Dr. John E. Nichols, Jr., MD
Reproductive Endocrinologist and Infertility Specialist
PREG Founder Medical & Laboratory Director discusses low-cost, high-volume IVF clinic v.s. PREG

Dr. Nichols, Why Low-Cost IVF isn’t always the best option?

IVF is the most effective, efficient treatment to achieve a pregnancy in any fertility center, but there are some costs that go along with the highly technical procedures. Unfortunately, IVF is expensive just based on all the steps that have to be done. Multiple monitoring labs and
ultrasounds for the patient going through her ovarian stimulation, egg retrieval and anesthesia, the highly skilled embryologists who work in the IVF lab with its specialized clean air systems, the incubators, all lab equipment, microscopes, and tools used to culture, examine and manipulate the eggs, sperm, and embryos including intracytoplasmic sperm injection (ICSI), assisted hatching and embryo biopsy for genetic testing, as well as fertility medications, contribute to the high costs of an IVF cycle.

PREG takes an individualized approach to our patient’s care as well we take into consideration the financial liability for our patients. We like for our patients to be well educated on the different types of treatment cycles to make an informed decision on which one gives them the highest probability to achieve a pregnancy. Once the patient makes the decision on which treatment to choose, we have global prices that include all the monitoring visits, retrieval, IVF lab expenses, growing the embryos out to blastocyst (a highly developed embryo), and potentially freezing the embryos to return for an embryo transfer later after the hormone levels have returned to a more normal state. There are no hidden fees to give the patient sticker shock after the cycle is complete.

PREG has also advocated with some of the major pharmaceutical manufacturers to obtain lower prices for fertility medications. We also rank among the highest in the nation for the number of patients that receive Compassionate Care discounts.

Other IVF centers can appear to have lower prices because monitoring, ICSI, growing embryos to blastocyst, embryo transfer, and other procedures are not included in the price quoted for an IVF cycle. Medications are also excluded from the fee schedules. These clinics are set up more like a la carte service and when all the fees are combined, they are usually close to the same price as other clinics. Another way to decrease cost for the clinic is to do a very high volume of cases since the IVF lab and equipment are somewhat fixed so that increasing supplies and personnel become the major cost issues. So, when you look at these centers doing high volume, they are doing lots and lots of IVF cycles. On a busy day at our PREG IVF center, we can be doing 4-6 egg retrievals that day whereas high-volume IVF centers are doing 10 to 20 retrievals each day. It’s just a different world! So that is one of the reasons when you look into these low-cost IVF centers, they may be able to do it at a lower price because of the sheer volume of cases they are doing.

Aren’t you compromising the level of care at this point?

You tell me. If you are doing 10-20 egg retrievals a day and your embryologist and staff are just going one after another, there certainly can be some effect on your personal quality and level of care because there is simply not enough time to get things done. Our doctor-to-patient face time is significantly higher because we aren’t necessarily trying to crank out the high numbers and we are much more concerned about the quality of patient care by taking the time needed for each patient. So, patients aren’t necessarily going to get a lot of personal time with the doctor/staff and can become just another number in these large volume centers that are churning patients in and out. In many ways, you do get what you pay for!

Dr. Nichols, PREG could do this if you wanted to, right?

We could definitely become a high-volume, low-cost center, but I don’t think that’s best for the patients. We have, however, elected to offer different versions of IVF. We have our
standardized version, which we call Full Stimulation IVF, which includes almost all of the IVF options available and uses a pretty aggressive ovarian stimulation protocol to try and retrieve as many eggs to hopefully create as many embryos as possible. We do offer lower-priced IVF protocols such as Minimal Stimulation IVF (using fewer medications and monitoring for ovarian stimulation but will result in fewer eggs retrieved and then fewer embryos available for use) and our Simply IVF (which uses the INVO cell vaginal incubation device in combination with the lesser ovarian stimulation protocols).

But we are very clear to our patients that if you want the lower cost, stripped-down versions of IVF, the pregnancy rates are generally lower than the Full Stimulation IVF protocols (can be up to 10-20% lower pregnancy success rates).

One of the other problems with some of the low-cost IVF centers is that they do not always include the cost of your medications and other possible IVF add ons (ICSI, assisted hatching, embryo culture to day 5, embryo biopsy, etc.) which can significantly increase your cost if they are not included in the quoted Low-Cost IVF rate. So, when patients are told they can do IVF for $5,000, the medication costs are not included (can be anywhere from $3,000 -5,000 more
depending on how much medication is needed) and then the different IVF add-ons fees.

Furthermore, if your low-cost IVF center is located in a different state or another part of the country, you will need to travel there for the whole IVF process for the monitoring, egg retrieval, and embryo transfer (can be up to 3 or more weeks) so there will be additional travel and lodging expenses. If you elect to do some of your monitoring/labs and visits at a local IVF
center and then travel to the low-cost IVF center later for the egg retrieval and embryo transfers, your fees for those local visits will be paid to the local clinic (at their prices) and will not be a part of your low- cost fees but will be in addition. You really need to make sure you are comparing these low-cost numbers to reality or as they say, comparing “apples to apples”. In many cases, the prices when calculated by taking in all the additional costs, travel, and other expenses above, can be about the same if done at a local IVF center.

PREG is not seeking statistics as much as it is the most affordable outcome for each patient, right?

So many of these low-cost IVF centers will do a Zoom consultation with a patient and order some labs and ultrasounds (usually done at a local IVF clinic at their cost) and then put together a protocol and run the patient through it. I’m not saying they aren’t doing a thorough job, but maybe they might not be getting the full picture of the patient’s infertility journey. There is no doubt they will get some patients pregnant successfully but if not, then the patient may have to do the whole process again. So maybe doing 2 low-cost IVF cycles would be more expensive than doing a more aggressive, better tailored, higher-cost IVF cycle once!

So, I’m hearing you say that you want due diligence for every single patient?

We take each patient/couple individually. What they want, what they are expecting, and what their infertility factors are before you go into treatment. We take into account their history, prior treatment, and perform a full diagnostic work-up so a customized treatment plan can be presented to each patient. That’s the kind of service we provide at PREG, personalized and tailored care to their specific situation and needs. We prefer to focus on our patients and their individual care and take the time to come up with the best plan to help them achieve a healthy pregnancy.

So, what do couples, or women in search of IVF need to look for?

Talk to your OB/GYN, your family, and friends and get honest feedback from the community.
Take time to meet with the reproductive endocrinologist, the fertility center, and their staff. Find out if your center employs registered nurses to coordinate treatment cycles or do they hire less trained medical assistants to save money. Please do your research to make sure you’re going to a reputable clinic that offers high-quality, individualized care and that you know what’s included/excluded from the fees quoted. Make sure you’re getting all the highly specialized procedures included in the IVF cycle such as ICSI, growing the embryos out to blast and they aren’t frozen on day three of development, cryopreservation (freezing) of any unused embryos, etc. Determine if outside monitoring is required and what those fees will be per visit. After careful consideration of your options, choose the IVF center that best suits your needs and gives you a strong possibility of getting pregnant and taking home a healthy baby.

PREG has IVF surgical centers in Greenville, Columbia, and Lowcountry and satellite offices in Asheville and Spartanburg. We offer highly personalized fertility care and management. Dr. Nichols is based in Greenville, SC, office. For more information on reproductive options call, or contact us today at 866.725.7734, or online at http://www.pregonline.com/contact-us.php