How to Navigate the Commerce of Conception

Infertility continues to rise sharply among American women, while more of them are seeking medical treatment to help their chances of having a child.

At the same time, there’s been little change in success rates for the $3-billion-a-year industry and costs remain high, even for those with health insurance coverage.

“Insurance doesn’t pay what the physician charges,” says Dr. Cristina Matera, infertility specialist at Columbia University’s Medical Center. “They will reimburse what they deem ‘reasonable and customary.’ How they figure that out, no one knows. You can go through ten or twenty thousand dollars out-of-pocket pretty quickly in infertility.”

Some 7.3 million American, or 12 percent of those in the so-called reproduction age group, have a fertility problem, according to the Centers for Disease Control. That’s 20 percent higher than 2006. Treatments to correct the problem are up at growing at a slightly lesser pace  — 16 percent — according to the Society for Assisted Reproductive Technology, SART.

Though many major health insurers — Cigna, Empire BlueCross BlueShield, EmblemHealth and Unitedhealth Group’s Oxford unit  — provide infertility coverage, it does vary.

Figuring out what’s covered, and what’s not

What’s more, sorting your way through the maze can be difficult and out-of-pocket expenses considerable. Read your policy carefully and pay close attention to coverage limits.

“There is not a ‘one size fits all,'” says Dr. Joel Batzofin of Batzofin Fertility Services. “For the most part, companies cover investigation and some treatment. Most will put a lifetime limit on the amount they will cover [ranging from] $10,000 to $30,000.”

Some, however, opt out of a lifetime limit and prefer to cover a fixed number of procedures.

For one couple, dealing with coverage has been difficult. Christine (her last name is being withheld upon request) and her husband say it has already resulted in a delay in starting treatment.

“Right now we’re using Cigna HMO, and are covered for one IVF treatment per year.” she says. “We are limited to $10,000 for the procedure and medications. We haven’t done it yet, because we’re in the process of fighting with Cigna because now they’re saying they don’t want to cover the meds, which could cost us around $5,000 out of pocket.”

Fertility doctors say Christine’s case illustrates the importance of getting a detailed pre-authorization letter from your insurance provider at the start of the process. It should confirm that your dollar or cycle limit, type of procedure, and doctor and or clinic is covered.

The chart below shows base fees for the major kinds of infertility treatment. Prices, of course, vary by clinic, and not all procedures are covered by insurers.

Treatment	Description	Price
Artificial Insemination	A relatively simple procedure during which sperm is placed directly into the uterus, at the point where the fallopian tubes begin.	$1,750-$3,000
Frozen Embryo Transfer Cycle	Frozen embryos (fertilized eggs) are thawed and transferred into the uterus during a future IVF cycle (see below). Frozen embryos may be stored for five years or longer.	$4,000
Standard IVF Cycle	The “In-Vitro Fertilization” process begins with hormone injections called “Follicle Stimulating Hormone” to stimulate the ovaries. Surgery is then performed to retrieve the resulting eggs, which are then combined with sperm in a laboratory for fertilization. The listed price is for one cycle; often more are required.	$9,000-$11,000
Donor Egg Cycle	Egg donors (typically between 20-30 yrs old), are injected with “Follicle Stimulating Hormones”, and also undergo egg retrieval. Their eggs are sent to the lab for IVF and the resulting embryos are transferred to the recipient.	$16,000 – $26,000
Medication (variable)	This range is per cycle, and depends on type of treatment.	$3,000-$5,000

Source: Data confirmed by Batzofin, and NYU Fertility Centers

These fees are for one treatment cycle — medical jargon for ovarian stimulation with hormone injections, egg retrieval, fertilization, “embryo” – or fertilized egg culture, and finally the embryo “transfer”, which is the placement of fertilized eggs into the uterus.

Calculating the odds

For most, the key to treatment and cost is the number of cycles, and success rates vary by age.

“Statistics show that most women who have the potential to conceive using IVF will do so in three cycles,” says Dr. Nicole Noyes of the NYU Fertility Center,

The latest SART data from The general rate, 40 percent, has been relatively stable since 2007, according to SART data; in 2009, for instance, 367 clinics reported 142,241 treatments with l56,778 live births.

Of that group, 41.4 percent under the age of 35 gave birth following one cycle. About half that many women between 38 and 40 were successful; for the over 42-group, the success rate slipped to 4 percent.

Using an donor egg may increases the odds of success for all groups; in 2009, 11.3 percent of all cycles used a donor egg, resulting in a 55 percent success rate.

“Clearly this is a better outcome, but at a substantially higher cost,” says Dr. Batzofin.

Deborah Spar, president of Barnard College and author of the book “The Baby Business,” says, “Only in the past five years have women become more comfortable with the idea of using a donor. Now, reportedly clinics are urging older women to move to donor eggs after one or two failed cycles.”

Regardless, infertility treatment is clearly a procedure where patients are sadly reminded that there is no guarantee and even multiples attempts can be unsuccessful.

How to mitigate the costs

Financing this venture can be daunting, especially given insurance variables. So keep these tips in mind.

Shop wisely for your clinic. Some try to mitigate patients’ out-of-pocket risk.

Batzofin Fertility, for example, offers a refund.

“At $18,750 for three cycles, you’ll get a refund of 75 percent, if you have not achieved a positive outcome after three cycles.”

Another cost-saving approach is to look for clinics staffed by multiple doctors, which negotiate group rates with insurance companies for themselves, and ultimately, for you.

“Many of the big IVF centers now are contracting and accepting insurance for infertility,” says Matera. “If the center has contracted that rate with an insurance company, the only out of pocket expense for the patient will be co-insurance.”

If you opt for an egg donor, doctors can offer cost savings by divvying up the eggs from one donor between multiple recipients.

“In most circumstances, we can split the eggs – half to one couple, half to another couple,” explains Madera. “This is about $10,000 cheaper because the couples are splitting the cost of monitoring and treating the donor.”

Dr. Matera also suggests freezing and storing extra embryos if you can, as an insurance policy all its own, which costs about $1,500 the first year and $1000 per year thereafter.”

If costs remain insurmountable, several companies offer treatment loans such as Springstone Patient Financing and the Advanced Reproductive Care. The interest rate range for an ARC loan ranges from 5 percent to 17.9 percent, depending on your credit history, debt-to-credit ratio and employment status.

What’s behind the confusing cost structure?

Finally, if you’re frustrated by what appears the absence of industry standards, there’s good reason.

The U.S. stands alone among developed nations in lacking ART regulation. Here, the governing body for infertility clinics is the American Society for Reproductive Medicine, ASRM, which gives guidelines and recommendations – not legal mandates.

“Lack of regulation causes massive uncertainties,” says Spar. “So, buyers beware. What happens if the egg doesn’t take? Is it the clinic’s liability? In this country, it’s proven close to impossible to get a regulatory response.”

How to Navigate the Commerce of Conception was provided by © 2011 CNBC.com