On Slate, Sarah E. Richards discusses a new NIH-sponsored study by Dartmouth IVF researchers that shows by skipping hormone injections and going straight to IVF, couples got pregnant three months faster, with fewer treatment cycles, and with a lower average cost [$61,000 vs $71,000]. Which makes the clear case that insurance companies should pay for more IVF sooner. Wait, huh?
Let's break it down: If you skip the $3,000 hormone injection treatment, you spend $3,000 less. [It takes a randomized study to figure this out?] If you start IVF even slightly earlier, it can improve your chances per $10,000 cycle, so you may save a cycle. So any one couple's likely savings are either $3k or $13k.
The study looked at 500 patients; assume that the 337 fewer treatment cycles applied only to the half who got the fast track. If, by definition, 250 of those cycles were the hormone injections, that'd mean 87 fewer IVF cycles, or a 1-in-3 chance of needing one less cycle to get pregnant. But that tally produces an average savings of only $4600. So maybe they didn't need a study to show that not spending $3,000 saves $3,000. So if the 337 treatment cycles are all IVF, then the study results mean skipping the injections means an average of 1.3 fewer IVF cycles/patient to get the same pregnancy rate, which is probably 0 fewer for some, 1 fewer for a lot of people, and 2 fewer for a few.
Which is all great in the abstract, but in reality, economic and psychological factors come into play, whether insurance covers fertility treatments or you have to pay out of pocket. There seems to be a definite, low-impact appeal to the first round pills [$500, 9% success] and second round shots [$3000, 15% success] before jumping straight to the highest-price, most elaborate treatment. [Also, are none of these treatments related to male fertility? Does the insemination step and/or IVF process just eliminate male uncertainty from the equation?]
And don't insurance companies look first at the overall cost savings, including the 24% of folks who never need IVF because they get pregnant in round one or round two? Is it possible to ramble any more inconclusively about a single, incomplete report of a yet-to-be-published study? At least Richards got paid to write hers.