Rolling the Dice at Having a Baby: Who Should Pay for the Gamble?

When an IUI is $1,000 for a 10 percent chance at pregnancy and IVF is $15,000 for a 40 percent chance, how does one decide on treatment, when money is an object?

I received a phone call recently from a woman whose husband is a cancer survivor. They successfully froze his sperm before he started chemotherapy.

It’s now three years later and this couple wants to put his cancer behind them and start their family together. His most recent sperm analysis shows he is sterile, his sperm count obliterated from surgical damage done to his lower abdomen. Their only chance at a biological child was frozen in three small vials somewhere in Colorado.

And their first fertility specialist used up two of those vials on two failed IUI (Intra-Uterine Insemination) attempts.

I almost cried right there on the phone. I was outraged anyone would allow them to proceed with IUI when this couple had so little sperm to work with. IUI is a procedure in which you inject a vial of sperm into a woman just before she ovulates. And you hope that one swimmer successfully fertilizes her egg.

Unlike IVF, which according to national averages has a 40 percent success rate, IUI only has up to a 10 percent success rate, depending on the medications used in conjunction with the procedure. And each attempt uses an entire vial of sperm.

As a patient advocate, I protect the rights of the patient, but I also ensure they are clear in their decision making and proceed down their path to parenthood with no regrets. More frequently than not, money or the lack there of, becomes one of the primary factors in decision-making because insurance companies do not routinely cover infertility treatments.

This couple, both social workers on fixed incomes, chose a procedure that was far more likely NOT to work than it was going to work because the cost was less than 10 percent of one round of IVF. Yet, here they are with only one vial of sperm left – and now realizing they might have to find the money for IVF anyway.

My stepson recently was attempting to complete a 75-hour English course in three days so he could graduate with his high-school class.  Those same three days were also filled with finals. I said to him, “You know it’s highly probable there just aren’t enough available hours for you to get it all done.”

He said, “I know, but I have to try.”

That’s how most patients feel regardless of the statistics. They have to try until they are out of tries.

On her second attempt, this patient got pregnant, but miscarried at six weeks. Like many patients who miscarry, she was devastated, yet hopeful that since she got pregnant once, she would get pregnant again.

She only has one chance left and is wondering what she should do with that chance. Should they pay $1,000 for a 10 percent IUI chance or $15,000 for a 40 percent IVF chance? In assisted reproductive technology where nothing is a sure thing and art can still trump science, how does one decide, when money is an object?

This patient expressed her frustration at the medical system for not taking responsibility for causing this infertility problem for them. I agree with her. “I’m a cancer survivor too,” I tell her, “and I can’t believe how much work it is for us to have a baby after treatment . . . and that we are supposed to finance it all ourselves.”

As medical professionals, we are supposed to do no harm. But you can’t treat cancer without doing harm. Who then should pay for the harm that is done? I believe society. I believe our medical system. Surely if you have cardiac damage from chest radiation, your insurance company will not deny you heart care.

Why then does insurance not cover infertility treatments, especially when the reproductive issue was caused by medicine?

An oncologist recently said to me, “Well because its an elective procedure.” I retorted, “So is breast reconstructive surgery and we passed a law to protect my right to have breasts. I’d certainly rather have my reproductive ability than my fake boobs.”

Society has long since let us know what to value based on the laws passed. We started valuing a woman’s voice when we passed a law giving her the right to vote. We started valuing the black community when we passed civil rights. We started valuing a man’s right to an erection when insurance companies agreed to cover Viagra.

Isn’t it about time then that we pass a law that tells us to value a cancer survivors right to bear biological children?

We have to try.