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May 2007 Blog Archive

Thursday, May 24, 2007
Evaluating Infertility Treatment Financing Plans; Questions to Ask about Medical Treatment Package Plans
by Diane N. Clapp, BSN, RN
Medical Information Director, National RESOLVE

The text below is from RESOLVE, the national infertility support group. Their Web site is: http://www.resolve.org/.

MANY CONSUMERS lack adequate health care insurance for infertility treatments, particularly for the assisted reproductive technologies (ART). As a result, some clinics have begun offering financing mechanisms that promise a specified number of ART cycles for a fixed fee, often with a "guarantee" that some portion of the fee win be refunded if treatment is unsuccessful. Such plans are sometimes referred to as "outcome based fee schedule plans," "shared risk plans," "money-back guarantees" or "treatment package plans."

Medical treatment package plans may provide benefits to consumers because (depending on the number of ART cycles utilized), such plans may lower the cost per cycle as compared to conventional payment plans. In addition, the promise of "money back" in the event treatments are unsuccessful may provide consumers with the financial resources to pursue other family-building options, such as adoption.

Several concerns have been raised about these package plans, however. For example, some clinics may accept only patients whose diagnoses suggest a high probability of successful treatment. And patients who are successful in their first cycle of treatment will pay more than if they used conventional payment plans. Moreover, because the clinic is simultaneously serving as a medical provider, and bearing financial risk much as an insurer does, a potential conflict of interest may exist. There are concerns that this dual role may create incentives to change standard treatment protocols or, for example, to transfer a greater number of embryos than would otherwise be recommended, thereby increasing the likelihood of multiple gestation.

Concerns about the outcome-based nature of package treatment plans led the American Medical Association to issue a policy statement in June. 1996 stating that "basing payment on medical outcomes is unethical and in violation of the AMA's existing code of medical ethics." This position is a matter of debate within the infertility community. The Society for Assisted Reproductive Technology (SART) Executive Council approved a public statement paper on the topic of outcome based fee schedule plans. In their statement, SART states, "In this time of managed care, ILMO, PPO and other discounted fee schedules, it would appear to be untimely to assign any ethical stigma to any fee arrangements as long as complete disclosure has been accomplished." SART's statement also includes "At the same time, the SART Executive Council continues to have serious concerns about the potential of practices exploiting a very vulnerable patient population by: misleading advertising, severely limiting the access of patients to an outcome-based fee (OBF) cycle by overly restrictive criteria (e.g. age, FSH), requiring expensive and/or unnecessary testing prior to accepting a patient into an OBF program, premature or inappropriate use of ART in patients who would be better served by less invasive and less expensive treatment and inappropriate use of ART techniques such as excessive embryos transferred or excessive ovarian hyperstimulation in an attempt to increase pregnancy rates at the expense of patient safety." The SART paper also stressed the need for these "fee schedule plans" to provide answers to consumers questions.

Within the broader infertility community, there are also concerns about how these financial plans may affect efforts to achieve comprehensive insurance coverage for all people who experience infertility. Infertility is a recognized disease that should be treated the same as other diseases for insurance purposes. Package plans differentiate infertility from other medical diseases and conditions, as no other treatment comes with a "money-back guarantee."

If you are considering purchasing in a medical treatment package plan that offers a specified number of cycles of the assisted reproductive technologies for a set charge, you may want to consider the following questions when evaluating a medical program.


Does tm program have written information describing what is included in the package plan?

Does the clinic report its ART success rates to The Society for Assisted Reproductive Technology (SART), a division of the American Society for Reproductive Medicine?

Does the clinic/program audit success rates for shared risk programs separately from the rest of the practice?

Does the clinic have multiple sites? If so, are success rates for each site reported?

Under the terms of the agreement or contract, what is the actual determinant of "success"?

How does the clinic describe "success"? Is it a clinical pregnancy, or live birth? For example, if you miscarry, is a refund made?

If you are making a large down-payment for a guaranteed number of cycles, how much, if any, money is refundable if you become pregnant after one cycle? Is your "down-payment" placed in escrow for possible return to you or are "package" payments co-mingled with general clinic funds?

Does the program have any policy in the event that ovarian stimulation does not result in a sufficient number or quality of oocytes or if the cycle is canceled?

A few clinics offering treatment plans require that the couple have one of the treatments used to treat possible immunologic response that may affect implantation. These treatments may include aspirin, Heparin or intravenous immunoglobulin therapy. These treatments are considered experimental. You may want to get a second opinion before you proceed with treatment. Is this cost included in the package?


What testing is required to be accepted into the program? Are the costs for screening tests included?

Is there an age restriction for package plan patients?

Are patients who have particular medical situations such as elevated FSH levels, DES exposed uterine problems, etc., not eligible for the package?

Is it necessary to send your medical records prior to treatment for acceptance into the program?


Will there be any differences in your treatment versus the standard fee-for-service patient?
Is there a waiting list to start a treatment cycle?

Is all medication monitoring done on-site or can you use a local clinic to monitor the initial phases of a treatment cycle?

Are there restrictions on how many cycles you can do in a set period of time and are you have to take rest cycles? If so, for how long?

Does the program have guidelines regarding the number of oocytes or pre-embryos transferred? Are there any requirements with regard to fetal reduction?


What, if any, arrangements can be made to use your health insurance? Can you get an itemized bill to submit for insurance purposes?

Is the cost of fertility drugs included in the package price? If not, what can you expect w pay for these drugs?

Does the package fee include intracytoplasmic sperm injection (ICSI), assisted hatching and co-culture if needed?

Does the package include fees for cryopreservation and a thaw cycle?

If donor sperm is needed, is the cost included in the package?

If donor egg is used, is the cost included in the package?

What happens if you decide after one cycle not to continue with the program? Is there a refund?

Wednesday, May 23, 2007
Book Looks at Fertility Industry
Liza Mundy of the Washington Post has just published a new book with her take on the fertility industry. Titled Everything Conceivable, she spoke the other day with NPR's Michelle Norris on "All Things Considered" about the numbers that are often left out, she says, of patient-physicians discussions about the potentialities of fertility treatment.

In the excerpt from her book on the NPR site, for example, Mundy details statistics regarding multiples, the plague of fertility treatment. She points the finger at a feel-good media that is most often happy to chatter about the kitchy-koo adorable multiples, while quietly leaving out the gory details that more often beset the usually premature babies and their resultingly distraught families.

Mundy tells Norris in the interview that she believes fertility physicians aren't as up front and graphic as they need to be when talking about all the possible ramifications of treatment.

Everything Conceivable is the second book in about a year to come out and plainly refer to the entity of the "fertility industry" (the first being The Baby Business by Debora Spar). The first was a critical success; it will be interesting to see how Mundy's book compares.
Wednesday, May 23, 2007
1st Baby from Frozen Egg Matured In Vitro
Another first for Canada's McGill University and Dr. Seang Lin Tan -- a 10 month old baby is the first to have been born as the result of a frozen egg used in the in vitro maturation (IVM) process.

Okay, this gets complicated... there's in vitro fertilization aka IVF, which is the technique used to make "test tube babies". Then there's oocyte cryopreservation, or egg freezing, which is becoming more readily available as a conception delaying tactic.

So little Noorfatima Khan was created when the McGill Centre staff collected -- here's the really different part, the part of the techniques that vary between IVF & IVM -- immature eggs from her mom's ovaries, then facilitated their maturation in vitro, froze the resulting mature eggs and later thawed them for use in IVF.

Got that?

Just what IS the point of the ever-increasing alphabet soup? Why is IVM so great, when clinicians seem to really be mastering the whole IVF thing?

Well, for one reason, IVM -- collecting eggs before they're fully matured and ready to be ovulated from the ovary -- doesn't require the horde o' fertility drugs that IVF does. That cuts your ART by more than half in some instances. Drugs are by far the most costly aspect of IVF treatment for many patients. It also means not having to endure painful and inconvenient injections, and all of the possible adverse effects of the drugs.

Oocyte cryo is becoming more user-friendly as lab technicians and fertility clinicians zero in on the best means of freezing and then safely thawing the fragile egg cell. Right now, its primary use is for women who are trying to preserve their fertility prior to undergoing oft-sterilizing cancer treatment. At least one thriving business, Extend Fertility, is also using the technology to cash in on the desires of young women wanting to put off biological motherhood until later in life.

McGill researchers feel that the combination of these technologies will increase the time-sensitive options needed by women pursuing cancer treatment. They also believe that the already slim (in Canada) pool of egg donors may expand a bit if donors don't have to undergo the typical fertility drug regimen and challenging cycle-sync issues of donor egg IVF.

Dr. Lin Tan's colleague, McGill scientist Ri-Cheng Chian, says in this article for the Globe and Mail that the average number of eggs produced in traditional IVF (did you ever think this technology would be referred to as "traditional"?!) is 10 eggs per cycle, entirely due to the use of super-ovulating fertility drugs for the sole purpose of increasing the odds of successful pregnancy outcomes. He goes on to state that an incredible 50 percent of those eggs wind up being chromosomally abnormal.

The IVM process is no fast track -- at McGill, where they've pioneered the technique, the pregnancy rate is only about 20 percent, as compared to about 35 percent averages for IVF (per SART reports). But in a way it's a step back to breathe a bit and reconsider the involvement of nature in the conception process.
Tuesday, May 08, 2007
National Anxiety & Depression Awareness Week May 6th -12th 2007
May is Mental Health Month, celebrated throughout the country to raise awareness of mental illness and educate Americans about ways to find help if they think they may be suffering from a mental health problem.

Opening up a dialogue about anxiety and depressiong is an important first step on the road to recovery. Below are tips from the ADAA for asking for help if you suffer from an anxiety disorder, and tips for helping someone you love.

Asking for Help

  • While it may be difficult, be open and honest with your loved ones. They may not understand, but that doesn't mean they can't be helpful.

  • If you're not comfortable talking about your problem, try describing your thoughts and feelings in a letter. It's a great way to open up communications.

  • Try to explain your experiences in a way your loved ones can understand.

  • When you need help, don't assume your loved one knows what you need. Be specific.

  • Explain that the help you need may change from one time to the next. Such is the nature of the problem and should not be taken as a personal rejection.

  • Work together to remain in situations until your levels of anxiety subside. If you must leave, try to go back as soon as possible.

  • Ask your loved one to support you in feeling good about what you did do, not bad about what you did not do.

  • Share your triumphs, no matter how small.

  • Having an anxiety disorder is not a sign of weakness or lack of moral fiber. Remember to be patient with those trying to help you as they may not know what to do

Helping Someone You Love

  • Recognize that the irrational feelings and thoughts experienced by someone with an anxiety disorder are different than the normal fear and anxiety responses that everyone feels from time to time.

  • Acknowledge that you don't understand if you've never personally experienced a panic attack or other form of irrational anxiety.

  • Appreciate that your loved one is aware that the thoughts and feelings are irrational, but feels powerless to stop them.

  • Help set specific goals that can be approached one step at a time if necessary.

  • Don't assume that you know what is needed. Ask how you can help. Listen carefully to the response.

  • Accept that what may be helpful one time may not be the next. Don't take it personally. It's the nature of the disorder.

  • Aim for positive reinforcement rather than judgment, criticism or blame.

  • Understand that knowing when to be patient and when to push can be challenging. It's a fine line. Achieving the proper balance often requires trial and error.

Recovery requires hard work on the part of the individual, and patience on the part of the family. It may seem like a slow process, but the rewards are well worth it. My hope for everyone is to
have an open-mind to the seriousness of anxiety and depression - acceptance, tolerance and a willingness to help or just be there are the keys to dealing and conquering it.

Please remember words hurt - even if you are not aware you are saying something "wrong." If you have any idea that someone you are close to is suffering, just ask. Maybe you can save someone time in recovering.
Friday, May 04, 2007
Courtney and Angela
While searching through the Oprah.com archives for articles on infertility, I came accross Courtney B Vance and Angela Basset's story. I had no idea that they were having difficulties for as long as they were, and I really had no idea about them becoming parents of twins. You probably remember Angela Bassett from How Stella got her groove back (older woman finds love with a younger man on vacation) or Whats love got to do with it (autobiographical movie about Tina Turner). Courtney B Vance is on the TV drama Law & Order Criminal Intent. Here is the article: Courtney and Angela's story

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