works came from Charles Revson, who famously said, “In our factory, we make lipstick. In our advertising, we sell hope.

Had the young woman not slept most of the 10 hour flight or been sitting close enough to engage in conversation I would have tried to learn more.  Given her rather casual, flip response to the fight attendant who had inquired pre-flight about her school work (again I was prepared to hear something about high school!), I’m guessing the discussion would have gone something like this:

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Me: So, uh, you’re studying to be a “fertility” doctor? How did you come to choose that specialty?

Med Student: Have you seen the profit margins of fertility clinics?

Me: What about helping the couples who are struggling with infertility?

Med Student: Have you seen the profit margins of fertility clinics?

Well, you get my drift. If her answer to the flight attendant had been “reproductive endocrinology” I might have suspected that she had a sister or aunt who had trouble conceiving, or that she had read about the plight of couples who wanted the opportunity to have their own child.  Instead I had visions of med students reviewing and assessing the most lucrative fields of practice. Let’s see … is it dermatology? plastic surgery? or fertility?

Now I know some folks might argue that she was choosing the least complicated of terms (e.g. cancer vs. oncology or heart care instead of cardiology) but most of the scientist types I know choose the formal name to describe their specialty and then explain if the situation requires it.

I also have a hard time imagining how this barely grown slip of a thing is going to have the emotional grounding and deftness to offer the 360 degree care required in treating those with infertility conditions.  I hope I misread the situation as I’d hate to think that profit was the primary motive for her specialty selection. Furthermore, I hope she’s the most caring of individuals who can appreciate the distress that will await her in the examining room.

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My encounter with this woman reminded me of the “fertility clinic” that sent me direct mail recently warning me about my biological clock. Can you say inappropriate?


20 Responses

  1. JJ

    January 3, 2008 4:52 pm

    I really hope for the sake of reproductive medicine that she WOULD be going into the field for the right reasons…I echo your thoughts–Im glad to be in a time where we have some solid medical professionals who are (hopefully) striving to do the right thing without $$ signs in their eyes…

  2. infertility just sucks

    January 3, 2008 5:14 pm

    Sometimes I wonder if the doctors at my clinic are ever ethically bothered by what I can only assume is an incredible profit margin. I suppose I’ll never know.

    Also, I’m glad to see that someone else is trying to push BlogHer to realize that there’s a gigantic community of IF bloggers out there.

  3. Kami

    January 3, 2008 5:16 pm

    Interesting timing . . .I recently came across pictures of my RE’s house (ok, a little internet research found it). This is someone who, I believe, sees himself as a patient advocate. He is concerned about how much people need to spend and tries to keep his expenses down while keeping his rates high.

    Yet, his house is a mansion and obviously no expense was spared. I would have posted about it in my blog – it kills me that people get rich while those of us dealing with IF go broke – but I believe he would be hurt if he heard my point of view (my blog is not a secret at my clinic although I don’t think anyone actually reads it.)

  4. beagle

    January 3, 2008 6:25 pm

    Having worked in a teaching hospital for my entire nursing career, I’ve had many an opportunity to hear the inner workings of the med student mind. I can say that many have their hearts in the right place and equally many don’t. Some choose for profit, or image (how cool is it to be a proctologist after all) and some choose for things like no on-call hours and a predictable schedule. Worst of all some choose whichever specialty they can get into (as opposed to their 1st, 2nd or 10th choice.)

    I kind of hope she changes her mind and goes into dermatology.

  5. Babystep

    January 3, 2008 9:32 pm

    I have always been bothered by the fact that these doctors can strike it rich in this field. It really is a business like any other business — a money making machine. I like my doctors they seem compassionate, but it is hard to ignore the fact that they took $30,000 from me without any guarantee that they can help me.

    • Pamela Jeanne

      January 3, 2008 9:51 pm

      What you and Kami say here (not to mention Beagle’s perspective) has always made me glad that my big checks were made out to a research hospital. I could always reassure myself that the lion’s share of the nearly $45,000 we dolled out went to further research and knowledge around infertility…sigh.

  6. Caro

    January 3, 2008 9:43 pm

    In her defence, I always use the simplest term do when asked what I do – especially by flight attendants. The more complicated form comes if telling someone I do cancer research doesn’t stop the conversation dead.

    • Pamela Jeanne

      January 3, 2008 9:55 pm

      Ah, I’d be very careful here. With both a sister and sister-in-law as flight attendants I can assure you that it takes some serious effort to be certified in everything from aiding passengers suffering heart attacks and heart failure to fire fighting to restraining passengers who threaten others’ safety to training in case of a catastrophic mechanical failure. I’ve helped my sister prepare for her annual testing and certification and quizzed her on a wide-ranging series of subjects. It’s far from an easy job and they deal with everyone from grumbling business passengers to other people’s out of control children. They are subject to anonymous FAA agents flying as passengers who note any missteps in the flight preparation etc. One small mistake and they can be fired.

      All of this “glamour” and they average a salary little more than minimum wage. This is all my way of saying don’t underestimate flight attendants, and by all means cut them some slack. They’re not the ones overbooking the flights or not building out the airport or flight control infrastructure most responsible for bad tempers and flight experiences.

  7. Irish Girl

    January 3, 2008 10:45 pm

    I’d love to think she’s specializing in “fertility” because she cares.

    Beagle nailed it. Some have the patients’ best interests at heart, others have different motives. This is true in any profession though, not just medicine. In this case, it is hurtful to those of us who pay a high price for a service with no guarantees.

    I wish she’d sat right next to you so you could have interviewed her. You are a fantastic advocate for all of us! Thank you!

  8. Lori

    January 4, 2008 2:51 am

    I admit it. I snickered at your imaginary conversation.

    I also notice that while we seek treatment for INfertility, they specialize in just plain old fertility. Sell the sizzle.

  9. motherofnone

    January 4, 2008 3:11 am

    Oh, this one’s tough. You know, I’ve never doubted the integrity of the REs I saw through Kaiser, only their commitment to my specific case, i.e. getting me (specifically) knocked up. I know that sounds strange and internally contradictory, but somehow that’s how I feel. I don’t think they were in it for the dough, but I also don’t think that they were the ardent and compassionate advocates I would like to think I would have been in their situation. At the end, my last RE acknowledged (just a little) that my case could have been handled better. That was scant compensation for seven years of frustration, but at least it confirmed my view…

  10. loribeth

    January 4, 2008 1:25 pm

    I have no idea what my RE’s motivation was for choosing his specialty. But I know it galled dh that he had an expensive Audi sitting outside his office.

  11. SaraS-P

    January 4, 2008 5:22 pm

    She might not have done any practical work, yet. Probably still memorizing vast amounts of terminology. There is still time for her to change career plans. Maybe one of her parents is in the fertility biz (er, I mean reproductive endocrinology) and that’s how she chose the specialty.

    Makes me think of all the psych students I encounter who have no interest in helping disadvantaged populations or of improving the human condition — they just want to be the next Dr. Phil.

    Interestingly, I often avoid saying I am a psychologist because of the media shrink associations the word has acquired. I often just say I teach at a university and let interested people ask for further details.

  12. Ann

    January 4, 2008 6:22 pm

    Because I love my RE and his office so much, I admit that I’ve never considered there might be clinics like the one that sent you the direct mail. Makes me appreciate what I have.

    With regards to money, I don’t think we can get mad at an RE with an Audi any more than we can a heart surgeon. The biggest difference? Insurance companies are far more likely to be the payers for a heart surgery than they are for IVF. That really isn’t their fault, although I know it’s hard to think of it that way. Hell, when I had my first visit with my RE, I was incredibly suspicious when he started talking about IVF as the next best option if oral meds couldn’t help me ovulate. I felt sure he just wanted my money. But after talking with him further, I realized he was just going by what he thought worked best, quickest.

  13. Carlynn

    January 4, 2008 7:42 pm

    Mmmm, the mind boggles. One would hope that RE do have some understanding of the experience of infertility. I know that I am always snappy with my RE and I can say that he has been great, never rising the bait and always patiently answering my 1001 questions, however wacky. Thank the universe for all the understanding medical staff we have come across.

  14. SL

    January 4, 2008 9:25 pm

    In her defense, I don’t know how many fertile friends I’ve spoken to about treatment where I used the word “reproductive endocrinologist,” got a blank look, and followed it with “you know – fertility doctor?” “Oh, yes.” People don’t know what an RE is! They don’t know! Isn’t that crazy? Our universe is apparently made up of many overlapping universes.

  15. chicklet

    January 5, 2008 3:19 am

    I shouldn’t find it funny but I’m messed up so I do. Not funny for you, just funny, all about the money. Cuz it’s not like it’s not something all we infertiles have thought – shit, this is a $$$$$ business!

  16. Nancy

    January 5, 2008 6:52 am

    Wow. I’d want to slap her.

    It’s a weird time for reproduction these days. Infertility is ~starting~ to get noticed and talked about without the whispers (even if the public STILL doesn’t “get” it). Hollywood babies are being followed by paparazzi and photographed more than the “stars” themselves. Magazines have a “bump watch” section in every issue. Ugh. I almost feel like a phoney ttc right now, like I have to follow it up how it’s because I legitimately want a child, not because I think it’s hip.

    I’m just afraid conversations like the one you described is going to become more commonplace. If her reason wasn’t for the “profit margin”, I wouldn’t of been surprised if I would of heard “because I want to meet famous people!” instead.

  17. May

    January 5, 2008 1:38 pm

    That’s the interesting thing about being British, and having all my ‘fertility’ issues dealt with by the NHS. Yes, it’s slow, and frustrating, and impersonal, and I’m frequently left feeling no one gives a toss about me in particular, but at least, at least, I am not being shafted to the tune of $20000 by someone with a house the size of a football pitch. None of my doctors are in it for the money. Their inability to give very focussed and particular care is due to the eight bazillion other patients they have, and their lack of allocated time and funds.

    My heart really goes out to my trans-Atlantic infertile sisters when I read about their money issues, and the vast unfairness that adds to the pile – those who can afford six or seven IVFs, those who can afford just one, those who can’t afford any at all.

  18. anon

    January 6, 2008 1:33 pm

    since she is barely into the adult world, maybe her source of inspiration is her very own parents and her beginnings as a person… it is possible!

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