LOWER YOUR INFERTILITY COSTS ( PART IV ): BEFORE YOU GO TO THE REPRODUCTIVE ENDOCRINOLOGIST; YOUR PRE-TREATMENT NECESSITIES

How to Properly Select an RE/ Fertility Clinic

$          Is it based just on your Ob/Gyn’s recommendation?   Friends? You deserve skilled & compassionate care …so do your own investigating and homework. It will pay off.

$          Costs can vary widely among different fertility clinics.  In the Chicago area, IVF costs vary among centers, but average $12,000 (with a $10-20,000 range) - not including medications.

$          Beware how some Fertility clinics can create overly inflated statistics!! … ‘Cherry-picking’ refers to doctors that choose only very ‘favorable’ patients to help improve their pregnancy rates. IVF programs that may be essentially identical in ability can look very different statistically if one of the IVF centers “cherry- picks” its patients.

a)  They can encourage patients who are ‘poor responders’ to exit their IVF program or       push patients to consider donor egg very early in their treatment before trying IVF.

b)  They can transfer larger numbers of embryos to the uterus to improve pregnancy rates, despite increased risks of multiples. This goes against SART guidelines.

c)  Some IVF programs may exclude HMO patients. For example, excluding HMO patients will always improve pregnancy success rates for an IVF program. Some HMO patients, even if they are older or may have a very poor prognosis, will often just keep trying IVF since it doesn’t cost them anything…they are“entitled” to up to 4 IVF retrievals in Illinois, based on the state mandate. These ‘poor prognosis’ patients with little chance for pregnancy, will lower an IVF program’s overall pregnancy statistics. On the other hand, most self-pay patients or patients with only a limited PPO insurance policy will generally not keep trying IVF if they have a very poor prognosis… they can’t afford it.

 THE INTERNET – A VAST WORLD OF INFORMATION

$          Typing the word ‘infertility’ into Goggle yields more than 14 million websites. Help!!!

$          The internet is a great place to start… it’s free, but it’s also very confusing.

$          Since anyone can post information on the internet …fact or fiction, be on the lookout for claims or cures that seem too good to be true. Listen to your intuition. Unsupervised ‘chat rooms’ can often be erroneous, dangerous and give out misinformation about treatments, REs and fertility programs. Why listen to chats? They may not know any more than you do about infertility, but just be more opinionated!

$          However, the internet can be helpful to search out various RE qualifications and practice styles. You want an experienced RE that will be accessible for your needs.

$          For same sex couples, gays and lesbians must search for friendlier infertility programs in certain states. It often depends on the state policies. Only 8 states (including Illinois) allow same sex couples to complete second parent adoptions, so fertility programs in those states tend to be friendlier to gays and lesbians desirous of fertility treatments. Call ahead to check on a fertility clinic’s experience and policies regarding same sex couples.

Start Your Treatment Plan… Pre-Treatment Necessities

$          Ideally your Ob/Gyn or PCP may have already performed many of the ‘basic fertility tests’ and examined you and your partner for any underlying medical conditions that might be affecting your fertility. The female has to generally undergo more extensive hormonal tests, but both partners will have to be screened for sexually transmitted diseases. 

$          Laboratory tests/costs for both women and men:

                                                                                    Chlamydia and gonorrhea                               $100.00

                                                                                    Hepatitis-B (both partners)                              $ 50.00

                                                                                    Hepatitis-C (both partners)                              $100.00

                                                                                    HIV (both partners)                                         $100-200.00

                                                                                    Syphilis                                                            $ 50.00

                                                                                    Rubella                                                            $ 50.00

$          Basic hormone labs/costs for women:

                                                                                    Luteinizing hormone (LH)                                $ 75.00

                                                                                    Follicle stimulating hormone (FSH)                 $ 75.00

                                                                                    Anti-müllerian hormone (AMH)                       $350.00

                                                                                    Estradiol (E2)                                                  $ 75.00

                                                                                    Progesterone                                                  $ 75.00

                                                                                    Prolactin                                                          $ 75.00

                                                                                    TSH (Thyroid stimulating hormone)                $ 50.00

                                                                                    Testosterone                                                   $ 50-200.00

$          If these diagnostic tests have not already been completed, see which ones can be done before you go to your infertility doctor.  Often some diagnostic tests may be covered if ordered by an Ob/Gyn or a PCP but not by a fertility specialist (RE). This often comes down to insurance coding since many of these tests are not limited to ‘fertility’. 

$          If your Ob/Gyn or PCP is willing to order them and codes them under a general women’s health code, they may often get covered.

$          Many doctors may be ‘sympathetic’ to the limitations of your insurance coverage and will try to accommodate you—but it’s up to them. It never hurts to ask and save money. However, your Ob/Gyn or PCP may suggest or insist on waiting for the infertility specialist to do the tests.

$          Men should always have a semen analysis (SA) since over 40% of couples are diagnosed with male factor problems. In order to save time and money, it is wise to go to the Fertility clinic for a more thorough SA, including sperm function testing. That way you don’t have to repeat this test if you simply have a basic SA from the Ob/Gyn ordering it at a hospital and then the fertility specialist needs a better evaluation.

$          ‘Diagnostic Only’ insurance: (covers -- some Hormone testing; Cultures; SA; HSG) do these diagnostic testsbefore you start any treatments (i.e. Clomid) or it’s not covered 

$          All of the above laboratory tests must be current. If it’s been over a year, most lab results will not count and will need to be repeated. 

$          Once you have done all you can do with your Ob/Gyn or PCP, obtain copies of all your medical records/labs to take with you to your first visit at the  Fertility clinic—this will save time and prevent certain tests from being repeated unnecessarily.

More Extensive Testing --  Generally Unnecessary?

Post-Coital Tests

$          Due to frequent false or inconclusive results, research suggests that this test does not provide much useful information and you should not have it done—don’t waste your money. Some doctors still do them, but I have not ordered one for over 10 years.  

Endometrial Biopsy

$          This painful test by the gynecologist can range from $300-500 including pathology fees and may be avoided by simply checking mid-luteal serum progesterone blood levels which are not painful and are just as accurate for documenting proper ovulation.

Laparoscopy

$          Diagnostic laparoscopy is no longer a standard part of the infertility investigation and in most cases is not necessary and therefore should be avoided. Laparoscopy surgery for pelvic pain, Endometriosis or ovarian cysts is appropriate and may be useful.