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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I’ve been following the events surrounding E! News personality Giuliana Rancic’s recent diagnosis of breast cancer with much concern. There is so much at stake here for women trying to build a family, and Ms. Rancic’s unfortunate diagnosis could be used to confuse many people. 

Obviously I hope all goes well for Ms. Rancic. For those unfamiliar with her story, Ms. Rancic’s fertility specialist ordered a mammogram for what appears to be screening purposes and found what is believed to be an early cancer in a 36-year-old woman who had undergone IVF twice before. This raises two questions that need to be addressed. First, did the IVF cause her breast cancer? The answer is no. Fertility treatments do not increase the risk of breast cancer. In fact, successful fertility treatments could potentially lower the risk if the mother breastfeeds. A number of studies have shown that breastfeeding reduces the incidence of breast cancer. By helping facilitate a successful pregnancy, we can help women access this proven preventative measure as well as the dream of family. There is no convincing data that proves that fertility treatment increases the lifetime risk, although the researchers are diligently following this.

The second question is much more serious and potentially controversial: can fertility treatments accelerate early, as yet undetected, breast cancers? I searched the literature and could not find any definite proof that this is true. But, the pragmatist in me has to admit that this concern has a lot of biological basis to be concerned. For example, breast cancers very often have receptors for estrogen and progesterone, two hormones that rise dramatically during fertility treatments and the subsequent pregnancy. In fact, cancers discovered after a recent pregnancy are associated with a poorer prognosis, but ironically these are cancers that lack these receptors. 

So we know that pregnancy can worsen a diagnosis of breast cancer, even though the treatment to get pregnant may not. As many of our patients are older and requiring help to conceive, I think it is fair to assume that we could be accelerating or worsening the prognosis of an as yet undiagnosed breast cancer. How do we best help our patients with this issue? Mammograms are the obvious screening tool, but unfortunately, debate rages over when women should begin mammogram screening. The U.S. Preventive Services Task Forces recommends breast cancer testing start at age 50, although the American Cancer Society advises yearly mammograms beginning at age 40 for women with an average risk. Some earlier studies even suggested age 35. I believe that any patient who is at increased risk, (i.e. family history) be screened, perhaps as early as age 30. Perhaps we need to screen everyone who goes through IVF treatment, and certainly those ages 35 and older; however, the benefit of this is again controversial.

Giuliana Rancic’s diagnosis has certainly brought this important issue to the forefront, but I’m not happy with the fact that this story is fodder for all those constantly looking for ways that advances in medicine can hurt us. The sensationalist press also will irresponsibly try to raise fear solely to increase their readership. At the end of the day, we need to realize that there are no free rides, no sure things, and no easy answers in medicine. Drugs have side effects and surgeries have complications. IVF has helped millions of people around the world, and we must stay diligent to make sure the risks are minimized. 

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From the moment I started thinking, many years ago, about opening an infertility clinic, I knew we had to do two things: provide the best possible care at the most reasonable price we could manage. We assembled the latest laboratory technology, passed the efficiencies and savings from that on to patients, recruited one of the top IVF lab teams in the country and structured our care protocols to ensure we partnered with our patients rather than running them through a cold, impersonal cookie-cutter program.

And then we had to prove that it would work.

Every month, we’ve seen more and more patients come through the door. First from the Midwest, then from across the country, and now we’re getting not only inquiries, but new patients flying in from Europe and Africa.

Along with more patients, we’ve watched our IVF success rates get better…and better…and better. While government regulations won’t let us go into detail, we can tell you that for October, our IVF success rate was 100 percent.

Yes, you’re reading that right. One hundred percent. Every patient in our October cycle has had a positive pregnancy test.

Now, we’re not going to achieve a 100 percent success rate every month, but that’s not going to stop me – or our stellar clinical team – from trying.

You see, our theory about creating a patient-focused, high-quality, efficient and effective fertility clinic is working, and it’s working better than even we ever imagined. So thank you, patients, for coming to us, trusting us and partnering with us. Let’s keep working together to achieve the ultimate success – turning your dream of having a baby into reality.

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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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(Note: We welcome Fertility Partnership Executive Director Andria Simckes in writing her first guest post for Dr. Simckes' blog.)

Misperceptions are sometimes hurtful, occasionally dangerous, and often get in the way of getting what we really want in our lives. The misperceptions about African-Americans and infertility are a perfect case in point.

For example, it’s a common perception that black women are incredibly fertile. They couldn’t possibly have problems with infertility, right? Wrong. In fact, according to RESOLVE, the infertility rate among African-Americans is nearly 1.5 times higher than other races. Unfortunately, that’s a statistic that very few people, especially black women, know. As a result, they suffer in silence when they can’t conceive, believing – even more so than other ethnic groups – that they’re all alone in their infertility.

And what about black men? That infertility rate statistic includes them, too, but that’s an even more taboo topic than black female infertility. Black men are supposed to be virile and sexually powerful – they couldn’t possibly have infertility problems, could they? Yes, they can. About one-third of the time when couples are struggling with infertility, the problem lies with the man, no matter the ethnicity. But again, how many black men haven’t even taken a simple, relatively inexpensive test to see if there is a problem, simply because of the misperception?

As African-Americans, we need to take the lead in doing everything we can to shake off these harmful misperceptions about our fertility. We need to demand more medical studies to fully understand why African-Americans suffer from infertility in such inflated numbers – current research is woefully inadequate and doesn’t give doctors enough information on which to base effective treatment protocols. We need to do all we can to spread the word about the sheer prevalence of infertility in our communities, and share the good news that – in many cases – help is out there.

Finally, we need to strip the stigma away from infertility. If you are black and battling infertility, you are not alone. You do not need to hide it. You do not need to just hope it will go away. Doctors like my husband and clinics like Fertility Partnership are out there ready to help with compassion and understanding.  Support is available through websites like The Broken Brown Egg. Let’s crush these misperceptions and turn the lights on a situation that’s been hiding in the dark for far too long.

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