IVF and Family Building: At The Prelude Network, Compassion is Key

Fertility care is an increasingly popular avenue for LGBTQ+ family building as people answer the primal call to parenthood. The science behind assisted reproductive technologies is sound, and it’s well understood: When the ingredients for life — sperm, egg, and uterus — are brought together, it’s possible for a child to be the end result.

But The Prelude Network (North America’s largest and fastest-growing network of fertility clinics, with more than 90 locations) understands that there’s more to fertility care than biological science. Compassion is key — in fact, the Network has a dedicated staff member to help patients understand the emotional components of fertility treatment and care. The feelings patients walk in the door with, as well as the highs and lows of fertility treatment, are real and powerful.

That’s where Chief Compassion Officer Dr. Alice Domar comes in.  “I've been in the field for a long time,” Dr. Domar says, “and I've done a lot of research on the psychological impact of infertility and the psychological impact of treatment. For the last 10 years, I've been doing research on why patients drop out of treatment, and the number one reason why insured patients drop out of treatment is stress. It makes sense to have a chief compassion officer, because the idea is for me to design programs to better support our patients so that they can stay in treatment until they have a baby.”

Dr. Domar doesn’t personally advise every patient in the Network, but she has created a trove of resources that prospective parents can draw upon for reassurance that their emotional journey is a normal and natural part of the process.

“Patients can literally get them from their phone,” Dr. Domar says of the articles she’s written. “I started off by writing a series on ‘How to Stay Sane,’ like, ‘How to stay sane on Mother's Day,’ ‘How to stay sane on Father's Day,’ and ‘How to Stay Sane When You're Doing Your First IVF Cycle.’”  

The articles are designed to address the specific experiences that patients might have, which includes the parts of the process that take place between procedures. Dr. Domar shares that one early essay addressed “How to Stay Sane During the Two-Week Wait” — because, she says, “the two-week wait between embryo transfer and pregnancy test is by far the worst time for patients. So now, every time a patient in The Prelude Network has an embryo transfer, they're handed this booklet, and it's a day-by-day instruction manual: ‘On day one, this is what you could do to reduce stress. On day two, this is what you can do.’

Plenty of Dr. Domar’s texts center LGTBQ+ patients specifically, but there are certain truths that apply no matter who’s looking for fertility care.  

“Infertility is brutal,” Dr. Domar states. “I published a paper about 25 years ago that showed that women with infertility had the same level of anxiety and depression as women with cancer, HIV-positive status, or heart disease. So, it has the same emotional impact as a potentially fatal disease.” For men, too, the emotional stakes are profound: “In general, men are stressed because they tend to equate fertility with manliness and virility,” Dr. Domar notes. “There is a lot of data to show that, in couples where it's a male factor that accounts for infertility, the man reports more stress than when it’s due to a female factor.  

“There was a study that came out of UCSF a few years ago that showed that around two thirds of women [experiencing infertility] were clinically depressed, and a third of men were depressed,” Dr. Domar notes. Moreover: “About 70-something percent of women were clinically anxious, and about 60-something percent of men were anxious.”  

Anxiety for LGBTQ+ patients would be understandable for other reasons, too. Prospective parents from the queer community are entering a medical context when they walk through the doors of a fertility clinic, and too many have experienced discriminatory treatment at the hands of medical professionals.  

Patients of every sort have nothing to fear from the providers at The Prelude Network, who treat everyone with the attention and respect they deserve. For LGBTQ+ families (and individuals seeking solo parenthood), that includes the understanding that queer patients have distinct experiences and needs that require specialized care.  

Dr. Domar illustrates with the example of a theoretical lesbian couple who “immediately have to go to insemination” because, unlike a mixed-gender couple, they won’t have made attempts, perhaps for years, to achieve pregnancy on their own before seeking fertility care. Even when they do undertake medical intervention, this theoretical couple “can't just take a couple of pills and go home and have sex” to see if they can achieve pregnancy without resorting to IVF, Dr. Domar points out. “They're going from deciding to have a baby straight to IVF, and they don't have any of that ramp-up time of more aggressive treatments that are going from zero to 60 more slowly.”

Another point to ponder: LGBTQ+ families seeking fertility care experience greater stress due to factors that go beyond disparities they might previously have encountered in a health care setting. Familial rejection, or even a lack of support for attempts to become pregnant, create unique stresses, too.  

“I'd say, of the LGBTQ patients I've had in my career, probably half of them have family members that say, ‘You shouldn't have a baby,’” Dr. Domar shares. “So, while there are reasons they might be less stressed because they haven't had [to go through a long ordeal of] infertility, there are lots of reasons why they could be more stressed” than their heterosexual peers.  

That lack of support isn’t limited to families; it can also be institutional. Dr. Domar cites state laws that mandate that couples must “have tried for a year before insurance would kick in and cover anything.” The disparity in such cases is obvious: “A lesbian couple, for example, would have then had to have paid for a year of inseminations, which is thousands and thousands of dollars before coverage would kick in” — an expense of both time and money.  

But who provides for the providers? Here, too, The Prelude Network leads by compassionate example.  “We're working on a booklet now on how to decrease stress if you're an employee of the Network who’s working with highly anxious patients,” Dr. Domar reveals. That’s only one way in which The Prelude Network cares for the very people who care for patients looking to build their families.  

That’s a natural extension of one of The Prelude Network’s fundamental philosophies: That providers bring more to patients when the providers are well cared for, too. In this respect, Dr. Domar and The Prelude Network are well matched, since Dr. Domar has been writing inclusive, compassionate texts about fertility care since well before she joined the Network’s staff.

“I had a book that came out 24 years ago called Conquering Infertility” Dr. Domar recalls. “There was a chapter on the challenges of LGBTQ people trying to have a baby. The Prelude Network’s marketing department decided that they wanted me to revise it. In addition to revising it, I changed all the pronouns, and enhanced the chapter on LGBTQ issues.”  

The book’s updated edition “came out about three weeks ago,” Dr. Domar adds, “and so now every patient who's receiving infertility treatment gets a free copy of the updated book. It's a very inclusive company.”  

To that observation, Dr. Domar adds: “I started my job a little over three years ago, and the company is based in Houston. I get to Houston, it’s the first week of June — you know, Pride Month. I get off the elevator, and there are rainbow flags on every door, every desk, in the bathroom. I thought, ‘This is amazing. Clearly, there's a huge focus on supporting the needs of everybody, not just heterosexual couples.’”  

Dr. Domar offers one basic truth that’s germane to all the texts she’s created in her prolific output as The Prelude Network’s Chief Compassion Officer: “Every patient deserves to get infertility treatment that matches what their needs are. It doesn't matter what their sexual orientation is. It doesn't matter if they're married or single. Anybody who wants to have a baby should be given that opportunity.

“Well, that's our whole company’s philosophy.”