November 21, 2007

IVF Researchers: Skipping Straight To IVF Saves Time, Uh, Money

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.

Skipping Baby Steps: The case for going straight to IVF. [slate]


I'm not sure I understand the double-negative construction of your question regarding male infertility, but I'll give it a stab. Distilled down to the most rudimentary: currently, fertility medications are primarily for women's fertility problems, while fertility procedures attempt to compensate for male and female issues.

More specifically, oral fertility medications (e.g. Clomid) treat ovulation issues, so that one is female only. There are a variety of injectable medications that treat different steps in the conception process, again on the female side.

IUI and IVF, along with other techniques like ICSI and assisted hatching are not gender-linked procedures - they can help overcome male or female infertility issues, depending on what you are up against. For example, if the male produces a low volume of sperm or a limited quantity of viable sperm, both IUI and IVF can address these problems.

[thanks, should've been clearer. I meant that when we hear about reports of male fertility issues and research, they start out by saying that male fertility problems account for--surprise--half of the cases. But this particular study only addresses female interfertility issues. According to the trial design, all the males partners in the study had normal sperm count and motility. I guess I haven't done the research on the entire experience and process leading up to IVF, which I'd expect involves isolating the fertility problems early on. -ed.]

Right, dear Editor. The endocrinologists do thorough workups on couples needing help, before any therapies or meds are started.

Couples can shorten this time by charting the woman's basal temperatures and other factors; doctors love to have more data to work with. At least mine did.

My husband and I went through all of the fertility work ups, did the basic meds (clomid) first, did a single round of IUI and then made a personal and financial decision to go straight to IVF. We skipped the two follow up IUI cycles our doctor recommended according to standard protocol. Our doctor did allow us to make this choice at anytime. Our insurance didn't care what we did, as it covered none of the IVF procedure itself, but it did cover any office visits (IVF or not).

It took us one round of IVF with ICSI (motility issues) and were were pregnant. I just had our baby girl. When I think of going through two extra months of hormones and heartbreak it makes me so thankful we had the freedom to choose.

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