Dr Andrew Greenland: 0:06

So welcome back to another episode of Voices in Health and Wellness. I'm your host, dr Andrew Greenland, and today's guest brings both deep compassion and an extraordinary track record in the world of reproductive ethics and fertility. Mary Fusillo is a registered nurse, bioethics graduate and the founder of the Donor Solution, a boutique egg donor agency that has helped over 1,100 families grow in the last 17 years. Hopefully that's correct. She recently launched a podcast of her own Eggsplanation diving into some of the most critical and nuanced ethical questions in facilities. Today, mary, I'm really thrilled to have you here. Thank you so much for joining us, especially with your own podcast just launching, and congratulations on explanation. Where are you calling from today, just for the benefit of our listeners.

Mary Fusillo: 0:48

Houston, Texas.

Dr Andrew Greenland: 0:50

Wonderful, so thank you for your time. What I'd like to just ask you, if you mind, is just tell us a little bit about your role and how the donor solution fits into the broader fertility landscape today.

Mary Fusillo: 1:02

Well, I got into the fertility field in 2019. I mean, in 1999, I'm like, oh, aging myself and I actually worked at a clinic where we were just starting to launch egg donation. Egg donation had been around about 14, 15 years and the usual method was, seriously, they'd go down the hall and say to some tech or some nurse or some resident, hey, do you want to be a donor? And there wasn't really a coordinated effort. So when I got in the field it was kind of a mishmash and there was only a couple hundred, maybe a thousand people at that time a year in the United States taking advantage of donor egg. So when I worked at this clinic, we said, well, there's got to be a better widget. So we decided to kind of use the sperm donor model. I could never understand why they weren't using that model originally, but so we started using the sperm donor model. So we would advertise for donors and like new college newspapers, the weekly giveaways that tell about the entertainment in the town, and we started out and then we had a very in-depth profile. It was 26 pages long. We asked their favorite color, their favorite flower, their favorite memory of their mother, their father, what was their passion, and at the time, really people weren't doing that. So we became very successful in that way because we also had people. We showed photos and before that people were like, oh, this all has to be anonymous, and I understood the reason for anonymity, but people were kind of keeping it a secret, whatever. It morphed into a pretty big donor pool.

Mary Fusillo: 2:35

I went to another clinic on the East Coast that had a humongous pool, kind of changed their way of doing it. Then I did consulting for a couple of years and told everybody else how to do their job, which was a great job. You have lunch for a living and you tell people how to do their job. But by 2007, I kind of wanted to go on my own. I was kind of tired of traveling.

Mary Fusillo: 2:55

I had, at the time, eight-year-old twins, and so I started my own business, the Donor Solution, and the goal was is to be a boutique agency where people could actually talk to somebody who wasn't trying to sell them a dream. We were trying to help them have a family, and a family has so many different components. So that's how we started. We morphed into Three Sisters, surrogacy we added that in 2012 and we have the Fertility Consultants, which is another business which helps people that are just starting out, that don't know which way to go. So over the last 18 years we've built into three different companies. So that's kind of the story how it started.

Dr Andrew Greenland: 3:34

Amazing. So what does it look like from a client journey point of view, somebody coming to see you? What does it look like and how might it differ from other things in the niche? Should we say how might it differ from other things in the niche?

Mary Fusillo: 3:44

shall we say I'd say our goal is to understand our client and what their needs are. For instance, yesterday I got a request from one of the clinics that we work with. Hey, we have an intended mother who is looking for a specific ethnicity and she wants this specific ethnicity in this specific area, like, for instance, if it was in England. She only wants them to be from Manchester and all the relatives are from Manchester, okay, so it's that kind of thing. And they want to be taller than you know, five foot seven, and they want long legs and they want them to have a musical ability and and also athletic ability, and the list was endless. And so our goal is is to help them face reality and also to kind of guide them and go you don't get the girl.

Mary Fusillo: 4:37

Okay, the donor does not come out in the delivery room, full grown college is already paid for. No, you get a baby. All this person has done is given you some DNA. Yes, that's her DNA, but most of us, our DNA is all the same. It tells you how to make an ear or how to make a nose. It's not the person, and so we really come at it from the nurture standpoint. We're also a big believer in epigenetics.

Dr Andrew Greenland: 5:03

So that's what our goal is is to counsel them that this is not the end of the world.

Mary Fusillo: 5:12

You're still going to have your own baby. So I guess a lot of expectation management from what you're saying, yeah, it's kind of like plastic surgery.

Mary Fusillo: 5:19

It's like, no, you're not going to look like. We had a run on people who wanted donors that looked like Whitney Houston the singer for a while and it was like, but you don't look like Whitney Houston, you don't sing like Whitney Houston, so it was just it's. It is managing expectations and I think that people, when they get to the stage where a donor is the only way they can build their family in the way that they want to, they want to be pregnant, they want to have a child with their partner. I think that you know they want their clone.

Mary Fusillo: 5:47

And so one of the ways that I've dealt with it for over the years, I think, ok, so when you go to the West End or you go to Broadway and you're going to see a famous actress, ok, you're expecting Helen Mirren. You know in some play, and you sit down in your seat and you're all excited and then they tell you tonight playing the role of blah blah is somebody else the understudy, because Helen Mirren is sick and you're so disappointed. It's like I came to see Helen Mirren but by the end of the play you've forgotten, because the goal of the actor is to make you forget who they are. But they are that character, and so that's my goal is to go. You expect to have this, this baby that's you, but at the end of the day you're going to completely not that you're going to forget, but you are going to push it to the recesses of your mind that this baby, um, had someone else help you have it.

Dr Andrew Greenland: 6:40

I do like your helen mirren analogy. I think that's really, really apt. So, um, what does a typical day look like for you? Right now I don't know what your specific roles in the business are. Talk us through a typical day, and I suspect there probably is no typical day, but just interested to hear how it works out.

Mary Fusillo: 6:54

You know it's weird because we've learned over the years that and I have a staff that's been with me forever I'm very, very fortunate, so everyone can do every job. But over the years I've kind of morphed from being the miss everything. Anytime you have your own business, you do everything at the beginning. So now I usually focus on business development and that sounds like, oh, business development. No, it means that we're always trying new and innovative ways to get people in to hear our story. I do believe we have one of the best ways to counsel people on using third party parenting, and so I want more people to know that. It doesn't mean that they have to come use our services, but I'd like them to know more about what it means to use a third party to have a baby and so like. Usually it's a bunch of emails, people looking for donors or surrogates.

Mary Fusillo: 7:44

I talk to all intended parents on the surrogacy side because it's so much more fraught with. You know it's a two-year relationship, so we're pretty picky because if we're going to have a two-year relationship with somebody, we've got to really like them. Donor on the other side is a pretty quick thing. It's like in and out in 90 days. You know they select their donor. The donor makes sure like in and out in 90 days. You know they, they select their donor. The donor make sure that she can do it. We get with their clinic. She goes and has her testing, she gets a calendar and she goes forward.

Mary Fusillo: 8:12

We do a lot of front end education with both our donors and our surrogates. So by the time they get to the clinic they know it. Okay, back in the old day we call them PowerPoints, but now they're decks. But we have, we give them this basically a PowerPoint presentation. We've had a lot of discussion with them about how it works so they're not blindsided and don't want to do it. I'd say that we also spend a lot of time putting out fires. Okay, the donor didn't show up at the clinic, the intended parents didn't pay their bill, the mother is freaking out the well. The worst is in the winter time when you're flying donors across the country because we work all over the united states and the weather impacts them and they have the eggs ready to be retrieved and they're stuck in chicago and they need to be in in um new york city. So that's that's always kind of like ah, how do we get this person from a to b got it.

Dr Andrew Greenland: 9:04

So I guess you've seen a lot over the years, but what major shifts are you noticing in fertility care or donor services more widely in the US?

Mary Fusillo: 9:14

Well, I started my business just to be local, because Houston is the fourth largest city Actually we're encroaching on Chicago to be number three and we had a lot of fertility services and one of the things that you will find in the US about fertility services is they follow the money. And Houston is a very prosperous town. There's the medical center the largest in the world and the oil industry or the energy industry, so a lot of highly educated people. They tend to wait longer to have babies, hence they need more fertility services. So that's kind of how. And then I realized I branched out to Dallas and I branched out to Austin and then I branched to LA, because I lived in LA and I like to go visit and pretty soon we're kind of everywhere.

Mary Fusillo: 9:59

I'd say our main focus is the Southwest, but we do do probably 30% international. So we do. Actually we get a lot of patients from the UK because of the lack of. They don't have to wait, it's not anonymous, they you know somebody's not picking their donor. We get. We have a lot of competition in Spain because Spain is quick and easy for some people, and we get a lot of people from Asia. So we're kind of worldwide. That's why the umbrella company over my businesses is called Family Solutions International. So we want people to know internationally they can come to us.

Dr Andrew Greenland: 10:37

Got it and how is the conversation around ethics evolving in this space, especially now? I know you're launching your own podcast Explanation and I know you have a degree in bioethics to have helped you navigate around all of the issues in this business. But what's?

Mary Fusillo: 10:54

happening. Well, let's see. Let's just talk about today. So today the the current administration in the united states has decided that they no longer need the five people who were the record keepers of the information about ibf cycles. So I think in in the uk I forgot what it's called, but it's the human embryology blah, blah, blah, something or other. Well, you know, they decided we don't need it, we don't need to track this anymore, and one of the big questions that they're trying to figure out with this data is you know what works where you know.

Mary Fusillo: 11:27

So all the IVF clinics have to send in, or had to send in, their information to the CDC Center for Disease Control, tracking it, information to the CDC Center for Disease Control, tracking it. We had this many starts. We had this many people make it to retrieval, this many people made embryos, blah, blah, blah. So you knew what each clinic statistics were for every age group and for every modality. Did they use donor sperm, did they use ICSI, did they have a donor, did they use a surrogate? And so you had all this data and they could look at trends and they could see what was happening and you could see fertility clinics.

Mary Fusillo: 11:58

Actually, they go up and down, and I've been in it for 26 years and there's dry years and there's crazy years because of the way the population is. So when the whole cohort of people turn 35, 36, 37, all of a sudden there's a big bump. So when that age group is less, then you don't have as many clients. So all that data, according to today's administration ruling, is well, we're not going to collect it anymore. Wow, ok, yeah, so can you imagine a whole discipline of science? Like you know, we're not going to worry about the data anymore.

Dr Andrew Greenland: 12:31

Very worrying.

Mary Fusillo: 12:32

Yeah.

Mary Fusillo: 12:34

What's working well for you and your team at the moment at the um the donor solution well, really, what's working the best is, private equity has hit the fertility world like a ton of bricks and um, it's just like everything else. You know, they bought up the vet practices. They've done this, they've done that. They took over, you know, kidney dialysis. So what's happened in my field is there's a lot of us, and I've always been a medium sized player.

Mary Fusillo: 13:04

My goal was not to be the biggest. My goal was to be a mommy and have a great career, so I wanted to put the two together and also make the same thing for all my employees. I wanted them to have the same thing. Um, and what's happened is they've been like pac-man okay, that shows how old I am, pac-man and, uh, they've been eaten up by private equity who now wants to squeeze the money out. So I said I could either join them or I can morph into something else, and so I decided to morph into something else and stay what our true calling was, which I wanted to provide an ethical business. I wanted people to have transparency, I wanted them to feel nurtured and cared for in the third party space, and so that's what we're trying to do, versus following the crowd into private equity and jumping off the dock.

Dr Andrew Greenland: 13:50

Got it. I mean, are you able to compete with obviously private equity if they're buying up all these clinics and merging them into one thing with all the kind of cost efficiency savings? There's not really savings.

Mary Fusillo: 14:02

That's the myth of private equity. And the second reason I went to graduate school in bioethics is because of this myth that private equity produces all these savings and that they have ethical things. No, venture capital is a great way. Venture capital is I come in and I want to invest in you because I want all of us to make money. Private equity is I want to make money, I don't care about you, and the deal is it's very much.

Mary Fusillo: 14:30

People get all caught up in it because they're like oh my God, I'm 68 years old, says the doctor, and I'm ready to retire and I have a couple million, but I really want a couple million more. And now they're going to pay me $3 million for my share of this company. I only have to stay for three more years. Well, how do they make that money? Okay, well, what they do is they cut people. They do a lot of smoke and mirrors with the patients. There's a lot of add-ons.

Mary Fusillo: 14:54

One of the big ethical issues I find in fertility is all these add-ons. It's like it's like when you go to the hotel and you think it's 120 pounds a night and then, oh, we have our 4% tax and we have our service charge and we have our tax. At the end of the day, you're going, I'm paying 200 pounds for this hotel room, and so it's the same thing with fertility. We're going to add this, this, this and this. I mean, it's pretty soon I'm like they're going to charge you for the Petri dish, and so you know that would be a bring your own Petri dish.

Mary Fusillo: 15:21

So I find that people we have had and I can't believe this is happening in the United States right now and everyone else is like freaking out about the economy is, and I don't want to jinx it, but we have had the best start um of any year, and now we're in the fifth month since the recession of 20, 2008, 2009 and covid. Now it's really weird. Why did we all of a sudden have great business? When everyone else is crying, we think, oh, actually, I think that in times of crisis, people know the only thing left is family and they want a family.

Dr Andrew Greenland: 16:02

Interesting and where are you? Are you running into any areas of friction in the work that you do, whether it's an operational marketing regulatory? What are the kind of pain points for you or the challenges?

Mary Fusillo: 16:09

I'd say well, on an irritating kind of a mosquito level organ donation from a cadaver, and so they want all this testing done. So we went through this big thing with West Nile. We've got right now the big buzzword is TB, because they had a cluster of cases in Kansas City of this. Oh, you know the kind that's resistant to you know, you're the doctor that, the one that's resistant to the drugs.

Dr Andrew Greenland: 16:45

Ok, oh, yeah, yeah.

Mary Fusillo: 16:46

Yeah, that's it OK. And so all of a sudden, everybody had to get tested for TB and it can't be back in our day. They did the little time test on you. No, no, no, no, you have to have this blood test. And it's like really, I mean, can we just look at it instead of lumping? They went down this thing with oh, a couple of years ago there was this fly that was biting people in Brazil and causing all these horrible birth defects. So all of a sudden, nobody could be a donor that had been to Mexico because Mexico had these certain things.

Mary Fusillo: 17:19

So I think sometimes they go a little nuts. They go nuts on chlamydia. Ok, the bad news is chlamydia is awful and we're glad that you got tested, but it doesn't affect your egg quality and if you get treated then you're good to go. And so they've kind of gone nuts about stuff like that. So that's like the irritating thing I hate about it. What I really hate about it right now, and what I think is just really ethically challenging, is how much it costs. Really. Your costs have doubled. I don't think so. You've gotten rid of all the licensed nurses, you've gotten rid of this, you've gotten rid of that, and now you're saying oh yes, we want to charge double what we did three or four years ago.

Dr Andrew Greenland: 17:58

Are there any restrictions in the US around marketing and the way that you sort of put yourself out there? I mean things like you know, digital visibility. Are there any way that you sort of put yourself out there? I mean things like you know, digital visibility. Are there any things that you have to fight against in order to be seen and heard by people, to put out your message, um, from a regulation no, it's the wild, wild west.

Mary Fusillo: 18:16

Seriously, right now, if you go on and you know that, you know how, like when you're on social media, like it follows you around, like if you put in the word shoes, all of a sudden you're inundated with all these shoes ads. So right now, um, uh, different agencies are advertising that a surrogate can be compensated a hundred thousand dollars plus for for carrying the pregnancy. Okay, and it's kind of like that's a lot of smoke and mirrors, because that's like if everything, that's like basic compensation, that's if you need a cesarean section, that's like if you're carrying triplets, that's if you end up on bedrest for two months, that's if you end up with a hysterectomy. I mean, it's like everything altogether maybe could add up to a hundred thousand dollars, but highly doubtful. And they're advertising that. And the deal is the, the um, the big private equity uh, I'd say agencies and the private equity IVF clinics, um, they have a lot of money cause they're trying to completely quarter the market. It's capitalism, I understand it, but they're spending in excess of 40 to 50 times a month more than we spend on advertising.

Mary Fusillo: 19:32

So we have to always. We're always like I pedal every day. How do we get people. How do we do this? Not on the donor side as much. They're not interested in an egg donation as much as they are surrogacy, because surrogacy pays big money to everybody, Okay, and but egg donation doesn't. So I'm like know what? That's fine, we're going to stay over here in our corner with egg donation doing what we've done for 18 years and we just have surrogacy as kind of a side thing for people that we help that need that. So everybody else is like running oh, I want to do surrogacy because it pays so much money.

Dr Andrew Greenland: 20:06

Got it. So, as a business owner, what metrics are you particularly interested in tracking to kind of see how you're doing and making sure that you're moving in the right direction? Are there any things you particularly focus on or anything you're particularly interested in trying to improve on?

Mary Fusillo: 20:20

I would say because we use this really great customer management system. It's called Orchid. I've shout out to them what it does is it captures everything. So in the past it was all literally spreadsheets, okay, but we've had them for about five years. And so somebody applies to be a donor Okay, and immediately the system sends her just directions, you know nice little emails and some information and a cute PowerPoint presentation and whatever.

Mary Fusillo: 20:50

And then our coordinator follows up with her. She has to complete her steps. So she has to have a profile, she has to have her medical record, she has to have a driver's license. We do a background check on her, that kind of stuff. What I found is at the end of every month that I can look at the metrics how many applied, how many qualified, because we rank them a one to a five, how many finished the paperwork, how many had an interview and how many actually went on our database. So if we get, I'd say we get a hundred to 150 applicants on the donor side a month and four or five actually become donors. So it's helpful to say let's tweak our advertising to add up or let's go in a different direction. Everybody else is running over here and I'm going to run over there so what?

Dr Andrew Greenland: 21:40

where's next for donor solution? What do you want to achieve in the next, say, six to 12 months? What's your vision for the business?

Mary Fusillo: 21:47

Well, number one I want to. We're going to, we're revamping the fertility consultants and we're revamping it to offer more services for people that maybe aren't don't need donor or don't need surrogacy, but they don't know where to go. Okay, so we get calls from a lot of people who are like you know, I don't know where to go. Okay, so we get a calls from a lot of people who are like you know, I don't know where to go. We've been trying for six months. My OBGYN says this I'm ready to have a baby, so we're going to offer a complimentary consultation of 20 minutes. I'm not the doctor, but I just want to hear their story and then give them some ideas and then they can actually buy a package of consulting, like, in other words, I'll be their mentor for like three different, you know three different calls to walk them through it.

Mary Fusillo: 22:31

Sometimes I get people who go I like I had somebody that was from El Paso, texas, and there's not a lot of IVF, there's not a lot of choices, and you're pretty far away from everybody else.

Mary Fusillo: 22:40

It's like six hours to Phoenix, it's like six hours to San Antonio, and so, you know, I said, look, why don't you tell me your story and then, if you want to, you can share with me, like your numbers, like your AMH or FSH, what tests you've had. And I'm not a doctor, I'm just going to say my experience shows me, hey, because the results are on there. This is what I suggest. Have you, have you talked to this person? Have you talked to that person? So the goal is that somebody that's kind of a coach for them and I hate the word coach, but an advisor and so and then we're also going to offer injections, because a lot of people get nervous about their surrogate or their egg donor taking the shots the right way. So we're going to have a group of registered nurses that will go to the home of the donor or the surrogate and give them their trigger shot or their progesterone shot, and so we just want to be all encompassing to help people navigate this without gouging them. That's my big thing.

Dr Andrew Greenland: 23:38

Mary, thank you so much for spending the time this evening. It's been really interesting hearing about your business, the donor solution and your ethos. Really like it, really interesting hearing about the business and the direction that you're taking it. So thank you so much for your time.

Mary Fusillo: 23:49

Really appreciate it thank you for inviting me you're welcome.