IVF often costs patients around $25,000 per treatment, with an expectation that patients will need multiple treatments, all because insurance no longer covers IVF. But quality IVF treatment can happen at a fraction of that price, as low as $8,000 per treatment, if the lab, doctors, and vendors integrate care.
The history behind high IVF treatment costs
Low cost IVF, minimal IVF, no monitoring IVF, vaginal incubator IVF, IVF tourism. Each of these terms hint at the desire to meet the needs of patients with minimal access to cash for their care. Why? Well, historically IVF has been a treatment for the wealthy.
As you may or may not know, health insurance companies rapidly eliminated coverage for IVF due to pregnancies that included twins, triplets and quadruplets. This occurred due to excessive embryos being transfer by some, now famous, IVF centers. Granted, it may have been an innocent result of a desire to help patients, but the outcome was that insurance companies now refused to cover IVF.
Despite the insurance companies pulling their coverage, the original prices stuck and really have changed minimally over the last 30 years! Even today, $25,000 per IVF attempt is hard for non-wealthy folks, especially since it takes an average of 2.6 IVF cycles to achieve a baby in the U.S. (All IVF centers report their results to the CDC and this statistic has remained roughly the same over the past 15 years.)
What this means is that only one percent of folks in the U.S. that need IVF can afford to do it. This is where HQA comes in. High Quality Affordable IVF came to market in 2015. This was the choice of myself and my team’s deliberate effort to reexamine IVF fee structures and identify the “true” cost of IVF materials, staffing, supplies facilities, technology, and the desire by HQA staff to take a 15 percent pay cut to help create truly HIGH QUALITY and AFFORDABLE IVF.
Creating high quality and affordable IVF
- Encourage companies and vendors to embrace volume over exclusivity.
- Build smart IVF labs.
- Source high quality and affordable products whenever possible instead of making them in house.
- Charge flat fees for embryo freezing, cultures and storage.
- Take advantage of online portals and virtual assistants to provide better access to doctors and nurses.
Embracing volume over exclusivity
We ask the pharmaceutical companies, the reproductive technology companies, the vendors, even lawyers and third-party agencies to partner with HQA to change the equation from “lots of profit per patient/few patients” to “many patients and little profit per patient”? This results in the same final number of dollars the clinic takes home, but the joy of helping more folks is wonderful and amazing. HQA’s choice was to partner with companies, ask our staff to reduce their pay, and see what happens. We became the fasting growing IVF center in the U.S. because of it. It worked! Volume with some profit over exclusive with excess profits.
Build smart labs
Why do I say excess profits? I’m one of the few board certified RE&I’s that has built more than one IVF lab; I’ve built 5! I also helped build the stem cell lab at the University of New Mexico and the molecular biology lab at Michigan State University. What is well known and seldom discussed in the IVF world is the fact that the IVF lab is responsible for over 70% of the success of the IVF program…not the doctor! How does this relate to costs? In 1985, a good embryologist could demand $250,000 to run a lab; there were very few human embryologist (most worked with farm animals) and they could ask for lots of money. Today a good embryologist earns about $100,000/year to run a lab. Building a lab has also changed. My first lab cost over $1.2 million to build, and it was only okay by today’s standards. My last IVF lab (2013) cost $400,000 to build and it is a far better lab than the first.
Source high quality and affordable materials whenever possible
In the old days, each IVF center had to make their own embryo culture media to grow embryos. Today we successfully use off the shelf embryo culture media and it’s 10x less expensive. Same thing with ICSI needles. We used to make our own ICIS needles (yikes!) and today, we buy boxes of 25 for 10x less than it costs for labor, materials, and the time it took in the past.
Embryo freezing by the previously used slow method was an all-day operation that required a sophisticated, expensive machine. You needed to have at least two machines in the lab and a whole day dedicated by the lab technician to achieve a freeze. Today, you buy a kit, get a food Styrofoam container ($5), add liquid nitrogen (vitrification) and 15-30 min later you are done. When ICSI was first introduced to help sperm fertilize eggs, clinics charged over $5,000 per case, HQA includes it without additional cost.
Charge flat fees for basic services
Today clinics charge by day for culture of embryos and charge more if you make more embryos. HQA utilizes a flat fee. Some clinics charge extra for blastocysts culture of embryos. HQA includes up to Day 7 of culture. We now know that “slowpoke” embryos can make babies, but many IVF centers dispose of the embryos after Day 5. HQA does not charge extra to grow to Day 7. It’s simply the right thing to do with our technology. While some IVF centers charge for embryo freezing and storage, HQA also includes 6 months embryo storage onsite and has negotiated 6 months storage at no cost offsite.
Utilize virtual options to create better access to health professionals
Access to highly trained professionals is also important in High Quality Affordable fertility care. What good is lowering the cost of IVF if you can’t see or talk to professionals about your care, especially if there are extenuating circumstances? HQA keeps fees low by using virtual assistants (RN’s) via our 24-hour HQA Solutions Center, online portals (via EMR), handouts and explanations of every step in the IVF process, plus immediate access to HQA doctors and nurses via cell phone.
Why does the HQA model work? There is a fixed cost with creating an IVF center. You need the same number of staff for 10 cycles a month as you would for 25 or 30. The only difference is that you work harder. Once you cover your overhead and reasonable profits, each additional patient is like icing on the cake. So why not reduce fees and get more and more of the 99 percent of patients that do not have access to care?
HQA has proven repeatedly that by integrating care, creating a family of services, asking staff and vendors to prioritize access to care, patient volume goes up and all benefit. No shortcuts. Profits are still generated for our practice and this allows for continued improvement. We continue to believe that doing “the right thing” will result in our patient’s success and our success.
About the Author, Dr. Magarelli
Dr. Paul C. Magarelli MD PhD is a Board Certified Reproductive Endocrinology & Infertility (REI) specialist who has national acclaim; he has practiced in Colorado since 1998. He is founder and Medical Director of High Quality Affordable Fertility Centers in both Colorado Springs and Denver Metro.