Factors that influence the cost of fertility treatments
Although general recommendations can be made regarding a cost-effective approach to treating infertility based on cost-effectiveness studies, there are factors present in individual patients that would change the efficacy, and therefore influence the cost-effectiveness, of certain treatments.
Two factors that influenced the cost-effectiveness of IUI, CC-IUI, hMG-IUI, and IVF cycles in our study were age of the female partner and low post-wash sperm numbers.
Under 38? Your cost is three times less
Women who were at least 38 years old had a cost per delivery nearly 3 times that of younger women. Despite the increased costs associated with compensating an oocyte donor, the use of donor oocytes in recipients 38 years of age or older reduced the cost per delivery to levels seen in younger patients.
Low sperm counts affects success rates
The numbers of sperm available for insemination also affected the success rates and the cost-effectiveness of IUI, CC-IUI, and hMG-IUI procedures. If fewer than 10 million motile sperm were available for insemination, then substantial reductions in pregnancy rates were noted, leading to higher costs per delivery for IUI, CC-IUI, and hMG-IUI cycles.
Our data suggests that a policy of proceeding to IVF rather than hMG-IUI in cases of low sperm counts would be cost-effective. Larger studies will be required to determine the cost-effectiveness of infertility procedures for different diagnostic groups. Just as age and the number of spermatozoa inseminated affect the success of the procedures studied, it is possible that certain diagnostic groups will have better success with specific treatments, resulting in altered cost-effectiveness of procedures for those groups.
Cost-effectiveness studies can be useful in establishing general guidelines of care for large groups of patients. However, these analyses are less helpful in counseling individual patients since decisions regarding treatments are influenced by considerations other than cost and effectiveness.
Consider time away from work and emotional factors
Factors commonly considered by patients include the time away from work, the convenience, and the many ethical issues surrounding infertility treatments. In addition, cost-effectiveness comparisons are most comfortably made when the treatments being compared are similar in effectiveness. Although we found IUI to be cost-effective compared with ART in our study, IUI was nearly 5-fold less effective than ART in terms of pregnancy rate per cycle.
To some infertile couples, costs may be less relevant when considering the increased time, frustration, and grief that may accompany more failed cycles with the less successful procedure.