Scott Roseff, MD, FACOG
Director of the PALM BEACH CENTER FOR REPRODUCTIVE MEDICINE,
Wellington, FL
The Cost of Alphabet Soup
ALPHABET SOUP (And What It Costs):

Your visits to the fertility doctor can be daunting. You're frustrated about not having been successful in pursuing your most precious dream of having a baby, while you're nervous because you don't know what your doctor will tell you about your test results. Once your testsare completed to find out why you're having fertility problems, your practitioner will talk to you about treatment options available to help you successfully conceive

options vary and should be individualized to you and your situation. Also, average costs for fertility treatments vary from center-to-center and from state-to-state. Some states mandate fertility treatment coverage by third party payers, while other (most) states offer little to no insurance coverage for fertility therapies. When your doctor finally reviews treatment options with you, the jargon used for those options can sound like "alphabet soup"! Most everything has an abbreviation or shortened name, and I've compiled a list of treatments and their associated alphabet soup jargon, below:

1. Timed intrauterine insemination (IUI) - This involves accurately determining the day of ovulation and going to the doctor's office for the IUI procedure. Partner or donor sperm is process in a laboratory, drawn up into a thin catheter, and the catheter is inserted into the uterus. The sperm is injected into the uterus (and fallopian tubes) with the anticipation the sperm will fertilize the egg in the woman's tube (where natural fertilization typically takes place). The IUI is timed to ovulation based on an ovulation predictor kit, serial blood hormone testing serial ultrasound monitoring, or a combination of these. Average cost in the U.S. = $865

2. Injectable fertility drugs ("superovulation") with IUI (SO/IUI) - The patient is placed on injectable fertility medications to stimulate the development of more than one egg. Monitoring is done with serial blood and ultrasound tests. When she ovulates multiple eggs, she undergoes an IUI. This increases the odds of conception over timed IUI because the sperm will have multiple egg "targets" to potentially fertilize compared to the one egg a woman ovulates without fertility drugs. Average cost in the U.S. = $2250.

3. In-vitro fertilization (IVF) - In a manner similar to superovulation, the woman uses injectable fertility drugs to stimulate the development of multiple eggs. However, those eggs are then taken out of her body (through her vagina under ultrasound guidance under intravenous anesthesia), fertilized in the laboratory to create embryos, and one or more of the resulting embryos are gently placed in the uterus (embryo transfer) several days later. Embryos are generally transferred to the uterus three or five days after egg retrieval (day 3 = embryo transfer; day 5 = blastocyst transfer), depending on each woman's individual circumstances. If sperm quantity/quality is poor, we inject sperm directly into the egg(s) to induce fertilization; this is called intracytoplasmic sperm injection (ICSI). IVF is the most advanced and usually the most successful therapy available to help someone achieve a pregnancy. Average cost in the U.S. = $12,400 (including medications).

5. Preimplantation genetic diagnosis (PGD) or screening (PGS) - PGD/PGS involves removing one cell from each embryo created through IVF and analyzing the cell for genetic abnormalities. This is typically done after growing the embryos for three days in the lab, although newer technologies are examining the possibility of removing one or more cells on the fifth day at a more advanced stage of embryo development (called blastocyst). Only the embryos deemed genetically normal are considered for subsequent embryo transfer. Indications for PGD include, and are not limited to, carriers of disorders such as cystic fibrosis, sickle cell disease, and Tay-Sachs, as well as women/couples who prefer to "gender select" (choose the sex of their offspring). Average cost of PGD in the U.S. = $3,550.

6. Embryo cryopreservation (freezing, or cryo) - Extra embryos are frozen and stored if they appear normal. Average cost in the U.S. = $800, plus an additional $800 per year storage fee.

Once your doctor outlines your fertility treatment plan, be sure to discuss any questions or concerns you have after hearing the "alphabet soup" he/she suggests, and, as you can see, it's imperative to investigate the costs. Since most fertility treatments are paid out-of-pocket, you should try to undergo testing/therapy at a center with the philosophy we maintain in our practice, "Do it ONCE, Do it RIGHT, and just make it WORK!".
Scott Roseff, MD, FACOG
Director PALM BEACH CENTER FOR REPRODUCTIVE MEDICINE, Wellington, FL
Phone: 561-333-8232
Website: www.reproendo.com