New Year, New Hope

December 28, 2013Carole No Comments »

There is reason to be optimistic for 2014 when it comes to infertility treatment.

  • IVF programs are getting better at choosing the “most-likely-to-implant” embryos through both genetic testing and embryo progression analysis (time lapse technology).
  • Take-home-baby rates have tripled since the beginnings of IVF from less than 20% to over 60% at the best programs.
  • Egg freezing is becoming more widely available since ASRM declared that the technology was no longer experimental. This may or may not be an immediate boon to patients because outcomes from egg freezing may not be known for many years, especially for those women who froze eggs this year to use 5 or 10 years from now. Many labs rushed to provide the service when it became something that could be reimbursed by insurance plans. Some labs may have offered services before they should have because there is a steep learning curve to egg freezing; eggs are much more difficult to freeze successfully compared to sperm or embryos. Still, I welcome the day when egg freezing will be as effective and as available to women as sperm freezing has been for decades for men.
  • The multiple-pregnancy rate from IVF continues to decrease, in favor of more singleton pregnancies, which have a better obstetrical prognosis- hopefully leading to not just more IVF babies, but healthier IVF babies and mothers.

What can you to to maximize your chances for success in the new year using these new technologies?

Be an informed consumer. I was delighted to see New York Times infertility blogger, Amy Klein, mention my blog as a good source of information for patients. For me, this is why I write about IVF for patients. I really believe that patients can help ensure their own happy endings by being informed and making choices based on information, not just hope.  So specifically, what can you do?

Check out the pregnancy outcomes for various programs in your area. Compare these pregnancy and live birth outcomes to the best in the nation and consider your options. Also, be sure that you are comparing apples to apples- look at pregnancy and live birth rates for your age group. The Society for Assisted Reproduction has the easiest search page, allowing you to search by your zip code and also link to national summary results for comparison. Obviously, you want to go to a better than average program. Many below average programs exist but there is no reason why you should spend your hard earned dollars with them.  Although there are limitations to this outcome data, it is a good first step for identifying clinics that are worth a closer look and doctor interview.

You may want to check out this site to see the top 25 programs in the nation to give you an idea about what is achievable with IVF- especially for younger patients or using egg donors. Realize that those top 25 programs with very low patient cycle numbers (less than 200) may not have statistically valid rates (eg. they may just have had a lucky streak, which will not hold when they have performed more cycles). The other caution is that these outcomes are usually two years behind so you will want to ask any clinic you interview for their most current rates, even if incomplete. In a future blog post, I’ll discuss how the reporting guidelines for IVF programs  have changed, particularly regarding how “embryo banking cycles” are treated and the implications for patients. Outcome results that are published in 2014 (submitted in 2012)  will still be under the old rules.

Get a full accounting of what you will be expected to pay out of pocket, with or without insurance. Ask your doctor about any “extras” (extra monitoring, additional cryopreservation fees, costs for embryo (or sperm or egg) storage, genetic testing fees) that might be available to you and could be added on to the base IVF cost (on average, $12,000 in the US). Also don’t forget the cost of ovarian stimulation drugs, they can be 30% or more of the total cost. Your doctor should be able to give some estimate of how much stimulation medication  he/she thinks you will need. In the past, the major pharma company providers of these drugs  (eg. Ferring)  have offered discount programs for infertility patients.

Consider all these costs associated with each IVF cycle in relation to your possibility of pregnancy, which varies widely depending on both your personal infertility factors AND clinical competence.  To give IVF the best chance, budget for 2 IVF cycles. Most patients who will get pregnant from IVF,  get pregnant by the third cycle. If you are not pregnant after 3 IVF cycles at a competent clinic, you need to try something else.  The high cost and the wide range of outcomes reported by US clinics (from less than 10% pregnancy rates to almost 80%) should drive home the message that choice of good clinic (good lab + good doctor) can make the difference between success and failure.

If you have insurance, understand its limitations. There is no such thing as a standard IVF policy. Which state you live in affects whether state law mandates that insurance for infertility be offered to you. Even if there is some insurance coverage mandated in your state, there may be a number of limitations on this policy including whether IVF is covered at all, the number of pre-IVF cycles you might be required to try first, the size of your employer’s company, your marital status or whether you are heterosexual, lifetime caps —all of these are used to limit available coverage. The good news is that some states compel larger employers to offer policies that include IVF. The infertility support group RESOLVE offers some good basic information about insurance coverage here.  Review your insurance policy and if your are still confused-don’t worry, policies are written to confuse you- talk to your insurance representative ideally with your treatment plan in hand- and get any  promises regarding your infertility coverage in writing before you start treatment.

If you don’t have any insurance, consider advocating for coverage. See Fertility Within Reach‘s webpage for more information about advocating for yourself for insurance coverage from your employer, your insurance company or your state legislature. You may be able to negotiate reduced fees from your doctor as well and some clinics offer reduced rates for servicemen and women, teachers, fire fighters or other groups. Don’t be afraid to ask your doctor for a discount.

Trust yourself. You are stronger, smarter and braver than you might feel when you are facing infertility. Also keep in mind that there are many pathways to parenthood. One of them will be yours. Best wishes to everyone for a Happy New Year!!

 

 

 

 

 

© 2013, Carole. All rights reserved.

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