Of the estimated five million infertile couples in the U.S., approximately two million are unable to conceive without IVF treatment. The majority have no insurance coverage for IVF, since only a quarter of employers or less offer insurance plans with infertility benefits. As a result, as many as 50 percent of American Infertile couples do not seek treatment for financial reasons. The fact is that per capita, utilization of IVF in the United States is about half that of the United Kingdom, 3 times less than in the rest of Europe and almost five times less than in Australia. The reason for this is the lack of IVF insurance coverage in the United States, unlike in other 1st world countries where there is often insurance reimbursement for IVF. For the vast majority of Americans for nwhom the cost of IVF is an out of pocket expense, the $10,000 to $20,000 fee per treatment cycle is simply cost prohibitive. This must change.

The main reasons why Health Insurance providers are reluctant to pay for IVF services are:

1. There is no reliable data on IVF outcome statistics in the U.S.A. that they can use to accurately gauge the true cost of providing IVF services. With reported IVF success rates varying so greatly from program to program, there is no reliable industry-wide standard upon which to base reimbursement.
2. The unacceptably high incidence of IVF multiple births brought about by the indiscriminate transfer of multiple embryos at a time exacts a high financial toll. The cost of treating pregnancy complications as well as the short and long-term costs of care for premature babies can be extensive.

A Proposed Solution
In my opinion, the solution could lie in linking payment by insurance companies to IVF outcome.

The first step would be to establish acceptable standards of performance in terms of live birth rates for different categories of IVF patients (age, FSH, etc.).

Second, IVF programs would be required to meet defined outcome standards to qualify for full reimbursement for services rendered. Those whose performance exceeds the required standard would be bonused, while those that do not would be penalized by receiving reduced reimbursement. Consistent failure to achieve acceptable outcomes might ultimately disqualify such programs from participating altogether. As a check to assure that success rates aren’t boosted at the expense of good judgment, programs that report an unacceptably high incidence of multiple births could be penalized.

Such an approach would serve to motivate IVF centers to achieve the highest standard of excellence in care so as to optimize outcomes. It would almost certainly lead to fewer IVF cycles having to be conducted in order to achieve a live birth and, at the same time, reduce the number of multiple pregnancies.

This formula would create a win-win situation for all parties:

• The insurance provider would save money through an inevitable reduction in the number of per patient IVF cycles needed a live birth, as well as by a decline in the number of IVF multiple births.
• The IVF program would win from increased productivity brought about by growing insurance referrals.
• The patient would win through having improved access to quality IVF, and a reduced incidence of multiple births.
• Society would win through higher success rates per attempted IVF, a reduction in multiple pregnancies, accelerated growth of IVF technology… in part related to incentivization of IVF programs to improve their results.

Health care providers are obliged to strive to improve the human condition and alleviate suffering. Thus, for the millions of infertile couples who have little hope of conceiving without access to IVF, and for the majority who need IVF but simply cannot afford it, the medical-scientific community and health insurance providers must rise to the occasion and strive to promote the accessibility, affordability and quality of IVF services in the United States.