For most couples getting pregnant is simple and easy.  They just get pregnant and don’t have to go through expensive infertility testing and years of praying and hoping for a successful pregnancy.  For others it is a difficult struggle.  While there are many reasons couples may suffer from infertility, one of the biggest hurdles that prevents them from getting pregnant is the financial aspect.  Infertility treatment is expensive and not covered by most insurances.

So, I get this question a lot from patients struggling from infertility.  If you are going to dip into your personal savings or take out a loan to start a family, what makes more financial sense IVF or adoption? 

Let’s start with IVF.  Let’s just review what IVF is first.  The infertility specialist will extract some of your eggs and then add your partners sperm in a laboratory outside of your body and then at the appropriate time place that embryo in your uterus.  Now, what does IVF cost?   On average, one IVF cycle will cost somewhere between $10,000-$15,000.  Of course, the variation in cost is also dependent on the reason for infertility and a lot of other parameters.  Now this in no way guarantees you a baby.  However, the technology is improving every day and the success rate is rather impressive at certain facilities.  A good percentage of youngish (early thirties) healthy women will likely get pregnant by three cycles.  

My patients that pursue IVF frequently get asked- why not just adopt?  Well for one it is way more expensive than the average person realizes.  The average adoption in the U.S. costs between $27,000-$30,000.  The average adoption overseas can cost as much as $58,000-$65,000.  Most patients have this perception that adoption is cheaper until they have already invested in the process.  And again, just because you spend this money, there is no guarantee that you will get a baby.  Another consideration with adoption is time.  Even under the best of circumstances, adoption can take years to bring a child home.  

Another less well-known option that is much more affordable than IVF or traditional adoption is embryo adoption/transfer.  When couples go through IVF, they usually end up creating more embryos that they can use.  So, thousands of embryos sit in a lab and go unused.  With this procedure, couples with infertility will use donated embryos and just have them placed in their uterus at the appropriate time.  The cost of this procedure is about $3,000-$5,000.  

The decision on how to expand your family if you suffer from infertility is very complex.  It is important that you educate yourself on your personal fertility.  If the cause of infertility is known, treatment will likely be a lot more successful.  Know and research different options on building your family before deciding whether it be IVF, adoption or even foster care.  If electing to try IVF or embryo transfer, be sure to research your local infertility specialists and make sure you know their pregnancy rates.  The best programs out there will have a high pregnancy rate and a lower number of embryos transferred.  We are fortunate to have two options here in town:  Idaho Fertility Center and Reproductive Care Center.  If seeking adoption (and there are definitely many children who would benefit from these services), then be sure to research and find a reputable adoption agency.  Your needs may vary depending on the area from where you are hoping to adopt a child.  Whatever you decide, good luck in finding the best option for you to bring the newest member of your family into your home :)

​Dr. Pam

As fitness wearables become more commonplace, many people may assume that if I wear my new gear and take my steps, I will instantly begin to look just like (insert your favorite fitness model’s name here).  I mean, it sounds simple.  Take 10,000 steps per day, burn an extra 500 calories per day, or 3,500 per week (the amount in a pound of fat), and then you’ll just walk any extra weight right off.  Unfortunately, as many people have discovered, that’s not exactly the case, and here’s a few reasons for these fitness setbacks:

1. Your actual body composition differs from the weight used in this calculation:  These metrics are for a 180 lb person who travels 5 miles in 10,000 steps and burns roughly 100 calories per mile.  So, if you only weight 120 lbs, then you’d really only burn about 300 calories over the same 5 miles.  Also, if your stride is too short to travel 5 miles in your 10,000 steps (ie perhaps you’re a bit more petite than allows for long enough strides to reach your 5 miles), then you may also miss out on hitting your burned calories goal.  Also, even at rest body composition can play a role in your metabolism with muscle burning 7-10 calories per pound per day whereas a pound of fat may only burn 2-3 calories per day.  Thus, even if you hit the 500 calories from the 10,000 steps, you may still not see results if you have a higher fat to muscle ratio as your baseline metabolic rate (calories burned at rest) is slower.  Also, as you lose weight, the amount of effort to burn the same calories in exercise increases while your basal metabolic rate decreases. 
2. Say you weigh exactly 180 lbs and your body composition exactly matches that of the test subjects.  Intensity in your travel may also affect the number of calories burned.  Walking at a 4mph pace (or a mile every 15 minutes) would put you on track for 500 calories burned.   So, it takes roughly an hour and fifteen minutes of walking to burn those 500 calories.  Say you increased your pace to 6mph (a mile every 10 minutes).  You could look to burn 444 of those 500 calories in just 30 minutes, or with only 3 miles of effort instead of 5 miles.  Add another 4 minutes of running, and you’d match the 500 calorie output in just 34 minutes instead of an hour and fifteen.  Alternatively, if you walked more slowly than 4mph, then it would take a longer time to burn 500 calories, so you’d need to extend your walking time to reach your goal.
3. Gender also plays a role in metabolism.  For instance, following puberty, most men began to increase their lean body mass as testosterone levels increase, whereas for women, we don’t see such a surge in lean muscle as testosterone levels are naturally lower than for men.  That being said, participation in activities, such as weight lifting, that increase lean body mass may cause a slight increase in metabolism
4. Age can also play a role.  As we age, we may begin to see a decrease in muscle mass over time.  This can be due to participating in less weight-bearing and strength-training activity, dietary changes and also that maintaining lean mass may become a little more difficult due to simply being older.  In addition to the loss of muscle mass from the changes listed above, the parts of the body responsible for metabolism begin to wear down.  While staying active and paying attention to diet can help offset these changes, the bottom line is that the whole pizza you could eat without gaining an ounce at 20 will make you gain weight at 40.
5. Speaking of diet, one of the biggest misconceptions about exercise is that once done, you can now eat whatever you want.  You know the extra 500 calories you burned?  Check out the number you’re putting back in your post-workout smoothie.  Or in your post-workout splurge at whatever fastfood you might be treating yourself with.  It’s so easy to “treat” yourself with more calories than you burned exercising, not too mention more vigorous exercise often makes us hungry, so we tend to eat more than when not exercising anyway.

The bottom line is that there’s no easy way to lose weight and stay fit.  Those who tend to have the most success make changes that they can live with long term.  Results from a crash diet and daily intense workouts will only last as long as your motivation.  Ultimately, you will gain the weight back.  If you hate running, then you won’t keep doing it.  If you find that you love hot yoga and long walks with your dog, then do that.  If you’re eating 500 calories a day and are always hungry, then you can’t do that forever, and the weight will come back.  It's the same with diet pills you take for a few months and then have to stop for heart health.  Switching out healthier recipes for foods you already love to eat can be something you can allows for not feeling deprived while making positive progress.  The bottom line is that more calories have to be expended than consumed for weight loss to happen.  Gradually eating more healthily and learning to be active in a fun way are changes can allow for lifelong success.
Dr. Nick