June 30, 2015

How Much Does IVF Cost?

How much does IVF cost?

Tell me, Doctor, “How much does IVF cost?”

The price of fertility treatment is one of the greatest obstacles to receiving care. Surprisingly, however, financial matters are the least likely subject to be discussed by physicians with their patients. Moreover, modern medical schools rarely teach practitioners-in-training to look at the price tag or how to discuss cost with patients. In fact the medical culture has traditionally avoided the business of medicine, including advertising, and have looked askance at practitioners who have frank discussions concerning cost.

Frank discussions are needed as health care costs are escalating for myriad reasons. 

Salaries of most physicians are stagnant or receding while those of managed care organizations and even “not-for-profit” hospitals have reached unprecedented levels. Such high incomes are of course sourced either directly from the patients’ pockets or indirectly through their insurers. However, the latter source requires that patients be lucky enough to have an insurance plan with a reasonable deductible that they can both afford and that covers the cost of fertility care.

So far, 13 U.S. states have mandated coverage for fertility care. However, not everyone living and working in those 13 states actually has coverage. To be covered by the mandate, one must work for a company that is headquartered in that state and has at least 100 employees. The Commonwealth of Massachusetts has re-affirmed upholding the fertility mandate at least for now. Since the Federal Government’s Affordable Care Act legislation has no provision for fertility coverage, there are no guarantees that these mandates are maintained into the future.

Regardless of state mandates, between 20% and 40% of people residing in a mandated state don’t have coverage for fertility care and approximately 64% of patients needing fertility services don’t think they can afford it. These people without fertility coverage comprise the “self-pay” market: they must pay the fees that the fertility center charges for their services entirely by themselves, while those with insurance pay a co-pay and or deductible payment before getting all or a substantial portion of their bill covered by their third party insurer.

So: ‘How much does IVF cost?’

Each fertility center has a different answer. Indeed, prices vary all over the country. For instance, within New England alone the cost for one complete IVF/ICSI cycle varies from $9,300 in our Fertility Center up to $12,900 in another (prices change frequently, please confirm with us for up-to-date pricing).

These prices typically cover:

  • management
  • monitoring
  • egg retrieval
  • anesthesia for the egg retrieval
  • sperm preparation and insemination by ICSI
  • embryo culture for five days
  • embryo transfer
  • follow-up pregnancy test 10 days after the transfer

While it would be convenient for the patient (and economically efficient) for a fertility center’s higher prices to coincide with higher success rates, in reality there is no correlation between cost and success across the nation’s fertility centers.Success should mean the chance of one healthy baby per single embryo transfer. It is very difficult for many patients to determine what are their chances for a healthy baby. Organizations that tabulate IVF clinic success rates themselves, such as the Centers for Disease Control (CDC) or the Society of Assisted Reproductive Technology (SART), make it difficult for the average consumer to even understand what success rates mean. The SART website disclaims as such to its visitors:

The data presented in this report should not be used for comparing clinics. Clinics may have differences in patient selection, treatment approaches, and cycle reporting practices which may inflate or lower pregnancy rates relative to other clinics. Please discuss with your doctor.

In other words, it is apparently hard to compare apples to apples when there are some oranges in the mix. It’s true: there are some individual differences between fertility centers as explained above. Nevertheless, major differences between programs are not necessarily all clinical, as the SART website implies. Instead, the greatest differences are primarily due to individual ART (Assisted Reproductive Technology) Laboratory differences.

The best method to determine the level of laboratory expertise is to look at success rates as they pertain to donor egg recipients and to male factor. There are caveats for sure, as in the case of donor rates, neither the CDC nor SART make a distinction between the age of the oocyte donor. If a Center uses primarily designated donors for instance a patient’s relative, the age of that oocyte donor may be considerably older than an anonymous donor who is usually in her early to mid 20s. Similarly for male factor clinical differences in how male factor is diagnosed and whether ICSI is performed using sperm collected surgically or otherwise may significantly impact fertilization rates and even the chances of a successful outcome. Unfortunately, neither the CDC nor SART have a mandate to enable patients to make meaningful comparisons so they can decide where is the best place for them.

A new concept has emerged that may shed light on helping patients decide where they should go for care. This concept is a“pay for performance” platform, which has been embraced by many insurers. Just as with patients, as far as insurance companies are covering the cost of fertility care, they want to make sure that they are getting the most for their money, too. Therefore they have established “Centers of Excellence” around the country which, according to their data, give patients the best chance at having a successful single-infant pregnancy at the best price. The Fertility Centers of New England is proud to have been named a Center of Excellence by both United Healthcare and Aetna for those needing IVF.

So again: ‘How much does fertility treatment cost?’

No matter what method of payment, fertility treatment will induce a high price. Though this cost always comes short of the worth of having a child of one’s own, patients should still closely consider and discuss the cost and success of their treatment with their physicians in order to find the “best bang for their buck”. Physicians should not be afraid to discuss either their success rates or the costs of their fertility treatments. Not to do so is unfair to those needing treatment. At the Fertility Centers of New England we strive towards a standard of total patient-and-practice transparency. This is one of many reasons why the Fertility Centers of New England has received accolades annually from the Better Business Bureau. Such transparency is not yet pervasive in the world of fertility medicine.

So to whomever you go for your treatment, make sure to not only ask ‘What are our chances of having a child under your care?,’ but also ‘How much does fertility treatment cost?’.

Have more questions? Contact us!

 

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Joseph A. Hill, III, M.D.

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility