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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Ever since the recent Newsweek article about our program was published I've been asked the same question again and again; how can you provide the same quality care at almost half the average cost and not sacrifice quality?

I wish the answer were more obvious to the medical community, but the answer is summarized well in the Newsweek article. The average cost of IVF in United States is $13,775, while the average cost in the rest of the modernized western world is just over $5,000. The real question is: why aren’t more fertility clinics in the U.S. pursuing more competitive pricing for its patients as Fertility Partnership is?

I’m not unrealistic – I do understand that the cost of running a medical practice is generally more expensive in the United States than in many other countries. Higher rent, more expensive insurances, and regulatory bodies that, while "protecting the public," are among the factors that raise the cost of a medical practice here. But, should those factors mean that IVF needs to be more than twice as expensive here? Many clinics say yes. Fertility Partnership is doing all it can to say no. My commitment to my patients is to continue doing all I can to provide the highest quality care at a fair cost, and I hope that other fertility clinics will follow.

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As I’ve mentioned before, one of the main reasons I created Fertility Partnership was to bring down the exorbitant costs of IVF and other fertility treatments. Advances in technology over the past few years have significantly reduced the hard costs – the direct costs of labor, equipment and supplies to conduct procedures. Think of it this way: 30 years ago, “mainframe” computers filled entire rooms and cost millions of dollars to install and keep running, and while their output was impressive at the time, it’s now seen as primitive and rudimentary. Today, the iPhone and iPad can do far more than these mainframe computers ever could, and their relatively inexpensive cost means that millions of people are able to afford them and do things even the creator of “Star Trek” never even imagined.

The same thing has happened to fertility technology. It now costs far less to do so much more and do it more accurately. Unfortunately, most infertility doctors haven’t passed those savings onto patients. Instead, they’ve steadily increased their profit margin while patients scrape, borrow and beg for the money to undergo fertility treatments.

With Fertility Partnership offering services that are usually 30-50 percent less than other practices, my goal is to shift that paradigm – but I tried to be realistic in my timeline for this, knowing that other practices would be reluctant to make this change for obvious reasons. Fortunately, I didn’t have to wait nearly as long as I thought. I’ve noticed that many practices around the country are actively looking for ways to cut costs for their patients and increase accessibility to fertility services.

Some might think I’d be upset about this – that I’d see them as copycats trying to steal Fertility Partnership’s thunder. In reality, nothing could be further from the truth. This trend to lower costs is exactly what I hoped for, because my ultimate goal is helping people who want to have babies get pregnant, regardless of their economic status.

No matter what the rest of the fertility care industry decides to do, Fertility Partnership is going to stay focused on helping begin families by using the latest technology to offer top quality, compassionate fertility care at a significantly lower cost. That’s our commitment to every single person who walks through the door at Fertility Partnership, and I hope my colleagues around the country embrace the same concept.

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As politicians continue to sling mud over health care reform in Washington, Fertility Partnership is taking what I think will be a slightly faster path in an effort to change the system. Our mission is simple: we want to help more couples afford fertility treatments and achieve their dreams of having a baby, especially those who’ve largely been ignored by the medical establishment. Among the most neglected groups – minority ethnicities such as African-Americans and Latinos.  

Too many people feel as if fertility care, including in vitro fertilization (IVF), is out of reach. For many, Fertility Partnership is changing that. We are dramatically bringing down the costs – not nickel-and-diming patients – and we’re talking with people who have never before been reached with this message.

Last year, $4.4 billion was spent in the fertility industry, but few minorities accessed these services. Sometimes the block is cultural, sometimes religious, and sometimes it’s a language barrier, but most often it’s just too much money. We don’t have concrete numbers on minorities that are using fertility services, but we do know it’s very limited. It's certainly not helped by the information one finds on the Web. If you look at infertility blogs or the websites for the big fertility clinics nationwide, minorities are virtually non-existent.

Fertility Partnership wants to make high-quality health care affordable. The cost of fertility treatments has come down dramatically, but the savings are not being passed along to patients. There’s no point in having this remarkable technology to help families have babies if the average person can’t afford it, and there’s certainly no point in ignoring large sections of our country’s population who need fertility services.

Fertility Partnership exists to help everyone – no matter what their ethnicity, culture, religion or sexual orientation – begin the family of their dreams. If you belong to a community or religious group that would like to hear more about fertility care in general or specific infertility issues related to your group, please contact our office or email me at esimckes@fertilitypartnership.com This e-mail address is being protected from spambots. You need JavaScript enabled to view it . I welcome any opportunity to share more and help make fertility care accessible and affordable to all.

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