In the presence of a significant pelvic factor the cost of “taking home a baby” using available treatment options is difficult to assess. In assessing cost for a specific treatment option, one should consider the success rate (percentage of patients who accomplish the goal of childbirth), the immediate costs of performing the treatment (professional and facility fees), and any costs associated with complications due to the involved procedure(s).
The out of pocket cost to the patient is generally the cost related variable most meaningful to individual infertile couples. Insurance coverage is not standardized in the USA and indeed is remarkably variable with respect to infertility coverage.
Most insurance companies do cover the required surgery, especially if the reason for performing the surgery is coded to address any associated pelvic pain or menstrual disorders. For infertility surgery (which is often very complex and results are highly operator [surgeon] dependent) an “out of (insurance) network” surgeon may be more cost effective for the infertile couple (“worth the extra money”) especially if the insurance policy has out of network reimbursement. This is because the (surgical) care obtained with the “best available infertility surgeon” may result in a several fold increase in fertility success.
The cost of surgery with an experienced (Reproductive Endocrinology and Infertility) board certified infertility surgeon who does not participate with a particular insurance might be very affordable for an infertility couple. In my own office, I work out a system that is usually comfortable for my patients.
Many insurance companies do not cover IVF or any of the ART procedures. However, many of these insurance policies will cover part of the required work (eg., ultrasounds, bloodwork, medications) if coded and billed independently. The oocyte (egg) retrieval, embryology lab (embryo culture) and embryo transfer is often not covered and these costs typically amount to 5,000-10,000 dollars (US) per IVF attempt (cycle).
Overall, most couples have a strong financial advantage (in terms of their own out of pocket expense) if they attempt surgical repair of the pelvis with an experienced infertility surgeon rather than In Vitro Fertilization. Additionally, almost all IVF candidates will have had a laparoscopy to assess their pelvis during the infertility evaluation (during which time an experienced infertility surgeon would have an opportunity to treat any identified pathology).
The cost of “taking home a baby” via reconstructive surgery (repair of the abnormal pelvis) includes:
- The percentage of women who go on to successfully reproduce after the surgery.
This factor is highly dependent on both the extent of pelvic damage that occurred prior to surgical repair, the surgical skill of the physician, and the willingness of the surgeon to spend the time required for optimal surgical (fertility) success. This is a cumulative rate since the woman can try to conceive for months-years following surgery.
- Facility (hospital or surgicenter) costs for use of the operating room
- Physician fees, including the surgeon’s fee (plus the fee for any assistants used) and the anesthesiologist’s fee.
- The cost of treating any surgical complications that might occur
- The cost of treating obstetric complications (eg., ectopic pregnancies or spontaneous pregnancy losses) that may have an increased incidence following surgical repair
The (“take home baby”) cost of In Vitro Fertilization that is performed in an attempt to bypass the pelvic factor includes:
- The percentage of women who become pregnant with the procedure.
This factor is highly dependent on patient selection characteristics and the quality of the IVF center used for embryology (culture of the embryos). The success rate is “per IVF attempt” since there is no (known) enhancement of fertility during menstrual cycles following the IVF cycle.
- Facility (IVF center or hospital) costs for use of the procedure room and embryology lab (including embryologist’s fees)
- Physician fees, including the surgeon’s fee and the anesthesiologist’s fee.
- The cost of treating any surgical complications that might occur (from the procedure or the medication that is used).
- The cost of treating obstetric complications (eg., ectopic pregnancies, higher order multiple pregnancies, spontaneous pregnancy losses) that may have an increased incidence following IVF