COST OF INVITRO FERTILIZATION

Report #6610 9/25/95

A Minnesota gynecologist is offering "Pregnancy or your money back" for infertile couples. (1) That's pretty amazing since reproductive gynecologists often are able to get their patients pregnant less than 5% of the time and an infertile couple can pay as much as $150,000 for one baby.

The cost for 3 attempts at fertilization is $16,000 plus $5100 for medication or 21,100. If they do not get pregnant, the guarantee will pay them $14,000. They have still spent $7,100. The average charge for one treatment cycle is $6,233 in the United States last year and many patients reqwuire three or more cycles. (2) Michael Katz, who investigates fertility industry practices for the Federal Trade Commission calls it a "rigged game in part." To qualify for the rebate, a woman must be under 35 and have normal uterine and ovarian function and men must have sperm. Thus, most infertile couples are not eligible for the rebate and among couples eligible for the rebate, the most common cause of infertility is infection which is treated with inexpensive antibiotics.(3,4,5,6) Of women being evaluated for infertility, 40% between the ages of 26 and 35 are infected with chlamydia or other mycoplasma, as are 36% of those with a previous history of uterine infection and 50% of those with tubal blockage. (3) In another study more than 60% had evidence of a past infection.(7) Men and women can be infected with mycoplasma, even though all available tests can't find it (7,8) and they may have no symptoms at all. They may have burning on urination, discomfort when the bladder is full or an urgency to void. Women may have only spotting between periods. (9) Treatment with the newer erythromycins, clarithromycin and azithromycin, can cure mycoplasma infections and help many women to become pregnant before they spend thousands of dollars on infertility evaluations.

By Gabe Mirkin, M.D., for CBS Radio News

1) Gianelli DM. Amiercn Medical News 1995(Sept 25);38(36):4.

2) JA Collins, M Bustillo, RD Visscher, LD Lawrence. An estimate of the cost of in vitro fertilization services in the United States in 1995. Fertility and Sterility 64: 3 (SEP 1995):538-545.

3) C Aspock, D Bettelheim, F Fischl, AM Hirschl, A Makristathis, P Pruckl, B Willinger, ML Rotter. Chlamydia trachomatis infections in patients attending an infertility clinic. Wiener Klinische Wochenschrift 107: 14 (1995):423-426.

4) K Yoshida, N Kobayashi, T Negishi. Urologia Internationalis 53: 4 (1994):217-221.

5) GA Greendale, ST Haas, K Holbrook, B Walsh, J Schachter, RS Phillips. The Relationship of Chlamydia-Trachomatis Infection and Male Infertility. American Journal of Public Health 83: 7 (JUL 1993):996-1001.

6) Z Samra, Y Soffer, M Pansky. Prevalence of Genital Chlamydia and Mycoplasma. Infection in Couples Attending a Male Infertility Clinic. European Journal of Epidemiology 10: 1 (FEB 1994):69-73.

7) S Chutivongse, M Kozuhnovak, J Annus, ME Ward, JN Robertson, W Cates, PJ Rowe, TMM Farley. Tubal infertility: Serologic relationship to past chlamydial and gonococcal infection. Sexually Transmitted Diseases 22: 2 (MAR-APR 1995):71-77. The majority of women with bilateral tubal occlusion reported no history of pelvic inflammatory disease symptoms. Other infertile women had a prevalence of C. trachomatis antibodies (60%), which was similar to that of patients with bilateral tubal occlusion (71%).

8) Chlamydia (a sexually-transmitted disease) is the most common cause (30%) of spotting between periods for women who are on birth control pills. Obstetrics and Gynecology May,1993;81(5):728-731.

9) A paper test Leukocyte Esterase strip dipped in urine detected venereal disease in men (chlamydia and gonorrhea) That's a painless way to find out what you have. Sexually Transmitted Diseases May- June, 1993;20(3):152-157.

10) American Journal of Epidemiology March, 1993;137(5):577-584.

11) LO Svensson, I Mares, PA Mardh, SE Olsson. Screening Voided Urine for Chlamydia Trachomatis in Asymptomatic Adolescent Females. Acta Obstetricia et Gynecologica Scandinavica 73: 1:JAN 1994:63-66.

12) Chlamydia and Mycoplasma Infections in Male Partners of Infertile Couples. Geburtshilfe und Frauenheilkunde 53: 8 (AUG 1993):539-542.

13) Single Dose Azithromycin Treatment of Gonorrhea and Infections Caused by C-Trachomatis and U-Urealyticum in Men. SD Hillis, A Nakashima, PA Marchbanks, DG Addiss, JP Davis. Sexually Transmitted Diseases 1994(Jan-Feb);21(1):43-46.

14) O Steingrimsson, JH Olafsson, H Thorarinsson, RW Ryan, RB Johnson, RC Tilton. Risk Factors for Recurrent Chlamydia-Trachomatis Infections in Women. American Journal of Obstetrics and Gynecology 170: 3(MAR 1994):801-806.

15) PE Hay, BJ Thomas, PJ Horner, E Macleod, AM Renton, D Taylor-Robinson. Chlamydia Trachomatis in Women - The More You Look, the More You Find. Genitourinary Medicine APR 1994;70(2):97-100.

16) LV Westrom. Sexually Transmitted Diseases and Infertility. Sexually Transmitted Diseases 21: 2 Suppl.(MAR-APR 1994):S32-S37.

17) BP Katz, S Thom, MJ Blythe, JN Arno, VM Caine,RB Jones. Fertility in Adolescent Women Previously Treated for Genitourinary Chlamydial Infection. Adolescent and Pediatric Gynecology 7: 3 (SUM 1994):147-152

18) MR Bush, C Rosa. Azithromycin and erythromycin in the treatment of cervical chlamydial infection during pregnancy. Obstetrics and Gynecology 84: 1 (JUL 1994):61-63.

19) SS Witkin, KM Sultan, GS Neal, J Jeremias, JA Grifo, Z Rosenwaks. Unsuspected Chlamydia trachomatis infection and in vitro fertilization outcome. American Journal of Obstetrics and Gynecology. 1994(Nov);171(5):1208-1214.CONCLUSION: Unsuspected C. trachomatis infection or reactivation of an immune response to the C. trachomatis heat shock protein may induce an inflammatory reaction in the uterus that impairs embryo implantation and/or facilitates immune rejection after uterine transfer of in vitro fertilized embryos.

20) K Czerwenka, F Heuss, J Hosmann, M Manavi, D Jelincic, E Kubista. Salpingitis caused by Chlamydia trachomatis and its significance for infertility. Acta Obstetricia et Gynecologica Scandinavica 1994(Oct);73(9):711-715. 38% of the women in the PID-positive group and 68% in the PID-negative group conceived within a period of one year after having completed a treatment with antibiotics.

21) SS Witkin, KM Sultan, GS Neal, J Jeremias, JA Grifo,Z Rosenwaks. Unsuspected Chlamydia trachomatis infection and in vitro fertilization outcome. American Journal of Obstetrics and Gynecology 171: 5(NOV 1994).