Right after Madison turned 40, she and her husband began in vitro fertilization. Each round cost the couple roughly $7,000. When the first two rounds failed, they felt short on money and time. “There was that financial burden and the emotional burden,” she says. “And with that comes desperation to look at other options.” In the course of her online research, Madison, who asked that her real name be withheld, came across a fertility-focused podcast called the FU Project, hosted by Tasha Blasi, a Los Angeles–based former high-school science teacher and advertising-sales rep who details her personal struggles — and eventual successes — with in vitro fertilization. (FU stands for “Fertilitites Unite,” Blasi-speak for the population of people hoping to conceive.)
Blasi, who has no medical training, launched a fertility-coaching practice in 2016; she is now one of the best-known coaches. Fertility coaching is a growing field in which practitioners offer advice, educational material, and emotional support to those experiencing difficulty conceiving or carrying a child. Sign up for one of Blasi’s programs and she’ll prep you for your appointment with your fertility doctor, urging you to push for particular blood tests or hormonal treatments. She’ll also go over your lab work, sometimes suggesting dietary supplements to take (which she encourages you to buy through a private online “dispensary”). She might point you toward a Blasi-approved fertility clinic, dietitian, or meditation program. Throughout, she’ll message you with encouragement, referring to you, affectionately, as “mama,” though you might not yet be one. “Unless you were born with a compromised reproductive system,” writes Blasi on her website “there is something else causing [infertility], and the sooner we can figure that out, the healthier you will be and your fertility will dramatically improve.”
These coaches seek to fill a real gap that many people hoping to conceive experience. Fertility treatments such as intrauterine insemination (IUI) or in vitro fertilization (IVF), in addition to being expensive and stressful, can be confusing to navigate. They might involve injections or other medications that can create physical or emotional discomfort. Often, first-time-parent hopefuls have to master an entirely new set of information and vocabulary in a short time, and patients can sometimes feel rushed or condescended to by medical doctors, especially when their issues are chronic or intractable, and crave more handholding than medical professionals at a typical obstetrics and gynecology practice are able or willing to provide. “If you are not sure what your doctor is proposing is the right call and you are always second-guessing and doing your own research and want an expert to confirm that what is being proposed is the right move,” Blasi writes on her website, “that is what we do for you.”
But while these services purport to address a gap in women’s health care, they can just as likely exploit it — a pattern that emerged in my interviews with multiple women who hired, or seriously considered hiring, a coach. Fertility coaches typically shield themselves with a boilerplate: This isn’t medical advice; there’s no guarantee of success. But even more so than in other coaching subsectors, the desperation among clientele — and therefore the opportunities for gouging and potential harm — is intense. Even coaches without a large following can charge hundreds of dollars per session.
After signing on for coaching with Blasi in July 2020, Madison says she felt encouraged. Her doctor had explained that there was roughly a 20 percent chance of success were they to embark on a third round of in vitro fertilization. Blasi thought the chances were better and admitted her into a program with a money-back guarantee. It would cost Madison nearly another $7,000, paid up front in two installments. That’s on top, of course, of the cost of the medical treatments themselves. But as time went on, Blasi’s suggested protocol began to conflict with the advice Madison says she received at her in-person doctor’s appointments; based on Madison’s lab results, Blasi had a hunch Madison suffered from endometriosis, Madison tells me, though her doctor was adamant this was not a relevant issue. At one juncture, after Madison recovered from a fever related to an infection, Blasi advised her to freeze her available embryos rather than go ahead with a transfer right away, though her doctor said it was safe to proceed. Blasi eventually deferred to the doctor’s advice. Still, Madison often felt caught in the middle: “The most stressful part of the entire process was having to navigate between conversations with Tasha and with my doctor,” she says.
The materials and advice disseminated by fertility coaches tend to rely heavily on an ethos of “feminist” self-determination: Aspiring mamas ought to see themselves as girlbosses whose hustle, pluck, and refusal to take no for an answer — along with maybe a bit of luck in the form of “baby dust” — will get them that BFP (fertility-forum lingo for a “big fat positive” result) on a pregnancy test. In the video on her site’s home page, Blasi asks the camera: “Can you believe what you are doing to try and get and stay pregnant, versus your friends?”
It’s the sort of reassurance that many patients are looking for. And as Dr. Alan Penzias, a reproductive endocrinologist at Boston IVF and associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, explains it, it’s a level of attention that simply “may exceed the resources that the practice is able to handle,” he says of typical obstetrics and gynecology clinics. But such mantras and encouragement also promote a kind of fantasy: that if a woman were to put in the effort, she, too, might finally have a successful pregnancy. “It makes me cringe,” said Debora Spar, a professor at Harvard Business School whose research has examined the market for fertility services. “Getting pregnant is not a matter of will or grit. As in many other areas of society, telling women that if they just tried a little harder, if they leaned in more consciously, it will all fall into place — it’s just not true.”
Still, the prospect is tempting, and many women are willing to pay. The costs of hiring a fertility coach vary widely: Michelle Streeter, a Charlottesville, Virginia, coach, offers a 30-day intensive program for $1,333; Laura Fletcher, who runs Selah Fertility in Orlando, Florida, charges $175 for an hour. On the higher end of the scale are coaches like Blasi. Until recently, Blasi’s price tag has run anywhere from $500 for a one-on-one session to $4,800 for a yearlong program to $7,800 for a “fuller support” option that lasts until your baby arrives. Today, she tells me, she’s condensed the long-term programs into a single six-month option that costs $5,800 (though her website refers to cost only as “in the mid-four figures” for a longer-term arrangement).
The fees can sometimes include techniques or products that haven’t actually been proven to be effective. In February, Anna, an Oregon-based business owner, booked a free consultation with Aumatma Shah, a naturopath who was a frequent featured speaker in fertility-focused chats on Clubhouse. At 38, Anna had a diagnosis of endometriosis and experienced four miscarriages and three rounds of IVF. Shah was keen to order extensive hormonal testing, including a spate of pricey workups known as the DUTCH Test, which measures hormone-metabolite levels in dried urine samples in order to identify imbalances that could be addressed with supplements or dietary changes. (The DUTCH Test has not been validated in independent scientific studies, says Penzias.) The fee for the coaching package would be $15,000. “It didn’t pencil out to me,” Anna says. “Would they really spend five hours a month on me at $500 an hour?” She chose not to spend the money.
Other coaching programs seem to be structured to nudge women to purchase additional products, suggesting that, perhaps, one more supplement or another mindfulness tool could make the difference. A few months before she turned 35, Courtney decided to become a single mother by choice, using a sperm donor. She purchased Blasi’s “foundations” package for around $1,000, which gave her access to educational materials. “Going into my first round of IVF, I was a blind sheep,” Courtney says. “Now, because of all the information I’ve learned from her, I’m so much more proactive.” She says she can better decode lab results delivered through a patient portal, such as a report that her follicles varied greatly in size — a “red flag,” she says, indicating potential difficulties with an egg harvest. (Penzias, who is also on the board of directors for the American Society for Reproductive Medicine, says this typically is not, in fact, the case.)
Courtney went on to book a one-on-one video meeting with Blasi, who reviewed her lab data and protocol history, for $1,500. She also reviewed Courtney’s drug and supplement regimen, recommending some tweaks. After a second round of IVF, Courtney’s embryo transfer was successful — she’s 12 weeks pregnant. She’s happy with her experience with Blasi, but she also felt put off by the regular sales pitches for a range of dietary supplements. Taken together, the pills in Blasi’s suggested regimen, such as vitamins C, D, and E and fish oil, could cost more than $100 per month. Blasi urged clients to order through Wellevate, which Blasi said promotes particular benefits like high-quality products and temperature-controlled shipping, though Courtney says the products arrived through regular UPS delivery. “I tried to really like Wellevate,” Courtney tells me. “But no, I’m sorry. With Amazon, I could order, and it’s here tomorrow, and it’s in the same container.” (Wellevate includes cold packs when shipping heat-sensitive products, an executive wrote in an email to me.)
Programs may also come with onerous terms that incentivize women to continue trying fertility treatments, month after month, likely in the hope of juicing a coach’s success rate — even if the patient’s medical picture or goals change. In the fall of 2020, Julia, a 42-year-old woman, was drawn to Blasi’s practice in part because of a money-back guarantee, a promotion the coach was advertising at the time. Julia, who asked to keep her real name private, had undergone five failed rounds of IVF. “There’s no downside,” she remembers thinking. “The worst thing that can happen is I get my money back because we don’t have a baby.” She signed on with Blasi, whom she paid $7,800 for coaching services that would extend until a baby arrived. A line in the client agreement she received from Blasi’s business reads: “If you follow my program and don’t get pregnant, and are no longer trying to get pregnant, I will give you your money back.”
Julia met Blasi in a one-on-one video call and was then assigned a member of Blasi’s staff for weekly phone check-ins. There were informational videos to watch, worksheets to fill out, and a private online forum for coaching clients to connect. In a follow-up conversation, Blasi suggested she switch to a fertility doctor to whom she regularly sends clients; Julia obliged. But when her additional treatments with the new doctor — this time, changing her embryo-transfer protocol — still failed, it was clear that she had exhausted this avenue, and further rounds of IVF made little sense. She and her husband decided to seek an egg donor.
Julia wanted out of the coaching program and she approached Blasi’s team for her refund. The team eventually replied, citing language in the client agreement that would have required her to undergo one additional embryo transfer under Blasi’s watch (incurring all the related costs) to become eligible for the money-back guarantee. They issued her a partial refund: less than a quarter of the $7,800 she had invested. “It was a slap in the face,” Julia says.
When I ask about this particular instance — albeit without naming Julia specifically — Blasi tells me that they addressed the question of whether a client would be eligible for a refund without having an embryo transfer in a phone call before she signed the client agreement. “We told her that, unfortunately, no, she would not qualify for the money-back guarantee without doing two transfers,” Blasi wrote to me in a follow-up text message. (Julia doesn’t recall this exchange.)
Blasi no longer offers a money-back guarantee, which she says she discontinued around 2020 “to protect myself more.” The guarantee, Blasi says, “set the precedent that I was taking responsibility for their fertility journey. And I didn’t love that, because I can’t get pregnant for them.”
When it comes to fertility coaches — as with the larger world of coaching — barriers to entry are virtually nonexistent, and there’s no standard certification process, professional oversight, licensing, or regulatory apparatus. Some fertility coaches with large, established social-media followings run training programs for which they recruit would-be coaches seeking an imprimatur, such as a certificate for attending training webinars.
Elizabeth King, a coach with more than 28,000 Instagram followers based in Irvine, California, runs one such program, Fertility Coach Academy. Last year, she came across a children’s book written by a woman named Tess Kossow called I’m Very Ferris, based on her experience with IVF and her now-4-year-old son. Kossow, who is 39 and lives in Carmel, Indiana, has an M.B.A. and left a career in media human resources a few years ago. A survivor of cardiac arrest who had done some heart-health advocacy work, Kossow was mulling options for flexible work that would allow her to help people with their health.
After they connected, Kossow signed on last fall for King’s training course, which cost around $2,000 at the time and took her about three months to complete. It included group calls with King and other trainees, slide decks on topics like polycystic ovary syndrome and sperm motility, and sessions focused on social-media marketing.
After passing a final exam and earning her certificate, which she displays on her website, Kossow launched her business in January. She is focused on growing her platform, she tells me. But she has not yet recouped her investment in the business, she says. Kossow prices her 90-minute “heart and soul” session at $150. So far, she has spoken with a few clients primarily through free one-on-one consultation sessions or slots she has offered as promotional giveaways. But despite the slow start, King has been reassuring, Kossow says. “I’m in an Indianapolis market — it’s not the biggest market out there,” Kossow tells me. (Though because she provides virtual coaching, she notes, her business isn’t limited to who is nearby.) “So I understand that, locally, it will be a little bit tougher than if I were in L.A. or if I were in Chicago or if I were in New York.”
King tells me that recouping that investment — not to mention building a profitable business — is not necessarily her clients’ immediate priority. They might be juggling other personal responsibilities, she says, or see it as a side hustle, opting for flexibility over growth. Since launching the academy last fall, King has retooled the program’s structure and rate, and now offers a $5,000 package for the three-month certification course, along with continuing support from King that lasts a year.
Not everyone walks away from their fertility-coaching experience unhappy, and coaches often plaster their social-media profiles and websites with glowing testimonials from women who got pregnant or gave birth after seeking their advice. Still, these businesses — which tap a pool of particularly desperate clientele, charge high fees, and offer services of questionable value — raise obvious ethical concerns.
“I can see how, if you have someone in the background telling you not to listen to your doctor, not to give up, that you’re going to spend more and more money,” Gwendolyn P. Quinn, professor at NYU Grossman School of Medicine in both obstetrics and gynecology and bioethics, tells me. Clients might derive real benefit from coaching services offered in an ethical manner, she says. But “people can get so caught up in what they want that they’re not listening to facts.” And unlike physicians or attorneys in private practice, a coach is not bound by professional codes or fiduciary duties, explains Nanette Elster, associate professor of bioethics at Loyola University Chicago Stritch School of Medicine. “When you have a commercial model like this, then the priority is not the client or the patient, but is instead the making of money,” she says. “The end game is profitability.”
Blasi says she focuses on preparing her clients to be their own advocates in the exam room. “If you’ve chosen the doctor, we go with the doctor,” she tells me. But if a client isn’t satisfied with the treatment results, she might ask, “Do you want to stay with this doctor?”
When Madison thought her fifth round of IVF had failed, she, too, approached Blasi for a refund, which she believed she was entitled to under the money-back guarantee. Blasi refused, citing terms of the agreement including a provision that stated the refund was subject to review. Later, Madison found out she was, in fact, pregnant. But her relationship with Blasi had eroded to the point that she’s not sure whether Blasi has added her 7-month-old daughter to the running tally of the more than 100 babies Blasi says have been born as a result of her advice.
In a follow-up email to me, Blasi emphasized that dissatisfied clients are rare, citing a 94.1 percent satisfaction rate across 488 women since 2017. Of the 29 dissatisfied clients, all but Madison received a full or partial refund, Blasi wrote.
The success a coach may have achieved after her own fertility setbacks, or the successes of other women in her testimonials, is understandably alluring — it’s easy to hope they might ultimately lead to one’s own healthy newborn. That hope is chief among the offerings of these pricey coaching services. While they can’t promise the birth of a child, the one thing they can guarantee is an uneven mix of cheerleading and back-seat driving couched in the trappings of empowerment. For a client who gets pregnant, it can feel like a win. But for those whose coaching experiences result in more time, money, and even pregnancies among their losses, this brand of optimism isn’t worth the cost.