We Were Paying Off $700K in Student Loans. And Doing IVF at the Same Time. #480

We got married in our thirties. Started IVF in the middle of paying off $700,000 in student loan debt. And Nii was working locums shifts several states away — the very thing funding our fertility journey was also making it harder.

This is the episode we've never been able to fully tell. Until now.

You'll hear:

→ Why we got married later — and what that cost us biologically

 → The rule we made when paying off debt (and how it complicated everything) 

→ IVF at $25,000 per round with no insurance coverage in Pennsylvania 

→ How locums income was our financial lifeline — and our biggest complication 

→ The appointments Renee attended alone while Nii was on the road 

→ What the IVF doctor said when Renee ovulated through her medications (and where Nii was) → Multiple rounds. None of them worked. 

→ How our boys came naturally — and the joke we make about their 529s 

→ 3 practical tips for physician couples navigating debt and fertility simultaneously

TEXT US: Have you ever had to choose between your financial goals and starting your family? Tell us your story. 1-833-230-2860 We read every message.

3 PRACTICAL TIPS FROM THIS EPISODE:

1. Know your state's IVF insurance laws before you choose where to live or work. Some states mandate insurance coverage for IVF (NJ, NY, MA, IL, and others). Pennsylvania did not cover us at the time. This is a factor worth researching — especially if you're in your thirties or planning to start a family.

2. Have the fertility conversation with your partner before you need it. Don't wait until you're in the middle of debt payoff to find out you need IVF. Talk to a reproductive specialist early. Get your baseline numbers. If you're a woman in medicine who wants children — consider freezing your eggs earlier rather than later.

3. Build your financial plan around your whole life — not just your debt. Your financial plan needs to account for more than the numbers. Build in the fertility timeline. Build in the family goals. Build in the geographic constraints. And if locums is part of your debt payoff plan — decide how far is too far before you take the assignments. Not after.

Find us on YouTube: www.youtube.com/@docsoutsidetheboxpodcast

RESOURCES MENTIONED IN THIS EPISODE: 

Locumstory. Learn how locum tenens helps doctors make more and have the lifestyle they deserve!. Check them out HERE!

Resolve Website - https://resolve.org/

FREE DOWNLOAD: 

Download the First-Gen Doctor Blueprint — everything we wish someone had told us about finances, career planning, and building a life in medicine. Visit: https://darkos.lpages.co/first-gen-physicians/

Have a question for the podcast?

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• Text us: 833-230-2860
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• Email: team@drniidarko.com 

ABOUT DOCS OUTSIDE THE BOX:  

We're Nii and Renee — first-generation doctors (Ghanaian and Haitian) who didn't have physician parents to guide us. We paid off $700K in student loans, went through multiple rounds of IVF, and learned everything the hard way.

This podcast is the blueprint we wish we'd had.

DISCLAIMER: Dr. Nii and Dr. Renee are physicians, not financial advisors or attorneys. Content shared in this podcast reflects personal experience and should not be considered financial, legal, or medical advice. Please consult qualified professionals before making financial or career decisions.

© 2026 Docs Outside the Box. All rights reserved.

Transcript

Personal Warning And Why It Matters

SPEAKER_02 0:00

Yo, what's good everybody? Listen, before we start today's episode, I just want to warn you all that this one is pretty personal. Um, this is actually more personal than anything we've shared on this show before. Um it is. If you think about all the 10 years that we've been podcasting, this is probably the most personal story um that we've shared. Because we've talked about debt, we've talked about relationships, but we never really talked about in vitro fertilization or IVF and what it's like to do IVF, have personal debt, and what it means to actually carry about $700,000 in student loans through some of the more harder moments of your life, right? Um, but before we get there and talk specifically about this episode, if you are a physician and you are wondering whether there's a different way to structure your career, um one that's gonna give you more financial flexibility and definitely more control, take a look at locumstory.com. Um, it's a free resource, it's unbiased information about locum tenants. I definitely wish it was there when we were doing things back in 2012. But what you'll find there is you're gonna find real physician stories. There's gonna be a free crash course to let you know how well you'll do with locum tenants, and you're also gonna get practical guidance to help you make informed decisions about your career. So locum's played a significant role in our debt payoff story, and as you're about to hear in this upcoming episode, you're gonna hear about how it played a role in our complicated IVF story. So check it out, locumstory.com. It's free, it's no sales pitch, just information. You ready? You ready to get into this?

SPEAKER_00 1:45

Ready to rock.

SPEAKER_02 1:51

Let's do this. Let's

Locums As The Hidden Backstory

SPEAKER_02 1:52

do this. All right, everybody. Welcome to Docs Outside the Box. I'm Dr. Ni, trauma surgeon, locum tenants physician, first gen doctor from Queens, which is the best. And today I am joined by Dr. Renee. You want to introduce yourself real quick, girl?

SPEAKER_00 2:08

You already did. That's all they need. I didn't I didn't even introduce you actually. Listen, that's that's all they need to know. Is this is Dr. Renee?

SPEAKER_02 2:14

He says it is just says it all. A word? Okay. Park Slope's finest, everybody. What present? You know what I'm saying?

SPEAKER_00 2:21

Get out of here.

SPEAKER_02 2:23

OB from Brooklyn. Woo ooh. So today, listen, we're gonna, like I said earlier, we're gonna be sharing something that um we've never shared before, and and at least with this much detail about our personal relationship. Um, we've talked about our marriage, we talk about how we share finances, we talk about how we paid off debt, um, but we never talked about specifically about IVF. Okay. No, we haven't. I feel like we have. No. And um specifically how having $700,000 of student loan debt, how that actually affected our ability to have a family. That's something that we really don't talk too much about. I think that's something that a lot of people don't talk about. You guys who are listening right now, you might be struggling with this right now. This episode is for you. This is this might be a little bit emotional, possibly, um, but it's gonna be honest, right? And I think it's gonna resonate with a lot of you all who are probably suffering through something similar, right? Particularly those who are really big or really not big, but people who have done delayed gratification with their careers, whatever it may be. It could be medical related, it could be whatever it may be. But if you're starting later in life, this may be something that you may have gone through. So, Renee, thank you very much for coming on the show because um this would have been weird, just me doing it by myself. I'm sure you can tell the story just as well as you can. Nah, there would have been a lot of mansplaining in this. They would have got me on the socials.

SPEAKER_00 3:50

You can't mansplain your own story.

SPEAKER_02 3:53

Uh, okay. Tried letting the the internet know about that.

SPEAKER_00 3:58

Anyway.

Late Marriage Meets Fertility Biology

SPEAKER_02 4:00

Anyway. Well, listen, let's start. Let's start. Listen, we we let's get this going. So I think the first thing to talk about and how this all, guys, how this all got started is we gotta set the stage correctly. Number one is we got married later in life, right? I got married in what? I was in my late 30s, you were what? Okay. Um, she getting tight. She getting tight. Let's go. I was in my late 30s, then. She getting tight. But um, we got married later on, mainly because of me, guys. I'm gonna be really honest. So it was mainly because of me.

SPEAKER_00 4:32

How do you figure that out?

SPEAKER_02 4:33

Well, I I think that I was the person who said that. Is it fair to say that you were considering marriage a little bit earlier than I was?

SPEAKER_00 4:43

No. It's not.

SPEAKER_02 4:46

Okay. All right. So consider all right, then I I need to correct this story because for me, guys, I'm gonna be I'm gonna talk for myself. Good. Right. So for me, I was raised that I wasn't going to get married until I finished everything. I wasn't gonna have children until I finished everything. My mother was very like she impounded it into my head at a very early age that once you get married, once you have certain types of commitments that you can't get out of easily, the goals that you have in life change and the things that you may want to get really take a uh may fall by the wayside. Is that fair to say? Well, that's that's my story. So for me, it was like I'm not getting married until I finish medical school, until I finish residency, fellow. All of that, once my career is established, or I at least I see the finish line, you're not gonna see me clank clank getting married. Okay. And I've shared that with you, right? Okay, but but there's nothing, but I mean, but you you're not following it. You just saying it act like all right, anyway, let's move on. I'm just saying. Right. So for me, I didn't get uh we didn't get married till our late 30s. I didn't finish my fellowship until what? I was 32, 33, right? And then obviously I proposed, you know, we had a couple of bumps here and there and stuff throughout our dating and in medical school residency and fellowship and so forth. But we kind of got things together and stuff. Yeah, at the end, it all came together at the end. But by the time, but by the time we got it together, it it was in our late 30s, right?

SPEAKER_00 6:17

Yes, but I just want to be clear that we didn't we didn't not get married early because of you. I was not thinking about being married while I was in medical school or residency.

SPEAKER_01 6:34

How about fellowship? What my how about when I was in fellowship?

SPEAKER_00 6:39

No, because you were in fellowship. First of all, we weren't even together when we were in fellowship.

SPEAKER_02 6:44

All right, guys, before we share too much, all right. So listen, guys, you guys get the point, right? So by the time we got married, you know, I'm in my late 30s, Renee's in her late 30s, as you all know, if you are medical professionals, higher risk of infertility. Is that correct to say? Can we agree on that?

SPEAKER_00 7:02

That, yes, it becomes more difficult to become pregnant. Yes. And that's just biology, okay? That's just biology, not mansplaining. And you're a doctor, so you're allowed to say that.

SPEAKER_02 7:11

Right. And we learned this the hard way. So for those who are, you know, if you're listening right now and you're like, yo, I'm just gonna delay, I'm gonna delay, I'm gonna delay, and my life is going to look like this at this age, just know that a lot of times it is biology doesn't allow that to occur. So my thought process is look, by the time I finish, I'm gonna be in my mid-30s, you know, then I'll be ready to get married and I'll be ready to support children. Then that's when I'll want children. But you don't think about that the person that you're dating, that biological clock is ticking and ticking and ticking and ticking. Yes. And you're dealing with old ovaries and shit.

SPEAKER_00 7:50

Get out of here. Now you mansplanting.

SPEAKER_02 7:54

Get them, get them, girls. So we put our career first. Um, we finished everything, we get established, you ready. But what happens when your body says, uh, yeah, like this ain't working. Yeah.

SPEAKER_00 8:07

Um, yeah, no, I mean, I think, yeah, people have to think about this career that they're going into and thinking about the implications of what life is going to look like. Sometimes you're not thinking about that. You think you have it all planned out, right? Because you're like, well, you know, I'm a woman. I should be able to have a baby, but you don't realize that essentially the human body is, you know, the physiology is physiologying. Right.

SPEAKER_02 8:36

So I know you're potting when you say you weren't thinking about it because I know you bullshitting. I'm not. You're a liar. I'm not. The time that we were dating towards the end when we were dating and off and on and so forth.

SPEAKER_03 8:47

Yeah.

SPEAKER_02 8:48

Was there any part of you that was like, yo, like my biological clock is ticking, I'm waiting on him? Or I may not be waiting on him, but my biological clock is still ticking. I may need to do this action. I may you never thought about that?

SPEAKER_00 9:00

No, actually. As an OB? No, I never actually thought about that because I mean, I wanted to have children, but if I didn't have children, I think I might have been okay with it. I don't know. I can't say now because the cat's out of the bag, but I I wasn't thinking about ticking clocks necessarily. What I was thinking about was where is this relationship going? You know, like, is this relationship worth my time at this point? That is what I was thinking. I mean, I'm just being honest. You're being honest with yours, right? Being honest with mine. Is this worth it? Is he the one? Should I be, you know, putting all my eggs, literal eggs, in this basket? Fellas, I'm just letting you know. See what I did there? See what I did there?

SPEAKER_02 9:50

Fellas, all I'm just saying to y'all is when you delay things and you're with a partner, don't forget, you know, they're just biological things that you ain't gotta go through that your partner is going through.

SPEAKER_00 10:02

And that's just men go through it too? Men go through it too.

SPEAKER_02 10:06

At an age or is it age-related or is it Yeah, there's some age-related infertility in men, depending on how What's the most common? Because you did you did a fertility fellowship. What's the most common? I didn't do a fertility fellowship. Because I know you ain't got no experience from me. Because you know, mine's were all good. Uh okay.

SPEAKER_00 10:26

And what I don't even understand what that means. You know what that means. I don't. I really don't understand what that means. First of all, I did not do a fertility fellowship. I did a health policy fellowship. I don't even know what I did.

SPEAKER_02 10:38

But you didn't you do like a didn't you do like a uh a rotation in fertility?

SPEAKER_00 10:42

Well, I'm an OB, of course. Like, that's like saying, like, you know, did did you work with an anesthesiologist as a as a surgery resident? Of course. Okay, you don't want to. Did you ICU?

SPEAKER_02 10:55

I did.

SPEAKER_00 10:56

Exactly. As a surgery resident. And it's the same thing. Like, I don't understand. Anywho.

SPEAKER_02 11:01

She's being tight on this. I'm not being tight.

SPEAKER_00 11:03

But no, I mean, yeah, men do have some age-related infertility. It's a little bit later for men, I think. But but for the record, that wasn't my issue.

SPEAKER_02 11:13

Yeah, and gotcha. All right.

When Infertility Becomes A Diagnosis

SPEAKER_02 11:16

So listen, let's let's move on to the IVF journey. I'm just saying, because we gotta be real, right?

SPEAKER_00 11:22

It wasn't my issue either. So, and actually, a lot of people. Are you sure about that? Yes, a lot of times, if not most of the times, people what are you laughing at?

SPEAKER_02 11:32

Now a man's playing. Okay, let's keep going.

SPEAKER_00 11:34

Okay, a lot of times there actually is no reason for the infertility that can be pinpointed. So that's very often.

SPEAKER_02 11:43

Take us back to when we first realized that we were having difficulty.

SPEAKER_00 11:46

Well, I will say this when we were engaged, we did talk about having children. We had talked about having children from before, in terms of like, you know, how many children would you like to have? How many children would I like to have? We talked about that. Um, but when we seriously talked about having children, it was right around the time we were engaged. And I said to you, I said, well, my age may be a factor, and therefore technically I should be considered infertile if I wait six months of regular intercourse and no pregnancy. So that's what that that was the discussion that we had. And so I think after six months, we were like, all right, let's just pull the trigger.

SPEAKER_02 12:38

So it was six months of having sex and not getting pregnant, basically. Okay. So what what is that process? Is there a diagnosis of your infertile? Like, is that like a doctor tells you you're infertile or you just know after six months of not getting some, or after six months of getting it and you not getting pregnant? Like, talk to us about that, how that diagnosis works.

SPEAKER_00 12:59

No, like that's a diagnosis. Like, that's it. That's all you need. Six months after the age, especially 35 and older, six months not pregnant, then you can be considered infertile. Okay. That like that's it. If you're if you're younger, then it's a year.

SPEAKER_02 13:15

Gotcha. What's what's what does a but give me like what does younger mean?

SPEAKER_00 13:19

Because I feel like somebody means before 35.

SPEAKER_02 13:22

Okay, so that's what I'm saying.

SPEAKER_00 13:23

Like what I said before, I said after 35 for six months.

SPEAKER_02 13:27

Okay, one thing that changes from from me was one, nothing happened with my sperm, but my hearing got worse. You know what I'm saying? So that's what I'm saying. As I got older. So it's sometimes I didn't catch what you said before. Okay, let's move on. She can't type. The emotional weight of hearing that you need IVF. What's up with that? Did you have any?

SPEAKER_00 13:46

No, I didn't necessarily have any emotional weight. What I did have, actually, though, was I think unrealistic expectations. Okay.

SPEAKER_02 13:54

Even as an OB. Give me an example. What do you mean?

SPEAKER_00 13:57

So I think I had an unrealistic expectation that, okay, well, if I don't get pregnant in six months, I'll do IVF and I'll just get pregnant from that. Right?

SPEAKER_02 14:06

That's that's what I thought. Money, money cures everything. Science cures everything.

SPEAKER_00 14:10

Science cure. It wasn't so much the money, but yes, it was the science, right? Because you see so many patients who come in, you're delivering lots of babies that have been delivered via IVF. So you think, okay, well, you know, it should work. And in the in the cases that it doesn't work, typically you're usually thinking it's, you know, someone who has some other issue, right? Some secondary reason for infertility, like, you know, PCOS, or I shouldn't say PCOS anymore. We're calling it PMOS. That's another discussion for another day. Um, but something like that, something like endometriosis, you know, some sort of, you know, anomaly. You know, you you're thinking of something else, right? Like there's some other reason. And I never had any of those issues. So I thought, ah, you know, we'll do some IVF and um we'll get pregnant.

SPEAKER_01 15:02

Okay.

SPEAKER_00 15:03

So that was that was my issue. Unrealistic.

SPEAKER_02 15:07

So the decision to start IVF, was there any hesitation about that? Let's talk about that.

SPEAKER_00 15:13

No, that I didn't have any again. Remember though, I'm OB. So I know because I see these patients, I know exactly, you know, what the algorithm is. The algorithm is, you know, 35 and older, you know, six months, no baby, no pregnancy, go for it. So for me, it was a it was a no-brainer. It wasn't anything that I had to sit down and think about and ponder, do I really want to do? It was a very easy decision for me. But I I recognize for you out there, you may not think that this is a very easy decision because sometimes you might feel stigmatized, right? Your family might be like, oh, when are you gonna get pregnant? Why you gotta do all of that? Just give it time. It's gonna happen. Don't, you know, don't just need to relax. Right. Y'all need to relax. But he's just not hitting it right. Well, I don't know about all that.

SPEAKER_02 16:11

That's the stuff they say.

SPEAKER_00 16:12

Well, I don't know about I never heard that before, but yes. Oh, you putting your legs up. You're not eating, you need to drink more water. Who out there needs to drink more water? You need to drink more water. So, yeah. Um, so no, it was a no-brainer for me, but I realized that you know, you may not necessarily see it as a no-brainer. You may see it as a stigma. And I think a lot of people probably do, or they are in such disbelief that they have gone through all this medical training only to become the patient.

SPEAKER_02 16:53

Okay. Here's one thing I wanted to ask you about is quickly, can you just talk about what multiple rounds of IVF looks like emotionally? What it feels like. Not from your perspective, but before. Did you think about that? No. Can you describe a little bit of that? Don't go too far, but just what do you think?

SPEAKER_00 17:10

No, but that's what I'm saying. Unrealistic expectations. I thought, you know, I'll do a round, I'll get pregnant, have a baby, you know, have some eggs left over, do another round, have another baby, have as many babies as I want. So when we went in, obviously you're just kind of scared. The one thing I will say is that I was concerned about whether or not I would produce enough eggs to do IVF. Because that I have seen where, you know, people go in, they put, you know, they should get shot up with all the hormones and then they retrieve eggs. And then by day five, you're supposed to have so many, right? Because you lose some along the way. But by day five, after your um, your your uh, what do you call that, putting the sperm together with the egg, you're supposed to come out with what they call blastocyst, right? So that's essentially the embryo that's supposed to go back in um into the uterus. So that's one thing I was afraid of. I was like, well, if I don't put out enough eggs, then I don't have enough, you know, I mean I have enough embryos. But then we were proven very wrong, right? Considering my age, I actually put out quite a bit of eggs and then we had quite a bit of embryos. We had a lot of embryos, actually. Um, so that was actually pretty surprising. Um, but then we kind of went through those.

SPEAKER_02 18:41

Well, uh look, we we can talk about our story, but I just the the like when you are seeing couples go through Okay, yeah. But how about this? Let's let's move on. We'll come back to that. Okay. Let's move on.

Expecting IVF To Be Simple

SPEAKER_02 18:56

Because I think what I want to throw in is guys, like things doesn't don't actually happen in a vacuum. So you got to remember, we're starting our IVF uh journey as we are paying off our $700,000 in student loan debt. As a matter of fact, we're starting it a little bit after we start to pay off our student loan debt. Yes. So one of the biggest things that we said when we started paying off $700,000 is we will not create any more student loan, or excuse me, we will not create any other type of debt whatsoever. So basically what that means is we had so much debt that we just said, listen, um, we're just gonna pay cash for everything else because there's no point in adding more debt. And now it's instead of $700,000, now it's whatever you want to get. If you want to get a car, now it's $713,000 or whatever it may be. So everything that we were gonna do from that point uh paying off debt until we paid it completely off, we're gonna do with cash. Now you throw on top of the fact that now we're gonna do IVF. Yes, then you throw on top of that we're in Pennsylvania, and at the time, Pennsylvania insurance really wasn't good at covering IVF. So we're talking realistically about $25,000 a pop for the entire process of doing IVF, right? Yes. How are we gonna come up with that, right?

SPEAKER_00 20:10

Yes. And mind you, we're only married, like we're married, what, less than a year? So, because we only went six months.

SPEAKER_01 20:18

Right.

SPEAKER_00 20:18

So we're married less than a year. So, you know, the dynamic there is you just got married and you're still figuring out this marriage thing, and you have to have this dynamic where you're on the same page almost immediately about money, which I think is it might be difficult for y'all.

SPEAKER_02 20:39

It depends, right? Because if you are a couple that decides to keep money separate, that could be hard. If you're a couple that decides to merge funds, but you are on equal or excuse me, opposite sides of how you actually manage money, that's still a problem. Yeah. The one thing that I did say um that I want everybody to kind of think about is we said $25,000. That's if it works. Right. Right? If it doesn't work, then you have to pay another $25,000. If it doesn't work, then you have to pay, you know, like it just, yeah, you got to remember like it's $25,000 for a shot to see if you'll get pregnant. Right. Not like it's not guaranteed. Right. So that's the one part that I think is difficult. Managing student loan payments, funding IVF rounds, and you guys can see where I'm going. I'm saying rounds plural and plural for us, because it didn't happen the first time, right? And the way how we managed it financially was by me doing locums on the side.

SPEAKER_00 21:36

I still do, remember?

SPEAKER_02 21:38

Yeah. So we took locums, but the majority of the times I was taking locums and I was geographically in a different location while you were doing IVF. You know, it was just, it was a lot. Yeah. And it gets really complicated.

Paying Cash While Owing $700K

SPEAKER_00 21:51

Yeah.

SPEAKER_02 21:51

You know. So uh really briefly, do you want to talk about real quick the medication process? Um, and how and how much that costs and so forth. Not like just let us know how that works.

SPEAKER_00 22:02

You know, what I remember of it now, right? Because it's so traumatic. But um so the medication process, first of all, you have to get your medications from a specialized pharmacy. So you're not walking into CVS talking about give me all the hormones. Like that's not happening, right? Except for maybe your birth control pills. Birth control pills you take, you know, because you obviously want the doctor to be able to control your cycles. And so, you know, you get on the birth control pills first, but then you start in on the injections. And those are the drugs that basically make your ovaries, they stimulate your ovaries to make eggs.

SPEAKER_02 22:42

Yeah. Those are expensive.

SPEAKER_00 22:43

Those are the ones that are expensive. And if I remember correctly, I feel like we paid like $5,000 a pop um for the, you know, for these drugs. And so you're injecting yourself, and it's very important to time your injections, right? You don't want to be, you know, injecting at like 12 and 12 at in 12 noon and then you know, 3 p.m. and then whatever. Like you have to time it so that you're almost exactly at the time. And the problem, remember, the problem was that I was working, but our IVF doc was in New Jersey.

SPEAKER_02 23:21

So we're working in Pennsylvania. That's what I wanted to talk to you about. Tell them, take, talk to them about what that was like timing.

SPEAKER_00 23:27

Yes.

SPEAKER_02 23:28

Clinic. You have clinic. Yeah. Then you got to go to IVF clinic. Talk to them about that briefly.

SPEAKER_00 23:34

A typical day in that two-week period, because you're doing this for about two weeks. A typical day in that two-week period would be I would wake up in the morning, I'd go to work at the clinic. Um, and then I'd get off from clinic at maybe 6 p.m. Remember, I'm in Pennsylvania. So I have to drive four hours to Jersey. Um, but I have to take my injection on that four-hour drive. So I have to stop on the turnpike at a rest stop, inject myself in the car, and then keep it moving to get to Jersey. By the time I get to Jersey, depending on you know how many stops I've done or whatever, I'm getting in by about 11 o'clock midnight. I'm waking up at five in the morning to go to the IVF center so I can do my ultrasound and my blood work by six o'clock in the morning. And then straight from the IVF center, I'm driving back to Pennsylvania so that I can do my afternoon clinic and then potentially be on call that night.

SPEAKER_02 24:36

And help others get pregnant.

SPEAKER_00 24:37

And deliver. At least help others deliver their babies. Okay. So that's a lot. That it was a lot. That's a lot because I was doing that probably about two, three times a week within that two-week span.

SPEAKER_02 24:50

And for clarity's sake, Renee chose this IVF clinic because that's where she did her rotation. So you didn't necessarily have to go to that one, you just happened to be comfortable going there. There were some in Pennsylvania closer.

SPEAKER_00 25:05

Yes. Well, closer, but still about two hours away.

SPEAKER_02 25:08

Gotcha. Gotcha. There's one thing that I wanted to talk about that is really interesting about our story, which has to do with me being far away and if the IVF medications aren't working.

Shots On The Road And Timing

SPEAKER_02 25:20

Or if they are working. So let's talk about ovulation. Let's talk about real quick. If you're ovulating through the medications, explain that happen what happens with that and what that means if I'm several states away. Boom.

SPEAKER_00 25:32

Yeah, this was really frustrating because there was one point you used to do locum sometimes a week at a time.

SPEAKER_01 25:38

Yeah.

SPEAKER_00 25:39

Um, and you'd be like away, away, not like a drive away, but like a plane ride away. And I'd be, you know, trying to get on this IVF bandwagon so that I'm ready for transfer. Um, and there there were at least two times when I ovulated through the medication, right? Where, you know, I was I was supposed to be on estrogen, just kind of being at bay and waiting for my doctor to manipulate things. And then I'd go for an ultrasound, go for blood work, and they'll be like, Oh, you're ovulating. I'm like, I am on hella estrogen. How am I ovulating? Like, this is impossible. And one day my doctor's like, well, just have intercourse. And I'm like, I can't because my husband is at work in another state paying for this.

SPEAKER_02 26:29

Yeah. Because we need we needed that income, you know, because remember, we are sticking to our thing, which is we're not gonna use credit cards, we're not taking a loan out for IVF, we're gonna pay cash for this. So, you know, I'm doing all these extra shifts. And like she said, I'm three, four states away. I can't just get on a plane, right? And this is like in the middle of an assignment. Right.

SPEAKER_00 26:49

Well, I mean, also you only have a 24-hour window. So, like, you know what I mean? It's like, no, it's happening right now. So you would need to be home right now, right? Because if you come home tomorrow, it literally could be too late.

SPEAKER_02 27:03

What what's that feeling like when you were at a rest stop? Because there's gotta be, you know, that drive, you're by yourself, right? That's a four-hour drive through the mountains, back into Jersey by yourself. That's taking the shots by yourself. What any feelings of isolation? Isolation?

SPEAKER_00 27:21

Not so much isolation. Talk to us about that.

SPEAKER_02 27:23

What you feel?

SPEAKER_00 27:24

It's it's a weird, how can I describe it? It's like it's almost like a what the hell? That that's I don't know how you describe that feeling, but it it's a a what the hell? Like, am I really doing this? Like in a car? Like, oh nobody's looking at me thinking I'm a drug addict, you know? Like, so I mean, I think that was the feeling that I had. Plus, you know, injecting yourself is not easy.

SPEAKER_01 27:55

It's painful.

SPEAKER_00 27:56

No, it's not that it's no, no, no, no, no. Before you get to the pain, it's not easy to inject yourself. It's not easy to pierce yourself. Like it's just not. You know, the the number of times that I had to like drum up the courage to even put the needle in, you know, is like like, oh my God. I don't know if you remember that. I used to be like, oh my God, oh my god, oh my god, oh my god.

SPEAKER_02 28:21

I had to inject you a couple of times.

SPEAKER_00 28:22

Yes, you've inject, oh, you injected me a bunch of times.

SPEAKER_02 28:24

We would use like frozen vegetables or what have you to numb up the skin. Yes. A whole bunch of different techniques.

SPEAKER_00 28:30

But it wasn't, it wasn't so much the pain. It's it's not it's not a pain that you're gonna do. It's the puncture. It's a it's uh, you don't want to harm yourself. Like you have like this, I don't know. I I I think that humans have an innate inability to harm themselves for the most part, right? For the most part. Um, and so I think that's what I was experiencing. I was experiencing this kind of like aversion to hurting myself. And so to inject myself, which I will say the smaller needles, way easier. But when it came to the big honking progesterone, because it's in oil. So you can't, it's not this little needle. It's like a really like thick, long needle. Like that one, I was just like, oh my god, oh my god, oh my god, oh my god. So yeah, that that was wow. Yeah. Oh my God. I'm like having like flashbacks of that needle.

Miscarriages And The Emotional Math

SPEAKER_02 29:32

How many rounds did we go through, Renee?

SPEAKER_00 29:35

Oh, we must have gone through six, seven rounds. Yeah, six, seven rounds. We even switched doctors at one point. Um what had at least six, maybe five or six miscarriages. Um the miscarriages, it's you know, I've treated so many patients with miscarriages. So to go through all of these miscarriages myself, you know, was a very interesting, I will say, experience. And part of the reason that I say it was interesting was because I didn't have the same experience as many of my patients. Like I didn't internalize it in the same way as many of my patients. A lot of times, you know, my patients they come in, they're, you know, pregnant, maybe they're finding out for the first time, or they knew before, but they're coming into the ER and they're miscarrying. And it's like this um it's like a like a future has been taken away from them, is the best way that I can describe it. You know, and you can see that with them. You can see that they saw their future, you know, they they saw what their family was gonna look like or how their family was going to change. And that's what they're they're experiencing that loss. Um, for me, it was more of a frustration of why isn't this working? Right. It wasn't so much like, you know, oh, I I lost a future or like I lost a baby. It wasn't like that for me. It was it was very technical. So it's, you know, it's kind of weird to say, but it was very technical for me. And I think that's because I'm an OB and I understand that miscarriages happen all the time. And I understand the mechanism of miscarriage in the first trimester.

SPEAKER_02 31:44

So I appreciate you sharing that because I think that's one part that a lot of people don't talk. That's one aspect that you have that a lot of people don't have. Um, so in general, we did multiple rounds of IVF, and I just want people to know that none of them worked. Just so y'all know. So I mean, for the for the sake of of this conversation or let's move it forward though. Yeah, yeah. And let's let's talk about how we made it work financially, right? So I want to pull back a little bit on the financial, um, the the mechanics behind, right? So now you and your element. I want folks to understand that you know, we had student loan payments, and y'all, we are making there are months where we're making like $9,000 towards the student loan payments. There's another month where we're putting $15,000 towards the student. I mean, these are painful payments that we're making, but we felt like we needed to do it. Yeah. There were some months we put $20,000 of student loan of money towards these student loans. It all depended on how much extra Renee was doing with her shifts and how many locums we both were doing. And we would just say, look, we would rather put all this money into the principal so it doesn't build up with interest.

SPEAKER_03 32:48

Yeah.

SPEAKER_02 32:48

Um, and now you throw on top of that IVF, which, you know, depending on how much medications you have left over from the previous failed um attempt, you know, like I said, it's getting between 20,000 to 25,000 around. We're paying that out of cash. I'm traveling. You know, sometimes you even traveled, you know, and you know, we're we're states away and it it it's rough. Yeah. But I will say that locums really helped us out a lot because I think the rates that we were getting with locums, I want people to really pay attention. Like, you know, this is 2012, excuse me, this is 2014, 15 that we're talking about. Yeah. You know, we're talking about like there's still a significant difference in the rates that people are getting for locums versus being an employee doc.

SPEAKER_03 33:33

Yeah.

SPEAKER_02 33:33

So that, you know, increased amount, that increased rate that we're getting from locums allowed us to, it basically was like an accelerant. And it allowed things to exponentially, you know, improve with our student loan debt. So I just want people to understand that. As much as the locums was helping out, I'll be honest with you, like, we gotta be honest, like that distance that was that potential distance that was, you know, like I said, we're working two weeks and then a week I'm gone. Right? Sometimes even longer. And then as soon as I get back from that week and a half or a week, then I'm back at it working at my my main job. So I think the finances worked, the financial math worked, but there's times where like the emotional side, the marriage part sometimes could get stressed. You gotta be careful about that. So the one thing that I was thinking about, I have this here on my notes, is if we had known about PSLF sooner.

SPEAKER_00 34:27

You always ask this question. Would that have changed anything about us? No. No, no, you know, I did not like having that monkey on my back, the student loans. I just I I don't know that I could have waited 10 years. I don't know. I don't know.

unknown 34:43

Yeah.

SPEAKER_02 34:44

Here's one thing that you talk about, which is you've talked about this before. So we we kind of have talked about IVF, but very vaguely, peripherally. Yeah, I mean, we yeah, we've mentioned you've talked about what it's like to go through IVF, but then you're delivering other people's babies.

SPEAKER_00 35:02

Yes.

SPEAKER_02 35:03

It was and there's a little bit of a what I not really a struggle, but kind of more of like a um like a like a it was an epiphany. Like poetic, just or just like irony.

SPEAKER_00 35:14

Yes, right?

SPEAKER_02 35:15

Like irony where it's like, yo, irony for me. You're struggling with this aspect, yeah, but then you have the the knowledge and the know-how to bring life into this world.

SPEAKER_00 35:25

Yeah.

Quitting The Job And Refocusing

SPEAKER_00 35:26

So the last miscarriage that I had, um you we got to six weeks. We got I got I was six weeks pregnant, and then I miscarried, and you said after all was said and done, you were like, you need to quit your job.

SPEAKER_02 35:48

Yeah, because my thought process is like we've heard these stories. I've read stories about uh women who have struggled who are in relationships, and like the husband saying, Hey, or they both come to that decision together, maybe your full-time job will be getting pregnant. In pregnant, going through this IVF uh struggle without, you know, the worries of having to go to clinic and operate and all these different things. Because at this point, by the time you are failed, multiple rounds, I shouldn't even say failed, by the time multiple rounds hadn't hadn't worked, we guys, at this point, we're like 75% done with our student loans.

SPEAKER_00 36:28

Yes.

SPEAKER_02 36:29

So there's a you we can see like the light at the end of the tunnel, the monkey is kind of coming off our back. And I just made the suggestion, and I was kind of nervous about it. I made the suggestion, I was like, hey yo, like, we ever thought about just quitting the job and just you know, because I thought barefoot and pregnant. I thought basically, I thought you were gonna come after me because I was like, Oh, I know this mug ain't telling me to just be pregnant. But I was like, maybe it might work. You know, just going to clinic, then going to your clinic, and then getting shots on the road, asking the truck drivers to give you shots. It ain't gonna work.

SPEAKER_00 37:02

I did not ask a truck driver to give me a shot. But uh when you said that, my first instinct was, no, I'm not quitting my job. That was my first instinct. I was like, I'm not quitting my job. Who is this man who's gonna ask me to? No. I no, that it wasn't even about that. It was more of my my thought process was actually this women get pregnant in war zones. Why can't I get pregnant with the stress of going back and forth to work and New Jersey and back to work?

SPEAKER_01 37:34

Yeah, but it ain't working.

SPEAKER_02 37:36

I get that, but that was my- And then that's when I bring in the math. Like, yeah, it ain't working and it's costing us. So yeah, well, you were more like it's costing us. Um, but you're gonna have to try something different. But I will tell you shit's getting expensive. For real. That's how I am, guys. So I I could be real and be like, I get all that bullshit.

SPEAKER_00 37:59

So what happened was that one day I was actually driving.

SPEAKER_02 38:05

Babies in war-torn areas. Why can't you Okay?

SPEAKER_00 38:10

You you done ranson? Okay.

SPEAKER_02 38:12

Go ahead, go ahead, go ahead.

SPEAKER_00 38:13

Um, no, what happened was I was driving to New Jersey one time. I was driving to, and I think it was for an IVF something. I was driving to New Oh, I think I was driving for my follow-up. I was driving, I think, for a follow-up visit. And I drove all the way to Jersey. And on my way there, I just had an epiphany. I was like, huh. I was like, you know, I've spent my entire life up until this point, you know, learning medicine, learning how to help people grow their families. And now, ironically, I cannot grow mine. And I was like, I've said, I have given enough attention to this part of my life. I need to give my full-fledged attention to now this part of my life. And for me, that's when it came. I was like, he's right, I need to quit my job. I need to quit my job. And so I went in, you know, I I came home. I told you I was gonna quit my job. You were very elated, although we were not gonna be making as much money. But you were very elated, and then I went in, put in my three weeks or three three weeks.

SPEAKER_02 39:30

Three months, notice, yes. Okay, but don't mess up. That's not where I'm going with this. That's not where you're going. No, no. But I get what you're saying. So she gave she gave in, she gave her three months' notice, and you know, that's how it goes. That was that. But listen, guys, listen, we want to, you know, before we end this conversation, because you know, we're getting towards

Insurance Laws And Practical Planning

SPEAKER_02 39:46

the end. Right. But we want to give you guys some practical tips. And I would did some research and I found some tips. So we want to make sure that you guys are able to take action on what we're talking about. Tip number one, I think this is the biggest one right now. But the landscape in 2014 is way different than the landscape in 2026, yeah. Especially in Pennsylvania. So know your state's IVF insurance laws before you choose where to live or to work. If you know that you're gonna be going through this process already, right? Yeah. So at the time we were in Pennsylvania, there really wasn't much coverage. There really wasn't an insurance mandate for fertility coverage. So, like I said, that meant 25k or in that range of 20,000 to $25,000 a pop for us each time. Um, but New Jersey had a mandate. New York Massachusetts, Illinois. There's a bunch of different places that have it. And I think that quite possibly, if we had known this, you know, could we have moved maybe or would we have known? I don't know. But it's just something that you something that you may want to know. Um, a good website to check out, guys, is resolve.org. Um, resolve.org is a really good nonprofit that puts a lot of information on infertility, whether it's where to find emotional support groups, what's the steps of IVF and everything that goes along with it. And it even has a nice little map that you can click on to find out what the state mandates are. So it's a it's a good place to check out. So I definitely recommend that resolve.org. So that's tip number one. Okay. Tip number two is have the fertility conversation with your partner before you actually need it.

SPEAKER_00 41:26

For sure.

SPEAKER_02 41:26

Right? For sure. So even if you're even if you're young. We didn't talk about this before. Right? No, we didn't. Like we were talking about while we got engaged, yes, but I already like proposed to you already. Yes. So it was bad form for me to be like, oh, you got old eggs. You know what I'm saying? No?

SPEAKER_00 41:44

So even if you're young, right? Because infertility doesn't just happen because of age. Infertility can happen for quite a number of reasons. And also prepare yourself that it may not be female infertility. It could be male infertility. Um, so I've definitely had patients where, you know, I remember one patient, the woman came in, she insisted. She was like, nope, it's me because the last time I took Clomid, and then, you know, we got pregnant and this, that, and the other. And I was like, yeah, when I do IVF workup, I work up everybody. And she insisted. I said, okay. I said, I'm gonna give you three months. I'll give you three months of Clomid. If you don't get pregnant, you come back, you test your husband. It was the husband. So um, you know, just it is something to talk about. What would you do and go all the way to the extremes, right? Where you basically say, okay, you've tried everything and now nothing is working. You know, what what should you do?

SPEAKER_02 42:48

Can can if you are, because obviously for the professionals who are listening to this, and it it doesn't have to just be medicine related. Anybody who's a professional, for the most part, they probably have done some type of delayed, um, they've delayed their career, or excuse me, they've delayed um family planning for their career. Is there any way that they can go to like a reproductive specialist before they start trying to kind of find out like baseline numbers or baseline level of fertility? Is there, does that happen at all?

SPEAKER_00 43:16

I mean, you can you can always make an appointment with an infertility doc. I mean, there's nothing wrong with. I mean, I guess based on your insurance, you always want to make sure that your insurance is gonna cover something. But even, you know, even if you just go to the OBGYN, like an uh, you know, a general OBGYN can at the very least do the preliminary workup. So you don't need to go directly to an IVF doctor. You can go just to your generalist OBGYN. They should be able to do something for you.

SPEAKER_02 43:50

Okay. Tip number three this is the last one build your financial plan around your whole life. Not talking about whole life insurance.

SPEAKER_00 43:58

I knew you were gonna say that.

SPEAKER_02 44:00

Around your whole life, not just your debt, right? Because we thought like our whole life was just our student loan debt. But we didn't think about well, what would happen if we can't have children? Yeah. And we wanted to use science, if we wanted to, you know, use the greatest and latest to help us. And what happens when it doesn't work? What happens if the the the most amount of money that you can throw in shit ain't happening still. What do you do then? Yeah. Right. So I just think that a lot of times, you know, you you you have the task at hand, but you forget like the other things. Like, well, you know, what if this example happens? What if A happens? What if B happens? What if C happens? You don't have to think about from A to Z, but I think it's important to have those conversations with your partner.

SPEAKER_00 44:43

Yeah.

SPEAKER_02 44:43

And just say, okay, well, you know, what if I have a medical emergency actually while we're having you know, what if I have an ectopic? What do we do there? What do we do?

SPEAKER_00 44:52

We we definitely had that scare. We definitely had me having a medical emergency. Um, yeah, we had a we had a couple of things happen while this was going on. And this is two and a half years. Like I want people to realize this went on for two and a half years. So you all like if you are thinking that it is going to just take, realize that you might not necessarily be in that bucket of people where it is going to just take. But if you, if it does just take, hey, congratulations to you because you know, the best thing that could happen is that you get pregnant, you start growing your family, and you don't have to pay as much for IVF anymore.

SPEAKER_02 45:41

So I so I think, you know, the next and the last thing we want to talk about is like this is where the story is going to land, right? So we like we said before, we did multiple rounds of IVF, it didn't work, right? We spent close to probably hundred, a hundred thousand dollars. Yes. Right. I think financially we were able to make it work, but it's exhausting. The travel um for you biologically, it could probably be, I could describe it as maybe exhausting.

SPEAKER_03 46:07

Yeah.

SPEAKER_02 46:07

Um, but both of our boys came naturally, right? Yes. Both of our boys came naturally.

SPEAKER_00 46:13

So can I tell

The Surprise Pregnancy And Next Steps

SPEAKER_00 46:14

the story?

SPEAKER_02 46:14

Quickly, please, because we're getting late on time.

SPEAKER_00 46:16

Okay, we're getting late on time. So by the time I had put in my three-month notice, the only thing that I was doing at that point was I was doing alternating every week massage and acupuncture. That's all I was doing. I wasn't on any, well, that's not true. Only thing I was on was uh prenatals and I was doing uh what's the name of that? Uh uh red leaf tea. That's all. That's all I was doing. Um and so we had decided that at the end of that three-month period where I would it would be my last day of work, I was supposed to go and pick up my new batch of medications so that I could start my round fresh for the first time without working. And so went to work. I no, I woke up that day and I said to you on my last day of work, I said, huh, I had a dream we had a baby boy. And you said, Do you remember what you said?

SPEAKER_02 47:18

I said that would be cheaper.

SPEAKER_00 47:22

You sure did. You said, Well, that would be cheaper. And I was like, oh, whatever. And then you said to me, Don't forget, babe. You keep forgetting to call the specialty pharmacy. You gotta, you gotta tell them, you gotta tell them to ship it. They were supposed to ship it to us. You gotta tell them to ship it to us. Don't forget, because I was supposed to call like three days before, and I kept forgetting. And I was like, oh yeah, oh yeah, yeah. Okay, I'll call them today. Went to work that morning. The entire day went went by. They threw, they had a cake for me. We're gonna miss you. We're gonna all this kind of stuff. And guess what? I forgot to do call the specialty pharmacy yet again. And I remembered at about five 15. And I was like, oh, they're still open. Let me call. So right before I called, I was like, huh. That's funny. I feel like I don't know. I've never taken a pregnancy test at work. And that day I took a pregnancy test at work, and I took the pregnancy test, put it in my drawer, literally forgot about it for like five, 10 minutes, and was like, oh, I need to call the specialty pharmacy. I was finishing up my work and I was like, oh, wait, let me check the pregnancy test. I opened a drawer where I guys, she was pregnant.

SPEAKER_02 48:40

And I was she was pregnant. Oh my God.

SPEAKER_00 48:42

Listen, people like anticipation.

SPEAKER_02 48:44

Okay, she was pregnant, guys. People like anticipation naturally, and that was amazing.

SPEAKER_00 48:49

Anticipation, Nate. Why you guys feel my done?

SPEAKER_02 48:53

Yo, what I'm looking at you like. And then I opened the drawer and then I looked at it, and then I turned it sideways. Damn it. She was pregnant naturally, y'all. You know, there's something called imagery, Nate. Oh my God. But guys, we joke about it now. Um, but we the other thing we joke about too, also is You like radio. You feel TV. We feel like the boys owe us money, though. No, we don't feel like I do because I always say in my mind that we've deducting us a little bit of money. We're deducting the IVF costs from their 529. You know what I'm saying? No, for real. No, it's not for real. But and but guys, we joke around and we mix it with some seriousness. But for me, in all seriousness, you know, all the travel, all the stress, um, all of I I I was very nervous um throughout this whole process. I had a lot of doubt.

SPEAKER_00 49:43

Um, but I know there was one point you didn't think we would we would ever have a baby.

SPEAKER_02 49:48

Yeah, I but it was worth it. The boys are worth it. Yeah where we are right now is worth it. And um, you know, if this is hitting close to you right now, um, I want to hear from you directly, actually. So have you had to ever choose between your financial goals and starting a family? Tell us your story. Hey, write to us, text us at 1833-230-2860. Once again, the question that I have for you all is if you've ever had to choose between your financial goals and starting your family, we want to hear about it. Um, the number to text us is 833-230-2860. Remember everybody, we read every message. And um, listen, y'all, if this episode resonated with you, please share it. Dr. Renee, thank you very much for being open about it.

SPEAKER_00 50:37

You know, you cut off my story. I know. That's okay.

SPEAKER_02 50:40

But um, I guarantee you though, there's a physician couple, there's a, you know, some type of professional couple, somewhere going through exactly what we went through. Yes. And they need to know that they're not alone.

SPEAKER_03 50:50

Yeah.

SPEAKER_02 50:50

Um, if that couple is you, text us. Once again, that number is 833-230-2860. Um, we read every single message. And also don't forget to check out our first generation Dr. Blueprint. The link is in our bios, also in the show notes. It covers finances, career planning, and basically everything we wish someone had told us earlier. And also, one more reminder: listen, if you're a physician warning about locums, I told someone about this already. Um, and they are looking at locums as possibly a career option. Make sure you check out locumstory.com. They got a free crash course. Um, there's real physician stories, there's unbiased information. I'm telling you, this place is the bomb. Go check it out. Um, locums played a big role in our story, and it was even slightly complicated, but it did play a role. So subscribe to us on YouTube, follow us on Instagram on DocsOutside the Box. I'm Ni.

SPEAKER_00 51:48

I'm Dr. Renee.

SPEAKER_02 51:50

This is Docs Outside the Box, y'all. Peace.