There are about 1.0 million infertile couples in the United States, for whom IVF offers the only rational opportunity to have a baby. About 10% of these women (100,000) undergo approximately 150,000 fresh IVF cycles annually. This represents a significant underservicing of the demand. The fact that more than onehalf of all IVF procedures are conducted by fewer than 10% of the programs, with the remainder being divided among the rest of the clinics means that most IVF centers in the USA perform fewer than 150 fresh IVF procedures annually. This makes it very difficult for all the IVF practitioners (physicians and embryologists) to gain optimal hands-on experience. In fact, with such small numbers of IVF procedures being performed by half the IVF programs in this country, it is virtually impossible even to develop meaningful statistics.
The main reason for the underutilization of IVF in the United States, is the matter of cost and affordability. Presently most IVF costs represent out of pocket expenses. A study reported in “Human Reproduction” a few years ago by the European Society of Human Reproduction and Embryology (ESHRE) revealed that direct costs of fertility treatment vary considerably from country to country with the United States topping the list. For example, the average price of IVF treatment is about $4,100 in Japan, $3,100 in Belgium, $8,750 in Canada and a whopping $13,800 in the U.S. Moreover, these costs have risen further, quite substantially, over the last few years. Simply stated, when it comes to IVF in America, the size of the pocket book usually determines the ability to have a family.
Central to making IVF affordable lies the need for insurance coverage”. However, Insurance companies are reluctant to cover IVF because of two main concerns:
- First, is the fact that the there is an absence of access to accurate IVF outcome data that would actuarially determine cost. Unfortunately annual IVF outcome reports by the Society for Assisted Reproduction (SART) largely relies on self-reporting of statistics by individual IVF clinics and does not require consistent validation through oversight or auditing. Hopefully, this will change because until and unless it does, insurance companies will likely remain reluctant to cover IVF.
- Second is the fact that the high incidence of IVF multiple births, largely brought about by a lack of control over the number of embryos being transferred per IVF procedure. The high incidence of serious complications resulting from prematurity-related complications drives up cost to payers, creating a strong disincentive to cover IVF services. drives up cost per baby.
Given a roughly 35% National IVF birthrate in women under 39Y of age ( and this declines with further advancing age), it follows that most women will require more than one (1) IVF attempts to have a baby. As such, the traditional “fee for service” system of payment will often put having an IVF baby outside the reach of many infertile patients requiring this service. It was against this background that I, more than 20 years ago first introduced the concept of Financial Risk Sharing with patients undergoing IVF. One example is the very popular “Two Cycle Plan” (which for a set fee which is slightly higher than the cost of a single IVF attempt) they gain access to up to two (2) fresh IVF cycles with as many fresh or frozen embryo transfers as needed to either achieve a live birth or use up all available embryos generated
Here I wish to offer a word or two of caution…… Beware of comparing one program’s quoted cost of IVF directly to another’s at face value. As with the purchase of any product or service, it is always important to first look at the base cost and then to evaluate the fees for additional services (“add-ons”). IVF Program A might include the cost for add-ons such as intracytoplasmic sperm injection (ICSI), assisted hatching and initial freezing and storage of embryos in their “base price” while Program B might quote a lower IVF fee that does not include the cost of some/all such add-ons. Unless this is taken into consideration, it is possible to erroneously consider the cost of IVF at Program B as being lower than at Program A .It is important to always compare “apples with apples”. First, examine the base fee per cycle, add the inevitable cost of anesthesia and fertility drugs and then ask about the extra cost of any “add-ons”.
Finally, patients are advised to view the cost of an IVF procedure as the cost of having a baby and not the cost of each individual cycle of treatment. Thus, another important consideration issue is the experience, quality and expertise of the doctor and lab, as this inevitably impacts the likelihood of a successful outcome (live birth).
The emotional cost of IVF
To describe the effects of preparing for, participating in, and post IVF anticipation as a “roller coaster ride” is a gross understatement. Anyone who has been through the process, whether successfully or unsuccessfully will attest to the fact that in the final analysis the emotional price turned out to be far greater than the financial.
Unquestionably, the majority of US women/couples going through IVF find the financial burden to be overwhelming. They have to massage every dollar available to afford a single cycle of treatment. As such they view the financial challenge as great. For them the knowledge that if they do not succeed the first time around, they might not be able to afford a second attempt, only serves to deepen their emotional stress. Here, it becomes even more important to seek out the best possible available venue for IVF services, in their area or out-of-town.
More than 70% of my IVF patients travel from out of town, state or country to Las Vegas for treatment with me. I fully recognize that for some, traveling away from home for IVF often denies access to built-in support systems and, as such, might represent a hardship and a sacrifice. That is where we I and my team come in to the picture. We strive to provide such support through being available and affable at all times. I personally provide all active patients with my cell phone number and invite them to call me at any time with questions, comments, concerns or any other issue(s).