As debate rages over coverage, rural Minnesotans face challenges getting fertility care
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Recently Ann Vote, 41, visited a New Ulm bookstore with her 12-year-old daughter, Ella. This is the kind of moment Vote dreamed about 14 years ago when she struggled with infertility. She had problems getting pregnant and suffered several miscarriages.
Vote said infertility causes a particular kind of grief and a kind of loss many choose to keep private.
“When you struggle with infertility, you dream of it, and you work hard, and you wait,” she said. ”You’re grieving the year you just lost without the family you thought you’d have at that point, and that is really tough.”
For many rural Minnesotans getting treatments is still really hard and expensive. The stark reality is 1 in 6 in the state are currently experiencing infertility, and for those living outside the metro, treatment options are especially limited.
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Living in rural Minnesota, Vote had limited access to fertility treatments she needed. On top of that “the cost was insane” she said.
Vote found a provider in rural Sleepy Eye who was able to help organize a successful treatment, and now Vote has two children. But, she wants to raise awareness of the challenges still faced in rural areas.
The cost of infertility
OB-GYNs at rural clinics can provide general reproductive health and fertility treatments such as injections, oral medications or intrauterine inseminations also known as IUIs. However, more invasive procedures such as IVF and egg retrievals, need specialists and fertility clinics.
Those are centralized in areas with populations that can support them. There are only four such clinics in Minnesota: three in the Twin Cities area, and one in Rochester.
Dr. Rebecka Docken is an OB-GYN in Alexandria who regularly sees patients dealing with infertility. She said they often travel two hours to see her. If Docken refers them to a fertility clinic in the Twin Cities, that’s even farther away. And Docken said those clinic’s waiting lists are often long.
“I think the emotional toll that takes on couples is really challenging,” Docken said. “It’s heartbreaking when you know they really desire pregnancy and they're not able to conceive.”
Docken knows. She experienced infertility too. She doesn’t think the current system is working for rural patients.
“I think that our politics and policies really need to protect that for patients,” Docken said. “It is such a difficult journey that if we put more regulations on it, that just puts up more barriers for care and makes it difficult to take care of patients and offer the patients what they need.”
This is also the story that Dr. Lindsay Leveille knows intimately in rural Staples as a family medicine physician. As she meets with patients who are trying to conceive, they are also trying to manage the logistics of travel and cost. Insurance deductibles vary from person to person.
Leveille empathizes with her patients as she’s pursued IVF treatment herself, which she said is “more difficult to obtain.”
“It’s a very common issue that we see and it can be frustrating for a lot of our patients, because it takes a lot of resources to figure out how to get to that specialized care, it's logistics,” Leveille said. “What if they can’t drive? You know, there’s no public transportation to get from these rural towns to larger cities. We just don’t have that availability.”
‘It’s just human’
Twin Cities-based family and marriage therapist Dr. Deborah Simmons works with couples going through infertility and pregnancy loss. She said there’s no fairness to any of this.
“It’s why there are assumptions about it, that somehow it’s the people in the upper class [who] get to do IVF and others don’t,” Simmons said. “But, that’s not the whole story. If there was some insurance coverage, anybody could get treatment, and everybody deserves whatever medical treatment they need.”
However the U.S. Supreme Court decision striking down Roe v. Wade which led to state law taking precedence on abortion law has complicated fertility treatment discussions, and specifically the legal status of fertilized eggs.
While there has been discussion on the state and federal level of a requirement that insurance cover fertility care, little progress has been made.
Back in Alexandria, Dr. Rebecka Docken said providers are continuing to care for their patients the best they can with what treatment options are available.
“I don’t really foresee us ever doing IVF in smaller communities, but I do definitely think medications and IUIs hopefully would be offered in these smaller rural communities,” Docken added. “And, I think that would take [down] a lot of barriers to care.”
Therapist Dr. Deborah Simmons said people need to remember what’s at the base of the debate.
“There is no political anything,” Simmons said. “It’s human beings who want to do the thing that humans do, which is to reproduce and to raise a family. There doesn’t need to be all of this other religious, political whatever, because it’s just human to want to have little humans.”
Simmons said there is loss, challenge and grief involved in infertility. She wished people would be more empathetic toward those who are facing it.
Back in 2020, a group of women came together and brought a public space to New Ulm where families can heal, reflect and honor those experiencing infertility. Ann Vote was one of the founding members. Since then, the space has become the physical representation of grief around the condition but also that support is there for those who are struggling.
Vote has a paver at the space dedicated to the three children she lost. She wanted others to know that infertility doesn’t discriminate and it is more common than they think. While she now has two children she loves dearly, the healing process from her experience still continues.
“I think it’s so important as we build relationships with other individuals, to make sure they know they are still loved and they are not broken,” she said. “That it is a journey, and that you’re there to support them.”