The cost of fertility treatments is crippling for those trying to conceive at a time when most Americans can’t even cover a $400 emergency expense.
So Extend Fertility, an egg freezing-only clinic that made headlines when it opened in 2016 because it cost half ($5,000) of what other practices charge to extract and freeze eggs (around $10,000), announced Thursday that it’s opened a full-service fertility clinic in NYC. And the Expect Fertility sister practice plans to provide the full spectrum of treatments — from diagnostics, to thawing and fertilizing frozen eggs, to in vitro fertilization (IVF) with genetically-screen embryos — for 30% to 60% less than the national average cost.
“There’s a lot of barriers to access: It’s very expensive; it’s hard to get appointments; it’s hard to get information; there’s not good insurance coverage. This space is begging for some disruption,” Dr. Joshua U. Klein, a co-founder of Extend Fertility, told Moneyish. “So we made a conscious decision to emphasize cost and cost efficiency.”
So they customize treatment for every patient, and have detailed conversations about their health, medical histories and how they want to start their families, before deciding exactly which tests are needed. In comparison, Dr. Klein said, many clinics will run the same barrage of diagnostic tests on every patient, which drives up costs. Expect Fertility’s CEO Ilaina Edison added that they’ve also strategically sourced their labs.
“There’s wide ranges in cost in genetic testing, with no difference in quality,” she said. So they’ve picked reputable labs with lower fees “to bring the best possible price to what our patient is doing.”
And Expect Fertility has picked up part of the tab. For example, IVF with genetically screened embryos can average $17,700 in a comparable clinic, which includes a $2,500 embryo biopsy (a specialized procedure that takes a sample from the embryo to test for genetic abnormalities.) Cities like New York and San Francisco, where everything is more expensive, can see that run closer to $25,000. But Expect Fertility isn’t charging extra for that, or for the sperm injection procedure to create the embryo. And so patients pay $8,000 for IVF with genetically-screened embryos instead. “The high volume in interest will cover the lower profit margins,” he said.
It’s important to note that some additional fees haven’t been included in their initial price tags, such as the $2,000 to $5,000 in medications required for an IVF cycle, although these are sometimes covered by insurance. But Expect Fertility is also offer financing options with third-party lenders including Lending Club Patient Solutions and Prosper Healthcare Lending to draw up monthly payment plans for patients.
Infertility affects 12% of people trying to conceive, and yet the issue has long been a lonely one that people were ashamed about. That stigma has lessened as women wait longer to have children, which makes it harder to conceive, paired with advancements in assisted reproductive technologies (ART) that have given people greater hope that they can start families.
Plus, celebrities have become more candid about their struggles to get pregnant: Chrissy Teigen and Morgan Spurlock have discussed using IVF; Kim Kardashian, Sarah Jessica Parker and Elizabeth Banks have had babies through surrogates; Olivia Munn raved about freezing her eggs. And — spoiler alert — Tuesday’s “This Is Us” premiere promised that Kate’s (Chrissy Metz) attempt to become pregnant through IVF — her doctor told her that she only has a 10% chance of success — will be a major story arc this season.
“There are some clinics that have gotten very good at getting people pregnant, and It’s gone mainstream,” Dr. Thomas A. Molinaro, a reproductive endocrinologist at Reproductive Medicine Associates of New Jersey (RMANJ), told Moneyish. “And so patients are taking advantage of that, and talking about it, and it doesn’t have the same stigma that it used to.”
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But fertility treatments are an expensive gamble that many can’t afford to take. Many people are forced to spend between $10,000 to $15,000 out-of-pocket for the procedures and medications required to retrieve and freeze their eggs — as well as $500 to $1,200 a year in egg storage fees. Yet only two to 12% of eggs are viable after being frozen, according to the Center For Genetics and Society. Then a single round of IVF can cost upwards of $20,000, yet there’s only a 30% chance that a single IVF cycle will result in a successful pregnancy. Women often need to do a few, which adds up to tens of thousands of dollars. “That’s choosing between buying a car, paying for a year of college – or the chance to have a baby,” Morgan Spurlock, the director of “Super Size Me,” told Moneyish while discussing his family’s $60,000 pregnancy struggle.
Yet the demand is there; more than 85,000 women in the U.S. still undergo IVF each year, and the number freezing their eggs has increased from 475 in 2009 to in 6,207 in 2015, according to the Society for Assisted Reproductive Technology. So now many clinics and startups in the global fertility services market valued at $16.7 billion in 2016 (and expected to exceed $30 billion by 2020) are finding ways to cut costs, provide payment plans — and in some cases, even offer money-back guarantees if one doesn’t conceive — to make these procedures more accessible to more people.
The Reproductive Medicine Associates of New Jersey launched its CareShare “shared-risk” program two years ago, which provides up to six IVF cycles for $32,000 — and if a baby is not born, then those patients get their money back. Shady Grove Fertility also has a Shared Risk 100% Refund Program, and Chelsea Fertility in NYC offers a $35,000 shared-risk program that includes four IVF cycles.
There’s caveats; patients must meet certain health criteria to qualify. At RMANJ, patients can’t have more than one previously failed IVF cycle, and they must be able to complete six IVF cycles before turning 41. And if they have their baby on the first round of IVF, they don’t get any of their money back — so they could spend tens of thousands more through this shared-risk program than if they’d just done a single pay-as-you-go cycle for $12,000 to $20,000.
But that also helps fund the program for everyone. “Some patients will support other patients, because they get pregnant (quickly) and end up paying more than they would have if they paid for one cycle at a time. But we have to be responsible in how we select patients who go into the program, and consider overhead costs, so that the program can continue,” said Dr. Molinaro, who added they’ve only had to refund a couple of people in two years. “We’re still putting our money where our mouth is. We believe in our technology. And we think it’s important to make sure patients are able to access care.”
Companies such as Facebook, Google, Apple are starting to offer fertility-related treatments to employees, such as offering egg freezing as a benefit, as well as adoption and surrogacy support. The Pentagon began offering egg-freezing and sperm-freezing as a benefit to U.S. troops in 2016.
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And for women who want to know whether there might be any red flags that indicate fertility issues on the horizon, such as a risk of early menopause, companies like Modern Fertility, Future Family and Everlywell are offering at-home fertility tests that check hormone levels and ovarian reserves (egg counts) for starting at $149 and $199, which is a fraction of the $1,000 charged for these tests in clinics, on average.
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Nicole Lyn Pesce is a social media reporter at MarketWatch and is based in New York.