Research paper on the Economics of In Vitro Fertilization.

1. Economics<br />In Vitro Fertilization (IVF) is a process in which an egg and sperm are combined in a laboratory dish where fertilization occurs. The fertilized and dividing egg is transferred into the woman's uterus. In Vitro Fertilization in Economics is a very expensive set of procedures including multiple cycles. Although advances in infertility treatment have helped thousands of couples become parents, the procedures are not without controversy. (IVF Cost, 2010) Such procedures can be quite costly and on average each cycle of IVF costs $8,158 plus an average of $4,000 for medications, debate exists about whether insurance plans should be required to cover them. (IVF Cost, 2010) <br />Cost estimates for insurance coverage of infertility treatments range from an additional $0.20 to $2.00 per member per month. (IVF Cost, 2010) Recently, studies have shown that assisted reproductive technologies have contributed to an increase in multiple births, which have a higher rate of prematurity than single births. In 2004, 8.1 percent of all newborns were below normal birth weight or less than 5.5 pounds, the highest percentage since the early 1970s. Preterm births cost society at least $26 billion dollars per year. (IVF Cost, 2010) <br />The laws vary from state to state; the laws for Illinois require certain insurance policies to provide pregnancy-related benefits which provide coverage for the diagnosis and treatment of infertility. Coverage includes in vitro fertilization, and is limited to four completed immature female egg retrievals except if a live birth follows completed immature female egg retrieval, then two more completed immature female egg retrievals are covered. <br />During any particular cycle the costs include the initial consultation which can be 6% to 10% of the basic IVF treatment cost. Basic IVF treatment usually includes doctor’s fees for egg collection, embryo transfer, and embryologist’s fees for intro fertilization, anesthetics, ultrasound scans, and the intracytoplasmic sperm injection which can be 28% to 40% of the basic IVF treatment cost. Creation of embryos by direct injection of sperm into egg, a procedure used for male infertility but increasingly common in standard IVF. Hormonal drugs can be 20% to 80% of the basic IVF treatment cost. Precise cost will depend on which drugs are prescribed for stimulating the ovaries. (Peter J. Neumann, Soheyla D. Gharib, and Milton C. Weinstein, 2008)<br />Embryo freezing is sometimes included in the basic IVF cost. Some clinics can charge up to 20% of the basic IVF treatment cost, plus around 10% of the basic IVF cost per year for storage and between 20% and 100% of the basic IVF treatment cost for later thawing and transfer. Other Immunological therapies can be up to 50% of the basic IVF treatment cost. Pre-implantation genetic screening, to pick the best embryos, can be 55% to 120% of the basic IVF treatment cost. Both procedures are offered by a few clinics, though there is little published evidence that they are effective. (Peter J. Neumann, Soheyla D. Gharib, and Milton C. Weinstein, 2008)<br />Regulatory fees can be 4% to 5% of the basic IVF treatment cost. Charged separately by some clinics and rolled into the general cost by others. The major extra cost, on top of the basic IVF treatment cost that everybody has to bear is the hormonal drugs. The amounts of hormonal drugs that are required depend upon your age, length of infertility, and physical condition of your uterus and endometrium which is the uterine lining. Taking an average inflation rate in healthcare expenditure of 3.5%, all costs have been converted to US$. Depending on the age of the women, the success rates, and number of cycles, the costs vary dramatically. (Making & Using Humans)<br />Depending on age the success rates for In Vitro Fertilization decline as the number of cycles needed increases. The percentages are 29.6% for women under 35 years old, 23.6% for women aged 35 – 37 years old, 18.2% for women aged 38 – 39 years old, 10.0% for women aged 40 – 42 years old, 3.2% for women aged 43 – 44 years old, and 0.8% for women aged over 44 years. For women under the age of 35 with about 3.4 cycles have costs on average around $34,000, women 35 – 37 with 4.2 cycles the costs rise to almost $43,000, women 38 – 39 with 5.5 cycles on average pay around $55,000, women from 40 – 42 years old with about 10 cycles pay over a $100,000, women 43 – 44 pay around $315,000 while having 31.3 cycles, and women over the age of 44 can reach costs of over $1,250,000 with about 125 cycles. The amount of cycles represents the number of cycles typically needed for these age groups to have a successful pregnancy and is not true in all cases of In Vitro Fertilization. <br />With In Vitro Fertilization people may choose to freeze eggs for later in case they are unsuccessful the first time. (Advanced Fertility Clinic of Chicago, 2009) This process is called Vitrification, to Embryologists; Vitrification is ultra-rapid IVF embryo freezing, instead of the traditional slow freezing process. Vitrification is the process of converting something into a glass-like solid that is free of any crystal formation. By adding a Cryoprotectant, water can be cooled until it hardens like glass without any ice crystals forming. This is important in the embryology world because ice crystal formation can be very damaging to frozen embryos or other frozen cells. Vitrification in IVF can allow freezing of spare embryos with better post-thaw survival rates and higher pregnancy and live birth rates from frozen embryo transfer cycles. Vitrifications of blastocysts have seen excellent post-thaw embryo survival and substantially higher pregnancy rates after frozen transfer procedures. (Advanced Fertility Clinic of Chicago, 2009) Cryoprotectants are useful because they can’t lower the freezing point and may prevent intracellular ice formation and they may protect cells by interacting with membranes as they change from a pliable to a rigid state. Embryos can be frozen at the pronuclear stage or one cell and at any stage after that up to and including the Blastocyst stage which is 5-7 days after fertilization. Different Cryoprotectants and freezing solutions and protocols are used for different stages of embryo development. Many IVF clinics are currently doing their entire embryo freezing at the blastocyst stage. (Advanced Fertility Clinic of Chicago, 2009)<br />There has been a recent trend in the IVF world away from the traditional slow freezing method that has been used since the 1980's. Vitrification for IVF embryo freezing is becoming a more widely used and accepted technology. From a well known fertilization clinic in Chicago called the Advanced Fertility Center of Chicago or the AFCC, these prices were listed for embryo storage and other IVF costs.<br />How much does IVF cost?Single Cycle In Vitro Fertilization Cost$9,500$1500 discount given if IVF stimulation monitoring is done out of town(or if monitoring is covered by health insurance)<br />Multiple IVF Cycle Pricing PlansThese Plans Give a Refund if You Don't Have a Baby Multiple Cycle In Vitro Fertilization Cost80% Refund Money Back Guarantee$16,000 - $27,500More info Multiple Cycle In Vitro Fertilization Cost100% Refund Money Back Guarantee$24,500 - $32,000More info <br />Costs for Additional Services (with Single Cycle Pricing)ICSI, injection of sperm directly in the eggs (for male factor cases)$1200Blastocyst culture and transfer (day 5 transfer)No additional costEmbryo freezing - (includes 1 year of storage)$700Frozen embryo transfer cycle (thaw, culture and transfer embryos)$2900Embryo storage$600/yearSperm freezing$100<br />Included services in AFCC’s IVF cost:<br />Ovarian stimulation monitoring<br />Anesthesia for egg retrieval<br />Egg retrieval procedure<br />Fertilization and culture of the eggs<br />Embryo transfer procedure<br />All physician, IVF lab, and facility fees associated with in vitro fertilization<br />Excluded services - not included in AFCC’s IVF costs:<br />Pre-IVF screening tests<br />Medications<br />Embryo or sperm freezing or storage - these are optional services<br />Pregnancy testing and monitoring of early pregnancy<br />Consultations with the physician<br />As you can see from the above charts, this can become a very expensive procedure. Most clinics offer financing and even money back guarantee’s if it does not work. Medication costs can be as low as $1500 for an IVF treatment; the average cost is $3000 and can be higher than this all the way up to $4500. The cost of IVF stimulation medications depends on drug dosing and duration of stimulation needed to get a good ovarian response. (AFCC, 2010)<br />Insurance sometimes covers IVF medications. (NCSL - National Conference of State Legislators, March 2010) Some clinics offer a cash discount of IVF costs and they are for couples without fertility insurance coverage, or those that prefer to pay in advance and submit their own billing to insurance. Insurance companies do not accept a package price for IVF because there is no CPT code for it. Insurance is billed by individual procedure; the total bill depends on what is done during the IVF cycle. The total billed to insurance for the IVF-related codes is about $8000 at the AFCC center. The total billed for ovarian stimulation monitoring for IVF is about $2000 and they vary slightly clinic to clinic. Unfortunately, what people do not always realize is the fact that some clinics have a much higher success rate than others. So even if it seems to be cheaper it could still end up costing you more if it takes you longer to be successful. (NCSL, March 2010)<br />Another issue that has risen is who gets custody in the unfortunate event of a divorce and the answer is; it depends. Even though there are no direct laws yet relating to custody the courts have released these statements “even had the husband and the wife entered into an unambiguous agreement between themselves regarding the disposition of the frozen pre-embryo’s, we would not enforce an agreement that would compel one donor to become a parent against his or her will”, “forced procreation is not an area amenable to judicial enforcement”, and “prior agreements to enter into familial relationships (marriage or parenthood) should not be enforced against individuals who subsequently reconsider their decisions”. (FertilityCommunity.com, 2010) In some cases, the father has been awarded custody over the frozen embryo and in other cases the mother has been awarded custody but often in the case of the mother getting custody the father is not required to pay child support because he has chosen to take no part in the decision process. This is very tricky in the court system and so, as of now, who will get custody almost depends on the same ways that custody is handled now in America and is always under different circumstances and with different outcomes. (FertilityCommunity.com, 2010)<br />In summary, In Vitro Fertilization can be very expensive and is not always covered by insurance agencies. Not only does the price go up with age but the chances for success go down as well, so the longer people wait to go through this process the more it is going to cost in the end. Custody is complicated and will depend on each individual case and situation in determining the outcome. Not only does these newer technologies change our social views and societal values, but is also changing our economy and how we look at parenthood.<br />Work Cited<br />Advanced Fertility Center of Chicago (2010) Retrieved May 20, 2010, from http://www.advancedfertility.com/cryo.htm<br />FertilityCommunity.com ( 2009) The Art & Law: Frozen Embryo Custody, Page 2. Retrieved May 22, 2010, from http://www.fertilitycommunity.com/fertility/art-law-frozen-embryo-custody,2.html<br />In Vitro Fertilization Retrieved May 20, 2010, from http://www.pennlife.org/subject_vitro.html<br />IVF Cost (2010) Retrieved May 8, 2010, from http://www.ivfcost.net/<br />NCLS (2010) State Laws Related to Insurance Coverage for Infertility Treatment. Retrieved May 1, 2010, from http://www.ncsl.org/default.aspx?tabid=14391<br />Peter J. Neumann, Soheyla D. Gharib, and Milton C. Weinstein (1994, July 28) The Cost of a Successful Delivery with in Vitro Fertilization. The New England Journal of Medicine. Retrieved May 10, 2010, from http://content.nejm.org/cgi/content/full/331/4/239<br />The Jones Institute for Reproductive Medicine (2010) In Vitro Fertilization - IVF - Success Rates. Retrieved May 24, 2010, from http://www.jonesinstitute.org/ivf-success-rates.html<br />