Posted by Lisa Rosenthal on Thu, Aug 05, 2010 @ 11:26 AM
I wrote last week about the cost of infertility treatment and even used the word elitist, which ticked some people off. Very shortly afterwards, I got into a spirited conversation with two of my closest friends about the political, emotional, financial in’s and out’s of infertility coverage in the United States. I was taken aback, frankly, listening to their points of view, and realizing that it was probably representative of the general public.
What I heard is that people without health insurance (that covers treatment), without a state mandate or without substantial financial resources, in essence, are out of luck, as far as they were concerned, about creating their families.
So my mind started jumping around about this and I started looking up information. Here are a few things that I found out.
About insurance, coverage and experimental treatment:
In the past, insurance carriers that do not have exclusions have denied claims for one of the following three reasons:
1. Infertility is not an illness;
2. Treatment of infertility is not medically necessary;
3. Treatment of infertility is experimental.
These are invalid reasons to deny your claim. Infertility is an illness (2). Medically necessary is usually defined by insurance policies as medically required and medically appropriate for diagnosis and treatment of an illness or injury under professionally recognized standards of health care. Treatments such as GIFT, IVF, ZIFT/PROST have NOT been on the American Medical Association's experimental list since the late 1980s.
Interesting information above, given that GIFT, ZIFT/PROST have not been options that have been used in infertility treatment for many, many years. This is information from INCIID, (InterNational Council on Infertility Information Dissemination, Inc.) a well respected patient advocacy organization, included in a paper written several years ago. The three reasons cited for non coverage are as true today as they were when this paper is written.
Many roads, in the early 2000’s led to the ADA (Americans with Disabilities ACT). It was felt that if infertility was recognized as a disease that it would be more compelling to have insurance covering it. While that has worked to a certain extant, has the ADA ruling been more helpful in creating state mandates? Currently we have 14 states with state mandated coverage.
From ASRM (American Society for Reproductive Medicine)in their area of patient information. A simple definition of infertility:
Infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction.
Under ADA, reproduction has been held by the US Supreme Court to be a major life activity. (In fact, no less important than learning or working.) More about whether or not infertility is considered a disease:
The U. S. Supreme Court held in 1998 that infertility is a disability under the Americans with Disabilities Act (ADA). But the Court subsequently held that a person is not considered disabled under the act if the disability can be overcome by mitigating or corrective measures. And a lower court held in 2000 that, while infertility is a disability, an employer’s health plan that excludes treatment for it is not discriminatory under ADA if it applies to all employees.
It seems to me that infertility is considered a disease, but a somewhat special disease in that treatment is considered optional, or even a life style choice as reported in Newsweek.
Here’s how the article begins:
When doctors at a local St. Louis clinic told Marcie Campbell it would cost more than $15,000 to try to get her pregnant, she was crushed. For somebody with polycystic ovary syndrome, coupled with blocked fallopian tubes, in vitro fertilization was the best option to conceive a child. But with a household income of $47,000 a year, it was hardly an option. (Missouri isn’t one of the 15 states that mandate insurance coverage for IVF.)
“I told them, ‘There’s no way.’ We can’t afford it. Maybe rich folks can,” says Campbell, 33.
It takes me back full circle to the conversation with my friends. Is infertility treatment elitist? Interesting to me that this article reports that this couple was able to afford treatment for $7,500, not $15,000; we all know that some prospective parents, in this economy can’t afford that either. 
We don’t dictate to couples without fertility problems how much money they have to have, how far up the corporate ladder they have risen before they start their family. Without infertility, when and how you start a family is entirely within your own discretion and that decision is made in the privacy of your own home. Is someone making minimum wage less able to raise a child? Less able to be a loving parent?
The article continues, pointing out the significant differences between insurance and affordable Infertility treatment here in the US and in Europe.
Whether infertility should be classified as a disease or a socially constructed need is a dilemma at the center of this debate. While most other developed countries consider infertility a medical condition and insurance policies often cover the costs of IVF, health insurers in the U.S. typically don’t think “wanting a child” is a medical necessity. 
We don’t value our children less in this country. So what is it? And better yet, going forward, what can we do to ensure that infertility treatment is either covered by insurance, a state mandate, or health care reform?
What can we do to make this a reality?
Posted by Lisa Rosenthal on Wed, May 26, 2010 @ 07:25 AM
Today's medical infertility day! Friday, we will continue the dialogue on egg donation with Evelina W. Sterling PhD and Sharon LaMothe. For today, for those of you who are new to this, or just suspecting that you may be experiencing a fertility problem or for those of you who have tried to get pregnant a few months or more and are starting to wondering, we don't want you to think that fertility treatment automatically means high technology and IVF (In Vitro Fertilization). Often top fertility specialists, (board certified reproductive endocrinologists) will start with protocols that are much less invasive and much less expensive. Read what Reproductive Medicine Associates of Connecticut (RMACT) has to say about IUI (Intrauterine Insemination) also known as Artificial Insemination.
Intrauterine Insemination (IUI)
Intrauterine insemination is also known as IUI and Artificial Insemination. This is a procedure that involves concentrating the semen sample into a small volume and then placing it into the uterine cavity. Sometimes you may hear this referred to as artificial insemination. The correct terminology is intrauterine insemination (IUI) because in the vast majority of cases the semen is placed into the uterus. In rare instances the semen is placed in the cervix or vagina.
Intrauterine inseminations with ovulation induction/superovulation can treat many causes of infertility including:
- Ovarian dysfunction (inability to ovulate normally on your own)
- Infertility associated with endometriosis (a painful inflammatory condition of the female pelvis)
- Cervical factor infertility (related to prior surgery)
- Unexplained infertility (infertility in which the exact cause cannot be identified).
- Polycystic ovarian syndrome (a common female endocrine disorder)
What is Intrauterine Insemination?
Intrauterine insemination serves several purposes in order to augment a couple's fertility. 30% of all infertile couples have a degree of male factor infertility. The sperm count may be low or may have low motility, or there may be many abnormal sperm. In these situations, by getting more sperm into the female reproductive tract, we can achieve better pregnancy rates. 
Intrauterine insemination also serves to bypass the normal barriers of entry of the sperm into the female reproductive tract. The cervix secretes mucus and antibodies, which can serve to prevent sperm from entering the female reproductive tract. You may be aware of the thin cervical mucus that is secreted around the time of ovulation. This is what allows sperm to enter the uterine cavity. In some women this cervical mucus is inadequate or contains antibodies, which can damage sperm and thereby prevent sperm from reaching the egg.
Intrauterine insemination therefore serves 3 purposes:
- It gets a high concentration of sperm into the female reproductive tract into the uterus thereby increasing the chance of sperm reaching the egg to achieve fertilization.
- It helps to get higher number of sperm high into the female reproductive tract thereby helping to overcome mild to moderate male fertility problems.
- Additionally with the help of our office and the use of an ovulation predictor kit we are able to synchronize timing to optimize a woman's chance of becoming pregnant
Therefore artificial insemination is an effective treatment for both male fertility problems and couples with unexplained infertility. In couples with unexplained infertility where all other testing is normal, intrauterine insemination (IUI) combined with ovulation induction/superovulation can double a couple's chance for pregnancy.
Most physicians recommend 3-6 attempts (depending on age of patient at time of treatment) at IUI prior to moving on to more aggressive treatment.
As always, we are available to answer questions or help you in any other way that you need it.
Posted by Lisa Rosenthal on Thu, Mar 25, 2010 @ 08:34 AM
To continue on the theme that Dr. Murdock addressed so beautifully yesterday, fear can often prevent one from making and keeping the first appointment with a fertility specialist. The fear about how much or how to afford infertility treatment is often as powerful as the fears about health or diagnosis or treatment. It is often a roadblock to the first appointment as what one hears in the media can be shockingly alarming and just as often, very exaggerated.
Rather than assuming that we can't afford fertility treatment, find out. Most women who experience infertility do not need IVF (in vitro fertilization) or the more expensive protocols. Many patients will find that their infertility clinics will start them on less invasive, less rigorous programs, such as the ones that Dr. Murdock described on our blog yesterday.
When IVF becomes the best choice, with the highest possibility of conceiving, then looking at how affording fertility treatment is possible becomes paramount. Where you live (different states have different mandates), what type of insurance you have and what type of programs are offered by infertility clinics are the first places that one needs to look to see if there is affordable infertility coverage.
If this all sounds overwhelming, then keep in mind that many infertility clinics are prepared to help you with the process of understanding the financial aspects. Some infertility clinics have a finance department dedicated to working with you on this issue. Some are even set up with programs that can help contain the costs and/or give you a bottom line so that you can more effectively plan for the fertility treatment cycle.
As in anything else, fear has that tendency of paralyzing you. Most of us have experienced that feeling of finding it impossible to move forward, sideways or even backwards when fear is involved. Taking a moment or two to stand or sit quietly can help and then it's important to face the fear and move on. Easier said than done, I know. Make the appointment at a reproductive endocrinologist's office, bring your partner, spouse, or friend and then go to the appointment. The financial aspects of infertility treatment may be far less scary up close than they are in our minds.
As a friend of mine says, shining a flashlight on those fears often shows them to be much smaller, more manageable then they seem in the dark. That goes for the cost of an IVF cycle as well.
Posted by Lisa Rosenthal on Wed, Mar 10, 2010 @ 11:50 AM
The financial cost of infertility is often misunderstood. In the state of Connecticut, there is an infertility insurancy mandate that covers many people. For those people not covered by the state mandate, often there is still some insurance coverage through the plans that they do have. There are men and women seeking infertility treatment who have no financial coverage whatsoever. You may be one of them.
At Reproductive Medicine Associates of Connecticut (RMACT), we have several different options for you concerning the financial aspects of infertility treatment. The information is right here, but please don't hesitate to call us and speak to us concerning your particular situation. If none of the plans listed here are an exact fit, rest assured, we will work and see what we can do about making fertility treatment affordable for you.
For our patients that are strictly self pay, we have a unique set of programs to make fertility treatment affordable while giving the highest standard of care.
The IUI Opportunity Plan at RMA of Connecticut
In most cases, couples who are having trouble conceiving and achieving a successful pregnancy are treated with ovulation induction and artificial insemination. These procedures are among the most widely used and successful treatment options in reproductive medicine. With The Opportunity Plan, patients at RMACT who do not have any infertility insurance coverage pay one price for up to three cycles of ovulation induction with oral medications and intrauterine insemination.
Cost of IUI: How The IUI Opportunity Plan Works.
You will be treated with up to three cycles of ovulation induction and intrauterine insemination with oral medications for a fee of $5,300. This represents a significant reduction in the total cost for three cycles of IUI with oral medications. The IUI Opportunity Plan includes all cycle monitoring (blood work and ultrasounds), sperm washes, intrauterine inseminations (two per cycle) and the injection necessary for ovulation timing. If you achieve a successful pregnancy at any stage during this treatment, the fee is non-refundable.
You can withdraw from The Opportunity Plan at any time. If you choose to withdraw from the Plan after starting treatment, you will be refunded:
| After beginning the | 1st cycle: | $1,700 |
| 2nd cycle: | $ 800 |
| | 3rd cycle: | $ 0 (no refund provided) |
If the RMACT clinical staff determined you are not a good candidate for The Opportunity Plan based on medical and laboratory findings, you will be withdrawn from the program and will receive:
| After beginning the | 1st cycle: | $2,500 |
| | 2nd cycle: | $1,200 |
| | 3rd cycle: | $0 (no refund provided) |
Costs associated with the fertility work-up/checklist, baseline blood work and ultrasound, sonohysterosalpingogram (SHG), outside monitoring, or medical treatment associated with an unsuccessful cycle (treatment for a miscarriage, ectopic or biochemical pregnancy) are not included.
In most cases, patients who fail to become pregnant following three cycles of IUI with oral medications should consider treatment with In Vitro Fertilization (IVF)1. RMA of Connecticut also offers The IVF Opportunity Plan for patients who want an affordable option for high-quality treatment involving IVF.
Cost of IVF: The IVF Opportunity Plan at RMA of Connecticut
In many cases, couples who want to have a baby are treated with in vitro fertilization (IVF). IVF is a process where eggs are retrieved from the woman and are combined with sperm in a laboratory. One or more embryos are then transferred to the woman's uterus. RMACT offers all of the services required for IVF as well as advanced procedures including intracytoplasmic sperm injection (ICSI), assisted hatching, and embryo cryopreservation.
During an IVF cycle, women are treated with medications to stimulate the development of multiple ovarian follicles to produce eggs for fertilization. The RMACT medical team closely monitors this process using blood tests and ultrasounds. Mature eggs are retrieved using a surgical procedure with ultrasound. We then combine the retrieved eggs and sperm and transfer a limited number of embryos into the woman's uterus to achieve a pregnancy.
The IVF Opportunity Plan includes one price for all cycle monitoring (blood work and ultrasounds), egg retrieval, anesthesia, embryo transfer, ICSI (if appropriate, on all eggs retrieved), assisted hatching and cycle medications.
How The IVF Opportunity Plan Works
Couples who are eligible for The IVF Opportunity Plan at RMACT pay $9,750 for one IVF cycle. The IVF Opportunity Plan includes all cycle monitoring (blood work and ultrasounds), egg retrieval, anesthesia, embryo transfer, ICSI (if appropriate, on all eggs retrieved), assisted hatching and cycle medications.
Patient financing plans offered by some IVF centers try to reduce costs or improve outcomes by using lower doses of medications or by limiting access to younger patients or patients who have not previously failed a treatment cycle. The IVF Opportunity Plan at RMACT is open to all patients who do not have insurance coverage. In addition, patients in The IVF Opportunity Plan are treated with the highest quality products and services including optimal doses of all medications to achieve a successful pregnancy.
Costs associated with the fertility work-up/checklist, baseline blood work and ultrasound, sonohysterosalpingogram, outside monitoring, or medical treatment associated with an unsuccessful cycle (treatment for miscarriage, ectopic or biochemical pregnancy) are not included. Costs associated with embryo or sperm cryopreservation are also not included. The IVF Opportunity Plan covers the cost of all medications leading up to the first pregnancy test.
You can withdraw from The IVF Opportunity Plan at any time. If you withdraw from the program prior to starting medications, you will receive a full refund. If you withdraw after starting medications you will be refunded $2,600. If your cycle is cancelled prior to egg retrieval due to a medical reason (i.e., poor response, premature ovulation) you will receive a refund of $3,650. Patients who choose The IVF Opportunity Plan at RMACT are treated by our outstanding team of surgeons, nurses and other specially trained patient care professionals. Find out if The IVF Opportunity Plan is right for you.
To learn more, contact a Financial Service Representative at RMACT at 203 740-0400.
The IUI and IVF Opportunity programs outlined above help make infertility treatment affordable for those with no insurance coverage. We realize that this is still a considerable investment and that's why we are happy to be able to put all of RMACT's considerable resources behind helping you achieve your goal of building your family. We want what you want. Let us help.