In just about every major city, or state, there is a unique program that makes IVF more affordable, and that has gone relatively unnoticed. In New York City, it is the New York State Demonstration Project. In San Francisco, it is the UCSF Low Cost IVF Program.
The cost of a single IVF cycle in San Francisco is now over $24,000, including expenses for the procedure, medication, ICSI fertilization and genetic testing of the embryos. That equates to nearly 40% of the average San Francisco average household income which is 50% higher than the rest of the US, where IVF affordability is likely even a thornier issue.
The UCSF Low Cost Program offers spectacularly interesting value: by our calculations, its costs ($3,000 per cycle) equate to 15% of a normal round of IVF at UCSF but deliver Live Birth Rates per retrieval of 20 - 30%, or about three quarters of what similar patients would see with a fully-loaded IVF cycle at the same clinic.
How does UCSF accomplish this? First, it limits the use of expensive medication and relies on a cheap, historically safe stand-in medication to stimulate egg production. Next, it commissions fellows, rather than its staff, to handle all of the procedures. Patients are placed on a lower dose, less expensive anesthesia for the egg retreival. UCSF then grows these embryos for a shorter duration (three days instead of five), which cuts down on laboratory expenses, and all of this is handled at San Francisco General Hospital, rather than at the upscale facility at Mission Bay.
The program was started by a resident, rather than faculty, and it could be an important model for other clinics to mimic in bringing down costs. While the findings offer poorer patients living at 2x or lower than the povery line an important path to parenthood, and represent a model of how this field could extend access to care, it creates a conundrum for the school, and industry, from a business standpoint.
From a patient’s perspective, undergoing a cycle like this would be tempting: it hardly costs more than a medicated IUI cycle, and yet offers rates of success more akin to IVF. The fear is that patients, if given the chance, would insist upon this route, and it would cannibalize higher-cost, higher-margin (and yes, higher success rate) standard IVF cycles.
Cannibalization of its existing business would have deep consequences for the school. Today, UCSF performs nearly 2,000 cycles per year and presuming they make roughly $5,000 in profit per cycle, this could impact a $10M profit pool, which goes to fund salaries, research, and efforts like this.
While we believe the school should consider raising the cap to help meet the needs of a broader population, this is an invaluable effort. Patients who have no realistic opportunity for treatment are afforded respectable chances to grow their families. Residents and fellows, who need hands-on training, and experience counseling patients, get on-the-job development. Other clinics get a blueprint for how they might drive costs out of the system, and profitably extend access to more hopeful families.