Costs associated with infertility treatment over 18 months

Abstract

OBJECTIVE: Describe costs of infertility medical treatment over an 18-month period by type of treatment and infertility etiology. Previous estimates have focused solely on costs of in vitro fertilization (IVF); we include all infertility-related treatment costs. DESIGN: Prospective cohort of 437 women followed for 18 months. MATERIALS AND METHODS: Women and their husbands/male partners were recruited after initial consultation at reproductive endocrinology practices in Northern California. Information on medications, diagnostic testing, and therapeutic interventions by the couple were collected from medical records. Costs were calculated based on resource use. Uniform costs based on 2005 national data were assigned to each service unit to standardize estimates across practices and over time. Infertility etiology (female only, male only, combined male and female) was determined from medical records and interviews. Bivariate analyses compared costs among treatment paths (no treatment, medication only, IUI with or without medication, IUI followed by IVF, and IVF only) and infertility etiology. Multiple regression analysis including female age, marital status, education, household income, race, and number of treatment cycles, as well as treatment path and infertility etiology, identified factors independently associated with costs. RESULTS: Cost data were available for 390 couples. Almost one third (31%, n=120) did not pursue any cycle-based medical treatment. The overall mean 18-month infertility cost was $14,480. Means for each treatment path are below.Table 1Costs by Treatment PathNo treatmentMeds onlyIUI onlyIUI with medsIUI-IVFIVF onlyOtherN (%)120 (31%)9 (2%)3 (1%)96 (25%)93 (24%)63 (16%)6 (2%)Estimated costs$935$2,247$2,181$9,784$26,297$31,813$19,957 Open table in a new tab Isolated male infertility was associated with the highest costs.Table 2Costs by Infertility EtiologyFemale onlyMale onlyFemale & malen (%)220 (56%)26 (7%)135 (35%)Estimated costs$13,709$20,485$15,090 Open table in a new tab In the multivariate model, treatment path was significantly associated with costs, but etiology was not independently associated with costs. CONCLUSIONS: Isolated male factor infertility was associated with the highest costs, but this effect was not significant after adjustment for type of treatments used and number of treatment cycles. Much of the cost of infertility treatment is driven by IVF and related treatments, but substantial costs are also associated with IUI plus medications.