By: Adam Fechner, MD
Many patients will tell you cost is their biggest concern about fertility treatment, and IVF can be a very expensive undertaking for many. When you factor in the cost of the frequent ultrasounds and bloodwork, the clinical procedures (egg retrieval, embryo transfer), the lab procedures and the medications, a patient can easily spend $15,000 or more on a single cycle. Costs can vary widely from region to region and even from practice to practice. Unfortunately cost can be such a deterrent that some patients significantly delay treatment, sometimes for years. This delay can reduce their chances for a successful cycle, as IVF success rates depend most heavily on a woman’s age. Thankfully, several states now mandate that insurance providers cover at least some aspects of infertility evaluation and treatment, so a patient’s insurance may actually cover the cost of some or even all of an IVF cycle (and in some cases multiple cycles, including medications). For those patients with no such insurance coverage, many fertility practices offer discounted pricing or even financing options to make treatment more affordable. And although many people don’t think to shop around for the best deal on IVF, they should feel free to inquire about pricing from multiple practices in their area as the prices may differ drastically.
Aside from the financial implications of IVF, there are some rare but potential risks associated with the procedure itself. These include risks of the medications, including overstimulation of the ovaries (ovarian hyperstimulation syndrome) as well as risks of the procedures themselves. For example the egg retrieval is a surgical procedure in which a needle is passed through the vagina into the ovaries, so there is a small risk of bleeding, infection, or damage to other structures around the ovaries, including blood vessels, intestines, etc. By far the biggest clinical risk of IVF, though, is the risk of multiple pregnancy (twins, triplets or more). The goal of any fertility treatment is generally one healthy baby. While many patients are ok with the possibility of twins (and indeed some actually request twins if possible), we do consider that to be a complication of IVF given the increased risk of pregnancy complications like preterm delivery.
Although often overlooked, we have to consider the emotional toll that IVF and other fertility treatments can take on a couple as part of the overall cost. For many patients, IVF may represent their last best hope for achieving pregnancy, and they may have sacrificed for years in order to afford a cycle. This puts enormous emotional pressure on the outcome. Add to that the daily injections, frequent early morning visits for bloodwork and ultrasounds, and supraphysiologic hormone levels, and it becomes clear to see why the incidence of depression and anxiety is so high among infertility patients. Thankfully there are support groups and individual therapists to provide support in these circumstances, but patients and physicians need to be sensitive to this real risk
