Explaining Goal #2

Goal #2: To improve access to the diagnosis and treatment of infertility and eliminate disparities in infertility care

Given that the average cost of one IVF cycle is more than $12,000, the financial barriers to treatment create a disparity among lower income infertility patients. A recent report from the Coronary Artery Risk Development in Young Adults (CARDIA) study indicates that among non-surgically sterile women, African American women had a twofold increase in odds of reporting a history of infertility. Financial barriers limit access to diagnosis, evaluation, and treatment and may lead to selectively underestimating the frequency of infertility in some lower income population groups.

Although the CDC white paper primarily deals with infertility within the United States, the Demographic and Health Surveys program estimates that 167 million ever-married women aged 15 to 49 years old in developing countries (excluding China) were infertile in 2002. In fact, infertility rates in sub-Saharan Africa exceed 30%. As these countries develop economically, the demand for infertility treatment and assisted reproduction will increase exponentially.

Determining the true cost of infertility will help improve access

There is still a great deal of controversy over the cost effectiveness of IVF, given the high cost. Besides analyzing the impact of maternal age and multiple births along with the costs, the financial impact of involuntary childlessness has never been thoroughly researched. Women become depressed, which may lead to decreased work productivity, or extended leaves of absence as women often grieve the losses so often incurred during infertility treatment.

The average $12,000 costs does not include diagnosis and treatment, and doesn’t take into consideration longer term disability costs that come with giving birth to multiples, premature deliveries, and low birth weight babies. Since many additional costs are borne by the patients, a tracking system needs to analyze the out of pocket expenses for care that are often not covered by insurance.

The cost of treatment is only likely to rise as more couples seek infertility treatment. The good news is, research into controlling these costs with more education and intervention among medical professionals to prevent infertility is developing quickly. As access to infertility treatment is improved, the costs can be tracked, and ultimately the cost effectiveness of prevention programs will help reduce the overall financial impact infertility has on the childbearing age population.

Higher income groups may be at higher risk for infertility

Although financial barriers are likely causing some underestimation of the frequency of infertility among some lower income population groups, the same may be true for higher income couples.

The infertility rate of professionals who opt to delay having a child is difficult to track, since they do not become a part of the infertility equation until they decide to start trying.

As it becomes a common part of American culture to delay childbearing until a career is established, or financial security is achieved, the actual number of professional, higher income women and men who are diagnosed with infertility is only likely to increase.

One term I heard for the first time when I was lobbying for support for this plan in Washington, D.C. was “health inequality.” In the context of the National Public Health Action Plan for the Detection, Prevention, and Management of Infertility, it relates to the fact that as a disease, infertility does not get ‘equitable health’ consideration within the healthcare system. This creates large variations in the quality of care that infertile Americans receive, and is likely preventing large populations of lower income couples from even having the opportunity to try to have a biological child with medical assistance.

The research and preventative measures proposed by the CDC through this plan would shed light on those disparities, and hopefully pave the way for standards of care that serve the needs of all populations seeking parenthood with the help of a medical professional.

In the next article, we’ll discuss Goal #3 of the plan: To improve the efficacy and safety of infertility treatment.

Read the Entire Four Part Series

  1. The Public Health Focus on Infertility
  2. Improving Access to the Diagnosis and Treatment of Infertility
  3. Improving the Efficacy and Safety of Infertility Treatment
  4. Improving the Quality of Life of Americans Who Live With Infertility