An article published in Newsweek Magazine, Should IVF Be Affordable For All?, has caused an enormous reaction in the Infertile community, flooding Newsweek.com's own Comment section, as well as social media networks, with furious exchanges of opinion.
Discussion includes the price tag of $15,000 for IVF and the fact that not all American states mandate insurance coverage of fertility treatment. Reading the many comments on Newsweek's website, I have no desire to engage in a verbal slinging match with people who are uneducated, yet very opinionated about infertility. I do, however, want to set out my perspective on this topic, having been through an unsuccessful IVF cycle myself, without the financial means to repeat it. Anyone who wants to comment here is welcome to do so.
1. According to a study by the European Society of Human Reproduction and Embryology, published in The Human Reproduction Update last month, direct costs of fertility treatment vary substantially between countries, but the U.S. stands out as notably more expensive than other countries.
This is direct evidence that the cost of IVF need not be as high as it is in the U.S. I know of plenty of women who are conceiving through IVF in other countries, including the UK where I live, where many women receive up to 3 IVF cycles on the National Health Service and private costs are about £8,000 (currently under $12,000). The United States fertility "industry" considers itself to be where the sun rises and sets, and take financial advantage of their patients accordingly. Foreign clinics are proving this wrong, and American couples should seek better schemes, through the new clinic founded by Elan Simckes in St. Louis called Fertility Partnership or others like it, charging $7,500 for IVF, roughly half the cost for the same procedure at many clinics, or clinics abroad.
2. A complicating factor, according to Dr. Sherman Silber, a reproductive specialist at St. Luke’s Hospital in St. Louis, is that up to 80 percent of infertility cases are caused simply by increasing maternal age. “It’s hard to call infertility a disease. It’s normal aging,” he says."
Dr. Silber's comment will play directly into the hands of those who argue that a) women are choosing to have children later, therefore their infertility is not a disease or medical condition that needs fixing but a lifestyle choice, and b) that the resulting need for IVF is self-imposed and shouldn't be covered by medical insurance.
In response to the first argument, there are many sociological/economic trends that have caused the average age of first attempts to conceive and first pregnancies to go up.
- Since the 1950's increasing percentages of women have gone on to higher education and/or employment because opportunities for both have increased.
- As a result, more women are leaving their parents' home as young adults and living independently for a time before meeting and marrying a man.
- Economic conditions now require that both parents need an income in order to pay for the rising costs of raising a family. Consequently, people are choosing to earn enough money ahead of time, before beginning to have their children.
These changes in conditions have necessitated a delay in timing of childbirth. Many infertile women have had no choice but to start later; therefore it can't really be seen as a lifestyle choice using free will.
It is also unfair to claim that infertility is self-imposed, therefore not deserving of insurance coverage. A commenter to the Newsweek article, NS says
"Having children via IVF is a cosmetic surgery. IVF is
effective less than 15% of the time and this after multiple attempts.
This should all come out of thier pockets and not mine." First of all, the word cosmetic refers to someone's or something's physical appearance, which is clearly not applicable to having medical treatment to overcome a reproductive obstacle, which refers to a function. Second, there are huge numbers of young women finding themselves infertile because of known health issues like PCOS, thyroid function, blood clotting, autoimmune dysfunction, irregular menstruation, etc... that are not self-imposed. Additionally, it is estimated that 40% - 50% of infertility in couples trying to conceive can be attributed to the man.
3. "David Fleming, director of the Center for Health Ethics at the University of Missouri, says the main concern with making fertilization affordable for more people is the risk of “commoditization” of babies. “The more you have access, the more people will do it.”
I have never heard of anyone in the UK say "I can get IVF free on the NHS, so I may as well do it." IVF is not a picnic in the park. It requires forced abstention from sex, heavy doses of medication (which can be seriously mood-altering, from my experience) administered by self-injection, dozens of physical examinations which require exposure of one's genitals to various medical staff and uncomfortable internal probing, a scary procedure to harvest eggs from a woman's ovaries and another to implant fertilized eggs back in to a woman's womb, a mind and heart-crushing 2 week wait, the possibility of multiple pregnancy/birth and the more-frequent-than-not disappointment that follows, when you have not conceived.
Making IVF more widely available isn't like an advertised release of an IPhone, a 2 for 1 manicure/pedicure, the UK government rebate on purchases of new cars, or getting a tattoo. Children take up a lifetime of love, attention, energy and expense. Parenting isn't something entered into lightly. Not only that, but we are sentient beings, i.e. we have the power to think and make decisions. Just because a woman could conceive 10 children doesn't mean she would. Most people are happy with 2 or 3 children. It's not often a case of "I can, therefore I will." Basically, I think David Fleming's statement is pure nonsense.
4. "Health insurers in the U.S. typically don’t think “wanting a child” is a medical necessity."
This argument assumes that we all either want or don't want to have children and that having children is not a right, likening it to breast augmentation, hair implants or surgically corrected vision: privileges if you can afford to pay for them. I disagree.
Our bodies were designed to reproduce in order to continue the survival of our species. Physically, the male and female of the human species is meant to function as two halves of a whole, each posessing organs which necessary to the conception, gestation and birth of offspring. The physical inability to do so is as much an integral flaw of our functionality as anything else that threatens our survival.
I believe that, in conjunction with our physical design, we are programmed mentally so as to support our need to procreate and, ultimately, to survive. Therefore, the ability to produce children is essential to our feelings of security, purpose and fulfillment. (Please don't misinterpret what I am saying as saying that everyone has to actually have children in order to feel secure, purposeful and fulfilled. I believe that most people do want to have children, but that some people don't, as with any rule and the exception to it.)
Conversely, it must be true that the inability to produce children creates a stress that threatens physical, mental and emotional wellbeing. It makes what other people see as a desire to have children, into a bona fide feeling of need. It can cause feelings of low self-worth, lack of femininity or masculinity, a feeling of being "broken" and in need of being fixed, hopelessness for the future, not fitting into their society and being classed as useless, freakish or pitiful.
Surely, if medical science exists that can assist infertile people to conceive, it would be of benefit to all society that this knowledge and skill be made available to anyone who wants or needs them. While I have no medical training, it seems to me that more frequent usage of IVF should increase the level of that knowledge and skill, raising the percentages of success over time. More success should inspire more medical research and progress, that can then bring costs down and increase availability.
Why aren't we (well, I am) all getting behind that? Is it a case of haves and have-nots; the haves not wanting to foot the bill for the have-nots to succeed? If you feel that way, I have a theory I would like you to consider. Over a lifetime, what you do for others and what they do for you, indirectly, evens out. If not in numbers, then in our contribution to society or in karma. If you tried to work it out in dollars and cents or pounds and pence, it would take so much time and effort, you could be losing some of your valuable time on this earth and miss an opportunity to either give or receive. So, don't bother. Just trust in it and go forward.
Wow. Super insightful and informative post. Thank you!
Pixie--
Cheese Curds and Kimchi
Posted by: Pixie | July 25, 2010 at 07:26 AM