One doctor's fight to bring low-cost fertility treatments to women who want to have a baby without going bankrupt.
Finding out you have fertility problems can feel like a punch to the gut. But just as you're dealing with the pain of that, American would-be parents get sideswiped with another cruel blow: The high cost of infertility treatments, particularly in vitro fertilization (IVF).
IVF In America
IVF is the most common medical procedure for infertility. It's often seen as the last-resort method for a woman who wants to carry her own baby when less invasive treatments, such as intrauterine insemination, have failed or aren't an option. And as the average maternal age increases, the demand for IVF is higher than ever.
Quick anatomy lesson: A perfectly healthy woman in her early 20s has a 90 percent chance of conceiving in under a year if she has sex every month, and less than a 10 percent chance of miscarriage. But by age 40 her chance of getting pregnant drops to 40 percent and the chance of miscarriage increases. Why? The average baby girl is born with about 300,000 egg cells, and that's all she'll ever have. According to a British study, by age 30, 95 percent of women will have just 12 percent of those egg cells left—and only 3 percent by the time they're 40. But hey, you only technically need one egg to get pregnant, right? Well, the eggs that are still there have aged along with the woman, meaning that by the time she's 40, a large percentage of her eggs are chromosomally abnormal. That can lead to miscarriage, infertility, and birth defects. This multitude of factors is why many women have trouble conceiving and carrying to term after age 35. IVF is often the best option as it allows doctors to harvest the eggs you have left and screen them for genetic problems before implanting them, giving you the best chance of having a healthy baby.
American women are paying more for the procedure than anyone else in the world, with an average cost of $12,000 to $15,000 per IVF cycle, according to data collected by IVF Worldwide. With three to nine cycles generally needed to successfully result in a pregnancy, this bill can multiply fast—and that's not even including other costs like the medications needed to increase egg viability for harvesting ($3,000 to $5,000 per cycle), specialists' bills, co-pays, testing, and time off work. Given these numbers, it's no wonder that only about 3 percent of women eligible to get IVF actually go through with it, limiting the procedure to the very wealthy (including celebrities) or the very desperate.
This heartbreaking state of affairs needs to change now, says Paul Magarelli, M.D., an ob-gyn, reproductive endocrinologist, and founder of HQA Fertility Centers. "When someone asks 'How do I have a baby?' the answer shouldn't be 'How much are you willing to pay?'" he says. "I'm so saddened when I see people crowd-funding their fertility treatments; it shouldn't need to come to that." But, he adds, there are ways to make IVF more cost-effective.
What Goes In to Having IVF
It all starts with understanding why IVF is so expensive in the U.S. First of all, IVF isn't just one thing, it's an umbrella term that covers a variety of different procedures, explains Dr. Magarelli. The most basic form of IVF, and the one most people picture, involves hormonally stimulating a woman's ovaries to make more eggs available, harvesting those eggs, fertilizing them with sperm in a petri dish, and implanting them in the woman's uterus. And then you hope the embryo stays in there and develops into a baby. However, a lot has changed since the 1980s and this description leaves out many of the modern advancements in IVF, he says. Now women have choices—to use frozen or fresh embryos, how many embryos to implant, whether or not to test the embryos for chromosomal abnormalities, whether or not to inject the sperm directly into the eggs, how long to wait between harvesting and implantation, whether or not to assist the eggs in "hatching," and many more options. Each of these comes with an additional cost. But for women who want the best chance of having a baby—and would you be going through all of this if you didn't?—these really shouldn't be seen as "extras" but just as best practice, he adds.
"Basically you're asking women to choose between cost and efficacy," he says. "This is a predicament unique to fertility. In no other medical situation would you ask someone to choose a less effective option just to save money. Have you ever heard of a surgeon charging extra to remove the whole appendix and not just the infected part? In medicine, you need to do the best procedure to get the best outcome. Every woman and her potential baby deserve the 'Rolls-Royce' of care and she shouldn't be penalized for making the healthiest choices."
Then there's the issue of medication. Gonadotropins, the hormones used as the foundation of infertility treatments, are ridiculously expensive in the U.S. These medications can tack several thousand dollars onto the price, and most aren't covered by insurance. "They're the only drug I know of that keeps increasing in price over time, rather than getting more affordable," says Dr. Magarelli, adding that even though the hormonal drugs have been around since the 1970s and more efficient manufacturing practices have been developed, they remain expensive.
One Possible Cost-Cutting Solution
So, what's a woman who just wants to have a baby supposed to do? Some go out of the U.S.—cross the border into Canada where the price drops by half. But this so-called "baby tourism" comes with its own risks, such as the woman facing a medical emergency in another country or differing health standards between labs. Other women lobby for legislation requiring insurers to cover infertility treatments (something that 15 states now do, either in full or in part). Lobbying is useful in a "big picture" way, but it isn't going to do much to help a woman whose clock is ticking and who needs to conceive ASAP.
But a third option is available. More doctors, like Dr. Magarelli, are revolutionizing the field by offering low-cost IVF. How? Basically, the process is optimized for the best outcome, according to current medical knowledge, and then it's offered as a package deal to a much larger group of hopeful women. Each woman still gets the attention of a trained fertility doctor, but because all the women are doing the same procedures, the team can manage more patients at once. The volume of customers allows for more efficient treatment and lower costs from drug companies, as the fertility clinics can get lower-cost fertility services and products from companies by buying in bulk. And for those who worry that these one-stop fertility shops may skimp on individual care, Dr. Magarelli says it's quite the opposite. IVF is all these clinics do, so doctors and staff become very specialized in it, and the facility is equipped to handle everything the procedure brings with it.
In addition, he says that fertility docs can save patients money by allowing them to get basic tests and procedures done in their local ob-gyn's office, making it eligible to be covered by insurance and more affordable—a safe and efficient way to get the necessary tests done in the comfort of your home doc's office.
And it's working. At Dr. Magarelli's clinic in Colorado Springs, for example, patients can get IVF for $5,900 a cycle—less than half of the national average cost and with 15 to 20 percent more successful outcomes (and success meaning babies born through IVF), he reports.
It's not a perfect solution. Not all clinics are created equal. And unless you are an M.D. yourself, it can be hard to understand the differences in treatment options and how they affect outcomes. But more and more doctors and companies are realizing the importance of offering affordable fertility treatments.
Bargain hunting for babies, picking out fertility treatments like you would sandwich fixings at Costco, may raise a few eyebrows. But it's time to change how we think about infertility—because 10 to 12 percent of women will struggle with it. Treatment shouldn't be reserved for rich TV stars.