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DOI: 10.1055/s-0033-1336600
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Publication History
Publication Date:
22 April 2013 (online)

Abstract
As fertility rates among women of advanced reproductive age have steadily increased, so has the utilization of fertility services. National health policies provide infertility treatment coverage in several developed countries; however, in the United States infertility treatment is largely privately funded, resulting in limited access to care. In response to the lack of insurance coverage, many practices offer fertility treatment on a risk-sharing or contingency fee basis. The ethical delivery of care under the auspices of these programs requires adherence to core principles including transparency, patient autonomy, and the delivery of appropriate medical care. Moreover, concerns regarding patient understanding and decision making have also been of foremost concern. Patients must be able to fully appreciate the financial and clinical implications of contingency fee programs. To further explore patient comprehension and satisfaction, we surveyed participants in our shared risk assisted reproductive technology program. The overwhelming majority of respondents felt adequately informed of and fairly charged for their treatment. Our results demonstrate that shared risk programs can receive strong endorsement from participants, which may lead to improved utilization of and perseverance with fertility treatment.
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References
- 1 Lutz W, Sanderson W, Scherbov S. The coming acceleration of global population ageing. Nature 2008; 451 (7179) 716-719
- 2 Hamilton BE, Ventura SJ. Fertility and abortion rates in the United States, 1960–2002. Int J Androl 2006; 29 (1) 34-45
- 3 Stephen EH, Chandra A. Declining estimates of infertility in the United States: 1982–2002. Fertil Steril 2006; 86 (3) 516-523
- 4 Stephen EH, Chandra A. Use of infertility services in the United States: 1995. Fam Plann Perspect 2000; 32 (3) 132-137
- 5 Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet 1978; 2 (8085) 366
- 6 Society for Assisted Reproductive Technologies. National data summary. Available at: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx . Accessed August 2, 2012
- 7 Malizia BA, Hacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. N Engl J Med 2009; 360 (3) 236-243
- 8 Dawson AA, Diedrich K, Felberbaum RE. Why do couples refuse or discontinue ART?. Arch Gynecol Obstet 2005; 273 (1) 3-11
- 9 Hughes EG, Giacomini M. Funding in vitro fertilization treatment for persistent subfertility: the pain and the politics. Fertil Steril 2001; 76 (3) 431-442
- 10 Brezina P, Shah A, Myers E, Huang A, DeCherney A. How Obamacare will impact reproductive health. Semin Reprod Med 2013; 31 (3) 189-197
- 11 Jain T, Harlow BL, Hornstein MD. Insurance coverage and outcomes of in vitro fertilization. N Engl J Med 2002; 347 (9) 661-666
- 12 Collins J. Cost-effectiveness of in vitro fertilization. Semin Reprod Med 2001; 19 (3) 279-289
- 13 Chandra A, Stephen EH. Infertility service use among U.S. women: 1995 and 2002. Fertil Steril 2010; 93 (3) 725-736
- 14 Stassart JP, Bayless RB, Casey CL, Phipps WR. Initial experience with a risk-sharing in vitro fertilization-embryo transfer program with novel features. Fertil Steril 2011; 95 (7) 2192-2197
- 15 Ethics Committee of the American Society for Reproductive Medicine. Shared-risk or refund programs in assisted reproduction. Fertil Steril 2004; 82 (Suppl. 01) S249-S250
- 16 American Medical Association. Code of Medical Ethics. Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion601.shtml . Accessed August 2, 2012
- 17 Scott Jr RT, Silverberg K. Ethics of guaranteeing patient outcomes: a complex issue whose time has not come. Fertil Steril 1998; 70 (3) 422-424
- 18 Santoro N. Tiptoeing through the mine fields of “money-back guarantees”. Fertil Steril 1999; 71 (5) 971-973
- 19 Levens ED, Levy MJ. Ethical application of Shared Risk programs in assisted reproductive technology. Fertil Steril 2011; 95 (7) 2198-2199
- 20 Brandes M, van der Steen JO, Bokdam SB , et al. When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary care subfertility population. Hum Reprod 2009; 24 (12) 3127-3135
- 21 Olivius C, Friden B, Borg G, Bergh C. Why do couples discontinue in vitro fertilization treatment? A cohort study. Fertil Steril 2004; 81 (2) 258-261
- 22 Practice Committee of the American Society for Reproductive Medicine; Practice Committee of the Society for Assisted Reproductive Technology. Guidelines on number of embryos transferred. Fertil Steril 2009; 92 (5) 1518-1519
- 23 Criniti A, Thyer A, Chow G, Lin P, Klein N, Soules M. Elective single blastocyst transfer reduces twin rates without compromising pregnancy rates. Fertil Steril 2005; 84 (6) 1613-1619
- 24 Stillman RJ, Richter KS, Banks NK, Graham JR. Elective single embryo transfer: a 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice. Fertil Steril 2009; 92 (6) 1895-1906
- 25 van Montfoort AP, Fiddelers AA, Janssen JM , et al. In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod 2006; 21 (2) 338-343
- 26 Csokmay JM, Hill MJ, Chason RJ , et al. Experience with a patient-friendly, mandatory, single-blastocyst transfer policy: the power of one. Fertil Steril 2011; 96 (3) 580-584
- 27 Thurin A, Hausken J, Hillensjö T , et al. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med 2004; 351 (23) 2392-2402