May 9, 2025 • 23 mins
What happens when a fertility professional with both nursing expertise and bioethics training decides to build a family-focused business in an increasingly profit-driven industry? Mary Fusillo takes us behind the scenes of The Donor Solution, her boutique egg donor agency that has helped create over 1,100 families while maintaining ethical standards in a field increasingly dominated by private equity.
Mary's journey began in 1999 when egg donation was still finding its footing. Instead of the casual "ask someone down the hall" approach common at the time, she pioneered comprehensive 26-page donor profiles that captured everything from medical history to favorite childhood memories. This revolutionary approach ultimately led her to establish The Donor Solution in 2007 as a values-driven alternative in the fertility landscape.
The most fascinating aspect of Mary's work involves managing client expectations. She compassionately helps prospective parents understand that while DNA matters, they're getting a baby to love, not a guaranteed carbon copy of the donor. Using a brilliant Broadway understudy analogy, she illustrates how initial disappointment over genetic connections eventually fades as parents bond with their children. This nurturing approach stands in stark contrast to the "you can have it all" marketing prevalent in the industry.
The fertility field is experiencing dramatic transformation as private equity firms acquire clinics and agencies nationwide. Mary candidly discusses how this has led to inflated costs, questionable add-on services, and diminished quality of care. Yet despite having fewer marketing resources than corporatized competitors, The Donor Solution is experiencing record growth – proof that ethical practice resonates with families navigating reproductive choices.
Looking for guidance through the complex world of fertility options? Mary's compassionate, no-pressure approach might be exactly what you need. Her commitment to transparency and fair pricing offers a refreshing alternative to the often overwhelming fertility journey.
📇 Contact & Social Handles
Guest: Mary M. Fusillo, RN, BSN, MS
Title: CEO & Founder, The Donor Solution | Host of Eggsplanation Podcast
Email: mary@familysolutionsinternational.com
Phone: (713) 827-0301
Website: www.familysolutionsinternational.com
Podcast: Eggsplanation (launching May 2025)
LinkedIn: Mary Fusillo LinkedIn (if confirmed)
Office Address: 717 Texas Ave., Suite 1200, Houston, TX 77002
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr Andrew Greenland (00:06):
So welcome back to another episode of
Voices in Health and Wellness.
I'm your host, dr AndrewGreenland, and today's guest
brings both deep compassion andan extraordinary track record in
the world of reproductiveethics and fertility.
Mary Fusillo is a registerednurse, bioethics graduate and
the founder of the DonorSolution, a boutique egg donor
agency that has helped over1,100 families grow in the last
(00:27):
17 years.
Hopefully that's correct.
She recently launched a podcastof her own Eggsplanation diving
into some of the most criticaland nuanced ethical questions in
facilities.
Today, mary, I'm reallythrilled to have you here.
Thank you so much for joiningus, especially with your own
podcast just launching, andcongratulations on explanation.
Where are you calling fromtoday, just for the benefit of
our listeners.
Mary Fusillo (00:48):
Houston, Texas.
Dr Andrew Greenland (00:50):
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 andhow the donor solution fits into
the broader fertility landscapetoday.
Mary Fusillo (01:02):
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 werejust starting to launch egg
donation.
Egg donation had been aroundabout 14, 15 years and the usual
method was, seriously, they'dgo down the hall and say to some
(01:26):
tech or some nurse or someresident, hey, do you want to be
a donor?
And there wasn't really acoordinated effort.
So when I got in the field itwas kind of a mishmash and there
was only a couple hundred,maybe a thousand people at that
time a year in the United Statestaking 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 usethe sperm donor model.
(01:48):
I could never understand whythey weren't using that model
originally, but so we startedusing the sperm donor model.
So we would advertise fordonors and like new college
newspapers, the weekly giveawaysthat tell about the
entertainment in the town, andwe started out and then we had a
very in-depth profile.
It was 26 pages long.
(02:08):
We asked their favorite color,their favorite flower, their
favorite memory of their mother,their father, what was their
passion, and at the time, reallypeople weren't doing that.
So we became very successful inthat way because we also had
people.
We showed photos and beforethat people were like, oh, this
all has to be anonymous, and Iunderstood the reason for
(02:29):
anonymity, but people were kindof keeping it a secret, whatever
.
It morphed into a pretty bigdonor pool.
I went to another clinic on theEast Coast that had a humongous
pool, kind of changed their wayof doing it.
Then I did consulting for acouple of years and told
everybody else how to do theirjob, which was a great job.
You have lunch for a living andyou tell people how to do their
job.
But by 2007, I kind of wantedto go on my own.
(02:53):
I was kind of tired oftraveling.
I had, at the time,eight-year-old twins, and so I
started my own business, theDonor Solution, and the goal was
is to be a boutique agencywhere people could actually talk
to somebody who wasn't tryingto sell them a dream.
We were trying to help themhave a family, and a family has
so many different components.
So that's how we started.
(03:15):
We morphed into Three Sisters,surrogacy we added that in 2012
and we have the FertilityConsultants, which is another
business which helps people thatare just starting out, that
don't know which way to go.
So over the last 18 years we'vebuilt into three different
companies.
So that's kind of the story howit started.
Dr Andrew Greenland (03:34):
Amazing.
So what does it look like froma client journey point of view,
somebody coming to see you?
What does it look like and howmight it differ from other
things in the niche?
Should we say how might itdiffer from other things in the
niche?
Mary Fusillo (03:44):
shall we say I'd say our goal is to understand
our client and what their needsare.
For instance, yesterday I got arequest from one of the clinics
that we work with.
Hey, we have an intended motherwho is looking for a specific
ethnicity and she wants thisspecific ethnicity in this
(04:04):
specific area, like, forinstance, if it was in England.
She only wants them to be fromManchester and all the relatives
are from Manchester, okay, soit's that kind of thing.
And they want to be taller thanyou know, five foot seven, and
they want long legs and theywant them to have a musical
ability and and also athleticability, and the list was
(04:26):
endless.
And so our goal is is to helpthem face reality and also to
kind of guide them and go youdon't get the girl.
Okay, the donor does not comeout in the delivery room, full
grown college is already paidfor.
No, you get a baby.
All this person has done isgiven you some DNA.
(04:48):
Yes, that's her DNA, but mostof us, our DNA is all the same.
It tells you how to make an earor how to make a nose.
It's not the person, and so wereally come at it from the
nurture standpoint.
We're also a big believer inepigenetics.
Dr Andrew Greenland (05:03):
So that's what our goal is is to counsel
them that this is not the end ofthe world.
Mary Fusillo (05:12):
You're still going to have your own baby.
So I guess a lot of expectationmanagement from what you're
saying, yeah, it's kind of likeplastic surgery.
It's like, no, you're not goingto look like.
We had a run on people whowanted donors that looked like
Whitney Houston the singer for awhile 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 andI think that people, when they
(05:33):
get to the stage where a donoris the only way they can build
their family in the way thatthey want to, they want to be
pregnant, they want to have achild with their partner.
I think that you know they wanttheir clone.
And so one of the ways that I'vedealt with it for over the
years, I think, ok, so when yougo to the West End or you go to
Broadway and you're going to seea famous actress, ok, you're
(05:57):
expecting Helen Mirren.
You know in some play, and yousit down in your seat and you're
all excited and then they tellyou tonight playing the role of
blah blah is somebody else theunderstudy, because Helen Mirren
is sick and you're sodisappointed.
It's like I came to see HelenMirren but by the end of the
play you've forgotten, becausethe goal of the actor is to make
(06:18):
you forget who they are.
But they are that character,and so that's my goal is to go.
You expect to have this, thisbaby that's you, but at the end
of the day you're going tocompletely not that you're going
to forget, but you are going topush it to the recesses of your
mind that this baby, um, hadsomeone else help you have it.
Dr Andrew Greenland (06:40):
I do like your helen mirren analogy.
I think that's really, reallyapt.
So, um, what does a typical daylook like for you?
Right now I don't know whatyour specific roles in the
business are.
Talk us through a typical day,and I suspect there probably is
no typical day, but justinterested to hear how it works
out.
Mary Fusillo (06:54):
You know it's weird because we've learned over
the years that and I have astaff that's been with me
forever I'm very, very fortunate, so everyone can do every job.
But over the years I've kind ofmorphed from being the miss
everything.
Anytime you have your ownbusiness, you do everything at
the beginning.
So now I usually focus onbusiness development and that
sounds like, oh, businessdevelopment.
No, it means that we're alwaystrying new and innovative ways
(07:17):
to get people in to hear ourstory.
I do believe we have one of thebest ways to counsel people on
using third party parenting, andso I want more people to know
that.
It doesn't mean that they haveto come use our services, but
I'd like them to know more aboutwhat it means to use a third
party to have a baby and so like.
(07:39):
Usually it's a bunch of emails,people looking for donors or
surrogates.
I talk to all intended parentson the surrogacy side because
it's so much more fraught with.
You know it's a two-yearrelationship, so we're pretty
picky because if we're going tohave a two-year relationship
with somebody, we've got toreally like them.
Donor on the other side is apretty quick thing.
(07:59):
It's like in and out in 90 days.
You know they select theirdonor.
The donor makes sure like inand out in 90 days.
You know they, they selecttheir donor.
The donor make sure that shecan do it.
We get with their clinic.
She goes and has her testing,she gets a calendar and she goes
forward.
We do a lot of front endeducation with both our donors
and our surrogates.
So by the time they get to theclinic they know it.
Okay, back in the old day wecall them PowerPoints, but now
(08:21):
they're decks.
But we have, we give them thisbasically a PowerPoint
presentation.
We've had a lot of discussionwith them about how it works so
they're not blindsided and don'twant to do it.
I'd say that we also spend alot of time putting out fires.
Okay, the donor didn't show upat the clinic, the intended
parents didn't pay their bill,the mother is freaking out the
(08:44):
well.
The worst is in the winter timewhen you're flying donors
across the country because wework all over the united states
and the weather impacts them andthey have the eggs ready to be
retrieved and they're stuck inchicago and they need to be in
in um new york city.
So that's that's always kind oflike ah, how do we get this
person from a to b got it.
Dr Andrew Greenland (09:04):
So I guess you've seen a lot over the years
, but what major shifts are younoticing in fertility care or
donor services more widely inthe US?
Mary Fusillo (09:14):
Well, I started my business just to be local,
because Houston is the fourthlargest city Actually we're
encroaching on Chicago to benumber three and we had a lot of
fertility services and one ofthe things that you will find in
the US about fertility servicesis they follow the money.
And Houston is a veryprosperous town.
(09:34):
There's the medical center thelargest in the world and the oil
industry or the energy industry, so a lot of highly educated
people.
They tend to wait longer tohave babies, hence they need
more fertility services.
So that's kind of how.
And then I realized I branchedout to Dallas and I branched out
to Austin and then I branchedto LA, because I lived in LA and
(09:55):
I like to go visit and prettysoon we're kind of everywhere.
I'd say our main focus is theSouthwest, but we do do probably
30% international.
So we do.
Actually we get a lot ofpatients from the UK because of
the lack of.
They don't have to wait, it'snot anonymous, they you know
somebody's not picking theirdonor.
(10:16):
We get.
We have a lot of competition inSpain because Spain is quick
and easy for some people, and weget a lot of people from Asia.
So we're kind of worldwide.
That's why the umbrella companyover my businesses is called
Family Solutions International.
So we want people to knowinternationally 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 yourown podcast Explanation and I
know you have a degree inbioethics to have helped you
navigate around all of theissues 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 currentadministration in the united
states has decided that they nolonger need the five people who
were the record keepers of theinformation about ibf cycles.
So I think in in the uk Iforgot what it's called, but
(11:14):
it's the human embryology blah,blah, blah, something or other.
Well, you know, they decided wedon't need it, we don't need to
track this anymore, and one ofthe big questions that they're
trying to figure out with thisdata is you know what works
where you know.
So all the IVF clinics have tosend in, or had to send in,
their information to the CDCCenter for Disease Control,
(11:35):
tracking it, information to theCDC Center for Disease Control,
tracking it.
We had this many starts.
We had this many people make itto retrieval, this many people
made embryos, blah, blah, blah.
So you knew what each clinicstatistics were for every age
group and for every modality.
Did they use donor sperm, didthey use ICSI, did they have a
donor, did they use a surrogate?
And so you had all this dataand they could look at trends
(11:55):
and they could see what washappening and you could see
fertility clinics.
Actually, they go up and down,and I've been in it for 26 years
and there's dry years andthere's crazy years because of
the way the population is.
So when the whole cohort ofpeople 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.
(12:15):
So all that data, according totoday's administration ruling,
is well, we're not going tocollect it anymore.
Wow, ok, yeah, so can youimagine a whole discipline of
science?
Like you know, we're not goingto worry about the data anymore.
Dr Andrew Greenland (12:31):
Very worrying.
Mary Fusillo (12:32):
Yeah.
What's working well for you andyour team at the moment at the
um the donor solution well,really, what's working the best
is, private equity has hit thefertility world like a ton of
bricks and um, it's just likeeverything else.
You know, they bought up thevet practices.
They've done this, they've donethat.
(12:54):
They took over, you know,kidney dialysis.
So what's happened in my fieldis there's a lot of us, and I've
always been a medium sizedplayer.
My goal was not to be thebiggest.
My goal was to be a mommy andhave a great career, so I wanted
to put the two together andalso make the same thing for all
my employees.
I wanted them to have the samething.
(13:14):
Um, and what's happened isthey've been like pac-man okay,
that shows how old I am, pac-manand, uh, they've been eaten up
by private equity who now wantsto squeeze the money out.
So I said I could either jointhem or I can morph into
something else, and so I decidedto morph into something else
and stay what our true callingwas, which I wanted to provide
(13:35):
an ethical business.
I wanted people to havetransparency, I wanted them to
feel nurtured and cared for inthe third party space, and so
that's what we're trying to do,versus following the crowd into
private equity and jumping offthe dock.
Dr Andrew Greenland (13:50):
Got it.
I mean, are you able to competewith obviously private equity
if they're buying up all theseclinics and merging them into
one thing with all the kind ofcost efficiency savings?
There's not really savings.
Mary Fusillo (14:02):
That's the myth of private equity.
And the second reason I went tograduate school in bioethics is
because of this myth thatprivate equity produces all
these savings and that they haveethical things.
No, venture capital is a greatway.
Venture capital is I come inand I want to invest in you
because I want all of us to makemoney.
(14:24):
Private equity is I want tomake money, I don't care about
you, and the deal is it's verymuch.
People get all caught up in itbecause they're like oh my God,
I'm 68 years old, says thedoctor, and I'm ready to retire
and I have a couple million, butI 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 threemore years.
(14:45):
Well, how do they make thatmoney?
Okay, well, what they do isthey cut people.
They do a lot of smoke andmirrors with the patients.
There's a lot of add-ons.
One of the big ethical issues Ifind in fertility is all these
add-ons.
It's like it's like when you goto the hotel and you think it's
120 pounds a night and then, oh, we have our 4% tax and we have
(15:06):
our service charge and we haveour tax.
At the end of the day, you'regoing, I'm paying 200 pounds for
this hotel room, and so it'sthe same thing with fertility.
We're going to add this, this,this and this.
I mean, it's pretty soon I'mlike they're going to charge you
for the Petri dish, and so youknow that would be a bring your
own Petri dish.
So I find that people we havehad and I can't believe this is
(15:26):
happening in the United Statesright now and everyone else is
like freaking out about theeconomy is, and I don't want to
jinx it, but we have had thebest start um of any year, and
now we're in the fifth monthsince the recession of 20, 2008,
2009 and covid.
Now it's really weird.
Why did we all of a sudden havegreat business?
(15:46):
When everyone else is crying,we think, oh, actually, I think
that in times of crisis, peopleknow 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 areasof friction in the work that you
do, whether it's an operationalmarketing regulatory?
What are the kind of painpoints for you or the challenges
?
Mary Fusillo (16:09):
I'd say well, on an irritating kind of a mosquito
level organ donation from acadaver, and so they want all
this testing done.
So we went through this bigthing with West Nile.
(16:30):
We've got right now the bigbuzzword is TB, because they had
a cluster of cases in KansasCity of this.
Oh, you know the kind that'sresistant to you know, you're
the doctor that, the one that'sresistant 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 ourday.
They did the little time teston you.
No, no, no, no, you have tohave this blood test.
And it's like really, I mean,can we just look at it instead
of lumping?
They went down this thing withoh, a couple of years ago there
was this fly that was bitingpeople in Brazil and causing all
(17:10):
these horrible birth defects.
So all of a sudden, nobodycould be a donor that had been
to Mexico because Mexico hadthese certain things.
So I think sometimes they go alittle nuts.
They go nuts on chlamydia.
Ok, the bad news is chlamydiais awful and we're glad that you
got tested, but it doesn'taffect your egg quality and if
you get treated then you're goodto go.
(17:32):
And so they've kind of gonenuts about stuff like that.
So that's like the irritatingthing I hate about it.
What I really hate about itright now, and what I think is
just really ethicallychallenging, is how much it
costs.
Really.
Your costs have doubled.
I don't think so.
You've gotten rid of all thelicensed nurses, you've gotten
rid of this, you've gotten ridof that, and now you're saying
(17:53):
oh yes, we want to charge doublewhat we did three or four years
ago.
Dr Andrew Greenland (17:58):
Are there any restrictions in the US
around marketing and the waythat you sort of put yourself
out there?
I mean things like you know,digital visibility.
Are there any way that you sortof put yourself out there?
I mean things like you know,digital visibility.
Are there any things that youhave to fight against in order
to be seen and heard by people,to put out your message, um,
from a regulation no, it's thewild, wild west.
Mary Fusillo (18:16):
Seriously, right now, if you go on and you know
that, you know how, like whenyou're on social media, like it
follows you around, like if youput in the word shoes, all of a
sudden you're inundated with allthese shoes ads.
So right now, um, uh, differentagencies are advertising that a
surrogate can be compensated ahundred thousand dollars plus
(18:39):
for for carrying the pregnancy.
Okay, and it's kind of likethat's a lot of smoke and
mirrors, because that's like ifeverything, that's like basic
compensation, that's if you needa cesarean section, that's like
if you're carrying triplets,that's if you end up on bedrest
for two months, that's if youend up with a hysterectomy.
I mean, it's like everythingaltogether maybe could add up to
(19:03):
a hundred thousand dollars, buthighly doubtful.
And they're advertising that.
And the deal is the, the um,the big private equity uh, I'd
say agencies and the privateequity IVF clinics, um, they
have a lot of money causethey're trying to completely
quarter the market.
It's capitalism, I understandit, but they're spending in
(19:26):
excess of 40 to 50 times a monthmore than we spend on
advertising.
So we have to always.
We're always like I pedal everyday.
How do we get people.
How do we do this?
Not on the donor side as much.
They're not interested in anegg donation as much as they are
surrogacy, because surrogacypays big money to everybody,
(19:48):
Okay, and but egg donationdoesn't.
So I'm like know what?
That's fine, we're going tostay over here in our corner
with egg donation doing whatwe've done for 18 years and we
just have surrogacy as kind of aside thing for people that we
help that need that.
So everybody else is likerunning oh, I want to do
surrogacy because it pays somuch money.
Dr Andrew Greenland (20:06):
Got it.
So, as a business owner, whatmetrics are you particularly
interested in tracking to kindof see how you're doing and
making sure that you're movingin the right direction?
Are there any things youparticularly focus on or
anything you're particularlyinterested 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 itdoes is it captures everything.
So in the past it was allliterally spreadsheets, okay,
but we've had them for aboutfive years.
And so somebody applies to be adonor Okay, and immediately the
(20:43):
system sends her justdirections, you know nice little
emails and some information anda cute PowerPoint presentation
and whatever.
And then our coordinator followsup 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 adriver's license.
We do a background check on her, that kind of stuff.
What I found is at the end ofevery month that I can look at
(21:06):
the metrics how many applied,how many qualified, because we
rank them a one to a five, howmany finished the paperwork, how
many had an interview and howmany actually went on our
database.
So if we get, I'd say we get ahundred to 150 applicants on the
donor side a month and four orfive actually become donors.
(21:27):
So it's helpful to say let'stweak our advertising to add up
or let's go in a differentdirection.
Everybody else is running overhere 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 inthe next, say, six to 12 months?
What's your vision for thebusiness?
Mary Fusillo (21:47):
Well, number one I want to.
We're going to, we're revampingthe fertility consultants and
we're revamping it to offer moreservices for people that maybe
aren't don't need donor or don'tneed surrogacy, but they don't
know where to go.
Okay, so we get calls from alot of people who are like you
know, I don't know where to go.
Okay, so we get a calls from alot of people who are like you
know, I don't know where to go.
(22:08):
We've been trying for sixmonths.
My OBGYN says this I'm ready tohave a baby, so we're going to
offer a complimentaryconsultation of 20 minutes.
I'm not the doctor, but I justwant to hear their story and
then give them some ideas andthen they can actually buy a
package of consulting, like, inother words, I'll be their
mentor for like three different,you know three different calls
(22:30):
to walk them through it.
Sometimes I get people who go Ilike I had somebody that was
from El Paso, texas, and there'snot a lot of IVF, there's not a
lot of choices, and you'repretty far away from everybody
else.
It's like six hours to Phoenix,it's like six hours to San
Antonio, and so, you know, Isaid, look, why don't you tell
me your story and then, if youwant to, you can share with me,
(22:51):
like your numbers, like your AMHor FSH, what tests you've had.
And I'm not a doctor, I'm justgoing to say my experience shows
me, hey, because the resultsare on there.
This is what I suggest.
Have you, have you talked tothis person?
Have you talked to that person?
So the goal is that somebodythat's kind of a coach for them
and I hate the word coach, butan advisor and so and then we're
(23:17):
also going to offer injections,because a lot of people get
nervous about their surrogate ortheir egg donor taking the
shots the right way.
So we're going to have a groupof registered nurses that will
go to the home of the donor orthe surrogate and give them
their trigger shot or theirprogesterone shot, and so we
just want to be all encompassingto 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 interestinghearing about your business, the
donor solution and your ethos.
Really like it, reallyinteresting hearing about the
business and the direction thatyou're taking it.
So thank you so much for yourtime.
Mary Fusillo (23:49):
Really appreciate it thank you for inviting me
you're welcome.
So welcome back to another episode of
Voices in Health and Wellness.
I'm your host, dr AndrewGreenland, and today's guest
brings both deep compassion andan extraordinary track record in
the world of reproductiveethics and fertility.
Mary Fusillo is a registerednurse, bioethics graduate and
the founder of the DonorSolution, a boutique egg donor
agency that has helped over1,100 families grow in the last
(00:27):
17 years.
Hopefully that's correct.
She recently launched a podcastof her own Eggsplanation diving
into some of the most criticaland nuanced ethical questions in
facilities.
Today, mary, I'm reallythrilled to have you here.
Thank you so much for joiningus, especially with your own
podcast just launching, andcongratulations on explanation.
Where are you calling fromtoday, just for the benefit of
our listeners.
Mary Fusillo (00:48):
Houston, Texas.
Dr Andrew Greenland (00:50):
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 andhow the donor solution fits into
the broader fertility landscapetoday.
Mary Fusillo (01:02):
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 werejust starting to launch egg
donation.
Egg donation had been aroundabout 14, 15 years and the usual
method was, seriously, they'dgo down the hall and say to some
(01:26):
tech or some nurse or someresident, hey, do you want to be
a donor?
And there wasn't really acoordinated effort.
So when I got in the field itwas kind of a mishmash and there
was only a couple hundred,maybe a thousand people at that
time a year in the United Statestaking 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 usethe sperm donor model.
(01:48):
I could never understand whythey weren't using that model
originally, but so we startedusing the sperm donor model.
So we would advertise fordonors and like new college
newspapers, the weekly giveawaysthat tell about the
entertainment in the town, andwe started out and then we had a
very in-depth profile.
It was 26 pages long.
(02:08):
We asked their favorite color,their favorite flower, their
favorite memory of their mother,their father, what was their
passion, and at the time, reallypeople weren't doing that.
So we became very successful inthat way because we also had
people.
We showed photos and beforethat people were like, oh, this
all has to be anonymous, and Iunderstood the reason for
(02:29):
anonymity, but people were kindof keeping it a secret, whatever
.
It morphed into a pretty bigdonor pool.
I went to another clinic on theEast Coast that had a humongous
pool, kind of changed their wayof doing it.
Then I did consulting for acouple of years and told
everybody else how to do theirjob, which was a great job.
You have lunch for a living andyou tell people how to do their
job.
But by 2007, I kind of wantedto go on my own.
(02:53):
I was kind of tired oftraveling.
I had, at the time,eight-year-old twins, and so I
started my own business, theDonor Solution, and the goal was
is to be a boutique agencywhere people could actually talk
to somebody who wasn't tryingto sell them a dream.
We were trying to help themhave a family, and a family has
so many different components.
So that's how we started.
(03:15):
We morphed into Three Sisters,surrogacy we added that in 2012
and we have the FertilityConsultants, which is another
business which helps people thatare just starting out, that
don't know which way to go.
So over the last 18 years we'vebuilt into three different
companies.
So that's kind of the story howit started.
Dr Andrew Greenland (03:34):
Amazing.
So what does it look like froma client journey point of view,
somebody coming to see you?
What does it look like and howmight it differ from other
things in the niche?
Should we say how might itdiffer from other things in the
niche?
Mary Fusillo (03:44):
shall we say I'd say our goal is to understand
our client and what their needsare.
For instance, yesterday I got arequest from one of the clinics
that we work with.
Hey, we have an intended motherwho is looking for a specific
ethnicity and she wants thisspecific ethnicity in this
(04:04):
specific area, like, forinstance, if it was in England.
She only wants them to be fromManchester and all the relatives
are from Manchester, okay, soit's that kind of thing.
And they want to be taller thanyou know, five foot seven, and
they want long legs and theywant them to have a musical
ability and and also athleticability, and the list was
(04:26):
endless.
And so our goal is is to helpthem face reality and also to
kind of guide them and go youdon't get the girl.
Okay, the donor does not comeout in the delivery room, full
grown college is already paidfor.
No, you get a baby.
All this person has done isgiven you some DNA.
(04:48):
Yes, that's her DNA, but mostof us, our DNA is all the same.
It tells you how to make an earor how to make a nose.
It's not the person, and so wereally come at it from the
nurture standpoint.
We're also a big believer inepigenetics.
Dr Andrew Greenland (05:03):
So that's what our goal is is to counsel
them that this is not the end ofthe world.
Mary Fusillo (05:12):
You're still going to have your own baby.
So I guess a lot of expectationmanagement from what you're
saying, yeah, it's kind of likeplastic surgery.
It's like, no, you're not goingto look like.
We had a run on people whowanted donors that looked like
Whitney Houston the singer for awhile 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 andI think that people, when they
(05:33):
get to the stage where a donoris the only way they can build
their family in the way thatthey want to, they want to be
pregnant, they want to have achild with their partner.
I think that you know they wanttheir clone.
And so one of the ways that I'vedealt with it for over the
years, I think, ok, so when yougo to the West End or you go to
Broadway and you're going to seea famous actress, ok, you're
(05:57):
expecting Helen Mirren.
You know in some play, and yousit down in your seat and you're
all excited and then they tellyou tonight playing the role of
blah blah is somebody else theunderstudy, because Helen Mirren
is sick and you're sodisappointed.
It's like I came to see HelenMirren but by the end of the
play you've forgotten, becausethe goal of the actor is to make
(06:18):
you forget who they are.
But they are that character,and so that's my goal is to go.
You expect to have this, thisbaby that's you, but at the end
of the day you're going tocompletely not that you're going
to forget, but you are going topush it to the recesses of your
mind that this baby, um, hadsomeone else help you have it.
Dr Andrew Greenland (06:40):
I do like your helen mirren analogy.
I think that's really, reallyapt.
So, um, what does a typical daylook like for you?
Right now I don't know whatyour specific roles in the
business are.
Talk us through a typical day,and I suspect there probably is
no typical day, but justinterested to hear how it works
out.
Mary Fusillo (06:54):
You know it's weird because we've learned over
the years that and I have astaff that's been with me
forever I'm very, very fortunate, so everyone can do every job.
But over the years I've kind ofmorphed from being the miss
everything.
Anytime you have your ownbusiness, you do everything at
the beginning.
So now I usually focus onbusiness development and that
sounds like, oh, businessdevelopment.
No, it means that we're alwaystrying new and innovative ways
(07:17):
to get people in to hear ourstory.
I do believe we have one of thebest ways to counsel people on
using third party parenting, andso I want more people to know
that.
It doesn't mean that they haveto come use our services, but
I'd like them to know more aboutwhat it means to use a third
party to have a baby and so like.
(07:39):
Usually it's a bunch of emails,people looking for donors or
surrogates.
I talk to all intended parentson the surrogacy side because
it's so much more fraught with.
You know it's a two-yearrelationship, so we're pretty
picky because if we're going tohave a two-year relationship
with somebody, we've got toreally like them.
Donor on the other side is apretty quick thing.
(07:59):
It's like in and out in 90 days.
You know they select theirdonor.
The donor makes sure like inand out in 90 days.
You know they, they selecttheir donor.
The donor make sure that shecan do it.
We get with their clinic.
She goes and has her testing,she gets a calendar and she goes
forward.
We do a lot of front endeducation with both our donors
and our surrogates.
So by the time they get to theclinic they know it.
Okay, back in the old day wecall them PowerPoints, but now
(08:21):
they're decks.
But we have, we give them thisbasically a PowerPoint
presentation.
We've had a lot of discussionwith them about how it works so
they're not blindsided and don'twant to do it.
I'd say that we also spend alot of time putting out fires.
Okay, the donor didn't show upat the clinic, the intended
parents didn't pay their bill,the mother is freaking out the
(08:44):
well.
The worst is in the winter timewhen you're flying donors
across the country because wework all over the united states
and the weather impacts them andthey have the eggs ready to be
retrieved and they're stuck inchicago and they need to be in
in um new york city.
So that's that's always kind oflike ah, how do we get this
person from a to b got it.
Dr Andrew Greenland (09:04):
So I guess you've seen a lot over the years
, but what major shifts are younoticing in fertility care or
donor services more widely inthe US?
Mary Fusillo (09:14):
Well, I started my business just to be local,
because Houston is the fourthlargest city Actually we're
encroaching on Chicago to benumber three and we had a lot of
fertility services and one ofthe things that you will find in
the US about fertility servicesis they follow the money.
And Houston is a veryprosperous town.
(09:34):
There's the medical center thelargest in the world and the oil
industry or the energy industry, so a lot of highly educated
people.
They tend to wait longer tohave babies, hence they need
more fertility services.
So that's kind of how.
And then I realized I branchedout to Dallas and I branched out
to Austin and then I branchedto LA, because I lived in LA and
(09:55):
I like to go visit and prettysoon we're kind of everywhere.
I'd say our main focus is theSouthwest, but we do do probably
30% international.
So we do.
Actually we get a lot ofpatients from the UK because of
the lack of.
They don't have to wait, it'snot anonymous, they you know
somebody's not picking theirdonor.
(10:16):
We get.
We have a lot of competition inSpain because Spain is quick
and easy for some people, and weget a lot of people from Asia.
So we're kind of worldwide.
That's why the umbrella companyover my businesses is called
Family Solutions International.
So we want people to knowinternationally 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 yourown podcast Explanation and I
know you have a degree inbioethics to have helped you
navigate around all of theissues 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 currentadministration in the united
states has decided that they nolonger need the five people who
were the record keepers of theinformation about ibf cycles.
So I think in in the uk Iforgot what it's called, but
(11:14):
it's the human embryology blah,blah, blah, something or other.
Well, you know, they decided wedon't need it, we don't need to
track this anymore, and one ofthe big questions that they're
trying to figure out with thisdata is you know what works
where you know.
So all the IVF clinics have tosend in, or had to send in,
their information to the CDCCenter for Disease Control,
(11:35):
tracking it, information to theCDC Center for Disease Control,
tracking it.
We had this many starts.
We had this many people make itto retrieval, this many people
made embryos, blah, blah, blah.
So you knew what each clinicstatistics were for every age
group and for every modality.
Did they use donor sperm, didthey use ICSI, did they have a
donor, did they use a surrogate?
And so you had all this dataand they could look at trends
(11:55):
and they could see what washappening and you could see
fertility clinics.
Actually, they go up and down,and I've been in it for 26 years
and there's dry years andthere's crazy years because of
the way the population is.
So when the whole cohort ofpeople 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.
(12:15):
So all that data, according totoday's administration ruling,
is well, we're not going tocollect it anymore.
Wow, ok, yeah, so can youimagine a whole discipline of
science?
Like you know, we're not goingto worry about the data anymore.
Dr Andrew Greenland (12:31):
Very worrying.
Mary Fusillo (12:32):
Yeah.
What's working well for you andyour team at the moment at the
um the donor solution well,really, what's working the best
is, private equity has hit thefertility world like a ton of
bricks and um, it's just likeeverything else.
You know, they bought up thevet practices.
They've done this, they've donethat.
(12:54):
They took over, you know,kidney dialysis.
So what's happened in my fieldis there's a lot of us, and I've
always been a medium sizedplayer.
My goal was not to be thebiggest.
My goal was to be a mommy andhave a great career, so I wanted
to put the two together andalso make the same thing for all
my employees.
I wanted them to have the samething.
(13:14):
Um, and what's happened isthey've been like pac-man okay,
that shows how old I am, pac-manand, uh, they've been eaten up
by private equity who now wantsto squeeze the money out.
So I said I could either jointhem or I can morph into
something else, and so I decidedto morph into something else
and stay what our true callingwas, which I wanted to provide
(13:35):
an ethical business.
I wanted people to havetransparency, I wanted them to
feel nurtured and cared for inthe third party space, and so
that's what we're trying to do,versus following the crowd into
private equity and jumping offthe dock.
Dr Andrew Greenland (13:50):
Got it.
I mean, are you able to competewith obviously private equity
if they're buying up all theseclinics and merging them into
one thing with all the kind ofcost efficiency savings?
There's not really savings.
Mary Fusillo (14:02):
That's the myth of private equity.
And the second reason I went tograduate school in bioethics is
because of this myth thatprivate equity produces all
these savings and that they haveethical things.
No, venture capital is a greatway.
Venture capital is I come inand I want to invest in you
because I want all of us to makemoney.
(14:24):
Private equity is I want tomake money, I don't care about
you, and the deal is it's verymuch.
People get all caught up in itbecause they're like oh my God,
I'm 68 years old, says thedoctor, and I'm ready to retire
and I have a couple million, butI 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 threemore years.
(14:45):
Well, how do they make thatmoney?
Okay, well, what they do isthey cut people.
They do a lot of smoke andmirrors with the patients.
There's a lot of add-ons.
One of the big ethical issues Ifind in fertility is all these
add-ons.
It's like it's like when you goto the hotel and you think it's
120 pounds a night and then, oh, we have our 4% tax and we have
(15:06):
our service charge and we haveour tax.
At the end of the day, you'regoing, I'm paying 200 pounds for
this hotel room, and so it'sthe same thing with fertility.
We're going to add this, this,this and this.
I mean, it's pretty soon I'mlike they're going to charge you
for the Petri dish, and so youknow that would be a bring your
own Petri dish.
So I find that people we havehad and I can't believe this is
(15:26):
happening in the United Statesright now and everyone else is
like freaking out about theeconomy is, and I don't want to
jinx it, but we have had thebest start um of any year, and
now we're in the fifth monthsince the recession of 20, 2008,
2009 and covid.
Now it's really weird.
Why did we all of a sudden havegreat business?
(15:46):
When everyone else is crying,we think, oh, actually, I think
that in times of crisis, peopleknow 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 areasof friction in the work that you
do, whether it's an operationalmarketing regulatory?
What are the kind of painpoints for you or the challenges
?
Mary Fusillo (16:09):
I'd say well, on an irritating kind of a mosquito
level organ donation from acadaver, and so they want all
this testing done.
So we went through this bigthing with West Nile.
(16:30):
We've got right now the bigbuzzword is TB, because they had
a cluster of cases in KansasCity of this.
Oh, you know the kind that'sresistant to you know, you're
the doctor that, the one that'sresistant 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 ourday.
They did the little time teston you.
No, no, no, no, you have tohave this blood test.
And it's like really, I mean,can we just look at it instead
of lumping?
They went down this thing withoh, a couple of years ago there
was this fly that was bitingpeople in Brazil and causing all
(17:10):
these horrible birth defects.
So all of a sudden, nobodycould be a donor that had been
to Mexico because Mexico hadthese certain things.
So I think sometimes they go alittle nuts.
They go nuts on chlamydia.
Ok, the bad news is chlamydiais awful and we're glad that you
got tested, but it doesn'taffect your egg quality and if
you get treated then you're goodto go.
(17:32):
And so they've kind of gonenuts about stuff like that.
So that's like the irritatingthing I hate about it.
What I really hate about itright now, and what I think is
just really ethicallychallenging, is how much it
costs.
Really.
Your costs have doubled.
I don't think so.
You've gotten rid of all thelicensed nurses, you've gotten
rid of this, you've gotten ridof that, and now you're saying
(17:53):
oh yes, we want to charge doublewhat we did three or four years
ago.
Dr Andrew Greenland (17:58):
Are there any restrictions in the US
around marketing and the waythat you sort of put yourself
out there?
I mean things like you know,digital visibility.
Are there any way that you sortof put yourself out there?
I mean things like you know,digital visibility.
Are there any things that youhave to fight against in order
to be seen and heard by people,to put out your message, um,
from a regulation no, it's thewild, wild west.
Mary Fusillo (18:16):
Seriously, right now, if you go on and you know
that, you know how, like whenyou're on social media, like it
follows you around, like if youput in the word shoes, all of a
sudden you're inundated with allthese shoes ads.
So right now, um, uh, differentagencies are advertising that a
surrogate can be compensated ahundred thousand dollars plus
(18:39):
for for carrying the pregnancy.
Okay, and it's kind of likethat's a lot of smoke and
mirrors, because that's like ifeverything, that's like basic
compensation, that's if you needa cesarean section, that's like
if you're carrying triplets,that's if you end up on bedrest
for two months, that's if youend up with a hysterectomy.
I mean, it's like everythingaltogether maybe could add up to
(19:03):
a hundred thousand dollars, buthighly doubtful.
And they're advertising that.
And the deal is the, the um,the big private equity uh, I'd
say agencies and the privateequity IVF clinics, um, they
have a lot of money causethey're trying to completely
quarter the market.
It's capitalism, I understandit, but they're spending in
(19:26):
excess of 40 to 50 times a monthmore than we spend on
advertising.
So we have to always.
We're always like I pedal everyday.
How do we get people.
How do we do this?
Not on the donor side as much.
They're not interested in anegg donation as much as they are
surrogacy, because surrogacypays big money to everybody,
(19:48):
Okay, and but egg donationdoesn't.
So I'm like know what?
That's fine, we're going tostay over here in our corner
with egg donation doing whatwe've done for 18 years and we
just have surrogacy as kind of aside thing for people that we
help that need that.
So everybody else is likerunning oh, I want to do
surrogacy because it pays somuch money.
Dr Andrew Greenland (20:06):
Got it.
So, as a business owner, whatmetrics are you particularly
interested in tracking to kindof see how you're doing and
making sure that you're movingin the right direction?
Are there any things youparticularly focus on or
anything you're particularlyinterested 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 itdoes is it captures everything.
So in the past it was allliterally spreadsheets, okay,
but we've had them for aboutfive years.
And so somebody applies to be adonor Okay, and immediately the
(20:43):
system sends her justdirections, you know nice little
emails and some information anda cute PowerPoint presentation
and whatever.
And then our coordinator followsup 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 adriver's license.
We do a background check on her, that kind of stuff.
What I found is at the end ofevery month that I can look at
(21:06):
the metrics how many applied,how many qualified, because we
rank them a one to a five, howmany finished the paperwork, how
many had an interview and howmany actually went on our
database.
So if we get, I'd say we get ahundred to 150 applicants on the
donor side a month and four orfive actually become donors.
(21:27):
So it's helpful to say let'stweak our advertising to add up
or let's go in a differentdirection.
Everybody else is running overhere 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 inthe next, say, six to 12 months?
What's your vision for thebusiness?
Mary Fusillo (21:47):
Well, number one I want to.
We're going to, we're revampingthe fertility consultants and
we're revamping it to offer moreservices for people that maybe
aren't don't need donor or don'tneed surrogacy, but they don't
know where to go.
Okay, so we get calls from alot of people who are like you
know, I don't know where to go.
Okay, so we get a calls from alot of people who are like you
know, I don't know where to go.
(22:08):
We've been trying for sixmonths.
My OBGYN says this I'm ready tohave a baby, so we're going to
offer a complimentaryconsultation of 20 minutes.
I'm not the doctor, but I justwant to hear their story and
then give them some ideas andthen they can actually buy a
package of consulting, like, inother words, I'll be their
mentor for like three different,you know three different calls
(22:30):
to walk them through it.
Sometimes I get people who go Ilike I had somebody that was
from El Paso, texas, and there'snot a lot of IVF, there's not a
lot of choices, and you'repretty far away from everybody
else.
It's like six hours to Phoenix,it's like six hours to San
Antonio, and so, you know, Isaid, look, why don't you tell
me your story and then, if youwant to, you can share with me,
(22:51):
like your numbers, like your AMHor FSH, what tests you've had.
And I'm not a doctor, I'm justgoing to say my experience shows
me, hey, because the resultsare on there.
This is what I suggest.
Have you, have you talked tothis person?
Have you talked to that person?
So the goal is that somebodythat's kind of a coach for them
and I hate the word coach, butan advisor and so and then we're
(23:17):
also going to offer injections,because a lot of people get
nervous about their surrogate ortheir egg donor taking the
shots the right way.
So we're going to have a groupof registered nurses that will
go to the home of the donor orthe surrogate and give them
their trigger shot or theirprogesterone shot, and so we
just want to be all encompassingto 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 interestinghearing about your business, the
donor solution and your ethos.
Really like it, reallyinteresting hearing about the
business and the direction thatyou're taking it.
So thank you so much for yourtime.
Mary Fusillo (23:49):
Really appreciate it thank you for inviting me
you're welcome.
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