The economic news lately has been sobering to say the least and certainly a drop in the economy usually forces patients to carefully assess their options when considering various treatment options. Fertility treatment can be very expensive and life would be so much easier if I had a crystal ball that allowed me to predict with 100% certainty when and through what means a couple (or individual) would achieve success. But life is not like that and so we are left to counsel patients using our best advice as to how to proceed.
We have certainly seen an increased interest in Natural Cycle IVF as the cost per attempt is less than traditional stimulated IVF and not much more than for a clomid/IUI cycle. Still, the more expensive, more invasive treatment options tend to work better. I tell all my patients that I cannot compete with traditional adoption in terms of return on investement, but this is a pathway to parenthood that may not be acceptable to all patients. Embryo adoption/donation is another path that is very successful and less expensive but is limited by the laws of supply and demand.
So in returning to that famous repository of infertility advice...here is the Question of the Day from 100 Questions and Answers about Infertility. If you don't already have this book, then go to Amazon.com and order it right away ... and make sure that you post a 5 star review ... and tell all your friends to buy it... and come by and visit me at Dominion Fertility or come to the MidAtlantic RESOLVE meeting on October 18th to tell me how much you love this blog. Also, for those of you who missed our recent stint on the Kane show on 99.5 here in Washington you can listen online as they have it set up as a podcast. My kids thought I sounded halfway intelligent which is heady support from teenagers...
19. How Expensive are Infertility Treatments?
The cost of fertility treatments may be covered by some insurance plans. In those patients without insurance coverage, the cost of fertility treatments varies widely depending upon the specific treatment utilized. For example, a cycle of ultrasound monitoring without the use of fertility medications culminating with intrauterine insemination may cost $1300 to $1500 in many clinics. Compare this with the cost of IVF with ICSI, freezing of extra embryos, and assisted embryo hatching and the price tag can reach approximately $14,000 to $16,000 plus the cost of injectable fertility medications which may cost $2,000 to $4,000. The use of donor-egg IVF, although extremely successful, is also very expensive as the cost of reimbursing the donor for her time and effort must be included in the treatment. The typical price range for donor-egg IVF is between $25,000 and $30,000 depending upon the clinic.
In most cases the more expensive, more invasive fertility treatment usually results in the highest pregnancy rates, and therefore couples are advised to carefully consider the proposed course of treatment and the costs that may be involved. Around the country several IVF centers offer money back refund programs. In these situations a couple accepted into the program pays a premium which covers several fresh IVF cycles as well as frozen embryo transfers. If they fail to conceive or are deemed no longer to be appropriate candidates for treatment, then all or a percentage of their initial payment is refunded. These programs have remained somewhat controversial but can allow couples to pursue other options if IVF is unsuccessful.
According to the ASRM Ethics Committee Statement of June 2006: The controversy surrounding such programs relates in part to the concern that such arrangements “appear to violate long-standing ethical prohibitions against paying contingency fees in medicine. This concern is based on Opinion 6.01 of the AMA Code of Medical Ethics, which states, “a physician’s fee should not be made contingent on the successful outcome of a medical treatment.”
Furthermore, the Committee Statement (which can be found on the ASRM website at http://www.asrm.org/Media/Ethics/ethicsmain.html) concludes, “the risk-sharing form of payment for IVF is an option that might be ethically offered to patients without health insurance coverage for IVF if certain conditions that protect patient interests are met. conditions are that the criterion of success is clearly speciﬁed, that patients are fully informed of the ﬁnancial costs and advantages and disadvantages of such programs, that informed consent materials clearly inform patients of their chances of success if found eligible for the risk-sharing program, and that the program is not guaranteeing pregnancy and delivery. It should also be clear to patients that they will be paying a higher cost for IVF if they in fact succeed on the ﬁrst or second cycle than if they had not chosen the risk-sharing program, and that, in any event, the costs of screening and drugs are not included.
“The Committee was especially concerned about incentives that risk-sharing programs create for providers to take actions that might harm patients in order to achieve success and avoid a refund. For risk-sharing programs to be ethical, it is imperative that patients be aware of this potential conﬂict of interest, and that risk-sharing programs not overstimulate patients to obtain a large supply of eggs or transfer more embryos than is safe for the patient, fetus, and prospective offspring. Patients should be fully informed of the risks of multifetal gestation for mother and fetus, and have had ample time to discuss and consider them prior to egg retrieval.”