Becoming a doctor is considered a noble and respected profession worldwide, demanding years of hard work, unwavering dedication, and a sincere commitment to improving human health.

Yet, for a young medical student, the journey to donning the white coat and stepping into the realm of healing is fraught with various challenges, each more complex and demanding than the last. One significant milestone in this journey is securing a residency or fellowship placement, a pivotal transition that transforms theoretical knowledge into practical, hands-on experience.

Reaching this crucial juncture is by no means a walk in the park. An exhaustive list of prerequisites awaits every aspiring resident: stringent competition for limited slots, mastering the intricacies of the application process, acing the formidable United States Medical Licensing Examination (USMLE), and for international students, navigating the labyrinth of obtaining an Educational Commission for Foreign Medical Graduates (ECFMG) certification.

Despite these obstacles, the flame of ambition continues to burn bright in the hearts of countless med students, fueling their dreams of a successful residency placement and a fulfilling medical career.

Stepping into this rigorous landscape is Dr. Michael Everest, a steadfast figure dedicated to turning students’ dreams of residency and fellowship success into reality. With the vision to empower med students with the right tools and guidance to achieve their residency goals, he started Residents Medical and the Everest Foundation.

More interestingly, however, Dr. Everest pioneered artificial intelligence in helping Residents Medical students get where they need to be.

“Imagine having a 24/7 study buddy during your college, undergraduate years, or even high school. You can have just that with Hannah,” says Dr. Everest excitedly. “Whether it’s studying late at night in your pajamas or seeking lessons and assistance from an AI Being edYOU has created, she’s always there to help and engage with you.”

The Hannah he’s referring to is an AI entity developed by edYOU Technologies, the company Dr. Everest founded mere months ago. Hannah is designed to function as a 24/7 study buddy and educational assistant. She offers personalized and continuous support for users, providing interactive communication and a unique learning experience.

“For instance, when studying, you can ask the AI to generate answers, like writing out ABC options. Moreover, during multiple-choice question preparation, the AI will assist you in selecting the correct answers, and if an answer is wrong, she will explain what went wrong and why,” Dr. Everest explains.

edYOU offers real-time data analytics to individuals while allowing them to retain complete control over their data without intending to keep it on the platform’s end. The platform provides users with their study information, allowing them to analyze their progress over time. They can review their learning journey from the past months or even years, identifying areas of weakness or subjects they excelled in.

“Our platform integrates the memorizing and quizzing process seamlessly. You interact with the AI directly, eliminating the need to switch between tools like memorizing materials, external chat GPTs, and search engines,” says Dr. Everest. “edYOU has its own patent-pending platform as well as tied into the LLM’s thus having a safe and reliable ecosystem in AI.”

It was the realization of the inherent bias and favoritism that exists toward certain ethnic groups in medical groups, particularly toward international students, which prompted Dr. Everest to act. He sought to level the playing field with Residents Medical, offering resources, a roadmap, mentoring, and a clear path toward securing medical residency, even in the face of significant time and monetary investment.

“When you have limited positions and thousands of applicants, many from prestigious institutions like UCLA, University of Chicago, Northwestern, or UCSD, it becomes challenging for individuals from countries like Sierra Leone or India to compete, Dr. Everest explains. “I sought to create opportunities and integrate these doctors into a program that provides the necessary support and test preparation, which is where Hannah comes in.”

While it might seem like the focus of Hannah and the team at edYOU is currently on medical students, the fact is that the learning platform is capable of helping more people of diverse backgrounds with diverse goals. Because of its easy-to-use interface, characterized by a human-like representation of Hannah, it might benefit people who struggle with traditional learning methods.

“Through this AI being, I witnessed how it significantly helped individuals with autism, as they found it more comfortable to relate to an AI than a human being,” says Dr. Everest. “Our approach not only benefits typical students but also supports individuals with special needs, social anxiety, dyslexia, and others who struggle with memorizing aloud in a classroom setting.”

With his eyes set on helping humanity and providing a voice for the marginalized and disadvantaged, there’s no doubt that Dr. Michael Everest and his teams at Residents Medical and edYOU will not rest until they help those who need it. Medical students are just the beginning. Or, as Dr. Everest put it, “We’re crafting a future where every student, irrespective of their background or circumstances, gets an equal opportunity to realize their dreams. Imagine a girl in Afghanistan who cannot go to school but can access a cell phone. She can utilize edYOU technologies to learn. That is the vision to help all to educate.”

McClatchy newsroom and editorial staff were not involved in the creation of this content.

Nick Kasmik works with the Top 1% of Entrepreneurs/Business owners majority in the Ecom, coaching, and consulting industries. Currently, Nick is the head Public Relations Manager at HighKey Enterprises LLC. He can be reached at nick@highkeyagency.com.

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It can be difficult to tell if your baby is getting enough milk when exclusively breastfeeding during the first days and weeks of a baby’s life. As long as your baby is gaining weight and having enough wet and soiled diapers, they are most likely getting the nutrition they need, according to the U.S. Department of Agriculture (USDA) WIC Breastfeeding Support.

Your baby should be gaining at least 5 1/2 to 8 ounces a week after the first week since birth, and either meet or surpass their birth weight 10 to 14 days after birth (as newborns tend to lose fluid after birth, up to 7% to 10% of their birth weight). If your baby doesn’t seem satisfied at the end of a feeding, and your pediatrician is concerned about weight gain, there are some natural ways to boost your milk supply.

Frequent Stimulation

Frequent stimulation is the only proven way to increase milk production, says Rhonda Daley, R.N,. an international board-certified lactation consultant in New Jersey. Daley recommends stimulating the breasts often to increase your supply. “Ideally, [the] baby should be feeding at least eight times in 24 hours. If this isn’t possible, the breast can be stimulated with [a double] electric pump, manual pump or through hand expression.” This increased stimulation will signal your body to produce additional milk.

A Proper Latch

When breastfeeding, it’s important that your baby latches onto your breast correctly. Your baby needs the nipple as well as a mouthful of breast tissue in order to extract milk. If your baby only latches onto your nipple, no milk will flow and breastfeeding will hurt.

A Healthy Diet

A balanced diet with two to three servings of protein, three servings of vegetables and two servings of fruit and whole grains is ideal when breastfeeding. If you are vegetarian or vegan, you will need to ensure you are getting enough zinc, iron and B12 in your diet by eating a variety of leafy greens, nuts, beans,and fortified cereals. In addition to a healthy diet, certain foods may produce positive results when it comes to milk supply. “Anecdotally, some parents report an increase in milk supply when they eat lactogenic [milk-inducing] foods such as fennel, oatmeal and turmeric,” says Daley.

Furthermore, the CDC recommends increasing caloric intake by 330 to 400 calories per day while breastfeeding compared to pre-pregnancy. While this amount may differ for each person, it should range between approximately 2,000 to 2,800 calories per day.

Emptying Your Breasts

Similar to increasing stimulation, emptying both breasts during feedings can support productive milk supply. You can either offer both breasts by switching sides during each feeding or stimulate both breasts simultaneously by using an electric or manual pump on one breast while feeding your baby on the opposite side. Draining the breasts regularly can also prevent engorgement, which occurs when milk is not drained and accumulates in the alveoli (where milk is stored) along with blood and lymphatic fluid, resulting in breast pain and swelling, potentially damaging milk-secreting glands, according to a study in The Journal of Family Medicine and Primary Care. The study also concluded that good breastfeeding practices, such as proper latch and frequency, prevented issues with engorgement.

Skin-to-Skin Contact

Mothers who practice skin-to-skin contact, which is when the unclothed baby is placed directly on a parent’s bare chest with a blanket or other light covering over them as needed, report higher levels of breastfeeding success within the first six months, according to a 2020 study in the International Breastfeeding Journal . Skin-to-skin contact releases oxytocin (a hormone that aids in lactation), supporting the let-down response. Oxytocin is also released when nerves within the nipple are stimulated, causing the milk to begin to flow.

The same also can be said for many aspects of the automotive industry, and increasingly, in packaging and other fields too. A new service from injection molding machine manufacturer Engel North America (York, PA) is designed to help you prove to customers and inspectors that you are on taking good care of your molding machinery.  Called Ever-Q, the program enlists the machine manufacturer and its employees to help plastics processors with the calibration and conformance of their injection molding machines. 

The Ever-Q documentation ensures that all machine parameters conform to the required specifications - from the barrel temperature to the clamping force, injection speed and holding pressure to repeatability of the cycle time. As part of the program, a technician from the molding machinery OEM will perform more than 20 series of measurements using independent calibrated devices, log the results and ensure that any deviations are within the acceptable tolerances.

For plastics processors' customers in the medical, automotive or other industries, the Ever-Q program provides a ensure that suitable calibration methods and measuring instruments are in use at the processor, and that his machines' tolerance limits are defined according to industry specifications. According to Engel, this program is an improvement over external calibration laboratories, which often work for several different branches of industry and so may lack injection molding expertise.

Calibration is performed to a variety of international standards. In the medical industry, Good Manufacturing Practice (GMP) is the accepted set of regulations while ISO 9000 and ISO 900, and others, define the requirements for quality management in the automotive industry.

Ever-Q calibration covers not only the factory calibration of the relevant parameters, but if the customer wishes it will be continued at the customer's facility for purposes of requalification.

By Nora Caley
From the July/August 2022 Issue

By any measure, healthcare is huge. Goods and services related to diagnosing, treating, and preventing disease will always be in demand. While telehealth exploded during the pandemic, delivering healthcare is still a mostly in-person business that needs a physical presence in every region. As a result, communities are attracting healthcare systems and health-related businesses by showcasing local skilled workforces, advanced infrastructure, and even the well-being and active lifestyles of residents.

Healthcare is a massive employer. The U.S. Bureau of Labor Statistics (employment by major industry sector) reported that there were more than 20.08 million jobs in healthcare and social assistance in 2021, up from 17.01 million jobs in 2011. The BLS estimates that in 2031 there will be nearly 22.7 million healthcare jobs.

Revenues are also large. According to IBISWorld (Hospitals in the US – Industry Data, Trends, Stats | IBISWorld), hospital revenue rose at a CAGR of 2.6% over the past five years, to a total of $1.4 trillion. The report points to the aging population’s expanding medical needs, broader access to public and private insurance, and rising incomes as factors that sustain the industry.

There are also many hospitals. The American Hospital Association reported in its 2021 AHA Annual Survey that there were 6,129 hospitals in the U.S., and 919,649 total staffed beds in all U.S. hospitals. One way that hospitals compete is to herald their innovative technology, including the newest medical devices. According to the Advanced Medical Technology Association, or AdvaMed, the U.S. is the largest medical device market in the world, comprising over 40% of the global medtech market.

Here are some locations that are successfully attracting healthcare systems and medical device companies.

GRAND JUNCTION, CO: PRIME DESTINATION

The Grand Junction area’s strategic location in the heart of western Colorado positions it as a prime destination for healthcare and medical device businesses. Its proximity to major cities like Denver and Salt Lake City offers excellent connectivity via major highways, railways, and an airport with direct flights to major regional hubs. This advantageous location enables businesses to efficiently serve a broad customer base while quickly accessing supply chains, clients, and markets across the region.

Grand Junction boasts a thriving healthcare ecosystem that supports the growth and success of businesses in the industry. The city is home to renowned healthcare institutions and hospitals, including Intermountain Health St. Mary’s Medical Center, Community Hospital, Family Health West, and the Grand Junction Veterans Affairs Medical Center, which provide exceptional healthcare services and foster collaboration and innovation. The presence of these institutions not only attracts top medical talent but also offers ample opportunities for research partnerships, clinical trials, and product development collaborations, providing businesses with a competitive edge.

The Grand Junction area is known for its highly skilled workforce, making it an ideal location for healthcare and medical device businesses. The city is home to Colorado Mesa University, which offers specialized programs in healthcare-related fields, ensuring a steady supply of talented graduates. The region is also Colorado’s only ACT Certified Work Ready Community.

Additionally, the region attracts professionals seeking a high quality of life thanks to its natural beauty, outdoor recreational opportunities, and affordable cost of living. This combination of a skilled workforce and a desirable living environment makes the Grand Junction area an attractive destination for businesses looking to recruit and retain top talent.

Colorado’s Grand Junction: Where Business Meets Adventure

The Grand Junction area is the largest metropolitan area in western Colorado, with the amenities and infrastructure companies need to operate globally. Situated halfway between Denver and Salt Lake City, the Grand Junction area is easily accessible by air, rail, highway, and WiFi. Read more…

The region’s business-friendly environment is a significant advantage for healthcare and medical device companies. The city provides various incentives to encourage business growth and development, such as tax benefits through its seven federally designated Opportunity Zones and state programs such as the Rural Jump Start Program.

Furthermore, local organizations, like the Grand Junction Economic Partnership, offer comprehensive support services, including site selection assistance, workforce development support, and access to state and local resources. These resources enable businesses to navigate the expansion or relocation process smoothly and maximize their chances of success in the Greater Grand Junction region.

As the healthcare and medical devices industry continues to evolve, businesses must carefully consider their expansion or relocation projects. Grand Junction’s strategic location, thriving healthcare ecosystem, skilled workforce, and supportive business environment make it an ideal destination for companies seeking growth and success in this dynamic industry. Businesses can embrace the possibilities and unlock potential in Colorado’s Grand Junction area.

Visit www.gjep.org for more information about Grand Junction, CO.

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Oral Medications

If your fallopian tubes are not blocked and your partner’s sperm tests come back normal, you may be a candidate for an oral fertility medication. These medications are typically small, inexpensive pills taken once a day for about five days during your menstrual cycle. The most common oral medications are clomiphene citrate, sold under the brand name Clomid, and letrozole, sold under the brand name Femara. Metformin is also used, although less commonly.

These drugs each work a little differently, but ultimately, they “send feedback to the brain to release more hormones which stimulate the ovary,” says Dr. Marsh. Perhaps counterintuitively, the science hinges on lowering your estrogen levels (or at least making your brain think that’s what’s happening). Why? The hormone that helps your eggs mature—called follicle-stimulating hormone, or FSH—can also increase your estrogen levels. When your estrogen dips, your pituitary gland compensates by pumping out more FSH to right the ship, so to speak.

If you don’t ovulate regularly, this surge of FSH may help you release an egg. If you do ovulate regularly, an oral fertility medication may lead to superovulation—a menstrual cycle in which you release more than one egg.

The idea is to “try to increase the odds of sperm and egg meeting in a given cycle,” says Kenan Omurtag, M.D., division director of the department of reproductive endocrinology and infertility at the Washington University School of Medicine in St. Louis.

Here are some basics on how these medications differ. Your doctor will advise on which, if any, oral fertility medication is right for you.

Clomiphene Citrate (Clomid)

Clomid is often the starting point in cases of unexplained fertility, which is when “the patient has regular cycles, the patient’s tubes are open and the partner’s sperm is normal,” says Dr. Omurtag.

The medication binds to a group of receptors in your brain that would typically bind with estrogen—almost like taking estrogen’s regular parking spot. This “tricks your brain into thinking your estrogen levels are low,” says Abigail Mancuso, M.D., a reproductive endocrinologist with University of Iowa Health Care in Des Moines, Iowa. In response, your brain releases more FSH, or follicle-stimulating hormone, a hormone that helps eggs mature in your ovaries, encouraging ovulation, she says.

Typically you take a tablet a day for five days, beginning around the third day of your menstrual cycle, and have sex timed to your fertile window (typically the six days of your menstrual cycle that you’re able to get pregnant). If unsuccessful, your doctor may increase dosage to two or three tablets a day during your next menstrual cycle.

For patients with unexplained infertility, Dr. Mancuso quotes a 10% to 15% chance of a successful pregnancy and live birth, based on current medical literature, though success rates are hard to predict. In one study in the New England Journal of Medicine, which looked at 750 women ages 18 to 40 assigned to take either clomiphene citrate or letrozole, 19.1% of patients who took clomiphene citrate achieved a successful pregnancy resulting in a live birth . Success rates often vary with age. On average, a 33-year-old who is a good candidate for Clomid will have slightly more success than a 34-year-old, who will have slightly more success than a 35-year-old, and so on.

Letrozole (Femara)

If your fallopian tubes are open and sperm is normal but you’re not having regular periods, your doctor may try letrozole, which is often sold under the brand name Femara.

Letrozole is a common first-line fertility treatment in patients with polycystic ovarian syndrome (PCOS), a condition that can lead to irregular periods. Unlike Clomid, which only tricks the brain into thinking estrogen levels are low, letrozole actually does affect estrogen production. The drug is an aromatase inhibitor, meaning it blocks aromatase, an enzyme in your fat tissue, from producing estrogen. Letrozole is marketed as a drug for breast cancer patients, but it’s extremely common for fertility providers to use since reduced estrogen levels can boost production of FSH, one of the hormones important in inducing ovulation.

Typically, you take one to three 2.5-milligram tablets daily for five days during your menstrual cycle and have sex timed to your ovulation window. Research suggests a higher dosage may be beneficial in patients who don’t have success with standard dosage .

In the New England Journal of Medicine study, 27.5% of patients ages 18 to 40 who took letrozole achieved a successful pregnancy resulting in a live birth . As with Clomid, success rates are hard to predict and often decrease slightly with age.

Price of Oral Medications

One cycle of any of these medications will likely cost less than $10 if covered by insurance and about $20 to $50 a cycle if not covered, depending on where you live. It’s common for oral fertility medication to be covered, though it depends on your insurance.

Side Effects of Oral Medications

The most common side effects of Clomid include hot flashes, mood swings and pelvic pain.

Meanwhile, the most common side effects of letrozole include fatigue and dizziness. Talk to your doctor for a full list of potential side effects, including rare complications.

Because of the chance of superovulation, taking Clomid or letrozole may lead to multiple births (such as twins or triplets). “We usually quote about an 8% to 10% risk of twins, and a less than 1% risk of triplets or higher order multiples,” says Dr. Mancuso.

Most providers will stop and reevaluate after three to six months of treatment with oral fertility medication.

Injectable Medications (Gonadotropins)

You can also stimulate your ovaries by injecting medication into the fatty tissue around your abdomen or thighs. Menopur, Follistim, Ovidrel, Gonal-F and Luveris are among the brand names you may encounter when discussing injectable fertility medications with your doctor.

Doctors refer to these medications as gonadotropins. In your body, gonadotropins are naturally occurring hormones that regulate ovarian function. The medications are man-made versions of these same hormones, namely follicle stimulating hormone (FSH) and luteinizing hormone (LH)—”powerful hormones that can release multiple eggs at once from the ovary,” says Dr. Marsh.

These days, it’s rare to use injectable medication alone. Rather, gonadotropins are primarily used in tandem with IVF, a process that allows the patient and doctor to choose how many embryos to implant in the uterus. Without that control, the use of gonadotropins often leads to twins, triplets or higher multiples because they are so powerful.

“[The TLC show] Jon and Kate Plus Eight, the sextuplets, that’s from injectable medication,” says Dr. Omurtag. “In the late 1990s [and] in the 2000s, a lot of those stories [of multiple births] were related to the use of gonadotropins. Then, over the first 10 years of the millennium, IVF success rates improved to the point where it didn’t really make sense to do those injectable treatments. It made sense to move straight to IVF.”

Using Injectable Medications Outside of IVF

For the last decade, the use of gonadotropins outside of an IVF cycle has largely been limited to the 5% to 10% of patients who don’t ovulate and thus won’t respond to oral medication, says Dr. Omurtag.

Recently, “you’re starting to see more niche use of gonadotropins outside of IVF,” he adds. For example, a doctor may suggest gonadotropins alone if you are in your late 30s and have a low egg count. Gonadotropins might also be paired with IUI in cases where the risk of multiple births is deemed low.

Price of Injectable Medications

One cycle of gonadotropins likely ranges from $3,000 to $6,000 without insurance coverage, depending on dosage and the market. Insurance coverage is employer-dependent.

Side Effects of Injectable Medications

Side effects of injecting gonadotropins may include:

• Fatigue
• Bloating
• Mood swings
• Nausea
• Bruising at injection site
• Mild pelvic pain or abdominal pain

One potentially serious side effect may be ovarian hyperstimulation syndrome, where the medication sends your follicle growth into overdrive, possibly causing fluid to leak into your abdomen or lungs. This is rare, and most cases are mild and can be easily treated. In extreme cases, ovarian hyperstimulation syndrome is life-threatening and patients need to be hospitalized.

On average, a patient who has gone through three cycles of injectable medications without success should move on to other fertility treatment options.

Intrauterine Insemination (IUI)

If you’re unsuccessful with oral fertility medications, the next step is likely intrauterine insemination, or IUI: injecting sperm directly into the uterus. IUI “puts the sperm closer to the egg so you increase the odds that at least sperm and egg will meet,” says Dr. Omurtag.

Some patients skip trying oral medications alone and immediately turn to IUI, depending on test results and their timeline. If your partner has a low sperm count, or if you’ve been diagnosed with unexplained infertility, you’re an “ideal candidate” for IUI, says Dr. Marsh.

IUI is often paired with oral medication. It can also be done with gonadotropins or with no medication.

What Happens During IUI?

Your doctor washes fresh sperm (collected the same day as the procedure), places it into a catheter and injects it into your uterus. “The wash can take one to two hours, but the procedure takes around five minutes,” says Dr. Marsh. The procedure also involves a speculum exam.

Success Rates of IUI

In cases of unexplained infertility, IUI “probably adds about a 3% to 5% chance of success, being liberal with it,” Dr. Omurtag says. This success rate is why IUI is often used in tandem with medication.

Price of IUI

Expect to pay roughly between $300 and $800 without insurance coverage for the basic procedure. “Some clinics recommend doing mid-cycle ultrasounds to monitor how the patient is responding and then use an injectable medication called a trigger shot to time the IUI, and those things can add to your cost as well,” says Dr. Omurtag. “The trigger shot may be $100, and the ultrasounds can be anywhere from $150 to $400 [as ballpark figures].”

Side Effects of IUI

Side effects may include minimal cramping and spotting. Talk to your doctor for a full list of potential side effects, including rare complications.

If you aren’t successful after three cycles of IUI, your doctor will likely recommend you move on to IVF.

In Vitro Fertilization (IVF)

When it comes to IVF, “it’s taking what you’re doing with the oral medications, with the gonadotropins, and hitting the boost button,” says Dr. Omurtag. “You’re maximizing your ability to get the ovary to make as many eggs as possible.”

During IVF, doctors retrieve your eggs during a short outpatient surgery, inseminate them in a lab and implant the resulting embryos, typically one at a time, in your uterus.

You may skip straight to IVF if your fallopian tubes are blocked, if your partner’s sperm counts are low, if you have severe endometriosis or if you’re freezing eggs or embryos. Or, you may make the decision to try IVF after at least three failed cycles of IUI.

What Happens During IVF?

“There can be many medications that go into an IVF cycle,” says Dr. Marsh. “In my practice, we typically start with oral contraceptive pills to coordinate the start of the cycle and then supply gonadotropins to promote growth of multiple eggs simultaneously.”

Most patients inject gonadotropins daily for eight to 14 days. These injections are made with small needles—similar to the needles used for insulin injection—and are typically performed at home. You can self-inject or ask a partner, family member or friend to help. Doctors monitor your progress with blood tests and ultrasounds every few days.

The egg retrieval process is an outpatient surgery that takes anywhere from 10 to 30 minutes and is typically done with anesthesia. Doctors use a needle to suction out the eggs that have matured in your ovaries. From there, an embryologist inseminates the eggs with your partner’s sperm to create embryos, which are left in the lab for three to five days to culture.

Depending on your treatment plan, an embryo may be transferred immediately to your uterus after the culture period, or embryos may be frozen to wait for results of chromosomal and/or genetic testing. “Any excess embryos are frozen to be used later to grow the family, if the first cycle works, or to try again if the first cycle doesn’t work,” says Dr. Omurtag.

The transfer process requires another short, outpatient surgery. It usually doesn’t require anesthesia.

When you’re preparing for an embryo transfer, your doctor may prescribe progesterone shots to help increase the chances of successful implantation.

Success Rates of IVF

About 50% of embryo transfers completed in the U.S. in 2018 resulted in live birth for women younger than 35 years old, according to the most recent CDC data . The number dropped to 44.1% for women ages 35 to 37, 37.6% for women ages 38 to 40 and 26.6% for women ages 41 or 42. For women 43 and older, the rate was 12%. The CDC offers an IVF Success Estimator tool that will calculate your estimated success rate based on your age and other factors. Remember this is an estimate—it’s impossible to predict how the procedure will go for you.

Price of IVF

IVF usually costs somewhere between $15,000 and $20,000. Make sure to ask your clinic if the quoted price includes medication. “For example, in our office, an IVF cycle is about $14,000. But when you add the meds, it can get more expensive,” says Dr. Omurtag.

Medication price depends on many factors, including your age and AMH level (the number that indicates roughly how many eggs are in your ovarian reserve), but may range from $3,000 to $6,000 for the entire treatment. There also may be separate bills for items like anesthesia, which can be a few hundred dollars.

Employers are getting better at including fertility treatments in insurance plans, Dr. Omurtag says, but it’s far from a given.

Side Effects of IVF

Side effects of IVF may include:

• Fatigue
• Bloating
• Mood swings
• Nausea
• Bruising at injection site
• Pelvic pain or abdominal pain
• Vaginal discharge

Like IUI, one potentially serious side effect of IVF may be ovarian hyperstimulation syndrome.

Other Assisted Reproductive Technology (ART)

Less common assisted reproductive technologies include:

• Assisted hatching. With this procedure, doctors use a laser to create a tiny hole in the hard outer layer of an embryo before implantation, typically on the third day of embryo development. This procedure aims to help the embryo break free of the hard outer layer, which is required for it to implant into the uterus. This procedure might be attempted in patients in their late thirties (or older) who have experienced at least one unsuccessful round of IVF. The success of assisted hatching is not well-proven, says Dr. Mancuso.
• Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT). Both of these procedures involve a laparoscopic surgery to inject either gametes (a mixture of egg and sperm) or zygotes (eggs that have been successfully fertilized in a lab) into the fallopian tubes. GIFT and ZIFT are used in less than 1% of fertility treatment cycles in the U.S., according to Dr. Marsh.

Fertility Surgery

Laparoscopic surgery, or simply laparoscopy, is a minimally invasive surgery that can detect and potentially correct issues in your uterus, ovaries and/or fallopian tubes that could be hindering your ability to get pregnant.

Through laparoscopy, a doctor may diagnose and/or treat:

• Blockage of the fallopian tubes, such as fluid from a prior pelvic infection or surgery
• Endometriosis lesions
• Uterine fibroids
• Pelvic adhesions

The procedure typically involves a small incision in the navel—and potentially a few other small incisions nearby—to insert a fiber-optic lens and tiny surgical tools used to cut out or burn off fibroids, lesions or other blockages.

This type of surgery may cost anywhere from $5,000 to $10,000 out of pocket. Depending on your situation, it may help to ask your provider about the possibility of billing the procedure under treatment for endometriosis. “A lot of times, endometriosis surgery will be covered by insurance where fertility isn’t,” says Dr. Mancuso.

Donors, Gestational Carriers and Surrogates

If you aren’t successful with IVF, it may make sense to explore donor eggs, donor sperm or donor embryos. These donations are more common than patients think, says Dr. Omurtag, and they have excellent success rates.

You may learn throughout the fertility treatment process that you’re unable to carry a child or that carrying a child presents a serious health risk. Gestational carriers or surrogates are also options. With a gestational carrier, you provide the embryos to implant. Surrogate is the term for a gestational carrier who also provides eggs.

Considering the fee paid to the donor or gestational carrier, IVF fees, agency fees and legal fees, third-party reproduction often costs into the six figures. There is also what is called a compassionate surrogacy agreement, in which the surrogate, typically a friend or family member, does not take a surrogacy fee. However, with medical and legal fees, the cost will still likely be at least $30,000.

Surrogacy laws vary by state. The National Infertility Association has more information on surrogacy-friendly states.