SANTA BARBARA, CALIF. – Some fertility specialists are pairing guarantees with pricing to entice patients to their assisted reproductive technology services.
Dr. Bill Yee offers a step-by-step approach in his fees. A patient who comes in, gets monitored, and is taken to egg retrieval pays a minimum of $1,000. If no egg gets retrieved, the fee stops there. If an egg is retrieved for attempted fertilization, however, the fee increases to $2,000, where it stays if fertilization is unsuccessful. Successful fertilization that produces an embryo increases the fee to $3,000 total. If the embryo doesn’t divide on day 3 or doesn’t look to be of suitable quality for cryopreservation, the fee remains at $3,000. If the embryo does become suitable for freezing and transfer, the fee is $5,000.
Dr. Richard Paulson
"It’s very, very simple," he said at the UCLA annual in vitro fertilization and embryo transfer update 2013. While this fee structure may seem controversial, "we find that patients love this," said Dr. Yee, a reproductive endocrinology and infertility specialist in group practice in Westminster, Calif. "This certainly is an alternative, especially for your poor responders."
Keeping costs down is an important strategy for gaining patients in the competitive field of fertility treatments. "It’s very expensive to do IVF in Southern California," said Dr. Yee.
Another innovative pricing schedule at a fertility center in Davis, Calif., drew attention in a November 2012 article in the Los Angeles Times, which reported "an ethics debate over embryos on the cheap." Dr. Richard J. Paulson, who gave a separate presentation at the meeting, said that he contacted the physicians at that clinic, which uses donor eggs and donor sperm to create a batch of embryos that get divided up among several patients for attempted pregnancies.
While one horrified critic called this the "commodification of children" in the news article, Dr. Paulson noted that it sharply cuts costs. The Davis center told him that they now charge $12,500 per patient for up to three transfers of one or two blastocysts; the center matches two to five recipients per donor cycle. If a woman is not pregnant after three transfers, she can choose either to get her $12,500 back or to roll the money into another three transfers. If there’s no successful pregnancy after that, there’s no refund.
"They say they’ve had about 200 patients and 90-plus are pregnant," said Dr. Paulson, professor of obstetrics and gynecology and chief of the division of reproductive endocrinology and infertility at the University of Southern California in Los Angeles.
"I’m not advocating it, but it’s an interesting way of putting your money where your mouth is," he said. "If we’re so confident that sperm really doesn’t matter, and that it’s all about the egg, and that egg freezing doesn’t matter because cryopreserved or vitrified oocytes have the same efficiency as fresh, then why wouldn’t we use this same kind of model and allow patients to be able to have this kind of money-back guarantee?"
Dr. Paulson said he is bothered by modern egg donation practices that match one recipient to one egg donor with 20 embryos, 19 of which stay in a cryopreservation tank for the next 15-20 years if the recipient gets pregnant on the first elective single-embryo transfer.
"I think egg freezing would be a good way of getting around that and convincing patients that it’s worth going this way," he said. "I think if we offer them some sort of money back, it might be helpful."
At the same time, he’s not thrilled with that idea. "I don’t like money-back [strategies]. I’m a very traditional guy and I like providing a service, and they pay you," he said, adding with a smile, "I’m very confused."
Dr. Yee reported having no relevant financial disclosures. Dr. Paulson has been a speaker for Ferring Pharmaceuticals and an adviser to Cooper Surgical.
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