Infertility out-of-pocket costs vary widely

Out-of-pocket costs for couples being treated for infertility range from a low of $912 for medication only to $19,234 for in vitro fertilization (IVF), according to researchers who say their data will help couples plan for the expenses they may incur.

“Urologists are on the front lines of counseling male and female partners about fertility options and almost all patients want to know the cost,” said lead author James F. Smith, MD, MS, of the University of California, San Francisco. “To our knowledge, no previous group has measured the actual out-of-pocket costs of reproductive care in prospective fashion.”

The current study is published online in the Journal of Urology ahead of the February 2014 print issue.

Many couples who seek infertility care have only partial or no insurance coverage, and the costs may be too burdensome for their household, according to Dr. Smith. Even for couples who are receiving fertility care, socioeconomic status may influence the success of fertility treatment. These problems are compounded by the lack of comprehensive infertility insurance coverage in the United States.

In the study, couples were recruited from eight reproductive endocrinology clinics. They were followed for 18 months from the start of treatment and were asked to maintain monthly cost diaries of out-of-pocket expenses, including clinic visits, medication, and miscellaneous expenses such as travel, parking, and food. A total of 332 couples completed cost diaries and had data available on treatment and outcomes.

More than half of the couples (55%), many of whom had incomes of more than $100,000, underwent IVF. Of the remaining couples, 19% received non-cycle-based therapy, 4% used medication to induce ovulation only, and 22% underwent intrauterine insemination.

The overall out-of-pocket expense was about $5,338.  Couples using medication only had the lowest out-of-pocket expense at about $912, while those who underwent IVF had the highest at $19,234. Couples spent about $6,955 for each additional IVF cycle.

Couples with male factor fertility paid around $9,404 more than those with female factor infertility only. Couples with insurance coverage for fertility care spent $2,152 less than couples without insurance. The out-of-pocket expense was not significantly associated with successful pregnancy.

“These data provide real-world estimates of out-of-pocket costs, which can be used to help couples plan for expenses that they may incur with treatment,” Dr. Smith said. “Communicating these costs clearly with patients at the onset of fertility care can help them prepare for treatment and make informed decisions about their options.”

In related news, the American Society for Reproductive Medicine has partnered with the Choosing Wisely campaign to provide recommendations on common tests for the evaluation of infertility that should be questioned by physicians before being ordered. The recommendations include:

• Don’t perform advanced sperm function testing, such as sperm penetration or hemizona assays, in the initial evaluation of the infertile couple. Studies document that extreme variability exists among these tests, with very little correlation between results and outcomes, according to ASRM. They have also been shown not to be cost-effective and often lead to more expensive treatments.

• Don’t perform immunologic testing as part of the routine infertility evaluation. Diagnostic testing of infertility requires evaluation of factors involving ovulation, fallopian tube patency, and spermatogenesis based on clinical history. Although immunologic factors may influence early embryo implantation, ASRM says routine immunologic testing of couples with infertility is expensive and does not predict pregnancy outcome.

Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, is designed to spark patient-physician conversations by providing lists of “things physicians and patients should question.”

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