A cost analysis of in vitro fertilization versus tubal surgery within an institution under two payment systems

The current health care climate places a premium on practicing cost-effective medicine. There is little in the literature, however, comparing alternative treatment strategies for patients with infertility. Mount Sinai Medical Center (New York) offers infertility services under two separate settings: the infertility clinic and the private office. The infertility clinic is available to all women, regardless of ability to pay, and primarily employs laparoscopy to treat patients with tubal disease, since alternative assisted reproductive technologies, including in vitro fertilization (IVF), are not available to them. In contrast, at the private office, women are evaluated and counseled by the same team of physicians and often proceed directly to IVF. We compared reproductive success rates and costs of 67 women undergoing IVF (group I) with those of 31 women treated in the infertility clinic (group II) over the same time period. The mean age of group I patients was similar to that of group II patients. However, the demographic makeup was quite different. Analysis of outcome data showed an IVF success rate of 25% per cycle and a pregnancy rate of 19.3% in group II patients. The cost of IVF per ongoing pregnancy was competitive with the cost of tubal surgery ($23,718.80 versus $24,333.89). We recommend that any comprehensive health care plan or insurance coverage plan recognize the efficiency of assisted reproductive technologies and not summarily dismiss their inclusion in a benefits package, since these technologies may, at times, offer a financially advantageous alternative.