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The journey to conception is a long, difficult road...
In pursuit of pregnancy. (coping with infertility)
American Demographics, May 1993 v15 n5 p48(4)
In pursuit of pregnancy. (coping with infertility) Paula Mergenhagen DeWitt.
Abstract: The treatment of infertility has become a large business and accounts for $2 billion in total annual revenues.
The National Center for Health Statistics reveals that in 1988, 11% of married couples, a total of 3.1 million couples, had
trouble conceiving or giving birth to a child. Infertility problems can be attributed to women in 50% of the cases, to men
in 40% of the cases and to both in 10% of cases. However, women are the primary recipients of infertility treatments,
which range in price from $4,000 to $11,000 per treatment.
Full Text: COPYRIGHT American Demographics Inc. 1993
At least 10 percent of infertile couples may benefit from high-tech treatments, but the costs and risks remain high.
Infertility has become a multibillion-dollar industry, driven by technological advances and an aging baby boom. Insurers
foot some of the bill, but most costs are covered by patients who will go to extraordinary lengths to have babies.
In November 1992, a 53-year-old woman in Anaheim, California, did something many people would consider literally
inconceivable. She gave birth to twins by her 32-year-old husband. Using eggs donated by a younger woman, the twisn
were conceived through in-vitro fertilization (IVF), the so-called "test-tube" method. The babies are now six months old.
Conventional wisdom holds that baby boomers are having infertility problems because they waited too long to try to
have children. Yet the overall infertility rate has fallen since 1976, although the number of affected women has increased
in some age groups. During the 1980s, medical treatment improved, and a new generation of active health-care consumers
with infertility problems sought help. Baby boomers are turning eagerly to high-tech remedies like IVF and artificial
insemination, as well as more traditional treatments like hormone therapy and surgery.
Many baby boomers have postponed parenthood, but few have abandoned the idea. An overwhelming majority of
people want to have children. According to a 1990 Gallup poll, 84 percent of childless adults under the age of 40 would
like to have children. The Gallup poll also found that 60 percent of childless adults aged 40 or older wish they had had
children. Modern medical technology is helping some to achieve their desire.
This is good news for businesses that sell diapers, baby clothes, and toys. It's also good news for doctors, counselors,
clinics, and hospitals who try to help infertile couples. Infertility has become an industry with revenues of $2 billion a
year.
The trend is more worrisome for insurance carriers and employers concerned with rising health-care costs. Infertility
treatments are expensive. So are the medical costs for the high-risk multiple births they often produce.
INFERTILE COUPLES
In 1988, 11 percent of all married couples with a wife aged 15 to 44--3.1 million--had problems conceiving or carrying a
pregnancy to term.(*1) According to the National Center for Health Statistics (NCHS), 1.1 million of these couples were
childless; the other 2 million already had at least one child. The total number and rate of couples with problems
conceiving or carrying babies hardly changed between 1982 and 1988. But since 1976, the number of childless couples
with a wife aged 35 to 44 experiencing difficulties has grown 37 percent. The number of people seeking help has risen,
too, from 1.1 million in 1981 to 1.4 million in 1987.
Men are responsible for the problem in about 40 percent of cases, and women in about 50 percent. It's a joint problem
about 10 percent of the time. A woman's age is a significant factor in impairment rates. Among childless couples, 36
percent with a wife aged 35 to 44 had an impairment, compared with 8 percent with a wife aged 15 to 24 and 20 percent
with a wife aged 25 to 34. Regardless of whose problem it is, however, women are the focus of most treatment since they
are the ones who must become pregnant.
Eighty-five to 90 percent of infertile couples seeking treatment could benefit from low-tech remedies such as surgery and
drugs, according to the U.S. Office of Technology assessment. But for 10 to 15 percent, conventional treatments do not
work. Many of them may decide not to get high-tech help, says Joyce Zeita, spokeswoman for the American Fertility
Society (AFS) in Birmingham, Alabama. But an increasing number are looking for help. The number of U.S. infertility
clinics performing high-tech procedures increased from 84 in 1985 to 270 in 1992.
Treatment programs exist as many hospitals, and there are at least two multistate infertility chains. IVF America
operates six clinics in five states, mostly in the Northeast. Treatments at its clinics have resulted in 1,200 births since the
company's inception in 1986. "That's between 5 and 10 percent of babies born [through high-tech procedures] in the
country," says director Vicki Baldwin.
In 1990, there were 14,150 IVF procedures performed, nearly twice the number in 1987, says AFS's Zeitz. Not all are
performed on aging boomers racing to beat the biological clock. Women older than age 35 are more likely to be infertile,
but younger women are more likely to be treated. "The bulk of procedures are done on people under age 35," says Zeitz.
Infertility problems for older adults may have as much to do with lifestyle choices as with biological facts. "Because of
divorce and remarriage, we are seeing a large number of people requiring reversal of sterilizations," says Dr. Marvin
Yussman, director of reproductive endocrinology at the University of Louisville. According to the NCHS, nearly one in
four women aged 15 to 44 ( or their current husband or partner) has been surgically sterilized for contraceptive purposes.
A 1986 medical study conducted by Spivak, Librack & Rosenthal found that 10 percent of women regretted their
decision, and 1 percent tried to have it reversed. Success rates of over 50 percent have been documented for both male
and female sterilization reversals.
Another growing area is patients with secondary infertility--people who already have a child but are having difficulty
conceiving again. "Ten or 12 years ago, we tried to just treat couples without any children," says Dr. Martin M. Quigley
at the Northeast Regional Center for Infertility and IVF. With the upsurge in divorce and remarriage, however, Quigley
noticed increasing demand from people who wanted new children with new partners.
Most of the infertility patients are in their late 20s and early 30s, and about 10 percent receive IVF, says Yussman. IVF
using a woman's own eggs is more successful in women under the age of 35. Older women "have less responsive eggs,"
says Yussman.
Because an increasing number of couples in their late 30s and early 40s want to become parents, new and innovative
techniques have been devised to fool mother nature. The number of procedures using donor eggs increased from 60 in
1987 to 547 in 1990, according to Zeitz. "This is a very successful choice for women in their 40s" who have no problems
other than aging eggs, says Quigley.
Many eggs donors are friends or relatives of the prospective mother, but the demand for eggs currently exceeds supply.
Some clinics have started advertising for donors, targeting the college-age population. Only 10 percent of those who
answer such ads will actually become donors, says Dr. Patricia McShane, vice president for medical affairs at IVF
America. "Most people don't really know what's involved," she says. Other potential donors are disqualified for medical
or psychological reasons.
WHO FOOTS THE BILL
High-tech infertility treatments are quite costly--the average procedure costs $7,000, and prices range from $4,000 to
$11,000 per try. Procedures involving donor eggs can be even more expensive. Older women run up the highest tab
because they typically go through more "cycles" of treatment to achieve a birth. Patients tend to be older in the
Northeast and West than in the South. "I think there's a different [regional] value placed or career and the age when
people get married," says McShane.
Nearly one in four patients at McShane's IVF America program in Boston is older than age 40. They are fortunate to live
in Massachusetts, one of ten states in which infertility treatment is a mandatory item for insurance coverage. Older
women "can re-cycle frequently" in Massachusetts, because assisted reproductive technologies are completely covered,
says McShane. Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, New York, Rhode Island, and Texas also
require insurers to include at least some coverage for infertility treatment, although high-tech procedures are not always
covered.
Thirty-eight percent of larger businesses offer some type of infertility coverage for their workers, an increase of 50
percent since 1989, according to a 1991 A. Foster Higgins and Company survey of 2,409 firms representing 13.8 million
employees nationwide. Although both public and private companies in all major industries were surveyed, most had
more than 1,000 employees. Large employers may be more willing to offer infertility coverage because most have some
type of managed-care health program already in place. Infertility treatment is "less likely to be used indiscriminately"
under managed care, says Patricia Wiley of Foster Higgins.
Adding infertility benefits does boost the cost of health insurance, and many smaller companies may not be willing to
absorb the expense. Some insurance policies cover certain procedures and drugs, but not others. "Peopole tend to use the
therapies that their insurance will pay for," says McShane.
Since many of them must pay out-of-pocket, people who seek IVF or other high-tech treatments tend to be affluent. "It's
not cheap or practical for everyone," says Quigley of the Northeast Regional Center. Tena and Donny Sherman of
Nashville saved for two years before having their IVF procedure. The treatment was successful within a month, but it
still cost the Shermans $9,000, which they paid themselves.
Why does IVF cost so much? Laboratory and equipment charges are part of the reason, and the failure rate is also high.
IVF America estimates that it has a success rate of 25 percent, for example, but a recent port on the company said it was
closer to 10 percent. The final reason is salary. Reproductive endocrinologists on the staffs of hospitals, HMOs, and
group medical practices are paid an average of $259,750 a year, more than any other medical specialty, according to
William M. Mercer, Inc. in New York City.
EXTRAORDINARY LENGTHS
Another cost consideration comes from the increased risk of multiple births from IVF procedures. Clinics find that the
chances of pregnancy are maximized when several fertilized eggs are introduced into a woman's body; so are the chances
of having more than one baby. One in four deliveries that result from infertility treatments yields multiples, says Zeitz of
AFS.
Multiple-birth babies often have serious health problems and can incur enormous hospital and medical bills. This is quite
costly for employers who must foot the bill and is also a significant hardship for parents. The twins that were born to
the 53-year-old California woman were 12 weeks premature, and each weighed less than 3 pounds at birth. "I think most
infertile couples worry about that," says Margaret Hollister of RESOLVE, a national advocacy and support group for
infertile couples based in Somerville, Massachusetts. "But many of them will go forward regardless."
Getting pregnant is not always the end of the road for infertile couples. Carrying a pregnancy to term can be just as
difficult as achieving it. In 1988, 13 percent of confirmed pregnancies ended in miscarriage. It is estimated that 1 percent
of all women suffer three or more miscarriages in a row. Bed rest, drug treatment, and surgery have been the traditional
treatment, but some women are now turning to hightech procedures like IVF and surrogate mothers.
The expense of infertility treatments and the stress that results from making choices about them can strain a relationship.
Nashville psychologist Ruth Arbitman Smith says that sometimes one partner is not completely supportive. With one
couple she counseled, "the husband felt that the whole focus was on getting pregnant and that this focus devalued the
marriage."
In the end, some people have to come to grips with the fact that they will never have a child of their own. "Everyone
thinks they are going to be one of the successes," says Smith. When they learn they are not, they may choose to adopt or
to remain permanently childless. Either way, they often go through a grieving process.
RESOLVE has 57 chapters in 38 states, with a nationwide membership of 25,000 individuals and 14,000 families. The
annual membership turnover is 50 percent, says executive director Diane Aronson, as couples find solutions to their
problems. Even so, family membership has grown 40 percent since the late 1980s.
Husbands and wives usually attend RESOLVE meetings together. "It's definitely a couples problem," says Philadelphia
chapter president Julie Ryan. "We try to stress that 'neither of you can have a baby alone.'" A majority of members are
in their 30s, but a significant number are in their 40s.
Many RESOLVE members are dealing with secondary infertility. "That's a hard group to get together," says Ryan,
"because they need babysitters."
American Demographics, May 1993 v15 n5 p48(4)
In pursuit of pregnancy. (coping with infertility) Paula Mergenhagen DeWitt.
Abstract: The treatment of infertility has become a large business and accounts for $2 billion in total annual revenues.
The National Center for Health Statistics reveals that in 1988, 11% of married couples, a total of 3.1 million couples, had
trouble conceiving or giving birth to a child. Infertility problems can be attributed to women in 50% of the cases, to men
in 40% of the cases and to both in 10% of cases. However, women are the primary recipients of infertility treatments,
which range in price from $4,000 to $11,000 per treatment.
Full Text: COPYRIGHT American Demographics Inc. 1993
At least 10 percent of infertile couples may benefit from high-tech treatments, but the costs and risks remain high.
Infertility has become a multibillion-dollar industry, driven by technological advances and an aging baby boom. Insurers
foot some of the bill, but most costs are covered by patients who will go to extraordinary lengths to have babies.
In November 1992, a 53-year-old woman in Anaheim, California, did something many people would consider literally
inconceivable. She gave birth to twins by her 32-year-old husband. Using eggs donated by a younger woman, the twisn
were conceived through in-vitro fertilization (IVF), the so-called "test-tube" method. The babies are now six months old.
Conventional wisdom holds that baby boomers are having infertility problems because they waited too long to try to
have children. Yet the overall infertility rate has fallen since 1976, although the number of affected women has increased
in some age groups. During the 1980s, medical treatment improved, and a new generation of active health-care consumers
with infertility problems sought help. Baby boomers are turning eagerly to high-tech remedies like IVF and artificial
insemination, as well as more traditional treatments like hormone therapy and surgery.
Many baby boomers have postponed parenthood, but few have abandoned the idea. An overwhelming majority of
people want to have children. According to a 1990 Gallup poll, 84 percent of childless adults under the age of 40 would
like to have children. The Gallup poll also found that 60 percent of childless adults aged 40 or older wish they had had
children. Modern medical technology is helping some to achieve their desire.
This is good news for businesses that sell diapers, baby clothes, and toys. It's also good news for doctors, counselors,
clinics, and hospitals who try to help infertile couples. Infertility has become an industry with revenues of $2 billion a
year.
The trend is more worrisome for insurance carriers and employers concerned with rising health-care costs. Infertility
treatments are expensive. So are the medical costs for the high-risk multiple births they often produce.
INFERTILE COUPLES
In 1988, 11 percent of all married couples with a wife aged 15 to 44--3.1 million--had problems conceiving or carrying a
pregnancy to term.(*1) According to the National Center for Health Statistics (NCHS), 1.1 million of these couples were
childless; the other 2 million already had at least one child. The total number and rate of couples with problems
conceiving or carrying babies hardly changed between 1982 and 1988. But since 1976, the number of childless couples
with a wife aged 35 to 44 experiencing difficulties has grown 37 percent. The number of people seeking help has risen,
too, from 1.1 million in 1981 to 1.4 million in 1987.
Men are responsible for the problem in about 40 percent of cases, and women in about 50 percent. It's a joint problem
about 10 percent of the time. A woman's age is a significant factor in impairment rates. Among childless couples, 36
percent with a wife aged 35 to 44 had an impairment, compared with 8 percent with a wife aged 15 to 24 and 20 percent
with a wife aged 25 to 34. Regardless of whose problem it is, however, women are the focus of most treatment since they
are the ones who must become pregnant.
Eighty-five to 90 percent of infertile couples seeking treatment could benefit from low-tech remedies such as surgery and
drugs, according to the U.S. Office of Technology assessment. But for 10 to 15 percent, conventional treatments do not
work. Many of them may decide not to get high-tech help, says Joyce Zeita, spokeswoman for the American Fertility
Society (AFS) in Birmingham, Alabama. But an increasing number are looking for help. The number of U.S. infertility
clinics performing high-tech procedures increased from 84 in 1985 to 270 in 1992.
Treatment programs exist as many hospitals, and there are at least two multistate infertility chains. IVF America
operates six clinics in five states, mostly in the Northeast. Treatments at its clinics have resulted in 1,200 births since the
company's inception in 1986. "That's between 5 and 10 percent of babies born [through high-tech procedures] in the
country," says director Vicki Baldwin.
In 1990, there were 14,150 IVF procedures performed, nearly twice the number in 1987, says AFS's Zeitz. Not all are
performed on aging boomers racing to beat the biological clock. Women older than age 35 are more likely to be infertile,
but younger women are more likely to be treated. "The bulk of procedures are done on people under age 35," says Zeitz.
Infertility problems for older adults may have as much to do with lifestyle choices as with biological facts. "Because of
divorce and remarriage, we are seeing a large number of people requiring reversal of sterilizations," says Dr. Marvin
Yussman, director of reproductive endocrinology at the University of Louisville. According to the NCHS, nearly one in
four women aged 15 to 44 ( or their current husband or partner) has been surgically sterilized for contraceptive purposes.
A 1986 medical study conducted by Spivak, Librack & Rosenthal found that 10 percent of women regretted their
decision, and 1 percent tried to have it reversed. Success rates of over 50 percent have been documented for both male
and female sterilization reversals.
Another growing area is patients with secondary infertility--people who already have a child but are having difficulty
conceiving again. "Ten or 12 years ago, we tried to just treat couples without any children," says Dr. Martin M. Quigley
at the Northeast Regional Center for Infertility and IVF. With the upsurge in divorce and remarriage, however, Quigley
noticed increasing demand from people who wanted new children with new partners.
Most of the infertility patients are in their late 20s and early 30s, and about 10 percent receive IVF, says Yussman. IVF
using a woman's own eggs is more successful in women under the age of 35. Older women "have less responsive eggs,"
says Yussman.
Because an increasing number of couples in their late 30s and early 40s want to become parents, new and innovative
techniques have been devised to fool mother nature. The number of procedures using donor eggs increased from 60 in
1987 to 547 in 1990, according to Zeitz. "This is a very successful choice for women in their 40s" who have no problems
other than aging eggs, says Quigley.
Many eggs donors are friends or relatives of the prospective mother, but the demand for eggs currently exceeds supply.
Some clinics have started advertising for donors, targeting the college-age population. Only 10 percent of those who
answer such ads will actually become donors, says Dr. Patricia McShane, vice president for medical affairs at IVF
America. "Most people don't really know what's involved," she says. Other potential donors are disqualified for medical
or psychological reasons.
WHO FOOTS THE BILL
High-tech infertility treatments are quite costly--the average procedure costs $7,000, and prices range from $4,000 to
$11,000 per try. Procedures involving donor eggs can be even more expensive. Older women run up the highest tab
because they typically go through more "cycles" of treatment to achieve a birth. Patients tend to be older in the
Northeast and West than in the South. "I think there's a different [regional] value placed or career and the age when
people get married," says McShane.
Nearly one in four patients at McShane's IVF America program in Boston is older than age 40. They are fortunate to live
in Massachusetts, one of ten states in which infertility treatment is a mandatory item for insurance coverage. Older
women "can re-cycle frequently" in Massachusetts, because assisted reproductive technologies are completely covered,
says McShane. Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, New York, Rhode Island, and Texas also
require insurers to include at least some coverage for infertility treatment, although high-tech procedures are not always
covered.
Thirty-eight percent of larger businesses offer some type of infertility coverage for their workers, an increase of 50
percent since 1989, according to a 1991 A. Foster Higgins and Company survey of 2,409 firms representing 13.8 million
employees nationwide. Although both public and private companies in all major industries were surveyed, most had
more than 1,000 employees. Large employers may be more willing to offer infertility coverage because most have some
type of managed-care health program already in place. Infertility treatment is "less likely to be used indiscriminately"
under managed care, says Patricia Wiley of Foster Higgins.
Adding infertility benefits does boost the cost of health insurance, and many smaller companies may not be willing to
absorb the expense. Some insurance policies cover certain procedures and drugs, but not others. "Peopole tend to use the
therapies that their insurance will pay for," says McShane.
Since many of them must pay out-of-pocket, people who seek IVF or other high-tech treatments tend to be affluent. "It's
not cheap or practical for everyone," says Quigley of the Northeast Regional Center. Tena and Donny Sherman of
Nashville saved for two years before having their IVF procedure. The treatment was successful within a month, but it
still cost the Shermans $9,000, which they paid themselves.
Why does IVF cost so much? Laboratory and equipment charges are part of the reason, and the failure rate is also high.
IVF America estimates that it has a success rate of 25 percent, for example, but a recent port on the company said it was
closer to 10 percent. The final reason is salary. Reproductive endocrinologists on the staffs of hospitals, HMOs, and
group medical practices are paid an average of $259,750 a year, more than any other medical specialty, according to
William M. Mercer, Inc. in New York City.
EXTRAORDINARY LENGTHS
Another cost consideration comes from the increased risk of multiple births from IVF procedures. Clinics find that the
chances of pregnancy are maximized when several fertilized eggs are introduced into a woman's body; so are the chances
of having more than one baby. One in four deliveries that result from infertility treatments yields multiples, says Zeitz of
AFS.
Multiple-birth babies often have serious health problems and can incur enormous hospital and medical bills. This is quite
costly for employers who must foot the bill and is also a significant hardship for parents. The twins that were born to
the 53-year-old California woman were 12 weeks premature, and each weighed less than 3 pounds at birth. "I think most
infertile couples worry about that," says Margaret Hollister of RESOLVE, a national advocacy and support group for
infertile couples based in Somerville, Massachusetts. "But many of them will go forward regardless."
Getting pregnant is not always the end of the road for infertile couples. Carrying a pregnancy to term can be just as
difficult as achieving it. In 1988, 13 percent of confirmed pregnancies ended in miscarriage. It is estimated that 1 percent
of all women suffer three or more miscarriages in a row. Bed rest, drug treatment, and surgery have been the traditional
treatment, but some women are now turning to hightech procedures like IVF and surrogate mothers.
The expense of infertility treatments and the stress that results from making choices about them can strain a relationship.
Nashville psychologist Ruth Arbitman Smith says that sometimes one partner is not completely supportive. With one
couple she counseled, "the husband felt that the whole focus was on getting pregnant and that this focus devalued the
marriage."
In the end, some people have to come to grips with the fact that they will never have a child of their own. "Everyone
thinks they are going to be one of the successes," says Smith. When they learn they are not, they may choose to adopt or
to remain permanently childless. Either way, they often go through a grieving process.
RESOLVE has 57 chapters in 38 states, with a nationwide membership of 25,000 individuals and 14,000 families. The
annual membership turnover is 50 percent, says executive director Diane Aronson, as couples find solutions to their
problems. Even so, family membership has grown 40 percent since the late 1980s.
Husbands and wives usually attend RESOLVE meetings together. "It's definitely a couples problem," says Philadelphia
chapter president Julie Ryan. "We try to stress that 'neither of you can have a baby alone.'" A majority of members are
in their 30s, but a significant number are in their 40s.
Many RESOLVE members are dealing with secondary infertility. "That's a hard group to get together," says Ryan,
"because they need babysitters."