Out-of-Pocket Fertility Patient Expense: Data from a Multicenter Prospective Infertility Cohort

Wu, Alex K.; Odisho, Anobel Y.; Washington, Samuel L.; Katz, Patricia P.; Smith, James F.

doi:10.1016/j.juro.2013.08.083

Cited by 110 publications

(62 citation statements)

References 18 publications

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“…Access to male infertility services would probably be affected by income and insurance status because most of these services are not covered by insurance and have considerable out-of-pocket expense when compared with male surgical sterilization [19,21]; however, in comparing infertility services that are not usually covered by most insurance with male surgical sterilization, which is usually covered, income and insurance status did not play a role in seeking out male reproductive services in the present study.…”

Section: Discussioncontrasting

confidence: 56%

Demographic and socio‐economic differences between men seeking infertility evaluation and those seeking surgical sterilization: from the National Survey of Family Growth

et al. 2015

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ObjectiveTo identify differences in demographic and socio-economic factors between men seeking infertility evaluation and those undergoing vasectomy, to address disparities in access to these services. Patients and MethodsData from Cycle 6 and Cycle 7 (2002 and 2006-2008) of the National Survey of Family Growth (NSFG) were reviewed. The NSFG is a multistage probability survey designed to capture a nationally representative sample of households with men and women aged 15-45 years in the USA. The variables analysed included age, body mass index, self-reported health, alcohol use, race, religious affiliation, marital status, number of offspring, educational attainment, income level, insurance status and metropolitan home designation. Our primary outcome was the correlation of these demographic and socioeconomic factors with evaluation for male infertility or vasectomy. ResultsOf the 11 067 men identified through the NSFG, 466 men (4.2%) sought infertility evaluation, representing 2 187 455 men nationally, and 326 (2.9%) underwent a vasectomy, representing 1 510 386 men nationally. Those seeking infertility evaluation were more likely to be younger and have fewer children (P = 0.001, 0.001) and less likely to be currently married (78 vs 74%; P = 0.010) or ever married (89 vs 97%; P = 0.002). Men undergoing a vasectomy were more likely to be white (86 vs 70%; P = 0.001). Men seeking infertility evaluation were more likely to have a college or graduate degree compared with men undergoing a vasectomy (68 vs 64%; P = 0.015). There was no difference between the two groups for all other variables. ConclusionWhile differences in demographic characteristics such as age, offspring number and marital status were identified, measures of health, socio-economic status, religion and insurance were similar between men undergoing vasectomy and those seeking infertility services. These factors help characterize the utilization of male reproductive health services in the USA and may help address disparities in access to these services and improve public health strategies.

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Section: Discussioncontrasting

confidence: 56%

Demographic and socio‐economic differences between men seeking infertility evaluation and those seeking surgical sterilization: from the National Survey of Family Growth

et al. 2015

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“…1 were between U$10-15,000, and individual couples' outof-pocket expenses were on average U$5300 and up to U$19,000 for the first IVF cycle, and on average U$7000 for subsequent cycles. 4 Holistic approaches to infertility management, such as Traditional Chinese Medicine (TCM) might address some of the needs of women experiencing infertility, not met in the Western medical approach. 5,6 In the last decade, herbal medicines including Chinese herbal medicines are being used for fertility by a small proportion of women in Western countries, e.g.…”

Section: Introductionmentioning

confidence: 99%

Chinese herbal medicine for female infertility: An updated meta-analysis

Ried

2015

Complementary Therapies in Medicine

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“…14,15 The higher reimbursement associated with ICSI has been postulated as one possible reason for the increasing use of this technology.…”

mentioning

confidence: 99%

Trends in Use of and Reproductive Outcomes Associated With Intracytoplasmic Sperm Injection

Boulet

Mehta

Kissin

et al. 2015

JAMA

285

127

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IMPORTANCE Intracytoplasmic sperm injection (ICSI) is increasingly used in patients without severe male factor infertility without clear evidence of a benefit over conventional in vitro fertilization (IVF). OBJECTIVE To assess national trends and reproductive outcomes for fresh IVF cycles (embryos transferred without being frozen) following the use of ICSI compared with conventional IVF with respect to clinical indications for ICSI use. DESIGN, SETTING, AND POPULATION Retrospective cohort study using data on fresh IVF and ICSI cycles reported to the US National Assisted Reproductive Technology Surveillance System during 1996-2012. MAIN OUTCOMES AND MEASURES Trends in ICSI use during 1996-2012 with respect to male factor infertility, unexplained infertility, maternal age 38 years or older, low oocyte yield, and 2 or more prior assisted reproductive technology cycles; reproductive outcomes for conventional IVF and ICSI cycles during 2008-2012, stratified by the presence or absence of male factor infertility. RESULTS Of the 1 395 634 fresh IVF cycles from 1996 through 2012, 908 767 (65.1%) used ICSI and 499 135 (35.8%) reported male factor infertility. Among cycles with male factor infertility, ICSI use increased from 76.3% (10 876/14 259) to 93.3% (32 191/34 506) (P < .001) during 1996-2012; for those without male factor infertility, ICSI use increased from 15.4% (4197/27 191) to 66.9% (42 321/63 250) (P < .001). During 2008-2012, male factor infertility was reported for 35.7% (176 911/494 907) of fresh cycles. Among those cycles, ICSI use was associated with a lower multiple birth rate compared with conventional IVF (30.9% vs 34.2%; adjusted relative risk [RR], 0.87; 95% CI, 0.83-0.91). Among cycles without male factor infertility (n = 317 996), ICSI use was associated with lower rates of implantation (23.0% vs 25.2%; adjusted RR, 0.93; 95% CI, 0.91-0.95), live birth (36.5% vs 39.2%; adjusted RR, 0.95; 95% CI, 0.93-0.97), and multiple live birth (30.1% vs 31.0%; adjusted RR, 0.93; 95% CI, 0.91-0.95) vs conventional IVF. CONCLUSIONS AND RELEVANCE Among fresh IVF cycles in the United States, ICSI use increased from 36.4% in 1996 to 76.2% in 2012, with the largest relative increase among cycles without male factor infertility. Compared with conventional IVF, ICSI use was not associated with improved postfertilization reproductive outcomes, irrespective of male factor infertility diagnosis.

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Out-of-Pocket Fertility Patient Expense: Data from a Multicenter Prospective Infertility Cohort

Abstract: These data provide real-world estimates of out-of-pocket costs, which can be used to help couples plan for expenses that they may incur with treatment.

Cited by 110 publications

References 18 publications

Demographic and socio‐economic differences between men seeking infertility evaluation and those seeking surgical sterilization: from the National Survey of Family Growth

Demographic and socio‐economic differences between men seeking infertility evaluation and those seeking surgical sterilization: from the National Survey of Family Growth

Chinese herbal medicine for female infertility: An updated meta-analysis

Trends in Use of and Reproductive Outcomes Associated With Intracytoplasmic Sperm Injection

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