Discussion
From this review, it is apparent that the evaluation of cost-effective approaches to infertility treatment is in its infancy. Nevertheless, some important principles have emerged from the initial studies in this field. In general, it appears that for infertile couples without tubal disease or severe male factor infertility, the most cost-effective approach is to start with IUI or superovulation-IUI treatments before resorting to IVF procedures.
Factors that have been identified as influencing the cost-effectiveness of a procedure include the woman's age and the number of sperm present for insemination. More work needs to be done to identify the influence that certain diagnoses have on the cost-effectiveness of infertility treatments. IVF is expensive, particularly if one considers the costs associated with multiple gestations and premature deliveries.
However, the cost of IVF still falls within the range of that for other medical procedures considered to be cost-effective and certainly falls below the upper limit of what the public is willing to pay for these procedures. Indeed, for patients with severe tubal disease, IVF has been found to be more cost-effective than surgical repair. In addition, the cost-effectiveness of IVF will likely improve as success rates of this treatment show gradual improvement over time.
The common policy of excluding infertility treatments from insurance plans is puzzling and accentuates the importance to the clinician of understanding the economics of infertility treatment, since costs are often passed directly to the patient. Current policies that have led to inequities in access to health care should not be tolerated.
Editorial Comment
DSM-An Option For Managing Infertility
Infertility affects 10% to 15% of reproductive-aged couples in the US. In spite of the large numbers of individuals affected, infertility has remained a relatively silent disease. And disease it is! The emotional and physical impact of childlessness on a couple can be devastating. However, third-party payers have long argued that infertility is not a disease, but rather a "condition."
While the semantics seem trivial to the casual observer, the legal impact of this wording is profound. Medical treatment of "conditions" is considered to be cosmetic in nature, and therefore deemed medically unnecessary (and uncovered). Medical procedures for "diseases" are considered warranted, necessary, and covered. Payers also perceive that medical therapies for infertility are largely unsuccessful. They are also rightly concerned about the impact of multiple pregnancy rates.
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