Recently, it was calculated that approximately 125 IVF cases per 1 million residents are performed in the USA during the course of a year. In most of the major westernized countries in Europe, they are performing between 400 – 500 cases per million residents. The United States is treating just one-fourth of the cases that are done in these European countries! Even though on average success rates are significantly higher in the US, we cannot help nearly as many people.
Why? The answer is obvious.
IVF is not a covered medical treatment in most states, and many Americans can’t afford the treatments. Other countries have some form of coverage. With one in seven couples in the USA struggling to build their families, many people are left untreated and unhelped.
The fact of the matter is that it is expensive to acquire the materials and equipment needed to run and maintain an IVF laboratory, staff an IVF clinic, and maintain a state-of-the-art clinic in full compliance with all regulatory statutes. So how do you bring the cost down?
This is a battle I have been fighting for years, and I invite you to read an article about my efforts in Newsweek, 2010.
Some clinics have tried what is called “shared risk programs”. That is where you pay for more than one round of IVF upfront and are given certain assurances that you will have a successful outcome. There are even promises or guarantees to return money if all attempts failed. We considered pursuing this at Fertility Partnership.
There is something to be said about calming the frightened couples with guarantees and opportunities to try more than once. What eventually dissuaded us from pursuing this practice is the simple fact that some of the companies that provide these services are publicly held, and annual profits are visible to any and all. They are apparently doing quite well financially with these programs and post millions of dollars of gains each year. This somehow seems to businesslike to us and not in the spirit of practicing medicine.
Also, typically patients can only get in on these “shared risk” programs if they meet certain criteria which in fact make them likely to be successful at IVF. I like to use the metaphor of throwing darts at a balloon.
IVF is like paying thousands of dollars for dark to hit a balloon and when the most wonderful of prizes. But, there are no guarantees. I believe that you have to keep your darts really sharp, that is to say, the best science and medical/clinical care. You have to engage your patients and keep them focused and calm as they take their shot at being successful. And our philosophy has been to provide each dart at the lowest cost possible. We are not going to “sell” you two or three darts at a time with guaranteed results. In the end, we believe that works out better for the patients.
So what about “low intensity” in vitro fertilization? It comes under various names such as “low dose”, “micro” and others. It is my understanding that these protocols for IVF developed from the idea that there are women who would benefit from lower doses of fertility medications during their cycles. Unfortunately, it has not panned out.
In a recent publication, Dr. Norbert Gleicher reported on their results. He states that “with an identical number of embryos transferred, after adjusting for age, patients using standard IVF demonstrated a 7-fold better odds for pregnancy and a cumulative pregnancy rate that was more than six times higher than that achieved in patients using low-intensity IVF cycles”. He also calculated that the average cost to bring a baby into the world from these technologies – live birth, was “$23,100 when low-intensity IVF cycles were used and $20,333 when standard IVF cycles were used (these are cumulative results, meaning multiple attempts may have been necessary).
Dr. Gleicher concluded from his research that “low-intensity IVF currently lacks clinical and economic foundations, and therefore should be offered only under experimental study conditions”. Unfortunately, there are some clinics that are marketing these protocols as low-cost alternatives to traditional IVF.
I feel certain that there are some couples who could benefit from this approach; however, we do not know who these couples are at this time. At Fertility Partnership, we don’t provide low-intensity IVF, but it’s easy to do, and we are ready to implement these protocols once we are convinced that is beneficial for the couple.
So what’s the answer? How do you lower the cost of in vitro fertilization?
The answer is by doing just that, lowering the cost of in vitro fertilization.
I believe that physicians need to lower their expectations of what they will ”earn” from each cycle and be prepared to provide treatment to the increased number of couples who will seek care as it becomes more affordable. We are only taking care of a fourth of the patients in the USA who require in vitro fertilization and all that goes with it. Clinics need to just lower their prices and roll up their sleeves to work harder and provide good care for more people.
