Fertility Forward
Fertility Forward
Ep 184: Fertility Legislation with Dr. Kaylen Silverberg
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Infertility is a treatable and curable disease, and infertility treatment needs to be more accessible and affordable to the average American. Today on Fertility Forward, we are joined by Dr. Kaylen Silverberg from the Texas Fertility Center to discuss something we haven’t really touched on before: fertility legislation and the importance of advocating for our rights to start a family! Tuning in, you’ll hear all about Dr. Silverberg’s career, what led him to fertility legislation, how he has worked with the government, and what he sees happening in the near future in fertility policy and the impacts of these changes. We delve into why IVF needs to be covered by insurance before discussing how you can get involved in making real changes to infertility policy. We even talk about how the conversation about infertility has changed over the years. Finally, and as always, Dr. Silverberg shares what he is grateful for today. Thanks for listening!
Hi everyone, we are Rena and Dara, and welcome to Fertility Ford. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Ford podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
SPEAKER_01Today on our podcast, we are so happy to welcome Dr. Kaylin Silverberg, a board-certified fertility specialist at Texas Fertility Center, who has been advising the White House and Domestic Policy Council on practical steps to make fertility treatment more affordable and accessible. He's been advocating for broader access to fertility treatment for more than two decades, and says there are a range of options from executive orders that can help veterans and federal employees to expanding coverage under the Affordable Care Act. So we are thrilled today to have Dr. Silverberg chat with us on a topic that we haven't really discussed too much about in the past. So we're very grateful to have you on.
SPEAKER_00Yeah, thank you so much for coming on. And obviously, this is such a hot button topic with the new policies proposed by Donald Trump. So we're so excited to have you on to share your expertise and knowledge to our listeners who may not know exactly what's been proposed and what that might mean for future.
SPEAKER_02Yeah, it's very complicated, I'll tell you that.
SPEAKER_01I'm sure I'm curious as to how you got involved more on the policy side.
SPEAKER_02Well, so I mean, like you said in my, and I guess in the intro, I've been going to Washington pretty much every quarter for like 20 years to talk about one issue or another, mostly related to medicine and obviously mostly related to infertility. I've been working with Resolve. I work with the American Fertility Association, ASRM as well. I mean, a bunch of different groups. Anyone that would have me, that would have me, you know, go in and talk to people who I've met in Washington over the decades, I'm happy to do. You know, you develop, when you go do this, people think that, you know, oh my gosh, I can never call on a congressman, I can never call on a senator. And it's totally false. What you'll understand is when you do this for the first time, you may hate it, in which case you don't go back, or you may be like me and kind of become a junkie of it. And so you get to meet people, you get to meet their legislative directors. I mean, you're never gonna walk in and sit out with, you know, Senator Smith from whatever state. You're gonna walk in first and you're gonna meet with their aides, you're gonna be with a legislative director. And gradually you work your way up the chain to the point that you do walk in, and Senator Smith or whoever will come up and grab you at the door and say, Hey, nice to see you. Thanks for coming. What are we gonna talk about today? And they bring you into your office or their office and you sit down and you go through your talking points. And my talking points are infertility is a disease. Okay, it's not some elective condition. My patients didn't choose to stand in the infertility line any more than anybody else chose to stand in the cancer line or the diabetes line. So it's a disease, it's not an elective condition. Unlike most other diseases, infertility is curable. We can't cure heart disease, we can't cure the common cold. But MERCER studies show that between 80 and 88 percent of patients who walk in the door of a rebreck of endocrinologist's office, stick with the plan, and carry it out, will walk out with the baby. So we know that infertility is very, very curable. And number three, we know that patients need more access and we know the cost needs to come down. And so the White House was aware of the stuff that I was doing. I've taken care of a bunch of Congress people from Texas. They got together and they wrote a letter to the White House and they recommended that President Trump ask me to be his advisor on IBF. I didn't get that job. I don't think that job exists, but I got to be an advisor to the White House and to the Domestic Policy Council. So if we start really kind of back more towards the beginning, July of last year, 2024, before the conventions happened, I got contacted and put in touch with a guy named Ed Martin, who is the head of the platform committee for the Republican National Convention. And they asked me if I would work with them to try and insert language, expanding coverage for IVF, potentially lowering costs for IBF, but making IVF care more available for general patients. And I said, absolutely, you know, right at my wheelhouse, that's exactly what I would love to do. And so I made a bunch of videos. I talked to a bunch of the members of the platform committee. This was all at the direction of the president because the president decided that IVF was going to be a hot button topic for him and he wanted this included. And the interesting thing was usually the platforms are 100, 150 pages long. President Trump had told the platform committee he wants something under 50. And what that means is everybody who is lobbying for inclusion of their cause in the platform had to really scramble to get any words in there at all. So we were lucky we got two sentences. Those two sentences came at a big price. I mean, it was hard fought, but we had to talk to a ton of people on the platform committee, made a bunch of videos, made a bunch of presentations, and at the end of the day, they chose what we put forward and they included it in the platform, which was Dynamite. We were very excited about that. We went to the Democrat Party also and asked them if they would like to meet with us or if they would like to include something in the Democrat platform, and they didn't want to meet with us for whatever reason. And we were nonpartisan. You know, the fact that we work with the White House is only because the White House asked us to work with them. If it would have been the previous administration and they would have called to ask us to work with them, we would have sat down and worked with them the exact same way. So I was really surprised by that, quite frankly. But anyway, it is what it is. And then, you know, the conventions happened, the election happened, and then as a result of the election, I got a call back in March asking of 2025 to go to Washington into the West Wing and to meet with Suzy Wiles, who's the president's chief of staff. So in April, I flew myself to Washington and went in and met with Susie Wiles. We were scheduled for a 15-minute meeting, and we ended up meeting for over an hour. I found her to be delightful, charming. I mean, I'd done my research and I read about her. I kind of knew her story. And, you know, she's got a reputation of being very tough and a very difficult negotiator, but also very fair. And I found her to be very different. I found her to be like, you know, somebody you really want to be friends with. She was highly educated. She had been very well briefed. She knew all the intricacies of IBF. She was very cordial. She showed me around her office. She showed me the paintings on the wall. I mean, this is right next door to the vice president's office, right down from the oval. You know, it's a very kind of heady experience to be there. And so we're talking, and after 15 minutes, Sarah, her assistant, comes and knocks on the door and says, Ms. Wiles, you know, your next appointment's here. And she said, Sarah, give me 15 more minutes. And so 15 minutes later, Sarah comes back, knocks on the door. And so Susie says, Sarah, give me 10 more minutes. And then she comes back again, knocks on the door, and Susie said, Sarah, I'm almost done. I'll come get you when we finish. So I'm thinking, okay, this must be going pretty well. You know, she didn't want to kick me out of the office. She's not, you know, criticizing my ideas and thoughts. And at the very beginning of the meeting, we talked for like two or three minutes, and she immediately gets up and she asked him to go get Vince Haney, who is the director of the domestic policy council. So he came in and sat down with us as well and started firing questions at me. You know, what do you know about the 1992 law? You know, he didn't tell me what law, lots of laws were passed in 1996, but I happened to know that it was the Wyden Law, which was the law that established the registry for tracking all IBS cycles in the country. This is what requires reproductive endocrinologists to report our data to the Center for Disease Control. He started firing one question after another at me. You know, what do you think about this? What how's the CDC doing? Are they doing a good job? Are they doing a bad job? Is this law working? Is it fixed? Is it fixable? And I said, well, let's take a step back. Because I was on the SART board in 1992 when this registry was enacted with a widen law went into effect. And what happened, thank you very much. What happened was we wanted information for patients so they would know in one cycle of IVF what's the chance of having a baby and what's it gonna cost? And I said, here we are two decades later. And the question we can't answer after spending tens of millions of dollars on this registry are what's the chance for success in one cycle of IVF and what's it gonna cost? So we started talking about that and ways potentially that it could be fixed and what we could do to you know to help things along. And one thing led to another, and I realized I was kind of being interviewed for a job. And so that led to a series of conversations, mainly with a woman named Heidi Overton, Dr. Overton, who is a physician. She got out of praxy medicine and went in to do research and works now full-time for the domestic policy council. And she is extraordinarily bright. I mean, I will say all of the people that I interacted with, very well briefed, highly informed about the issues. They really knew what was going on. A lot of them, and this is one thing that we have in our back pocket all the time, all of us who work in the fertility field, a lot of the people that I met with had personal stories about infertility. Either they'd gone through it themselves, their daughters had gone through it, their granddaughters had gone through it, they've got grandchildren because of this. You know, I can tell you because it's not secret, I take care of a legislator from Texas, a congressman from Texas, who you would think would be the last person on the planet to support IBL. Very devout right-wing Christian. He's a great guy, but very devout right-wing Christian. We met, he was kind of wary of me, I was kind of wary of him, and we hit it off 25 years ago. And over the years, he sent his four kids to see me, and he has eight grandkids now. And he is the biggest flag waiver for IBF on Capitol Hill. And so it's because of these personal stories and because of personal experiences that we are so much more powerful than we think we are. You know, you think about it, you have lobbyists who go in and talk, and I'm not a lobbyist, I don't mean to imply that I am, but you have people who go in and educate members of Congress about the Defense Department. Maybe they represent a company that wants to order more missiles or wants more missiles sold to the government. Nobody's got personal experience with missiles, but people have personal experience with infertility. They have personal experience with wanting families, with having family members who, despite their best efforts, have been unable to conceive a family. And so this is why it's it's so important. And I'm so excited and so proud of the fact that so many of my colleagues are involved in this also, because we are barraging Capitol Hill and we finally have a receptive audience. And it came from one of the most unlikely places. I mean, if you would have asked me two years ago, you know, hey, who do you think is going to be more supportive of something, you know, in favor of IVF, I would not have picked the president. You know, he would not have been my first choice. But then I'm hearing him on a campaign trail and he says he's the father of IVF. And, you know, the other things that he says, and I'm thinking maybe there's an opportunity here.
SPEAKER_01And it was smart for you in that you had been going to Washington for quite some time, it sounds like, creating these relationships and meeting the right people. So I do believe in many ways it's the right timing. It's you worked hard.
SPEAKER_02I mean, you know, my dad's got a plaque on his desk that says, luck is what happens when preparation meets with opportunity. And I mean, I live by that. I mean, you have to prepare. You and you know, I would go to Washington and I would talk to anybody who would talk to me. I don't care if they were a senior senator from whatever state, or if they were a freshman congressman who had just been elected, who knew nothing. I would be so happy to talk to them. I'd be so happy to talk to their aides. You know, a lot of people go to Washington and it's like, hey, look, you know, I got blown off because I only met with their legislative director or their aide, or they sent me back to their district in Texas to go talk to them there. They don't even want to talk to me. Couldn't be further from the truth. Couldn't be further from the truth. You get relationships with these people, you get relationships with their chiefs of staff eventually, the legislative directors, you get in with them, you establish relationships with them. And it's so wonderful because you realize one person who is committed can really make a difference.
SPEAKER_00It's pretty amazing, you know, and we've had on our podcast a couple of times Kim Thornton, who is a reproductive endocrinologist at RMA. And I myself used to be involved with Resolve and go to Albany. And as you said, it's it's very cool. You know, I think a lot of times people think, oh, I I can't do that. It's not how do I know what to do? And who's gonna meet with me? But with Resolve, you know, it really opens doors and you go and you meet directly with Congresspeople or senators or and you really do have access. And you know, I've learned myself all of this. It's just getting in front of people, right? They get so many things thrown at them, and it's just what are they gonna hear?
SPEAKER_03You're exactly right.
SPEAKER_00What do their constituents want? Because at the end of the day, they want the vote. So if all of our constituents you know want changes for fertility treatment, okay, let me listen to that, right? Let me hear about it.
SPEAKER_02Totally right. I'm so glad you had Kim on because Kim is a founding information. She's fantastic. She's a great doctor, but she's also a great advocate.
SPEAKER_00Yeah, and it's as you said, you know, it's very accessible and it's up to us, you know, in the field or patients to get in front, say what we want, and advocate for change. That's how it's going to be done. And it's thanks to people like you or Kim Resolve, you know, that's really led this change.
SPEAKER_02Yeah. Yeah. And that's really what happens. That's how it's that's how it's made. You know, people talk about you know, making sausage, and you know, it really is the process of legislation is ugly. And I'm sure we'll get into it in a little while because the president has a couple of different paths he can go now, because I don't think that what he's announced so far is the be all and end all. I think this is the opening salvo. And I do think he's got legislative options, and he's also got executive options, things that he can pursue.
SPEAKER_01We'd love to hear that. I'm curious as to what you've heard and what you feel potentially can be down the road.
SPEAKER_02Well, first of all, let me be really clear about what I've heard. Okay. So some things that I've heard I can't talk about, very, very, very few things. Okay. I mean, it makes it sound like I am not important. I am a cog in the wheel. I totally understand my role, no question about it. These people that I meet with are extraordinarily good at asking questions and extraordinarily skilled at not answering questions. So they ask me for my opinion all the time, and I give them my opinion. As you can tell, I talk all the time. And so I'm happy to give them opinions about anything they want to know. But when I ask them, well, where is this going? Or what do you think about this, or what is the president thinking about this, or what's the White House thinking about that? Brick wall. Okay, so I don't want to make it sound like I've got insider information because I don't. I would love to, and I've been involved in conversations where you think that I might, but I just don't. But I do know certain things. I know the president, for example, let's talk about what he did the other day when he had his press conference. I've been working with Serono for 30 years since I got into this field. Okay, and I've worked with Oregon, I've worked with Faring. They've got tremendous people at these companies. And I truly, honestly believe that the people who work in these companies are focused on doing everything they can do to help couples have families.
SPEAKER_00Okay, I just want to interject for our listeners too. All those companies you just mentioned, they're pharmaceutical companies.
SPEAKER_02Right, pharmaceutical companies, right? And you know, people, some people out there who don't understand the system are critical of doctors' relationships with pharmaceutical companies. It couldn't be further from the truth. There's nothing sorted, there's nothing backhanded, back-allied, you know, anything under the table, stuff that goes on, at least not in my experience. I can tell you, these companies are anxious to do the right thing. They really are because of what they do. And I think that certain people go into different fields because they gravitate towards it, right? And I think that people who are compassionate and people who are pro-family will go, you know, they're more likely to work for a company like Serono, Oregon Honor Fair. And so, and I found people in, you know, in all three of those companies who are really committed to our patients and helping them, you know, get what it is that they want, which is a family, right? It's not complicated. But anyway, I've been working with Serono doing research projects with them for 30 years. And one thing that we've been advocating for a long time is getting a drug that's sold in almost every other country around the world except the United States. I want to get that drug into the United States. It's called pergaveris, okay, and it's a combination of recombinant, and I'll explain this in just a minute, recombinant DNA-produced FSH and recombinant DNA-produced LH. All right, so before your listeners' eyes roll back in their heads, let me explain to you what all this means. So when a woman is making an egg, it's a very complicated endocrinologic game that's going on in her body. The signals start in a part of the brain called the hypothalamus, and those signals are sent to a little pea-sized gland that lives behind the nose called the pituitary gland, and those signals are sent throughout the body to the ovaries. And the net result when the system works the way it should is that women start to have eggs develop in their ovaries at the beginning of their cycle. And through this complicated endocrinologic game, one egg wins the game, ovulation occurs, that egg gets to come out and play with the sperm and hopefully make a baby. All of the other eggs that started to develop early in the cycle aren't selective. They die a fiery, horrible death in the ovary, never to be heard from again. Okay, and I come from Austin, we're one of the capitals of recycling. There's no recycling. These eggs are gone, they're gone, they're never coming back. They're not put back in the pool where they can come out next month. They're done. And this is why women's egg supplies decline from maybe 15 to 20 million eggs 20 weeks prior to birth, to six to seven million eggs around the time of birth, to 300 to 500,000 eggs around the time of puberty, to maybe 10,000 eggs or less around the time of age 40. And this is why women's fertility declines, is why the risk of miscarriage goes up as women get older. So, what these pharmaceutical companies have done is they have made drugs initially out of these hormones that are made by the pituitary gland, but eventually they were able to make them using recombinant DNA technology, which makes them more pure and safer. And they market those drugs and they market those drugs, you know, a variety of different drugs, gonalf, folistem, minopure. I mean, those are kind of the leading drugs in the United States now for fertility. But pergavarus is different because pergavarus combines FSH and LH in one product. Now you may say to me, so what's the difference between FSH and LH? FSH stands for follicle stimulating hormone, and that tells you exactly what that drug does. It stimulates the follicles or the egg sacs to grow. LH stands for luteinizing hormone, and luteinizing hormone causes the ovaries or the testicles in men to make testosterone. Okay, it does other things too, but in a nutshell, it causes it to make testosterone. Then there's an enzyme in a woman's body called aromatase that changes that testosterone into estrogen. Okay, so when you give an FSH-only product like gonalf or like or like polystem, you'll cause eggs to develop. And when you give an LH-containing product, like is in Mini Pure currently in the United States, okay, that causes estrogen levels to really go up fast. Pergavarus is a combination of those two drugs. So in one drug, you get the benefits of FSH and you get the benefits of LH. And so Serono has not brought that drug into the United States for 15 years. And the reason they haven't is because the FDA set up pretty high bars, pretty high metrics that they would have to achieve or demonstrate with the with a big, very expensive study to show that that drug should come in the United States. Kind of silly because one of the components of Probarus is gonal F. And another component of Protuvaris is a drug called Lubarus, which is recombinant LH. So what Serono did when they made Protoberus is they combined the recombinant FSH, recombinant LH, put it in one product. Those two drugs that were combined are each independently already approved by the FDA. But the FDA is not satisfied with that. Nor are they satisfied with all of the data that's been performed around the world on this drug. They wanted Serrono to pay tens of millions of dollars to do additional studies on this drug in the United States. And Serono had to make a business decision that it was better for them and their company to just not even bring the drug into the United States. So one thing that I advocated for was to try and get this drug in the United States. And the president gave Sorrono a waiver, a priority waiver, that will hopefully enable the FDA to approve this drug quickly and get it in the United States. Okay. And the more choices patients have, the lower the cost will go. So bringing Pergavaris in the United States is going to drive down the cost of pergaverus and gonaleth and polystem and hopefully Mini Pure as well. Okay.
SPEAKER_01That's fascinating. Is it in Canada?
SPEAKER_02I think it's in Canada, yeah.
SPEAKER_01Wow. But that's fascinating that uh yeah, it sounds like in Europe and Canada it's approved. But that one thing alone can make a big difference in terms of Oh, yeah.
SPEAKER_02So that's gonna make a big difference. The second thing the president announced was that they had struck a deal with Serono using the president's most favored nation status to tremendously lower the cost of donor. So because the president has this policy, most favorite nation status, he does not want drugs sold in the United States for more than the lowest price that they're sold around the world. And so we know that drugs in the United States, it's not a secret. Drugs sold in the United States are more expensive than anywhere else in the world. Why is that? Well, lots of reasons. Number one, we do the research here, and research costs money. Number two, we fortunately or unfortunately, as you look at it, have lots of lawyers. And lots of lawyers find things to do to keep themselves busy, and one thing that they do is they sue people. And so the cost of litigation is a lot higher in the United States than anything else, and that raises the cost of these drugs. And there's a lot of other reasons, also. I don't want to be overly simplistic and I'm not trying to be snide about lawyers. I'm married to a lawyer, my dad's a lawyer, my sister's a lawyer, maybe my daughter's a lawyer, they're all lawyers. You know, so and I have respect for them, but it's just a fact. And so, with the president's most favored nation status, the bottom line is the price of gonalf now is coming down to the point that you'll be able to buy it in the United States less expensively or at least the same price as the lowest price for which it's sold around the world. You know, I'm in Texas. We are very close to Mexico. And I have lots of patients over the years who come to me to say, hey, listen, that drug that you're prescribing for me, gonalf, is really expensive. Can I go to Mexico and get the drug? And I just do the you know, la la la la la thing, you know, and I say, look, I'm writing you a prescription. The risk that you run is, granted it's made by the same people, granted it's you know made under sterile conditions, but we don't know if it's sat out on trucks in the desert in the heat for days, weeks, months, years. We don't know if anybody's messed with it afterwards. We don't know, you know, it may very well be the same, but the FDA has a policy that if you're caught at the border bringing drugs in, okay, they can confiscate your medicine. So you're taking a big risk. I strongly encourage you not to do that. I strongly encourage you to stay in the United States, get your drugs here, and we'll figure out a way to help you pay for it. But now, because the price of Golf is coming down, what that's gonna do is that's gonna cause the price of thalstem to probably come down, Mini Pure will probably come down. So this action, this most favorite nation trading status, is really gonna dramatically drop the cost. And what I've been told, and this is maybe not public, but what I've been told is that they will look at your income. So when you're getting this prescription filled, and these drugs, no question, cost thousands of dollars, but they will look at your income. And if your income is above 550% of the poverty level, which I think is about$115,000, you will pay no more than X, which I think is a little less than$4,000 for an entire cycle of medication. Okay, far less than you're paying now. If your income is less than 550% of the poverty level, then you'll pay no more than$3,000 for all of your drugs. So patients right off the bat are going to save anywhere from two to$10,000 per cycle.
SPEAKER_00That's amazing.
SPEAKER_01That's a large amount.
SPEAKER_00That's amazing. Because as yeah, as you know, a lot of patients, you know, even if they have, they might have coverage, but usually the drugs are not covered, and those usually run thousands of dollars.
SPEAKER_02Yeah. So those are the first two things the president did. The third thing that he did was he is putting in place a policy. So, you know, when you go through open enrollment and you check the box, you know, I want spousal coverage or I want family coverage, and then you get other boxes that you can check also. So one box typically is do you want dental coverage? One box is do you want vision coverage? One box is do you want expanded death and dismemberment coverage or life insurance coverage or disability coverage? You know, do you want more of those things? Well, the president has made infertility the fourth leg of this four-legged stool. So now when you're in open enrollment, in addition to being able to get basic health insurance, you'll also be able to check off those boxes. And not only can you get vision or dental or expanded life and disability insurance, but now you'll be able to check the box that you want infertility coverage as well. And so this is gonna help thousands of maybe hopefully millions of employees who work for small and medium-sized companies that maybe can't afford to go contract with a progeny or a Maven or a carrot or somebody like that, it's gonna enable those employees at those companies to be able to get access to infertility insurance as well.
SPEAKER_00That's huge. That's incredible.
SPEAKER_02So, really, in just doing those three things, in my opinion, the president's fulfilled his promises of expanding access and lowering the cost. But I know maybe inside information, there's more coming. So he is he is not done with this subject yet. And I think our patients are going to continue to be very pleased with what they see.
SPEAKER_00Well, I think this is huge for a patient and for future implications. I know yourself, Darren, I, we've been in the field for for a while and to really see wow, people really are raising their voices, and this is changing in a great way for patients. Because obviously, for so long, cost has been a barrier to care. And unfortunately, that's why a lot of people either can pursue treatment or stop, which is heartbreaking. And finally, I think you know, infertility is being recognized at least at the beginning as a disease, and we can treat it and let's make this accessible and let's make this a better system for everybody.
SPEAKER_02Yeah, that's exactly right.
SPEAKER_00I think that's very positive and a message of hope, which is wonderful to hear. And much needed these days. It's been a long time coming.
SPEAKER_02Right. Well, you know, people say all the time that I mean, I'll give you an inside anecdote. So, you know, people say all the time, well, IVF is so expensive. You know, the government's never gonna cover it because it's way too expensive. So when I was with Susie Wiles, the president's chief of staff, I said to her, you know, because she says to me, Well, why is IVF so expensive? And I said, Well, let me ask you a question. You're out playing soccer, okay? I mean, she's not gonna play soccer, I'm not gonna play soccer, we're too old to play soccer anymore. But let's say you're out playing soccer, you're riding a bike, and you fall and you hurt your knee, and you go to the orthopedic surgeon, and the orthopedic surgeon says, Oh my gosh, you tore your ACL. Now we're gonna need to go fix it. Okay, what does it cost? And I'm gonna ask the two of you, what does it cost to fix an ACL? What do you pay when you tear your ACL and you have to go get it repaired?
SPEAKER_00No insurance or saying out of pot. I was gonna say, without insurance, hundreds of thousands of dollars, tens of thousands?
SPEAKER_02It's sixty-one thousand dollars. Okay, that's the average, okay? And I said to Susie Wiles, what do you think it costs? And she says, I don't know,$4,000,$5,000. I said, how about$61,000? Right? Well, she was blown away by that. And I said, but nobody knows that it costs$61,000 because nobody pays$61,000 because it's covered by insurance. So everybody talks about the fact that IBF is so expensive, it's$20,000 to$25,000. No question, very expensive. I'm not trying to say it's not, but if you say compared to an ACL repair for a third of the cost of an ACL repair, you can have children. Okay, it kind of puts that into perspective. And the other perspective that it puts it into is nobody pays$61,000 for an ACL repair because it's covered by insurance, which is why we need to have IVF and fertility treatment covered by insurance also. We're not asking for anything more than anybody else has. All we're asking is for equity. Okay, we want the exact same treatment for our disease that everybody else has for their diseases. You know, every two weeks, every single patient I have who's employed has money taken out of their paycheck to be applied to insurance. Premiums for their health insurance. They are subsidizing all of their fellow employees who have kids who have childhood related illnesses. Colds, God forbid, pneumonia, RSV, you know, different things like that. They're not complaining about doing that. But on the other hand, everybody else is complaining about the fact that we don't want to add infertility coverage because then all the other employees who don't suffer for infertility are going to have to subsidize the cost of fertility insurance for patients with infertility. No kidding. All we want is fairness. We want the exact same thing that everybody else has. And we don't want diagnostic coverage. I mean, can you imagine a world in which, God forbid, you go in for a mammogram and they find a lump and they say to you, oh gosh, Miss Smith, I'm so sorry. You probably have breast cancer. And you know what? You don't have coverage for the treatment of breast cancer. You have coverage for the diagnosis of breast cancer. So you've only got a$40 copay for your mammogram. But now you need, God forbid, a mastectomy or chemotherapy or radiation therapy, and you have no coverage for that. Nobody would support that. Nobody would think that's a good idea. But that's what a third of our infertility patients have. They've got diagnostic coverage and no treatment coverage. So all of these things need to be addressed. It's not a simple fix and it's not a simple problem. President can't say, light switch, I'm going to turn the light switch on now. Everybody's infertility is covered and medications are free. He can't do that. What he can do is take incremental steps. And thank God we have somebody now in Washington who is listening, who is taking incremental steps. And I'm praying that people from both parties are paying attention to what's going on. Because if you look at the polling, 86% of the American public is in favor of everybody having access to IBF. 86% of people in Washington can't go outside and say it's sunny or it's raining. Yet 86% of people in the United States say IVF should be covered, should be a cover benefit. So if people from both parties are listening, they are going to make this easier for us instead of hard. Because for 20 some odd years I've been doing this, it's been hard.
SPEAKER_00Well, if only everyone would present it how you did, right? And you know, I know a lot of times with my patients, certain analogies, you know, I same idea. I say, okay, well, let's compare it to cancer because that's just more understood, right? You know, and that used to be 20 years ago, right, not as understood as it is now. Now people understand, okay, that's hard. And then it's covered, or people know how to sort of support infertility, unfortunately, is not there yet. I think it's still very misunderstood, but I think it's getting there to hopefully a point where it's going to be understood like that.
SPEAKER_02Yeah. And it's getting there because we have thousands of people who are trying to spread the message. And now we're more and more receptive audience.
SPEAKER_00Exactly. Well, I think more people are talking about it, they're being open about it.
SPEAKER_01You're right. People are open and more people are, if they aren't experiencing it, they know someone, friend, family who's experienced it. Oh, you're right. They're currently experiencing it.
SPEAKER_00So this has been, I mean, such a wealth of information and I find really positive and hopeful for future. And, you know, I know when when Kim has come on, you know, we've always said that if this is inspiring you and you want to get involved, it's so easy. You know, just go to the Resolve website, resolve.org. There's a million ways there that can point you to advocating. And it can be even writing letters from your home to going in person to Albany, to DC, to your states, wherever your state Congress people meet, whatever it may be, but there's tons of ways to be involved. And again, it can be from your home sending a letter, or it could be giving more of your time and energy that will point you in the right direction how to get involved. And it really is possible anybody to work for this.
SPEAKER_02Yeah, and that's what people don't understand because they're so intimidated. I don't know why going to Washington seems to be so intimidating to so many people, because it's really not. I mean, it's fun when you're there. There's history everywhere you look, there's incredible things to do. You know, make a weekend of it, go up in the lobby on Friday or go meet with someone, go meet with your own representative. You can Google who is my representative, and you put in your zip code, and immediately it'll tell you who your representative is. You can call and make an appointment, which is probably the better thing to do. But you can even, if you're in Washington, just stop in. They will have somebody sit down and talk to you. It'll either be a legislative director or an aide or somebody. Give your listeners or watchers a couple of other resources. ASRN, the American Society for Reproductive Medicine, uh, incredible organization. It's the organization that we all really participate in and we'd like to represent us, and they've got a very effective lobbying operation there. And then also an organization that I'm associated with and the head of the medical advisory board for an organization called Americans for IBF. And what we're doing now is we're drafting legislation to hopefully submit to Congress to try and give the president even more options. We are it's a bipartisan. We've already gotten our supporters from the House of Representatives, our two sponsors are Debbie Washington Schultz from Florida, and a guy named Zach Nunn from Iowa. And then on the Senate side, we have Corey Booker, Senator Booker from New Jersey, and we're hoping to get Senator Marshall, Roger Marshall from Kansas, who by the way is no B Gen, or some other one another senators as well from the Republican side. And then we'll have our four co-sponsors. We'll be able to introduce this. Hopefully, it'll be debated. Hopefully, it'll make it into committee, and then maybe even make it out of committee, but it'll give the president some more options of things he can do. Another thing that he can do now without taking any legislative action is through executive order. So the president has the control, he doesn't control insurance, private insurance, he has no control over that. But he does have control over insurance that federal workers have. So with a stroke of a pen, he could provide coverage for infertility treatment, including IBF, for federal workers, active duty military, retired military. So that's millions of people when you think about it. So we're pushing for that. There are all kinds of other actions that can be taken. They can take money that hasn't been spent from some of the different title programs, Title IX, Title XI. I'm not, you have to excuse me, I'm not well versed in all of what those are. I know generally what they are, but they can take monies that have not been spent on those titled programs and redirect them to improve access to fertility care. So there are all kinds of things they can do. They can do tax credits, they can go down lots of different avenues to try and find the money to be able to pay for some of this stuff and be able to expand access.
SPEAKER_01I would love to hear how that goes in terms of your committee. And I would love to have you back on for sure as things change and evolve. Because it seems we could see how passionate you are and how much you've already done. But I have a feeling that there'll be even more that you and the people that you work with can do. And it's reassuring to hear that it seems like we're getting closer.
SPEAKER_02We're definitely getting closer. I mean, the ball is definitely moving down the field. I mean, there's no question not to use a sports analogy. I know you shouldn't do that. You know about it. I love sports analogy. I do too. I do too. I can't help it. But um, anyway, I mean, we're definitely making progress. And let me tell you, the progress begets progress. And what I mean by that is 20, 25 years ago, it wasn't easy to have any of these conversations because nobody wanted to talk about it. Now everybody wants to talk about it. And it's easy to have these conversations, and we got to be organized. You know, one thing that I can tell you that a bunch of different pharmaceutical companies are doing now, these are companies that have competed against each other for years and years and years, but they're starting to work together when it comes to lobbying in Washington. So they've established committees, they've established groups of people who will show up in Washington and go in, you know, we just barnstorm the Capitol and go from office to office to talk to people. And it's really incredible as to how much easier this is all becoming.
SPEAKER_00Yeah, it's really incredible how much things have changed.
SPEAKER_02It's great, but it's because people like your listeners are, you know, making phone calls or they're, you know, going into these offices in Washington or in their own states. I talk about the federal level because that's really where I work, but there is just as much work that needs to be done on a state level as well. And so a lot of these organizations I'm referring to now, some of the pharmaceutical companies, I know Fairing's very involved, and Serono is obviously involved, Organon is involved, Cooper Surgical is involved. And all of these companies now are working to establish lists of physicians in each of the 50 states that we can call on. We can educate them to make sure they understand where we are on these issues. We can make sure they're on our side. We can then call on them when legislation gets to the floor of you know of the legislature in Missouri or Kansas or Arkansas, anywhere, California. We can then call on specific physicians who are already well versed in the legislation. We can have them go and call on their representatives in their local states. And that is just as important. You know, we saw what happened in Alabama, you know, which at the time I thought was one of the worst possible things that could happen for our field. But we had a rogue Supreme Court justice in the state of Alabama who starts changing the rules in Alabama, making IBF really inaccessible. And within a couple of days, the major fertility centers in Alabama had all closed down because they were afraid to work. That's the first half of that story. Everybody knows that half of the story. What most people don't know is that in Alabama, within five days, I think it was, both houses of their state legislature drafted legislation to protect IBF. They debated it, they voted on it, they passed it, they sent it to the governor's desk, and the governor signed it into law. So I went from thinking, oh my God, what a disaster for our field, to thinking, oh my God, maybe this could be the spark that gets things going. And that's exactly what happened. Because coincidentally or not, the president picked up the ball at that time and started talking about infertility and IBF. Katie Britt, who's one of the senators from the state of Alabama, had the president's ear and she started to talk to him about this as well. And maybe that was what really sparked all this to happen, but something changed. And the president really got behind this, made this a campaign issue, made it a big issue for his administration, made it a priority. And not that Susie Wiles can talk to some nobody cogging the wheel from Austin, Texas for over an hour about what's going on and try and move this down the road.
SPEAKER_00Well, I think much to continue to unfold. And this is it's such an exciting time, which I think sounds kind of surprising, but it really is. You know, I think there is positivity and hope here. And it's so wonderful to have people like yourself working so hard for patients in the field.
SPEAKER_01You're so passionate. And I can only speak for myself, and I'm sure Rena too. We've learned so much that I can only imagine our listeners also got so much out of this. Thanks for telling the story about Alabama. I did only hear the first half of it. So it's very reassuring to know the story came out much better than I had anticipated.
SPEAKER_02It did. And that's you know, that's something that's so discouraging to me because I want to be so nonpartisan or rather bipartisan about this effort because I don't care what anybody's personal persuasion is or personal feelings are, doesn't matter to me at all. I will talk to anybody who will listen about doing the right thing for our fertility patients. You know, we're their advocates, we're in a position where fortunately we've got access to companies that have access to the politicians. We've got access directly to the politicians, we've been pursuing it. And I just can't stress the message enough that one person can make a huge difference. So, you know, when you may have a listener right now who's sitting at home thinking, you know what, I've never done this before. I'm intimidated about doing it. I don't know how to do it, but I'm going to get involved. And a month from now, they're sitting in front of some representative in some office in Washington and, you know, the Rayburn building, and they're sitting there having a conversation about their own story. And the next thing you know, that person talks to another person. I mean, that's how this happens. You people talk about grassroots operations. This is the ultimate grassroot operation. You know, people want to break it out into are you pro-life, are you pro-choice? I mean, who is more pro-life than a fertility doctor or a fertility patient? And I'm not talking about the political pro-life or pro-choice. That has nothing to do with anything. This is all about believing that every single person on this planet has a right to be able to have a family of their own.
SPEAKER_00Absolutely. Absolutely. And I think that's what's really important to stress.
SPEAKER_01We are so grateful to have you on. Thank you so much, Dr. Silverberg, for telling your story and for sharing with our listeners the incredible work that you and your community has done, and I have full of faith we'll continue to do for many years to come. So, how we like to end our podcast is with words of gratitude. So, Dr. Silverberg, what are you grateful for today?
SPEAKER_02Oh my God, I'm grateful for your listen. I'm grateful for you guys because you gave me the opportunity to reach out and spread this message to other people. I'm grateful for your listeners because most of them I suspect are suffering from infertility, and they're heroes. I mean, they're absolute heroes. I mean, anybody who can go through, you know, fertility treatment is not for sissies. Anybody who can go through fertility treatment, deal with disappointment after disappointment, shots, blood draws, ultrasounds, the hell with their own schedules and the fact that they've got lives and they, you know, have to cancel things and move them around for appointments. Every single one of your listeners is a hero. And they need to be inspired and they need to be supported because we need them to do something for us. And that is we need them to get out and spread the word. We need them to not be quiet. We need them to not be suffering in silence. We need them to be supported and be out on the road doing what the rest of us are doing.
SPEAKER_00I love that. And I love how you called them heroes because absolutely agree. Well, of course, you know, it's making me think of a patient I had this morning who just went through a retrieval. And I mean, she's just had a super rough road with multiple late-term losses, obviously very traumatic. And I was asking her how it went, and she's just so calm and stoic, and you know, it was it was totally fine. And, you know, it's just such a reminder that humans really are so resilient and really can do hard things. And I don't want to gender discriminate, but particularly women, you know, I think really just sort of go through this and take it on. And a lot of times don't stop to try and realize, okay, I just added something huge into my life. Okay, I gotta take something out to make space for this. And this, you know, the treatment, it really is a big deal. And I guess sort of same, you know, super grateful for my patients who really inspire me every day too and and ground me. What about you, Dara?
SPEAKER_01I just want to piggyback on that. Grateful in general, just looking back, that I think wasn't the first successful IBF back in 78, I want to say. Just to see the evolution, to see how far we've come. I mean, it's taken a long time, but just to see, you know, Reen and I have been in the business for quite some time now and have been on the other side as patience as well. So just grateful for the community, grateful what was done back in 1978 and where we are today. And I'm I'm someone who does have hope that there is more to come and more positive things to come in the future for this field. And really, you are a remarkable human, Dr. Silverberg, for what you have done. And I know you're very humble. And I know you say it starts with just going in and speaking your mind, but really you are just someone that I really admire and cannot wait to see what's to come in the future. And I want to say a big thank you.
SPEAKER_02Oh gosh, thank you.
SPEAKER_00Yes, thank you so much. So wait to see how this unfolds and then hopefully have you back as things progress.
SPEAKER_03Happy to do it.
SPEAKER_00So in the off chance, and so our listeners, you are practicing out of USF in Texas, correct?
SPEAKER_02No, well, so we're part of USF, and I run Texas Fertility Center.
SPEAKER_00Oh, okay.
SPEAKER_02And we go 246 miles of Texas Interstate from Cedar Park to Round Rock to Austin to New Bromfels to San Antonio to Corpus Christi.
SPEAKER_00Okay. So if anyone is looking for in Texas, they know where to find you.
SPEAKER_02Love to see them.
SPEAKER_00All right. Thank you so much.
SPEAKER_02Thank you so much for the invitation. It was really a pleasure meeting you.
SPEAKER_00Likewise.
SPEAKER_01Thank you so much for listening today. And always remember, practice gratitude, give a little love to someone else and yourself, and remember you are not alone. Find us on Instagram at fertility underscore forward. And if you're looking for more support, visit us at www.rmany.com and tune in next week for more fertility forward.