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Fertility Treatment During the Recession
a blog by David Kreiner, M.D., F.A.C.O.G.
Financial hardships have increased fertility challenges for many couples attempting to build their families. According to a new study released at the ASRM meeting in Atlanta last week, the recession has severely affected access to fertility treatment in this country.
Fifty-eight percent of infertile couples who chose not to pursue treatment cited cost as the primary reason. About seven percent of couples with frozen embryos discarded them from October 2008 to March 2009, a nearly three-time increase from the prior six months. Fifty-seven percent of egg donors in 2008 planned to use the money they earned from donation to pay for school, up from 28 percent from 2002 - 2004.
In the New York metropolitan area, most programs see only about 20% of patients who do not have insurance to pay for their IVF cycles. Furthermore, it’s estimated that for every patient who does an IVF cycle, there’s at least another two to three would also benefit from the fertility therapy. Unfortunately, for those with an insurance cap and for those paying out of pocket, there is enormous financial pressure to conceive in the fewest number of cycles to minimize the cost. Hence, they transfer multiple embryos with a resulting increase in multiple pregnancies and the complications of premature deliveries -- medical, emotional and financial.
New York State offers a grant for patients in need of IVF; it’s income based and diminishes the entire cost of the cycle for some lower-to-middle income patients to just a few thousand dollars. However, even this rich program does not cover the cost of frozen embryo transfers and therefore still encourages patients to transfer multiple embryos. Other IVF programs, including my own, offer income-based grant programs and IVF studies that significantly reduce the cost of a cycle and make it affordable to nearly everyone in need.
The problem remains that none of these programs discourage patients from “putting all their eggs in one basket” and risking dangerous multiple pregnancies. Two years ago, I proposed an alternative financial program that does eliminate the financial need to maximize one’s chance of conceiving in a single cycle. It is called the Single Embryo Transfer Program at East Coast Fertility. A couple pays the standard $12,000 fee and their egg freezing, storage and frozen embryo transfers are included for an unlimited number of times until they have their baby. I wonder if cost would still stand in their way if patients knew about this program? The beautiful part of the program is that it allows us to avoid risky multiple pregnancies. According to the CDC, by avoiding the medical, emotional and financial hardships caused by the multiple pregnancies, we’d save $1 billion per year (if the program was utilized by all patients who are candidates for it throughout the country).
Yet another side effect of the economic downturn and lack of insurance coverage for IVF has been the fact that patients can have a gonadotropin/IUI cycle for free with a 30 percent risk of multiples and five percent risk of triplets (or more) if their insurance covers it, foregoing the safer IVF alternative where one can control the number of embryos transferred. For patients paying out of pocket, many still choose to risk multiples with the less expensive gonadotropin/IUI cycle, despite its much lower success rate.
But, all couples don’t need a full stimulation IVF cycle. Many couples could try a lower stimulation IVF known as “MicroIVF.” The cost of MicroIVF varies, but at my program it’s offered for approximately $3,900, about the cost of a gonadotropin/IUI cycle and a far cry from the average cost of IVF. MicroIVF does not have the effect on the body that a gonadotropin cycle has, nor does it have the high risk of multiple pregnancy. It can also be combined with the Single Embryo Transfer Program.
We haven’t done a good enough job communicating to patients how they can afford fertility treatment, with insurance or without. Money can be a barrier to many things, so let’s not make it a barrier for couples to have families. There are solutions available that will allow patients to afford the care they need to make their dreams of a family come true.