Recently it was calculated that approximately 125 IVF cases per 1 million capita are performed in in the USA during the course of a year. In most of the major westernized countries in Europe they are performing between 400 – 500 cases per 1 million capita. That is just one fourth of the cases that are done in these other countries! Despite the fact that on average USA IVF success rates are higher than those countries, we do not help nearly as many people. Why? The answer is obvious. IVF is not a covered medical treatment in the USA and so, the overwhelming majority of Americans just can't afford the procedure. In many European countries there is generally some form of coverage, but  if the family has to pay out of their own, the costs are less than half than what they are in this country. With one in seven couples in the USA struggling to build their families, that leaves many people left to fend for themselves.

Two and half years ago, we opened the Fertility Partnership with the goal of providing state-of-the-art reproductive health care in a caring and compassionate environment. As we opened our doors in the heart of the worst economic crisis in 70 years, it was clear that the best way to be compassionate was to make it as affordable as possible. In August 2010 the Fertility Partnership was featured in  Newsweek Magazine describing our efforts to lower the cost of Advanced Reproductive Technology. It was a fascinating article that stirred up some controversy. For example, it touched upon some difficult topics such as the "economic selection" that created by the high cost of fertility procedures . That is to say, only infertile couples with economic means will be able to reproduce. We have learned a lot since we've opened, and so I thought it appropriate in honor of National Fertility Week to reflect on what we've learned during our quest to provide the best care at the most reasonable cost.

The fact of the matter is that the materials and equipment needed to run and maintain an IVF laboratory, staff an IVF clinic, and all that is needed to maintain state-of-the-art clinic in full compliance with all regulatory statutes is just very expensive. So how do you bring the cost down? Some clinics have tried what are called "shared risk programs". That is where you pay for more than one round of IVF upfront and are given certain assurances that there will be a successful outcome. There are even promises or guarantees to return money if all attempts fail. We initially considered pursuing this at Fertility Partnership because there is something to be said about calming the frightened couples with guarantees and opportunities to try more than once. What eventually dissuaded us from pursuing this practice is the simple fact that some of the companies that provide these services are publicly held and annual profits are visible to any and all. They are apparently doing quite well financially with these programs and post millions of dollars of gains each year. This somehow seems too businesslike to us and not in the spirit of practicing medicine. Also, typically patients can only get in on these "shared risk" programs if they meet certain criteria which in fact make them very likely to be successful at IVF, ad so they are "safe bets". I like to use the metaphor of throwing darts at a balloon. IVF is like paying thousands of dollars for a dart to hit a balloon and win the most wonderful of prizes. But, there are no guarantees. I believe that you have to keep your darts very sharp, that is to say the best science and medical/clinical care. You have to engage your patients and keep them focused and calm as they take their shot at being successful. Also, our philosophy has been to provide each dart at the lowest cost possible. We are not going to “sell” you two or three darts at a time with guaranteed results. In the end, we believe that works out better for the patients.

So what about "low intensity" in vitro fertilization? It comes under various names such as "low dose", "micro", and other names that are in fact trademarked and so I will not mention them. It is my understanding that these protocols for IVF were developed with the idea that there are women who would benefit from lower doses of fertility medications during their cycles. Unfortunately it has not panned out. In a recent publication Dr. Norbert Gleicher reported on their results. He states that "with an identical number of embryos transferred, after adjusting for age, patients using standard IVF demonstrated a 7-fold better odds for pregnancy and a cumulative pregnancy rate that was more than six times higher than that achieved in patients using low intensity IVF cycles". He also calculated that the average cost to bring a baby into the world from these technologies i.e. live birth, was “$23,100 when low intensity IVF cycles were used and $20,333 when standard IVF cycles were used (these are cumulative results, meaning multiple attempts may have been necessary). Dr. Gleicher concluded from his research that "low intensity IVF currently lacks clinical and economic foundations, and therefore should be offered only under experimental study conditions". Unfortunately, there are some clinics that are marketing these protocols as low-cost alternatives to standard IVF. I feel certain that there are some couples who could benefit from this approach; however we do not know who these couples are at this time. At Fertility Partnership we don't provide low intensity IVF, but, it's in fact quite easy to do and we are ready to implement these protocols once we are convinced that is beneficial for a particular couple.

So what's the answer? How do you lower the cost of in vitro fertilization? The answer is by doing just that, lower the cost of in vitro fertilization. I believe that physicians need to lower their expectations of what they will ”earn"  from each cycle and be prepared to provide care to the increased number of couples who will come seeking care because it's less expensive. We are only taking care of one fourth of the patients in the USA who require in vitro fertilization and all that goes with it. Clinics need to just lower their prices and roll up their sleeves to work harder and provide good care for more people.

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If you’ve been following this blog or Fertility Partnership, you probably know that I created this clinic specifically to help as many people as possible have the baby of their dreams at the most affordable cost that  I could provide. I’m proud of the success we’ve had in doing that since we opened in December 2009; most notably, not only has Fertility Partnership offered IVF approximately 30 percent lower than the national average, but other St. Louis area fertility clinics have lowered their price since we entered the market. 

I am always looking for opportunities to make fertility treatments even more accessible, so that’s why I am excited to announce that Fertility Partnership will be giving away one free IVF cycle at the Midwest Infertility Awareness (MIA) Conference on Saturday, Nov. 12. The package we’ll be giving away is valued at more than $9,000 and will be handed out at the end of the conference to one attendee who must be present to win. 

For more details or to register for the conference, please visit the MIA website or Facebook page. I’ll be at the conference as well, and I’m looking forward to meeting as many of the attendees as possible as well as speaking at the event. I hope to see you there, and I look forward to meeting the winner of the IVF cycle giveway.

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One year. In one way, I can't believe that Fertility Partnership has been open for one year, because the year has flown by. On the other hand, opening this clinic has been a dream of mine for many years, so it feels as if it was the longest year I've ever experienced. No matter what, it's been the most exhilarating and rewarding year of my life, and I am thankful for all the milestones we've achieved this year in partnership with the many patients who chose to come to us for help.
 
Most notably, I am excited that Fertility Partnership patients have given birth to 16 babies, and many more are pregnant. It's humbling and thrilling to think about all the patients I've met in the past year who have believed in our concept of care and trusted us to partner with them. Our patients represent a variety of ethnicities, socioeconomic levels and geographic locations - exactly what we hoped. In assessing the average income of our patients, an independent business development company found a great variation in the income of Fertility Partnership patients. Not only that, but the average income of our patients is within $200 of the average income of St. Louisans. One of my main goals with the clinic was to move high quality infertility care beyond the realm of only the wealthiest, making care accessible to the average person - the fact that we've done that is deeply satisfying.
 
We've also extended our reach throughout the U.S., caring for patients from California to the Carolinas, as far north as Minnesota and south to Texas. We've even had patients come in from overseas, including two patients from Nigeria. And, the sheer variety of ethnicities represented by our patients is exciting to see and represents another major goal achieved for Fertility Partnership.
 
Among the other notable milestones reached in the past year: we've been featured in numerous media outlets including Newsweek.com, CNN Headline News, Oprah Radio, AOL Health and KTVI FOX 2 News; established partnerships with two acupuncturists and a psychotherapist - who offers therapy sessions at a 50 percent discount to Fertility Partnership patients; and increased the number of patients in each cycle so rapidly that we've already had to install two new incubators and expand our staff.  

And, in a truly exciting achievement, our success rates have been significantly above the national average. Although we cannot publish our exact success rates without CDC approval, which won't  be available until 2012, I can say that I am extremely excited about our achievement. I credit this to our stellar staff, who has jelled beautifully and is singularly focused on providing the most compassionate care of the highest possible quality to every patient who walks through our door.

So that's our first year in a nutshell - what a year! Thank you to each and every patient who trusted us to help you achieve your dream of having a baby. We take our commitment to you very seriously and do all we can every single day to make your experience the best it can possibly be. Keep trusting us and keep an eye on us - in 2012 we're going to keep growing while keeping our commitment to providing compassionate, high quality infertility care at an affordable cost.

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One of the surprises of our first year at Fertility Partnership has been the number of people who have traveled long distances to receive infertility care from us. We’ve had patients fly in from both coasts (in fact, our first babies were just born on the East Coast!) and, incredibly, as far away as Nigeria to take part in our unique blend of compassionate, high-tech, lower-cost IVF.

I really shouldn’t be surprised. In a recent survey, 74 percent of American women age 25 to 45 said they would consider traveling outside the United States to receive fertility treatments. While I’m excited that patients from all over the map are responding to Fertility Partnership’s philosophy of care, I’m also saddened that people seeking infertility care are finding it necessary to travel such long distances – even out of the country – for quality, yet affordable help. To be away from the comforts of home, family and friends at what can be an emotionally and physically draining time is not an easy decision, but when you hear stories like one told by a California patient of ours, you understand why patients choose to travel.

This particular patient was lucky enough to have family here in Missouri, so she literally picked up and moved from California to go through IVF with Fertility Partnership. She made the decision to do so after evaluating many IVF clinics on the West Coast, as well as watching friends go through infertility treatments with local clinics. One neighbor’s experience was typical: she’d spent $75,000 for three rounds of IVF and, devastatingly, never conceived. Our patient decided that, even with a move to the Midwest, the Fertility Partnership experience offered the right combination of quality fertility care at a more reasonable cost.

I’m thrilled to report that patient conceived with her first IVF cycle – for a fraction of the cost her West Coast neighbors and friends were charged, and she’s now enjoying her twin pregnancy with her family in Missouri. While her situation isn’t typical – not everyone has family here, I realize – it is indicative of the lengths people will go to in an effort to find the best assisted reproductive technology for them. In fact, we’ve just had a St. Louis couple who were planning to go all the way to the Czech Republic for IVF find us and decide to stay and receive treatment here at Fertility Partnership.

It’s also part of what Fertility Partnership is trying to change about infertility care. When we have almost three-fourths of women saying they’d consider going outside the United States for health care – any health care – there’s a big problem that needs fixing. A July Newsweek.com article asked the perfect question: “Why is IVF so expensive in the United States?” As Fertility Partnership proves, it doesn’t have to be. It is possible to provide the highest quality fertility care with sincere compassion at a lower cost. We do it for our patients every day.

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This week I met with a data expert to analyze our patient data, with the goal of better understanding who our patients are so that we can reach out to them and serve them even better. The analysis actually disclosed something very surprising. The average family income of our patients is within $200 of the median income of $53,189 for families in the St. Louis metropolitan statistical area (MSA). What does that mean? It means our patients are an accurate cross-section of the St. Louis metropolitan population, and that’s a big achievement.

While we do take care of doctors and lawyers, we're also providing fertility treatments for food servers and car wash attendants. I cannot tell you how good this makes me feel. In most clinics, the cost of IVF and other assisted reproductive technologies (ART) is still so high, it has remained a luxury of the wealthiest Americans. At Fertility Partnership, we have brought down the cost in the hope of making it more affordable for people across a wider range of economic levels. Now that we have hard data that shows we actually are bringing in patients who represent an average sample of the population of our area, we know we have achieved one of our goals, and that feels great!

But, we’re not resting on our laurels. We’re going to continue doing all we can to make fertility care as affordable and accessible to as many people as possible, while keeping our commitment to providing the highest quality of care with compassion and sensitivity. Thanks for helping us achieve our goals, and thank you for continuing to support our efforts to help our patients achieve their dream of having a baby.

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