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Money Woes Keeping Many Couples From Fertility Treatments
Date:10/22/2009

They're foregoing expensive therapies or opting to discard stored embryos, studies show

THURSDAY, Oct. 22 (HealthDay News) -- A squeeze on finances is now playing a key role in many couples' decisions about fertility treatments, including whether they will try to conceive using assisted reproductive technology or whether they will discard leftover embryos put into storage, new studies show.

Among the new findings, presented this week at the annual meeting of the American Society for Reproductive Medicine in Atlanta:

  • More than half (58 percent) of couples diagnosed as infertile who opted not to pursue treatment said cost was the primary reason;
  • About 7 percent of couples who had leftover embryos in cold storage discarded the embryos from October 2008 to March 2009, a number that was almost three times higher than six months prior;
  • About 57 percent of young women who donated eggs to infertile couples in 2008 now say they planned to use the money to pay for school, up from 28 percent in 2002-2004.

Given the high cost of fertility treatments, which are often not covered by insurance, experts said they weren't surprised by the findings. A single cycle of in vitro fertilization (IVF) costs about $12,000, and several cycles may be needed, according to the ASRM.

Yet some fertility experts said they were hesitant to blame the recession on the new numbers. Dr. Peter McGovern, director of the division of reproductive endocrinology and infertility at Hackensack University Medical Center, said his practice is as busy as ever.

"We're not seeing much of a difference, quite honestly, compared to better times," McGovern said. "It could be that the drive to reproduce is so important people are somehow making it happen."

In one study, researchers followed 448 infertile couples from eight fertility clinics for 18 months. Of those, about 27 percent decided not to pursue treatments including in vitro fertilization, in which the egg and sperm are joined outside the womb and then the embryo is placed back into the mother.

About 58 percent of these couples said the primary reason to discontinue treatments was money, 38 percent cited life conflicts such as moving or a death in the family, and 26 percent cited medical futility.

Depression and increasing age also made it less likely a couple would pursue treatment, while those with a college education and higher incomes were more likely to go through with it.

"It's financially challenging for some patients to pursue fertility treatments," said Andrew La Barbera, scientific director of the American Society for Reproductive Medicine. "In most states insurance coverage for assisted reproductive technology [ART] is not mandated. Most patients have to pay for ART procedures themselves and it's not easy."

Financial stress linked to a worsening economy may be prompting more couples to dispose of leftover embryos being kept in cold storage, a second study found.

Researchers found that between October 2008 and March 2009, about 7 percent of couples discarded frozen embryos, compared to rates between 4.3 percent and 2.3 percent in the two years prior.

Fees to store embryos at minus 310 degrees Fahrenheit can cost several hundred dollars a year. For many couples, deciding what to do with unused embryos is a difficult ethical and emotional decision. The researchers concluded that "extreme economic conditions have forced patients to address an issue they have historically chosen to postpone when financially viable."

The economic downturn may even be affecting the decisions of egg donors, who are paid between $4,000 to $10,000 to donate eggs to infertile women undergoing IVF.

In another study presented at the ASRM meeting, researchers found little change over the past few years in prospective egg donors' average age, education level and marital status. However, they did find a change in what donors planned on doing with the money.

Researchers at Reproductive Medicine Associates of New York and Mount Sinai School of Medicine in New York City compared the screening interview records of 54 women who sought to donate eggs between 2002 and 2004 against the records of 46 women who sought to donate eggs in 2008.

About 57 percent of the women said they planned to use the money for schooling in 2008, compared to 28 percent in 2002-2004. Yet fewer said they planned to pay down debt or save the money in 2008 than in the earlier period.

Despite a difficult economic climate, many women who donate eggs do it for reasons beyond the money, McGovern reasoned. Donating eggs requires substantial time, effort and discomfort, including physical and psychological screenings, daily injections of fertility drugs that can cause side-effects including headache, cramping and bloating, multiple trips to the clinic, ultrasounds and blood tests.

"Egg donors don't tend to be very mercenary," McGovern said. "I find them to be a very generous group. It's a lot of work, not like being a sperm donor."

More information

The American Society for Reproductive Medicine has more on fertility treatment.



SOURCES: Peter McGovern, M.D., director, division of reproductive endocrinology and infertility at Hackensack University Medical Center in Hackensack, N.J. and the University of Medicine and Dentistry of New Jersey in Newark; Andrew La Barbera, Ph.D., scientific director, American Society for Reproductive Medicine; presentations, Oct. 20, 2009, annual meeting, American Society for Reproductive Medicine, Atlanta


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