This is the third in a series of 10 responses to common questions/concerns about IVF treatment.


Question #3
Can I Afford IVF?
In most developed countries, infertility is considered a “medical condition” and accordingly, providers of health insurance will usually cover the costs of IVF. In the United States however, insurance providers tend not to consider infertility as a “disease entity,” therefore, IVF is covered in less than 20% of cases.

A study reported in the journal “Human Reproduction” in mid 2010 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. In addition, only about 25% of the estimated demand for fertility treatment in the U.S. is met each year.

The above-mentioned study is really an understatement of the problem. The fact is that fewer than 100,000 women out of a pool of more than one million potential IVF candidates in the United States undergo IVF per year. About 150,000 fresh IVF cycles are conducted annually by 350+ IVF programs. Thus, it is not simply a matter of modest underutilization. In reality, the number of IVF procedures performed annually in the United States barely scratches the surface of the demand.This underutilization appears to be most pronounced among minorities and the low-income population. Simply stated, when it comes to IVF in America, the size of the pocketbook usually determines the ability to have a family.

Furthermore, more than half of all the IVF procedures in the U.S. are performed by fewer than 10% of the programs, with the rest being divided among the remaining clinics. Since larger programs perform more than 600 procedures a year, it means that most others are performing fewer than 150 cycles. Since in most such programs, the procedures are divided among more than one RE and more than one embryologist, it is hard for them to gain the required experience. Simply stated, no one can gain optimal expertise doing so few procedures. In fact, it is virtually impossible to even develop meaningful IVF statistics with such small numbers – especially when they are spread across several demographic and clinical categories of patients. Consumers should be attracted to an IVF program because of its reliability and quality. But merely interesting more consumers in the concept of IVF is not enough – the procedure must be made affordable.

This having been said, central to making IVF affordable is the need for widespread IVF insurance coverage. However, there is reluctance (some of it justified) on the part of insurance companies to cover the high costs associated with IVF treatment. These costs are linked to two factors:

1. First is the fact that the absence of accurate data on IVF outcome statistics makes it difficult to actuarially determine the costs associated with having an IVF baby. This is because success rates vary so widely, that accurately determining an “average” cost is virtually impossible.

• Second is the high incidence of IVF multiple births and the costs they incur. These costs are due to the additional care and treatment required during gestation, extended neonatal care (because most multiples are delivered premature) and many times ongoing medical issues for years afterward. The frequency of high-order multiple births is largely due to the lack of control over the large number of embryos being transferred in any given IVF procedure.

Thus, before insurance companies are likely to cooperate and increase insurance reimbursement, IVF programs must become accountable when it comes to reporting their success rates. Secondly, the risk of IVF multiple pregnancies must be driven down.

Unfortunately, the annualIVF Success Rate Report by the Society for Assisted Reproductive Technology (SART) does not demand any real validation or auditing of IVF outcome statistics by its member programs. In fact, presently these results are submitted without external oversight and are published in the annual SART Success Rates Report exactly as declared by the clinics. Hopefully, this will change, because until and unless it does, insurance companies will with justification remain reluctant to cover IVF.

When it comes to the issue of reducing the number of IVF multiple births, the only way to accomplish this is through regulation of the number of embryos allowed to be transferred per IVF procedure.

Because of its high cost, the absence of insurance coverage for IVF makes it unaffordable to most that need it. Furthermore, given a 35% National IVF birthrate in women under 39 years (significantly lower in older women), most women will require more than two attempts to have a baby. As such, when it comes to IVF, the traditional “fee for service” system of payment puts having a baby outside the reach of the majority of infertile couples.

In order to bring having a baby within the reach of more couples, we have, over the years, developed and participated in a number of programs that help provide access to IVF treatment for couples who would not otherwise be able to afford it. These include:

• IVF Package Plans that provide multiple IVF cycles for a single fee (significantly less than the sum of the individual cycles)

• “Access Plans” that offer discounted IVF treatment to military families, teachers, and couples with limited income

• Donation of free IVF treatment through the “From INCIID the Heart” IVF scholarship program administered by the International Council on Infertility Information Dissemination (INCIID)

• Donation of free IVF treatment through our regional seminars

• Provision of no-cost egg freezing and sperm freezing services to cancer patients through our Fertility Rescue initiative.

We have a lot of work to do before IVF becomes affordable and available to all of those who need it. Until the aforementioned issues of accountability and regulation are addressed, we can only assume that insurance companies will continue to decline to provide IVF coverage. In the meantime, the onus is on individual IVF programs to make treatment as accessible and affordable as possible for the largest number of people.