For couples who need help to conceive, the services available have become a confusing array of medical, emotional, financial and - sometimes - legal options.
That's why a new specialty has cropped up: the fertility consultant. While a fertility specialist - or reproductive endocrinologist - is the physician who can make the science happen, a fertility consultant can help couples navigate the maze: what doctor to choose, which clinic has the best statistics and intangibles that can't be answered in a spreadsheet. A fertility consultant is part researcher, part consumer advocate and part sympathetic ear, among other things.
"I'm here to show them options," says Angie Best-Boss, a fertility consultant based in Indianapolis and co-author of the book "Budgeting for Infertility." Ms. Best-Boss and Evelina W. Sterling founded My Fertility Plan (www.myfertilityplan.com) 13 months ago.
"Couples going through this process can be incredibly vulnerable," Ms. Best-Boss said. "They want this so badly. It is hard to differentiate between clinics who will help you get what you want and those that just want your money.
"There are a lot of fantastic doctors out there, but there are also lots of horrendous ones, too," she says. "This is an industry that is not regulated at all. What you can't get on Google is whether an agency is going to push you toward using an egg donor so that clinic can boost its stats."
Ms. Best-Boss, who has a master's degree in counseling, says she gets calls for help with everything from how to start the process to how to organize a complicated and expensive conception attempt featuring a surrogate, an egg donor and a lawyer.
My Fertility Plan's basic rate is $125 for a 50-minute phone session. There also is a $1,200 plan that includes six one-hour calls and many e-mails, Ms. Best-Boss says.
"We serve as a sympathetic ear and a sounding board," says Ms. Best-Boss. "We're there to help consider some of the emotional and spiritual issues."
Kathy, a 40-year-old Texas woman who asked that her last name not be used for privacy reasons, contacted Mindy Berkson, founder of Lotus Blossom Consulting, last spring when she realized she needed a team of specialists to pull together a complicated situation. Kathy says she was going to need a gestational surrogate and a sperm donor to successfully conceive a child.
"It is easy to become overwhelmed and confused by this process," says Kathy, who is a physician. "It is hard to separate objectivity from subjectivity. Mindy put into place things I had never thought of. She has five backup plans."
Beth Weinhouse, editorial director of Conceive magazine, says as technology has gotten more complicated, so has the information prospective parents need to research.
"A couple probably doesn't really need this service if they are just going to a local fertility doctor," Ms. Weinhouse says. "But if they need a lawyer or an egg donor, it gets really complicated. Someone who has been there can be really helpful."
Ms. Weinhouse adds that as with any fee-for-service situation, there should be a little bit of buyer beware. A fertility consultant does not need any training or certification, so there are no standards or and there is no recourse for complaints.
Many fertility specialists are not pleased with the idea of a third party being involved. Large clinics most often have a staff of professionals - including social workers, counselors and financial coordinators - to assist the medical personnel.
"I would consider it a failure if a patient thought they needed a fee-for-service fertility consultant," says Dr. Laurence Udoff, a reproductive endocrinologist with Genetics & IVF Institute in Fairfax. "A fertility clinic should address all the needs of their patients. This should include emotional [and/or] psychological support and assistance understanding financial issues related to infertility treatment. At GIVF, we either have specific personnel available to address these issues one on one or can refer a patient/couple to the appropriate place. Our staff - nurses, doctors, coordinators - consider themselves patient advocates and will work closely with patients to help them achieve their goals."
Still, fertility consultants say they are providing a valuable service. Ms. Berkson, founder of Lotus Blossom Consulting, says she has helped produce 192 pregnancies among her hundreds of clients in the past five years. Clients pay several thousand dollars - prices vary depending on services - for Ms. Berkson's expertise.
"I think the most important asset is my advocacy piece," says Ms. Berkson, whose office is in Chicago. She specializes in egg-donation cycles. By using a consultant, a couple can make the pool of potential donors much wider. That cuts down waiting time while increasing the likelihood of a couple getting the requested specifics in the donor's genetic attributes. Ms. Berkson also says she can help patients maximize dollars by reviewing insurance coverage and drug benefits.
Kathy says Ms. Berkson has done all of that.
"Mindy is like a giant encyclopedia of things you need to know about the process," said Kathy, who has identified an out-of-state clinic, a donor and surrogate and will start the conception process in February. "She has helped me save money by suggesting different insurance options. She found me an acupuncturist and an attorney. She saved me time - how do you weed out what is right and not just by going on the Internet?"