Question 20. How expensive are infertility treatments?

Children are not cheap. Unfortunately, those patients with infertility are having to invest in a bit more than dinner and a movie in order to have the privilege of spending thousands of dollars to house, feed and entertain the little monsters. But seriously, when contemplating the array of treatment options one must consider the economic aspects when making a plan. Unfortunately, the fertility treatments that work the best tend to be the most expensive and most invasive options. So let's look at the options available and a range of what these treatments cost in most clinics. Your experiences may vary from clinic to clinic and these are typical not recommended prices....

Also, many clinics offer IVF Guarantee Programs which refund a portion or all of the cost if a couple fails to deliver a baby. Many patients really embrace this concept and I certainly understand the attraction but I still recommend that you read the fine print and make sure that you fully understand what specific costs are included in such arrangements.

Good luck to all and have a great weekend as you peruse today's Question of the Day:


20. How expensive are infertility treatments?

Some insurance plans may cover the cost of a fertility evaluation but not cover any fertility treatments per se. Other plans may stipulate a certain lifetime benefit for fertility case and still other plans may provide a specific number of treatment cycles.

In those patients without insurance coverage, the cost of fertility treatments varies widely depending on the specific treatment utilized. For example, a cycle of ultrasound monitoring without the use of fertility medications, culminating with intrauterine insemination (IUI), may cost $1300 to $1500 in many clinics. Compare this with the cost of IVF with intracytoplasmic sperm injection, freezing of extra embryos, and assisted embryo hatching, for which the price tag can total $14,000 to $16,000 (not including the cost of injectable fertility medications ($2000 to $4000)). The use of donor-egg IVF, although extremely successful, is also very expensive, because the donor must be reimbursed for her time and effort as part of the treatment and also because of the extreme screening tests mandated by the FDA. The price for donor-egg IVF typically ranges between $25,000 and $30,000, depending on the clinic. Unstimulated or Natural Cycle IVF may represent an economically attractive option since it may cost a fraction of stimulated cycle IVF (e.g. $4400 per cycle in our clinic).

In most patients, the more expensive, more invasive fertility treatments usually result in the highest pregnancy rates. Couples are advised to carefully consider the proposed course of treatment and the costs that may be involved.

Many IVF centers in the United States offer “money back” (refund) programs. A couple accepted into such a program pays a premium that covers several fresh IVF cycles as well as frozen embryo transfers (FET). If they fail to conceive or are deemed to no longer be appropriate candidates for treatment, then all or a percentage of their initial payment is refunded. These programs have remained somewhat controversial but can allow couples to pursue other options if IVF proves unsuccessful.

According to the ASRM Ethics Committee Statement of June 2006, the controversy surrounding such programs relates in part to the concern that such arrangements appear to violate long-standing ethical prohibitions against paying contingency fees in medicine. This concern is based on Opinion 6.01 of the AMA Code of Medical Ethics, which states, “a physician’s fee should not be made contingent on the successful outcome of a medical treatment.”

Furthermore, the 2006 Committee Statement (which can be found on the ASRM website at http://www.asrm.org/Media/Ethics/ethicsmain.html) concludes, “the risk-sharing form of payment for IVF is an option that might be ethically offered to patients without health insurance coverage for IVF if certain conditions that protect patient interests are met. These conditions are that the criterion of success is clearly specified, that patients are fully informed of the financial costs and advantages and disadvantages of such programs, that informed consent materials clearly inform patients of their chances of success if found eligible for the risk-sharing program, and that the program is not guaranteeing pregnancy and delivery. It should also be clear to patients that they will be paying a higher cost for IVF if they in fact succeed on the first or second cycle than if they had not chosen the risk-sharing program, and that, in any event, the costs of screening and drugs are not included.

“The Committee was especially concerned about the incentives that risk-sharing programs create for providers to take actions that might harm patients in order to achieve success and avoid a refund. For risk-sharing programs to be ethical, it is imperative that patients be aware of this potential conflict of interest, and that risk-sharing programs not overstimulate patients to obtain a large supply of eggs or transfer more embryos than is safe for the patient, fetus, and prospective offspring. Patients should be fully informed of the risks of multifetal gestation for mother and fetus, and have had ample time to discuss and consider them prior to egg retrieval.”