title: Out-of-pocket fertility patient expense: data from a multicenter prospective infertility cohort.
abstract: OBJECTIVE
  The high costs of fertility care may deter couples from seeking care. Urologists often are asked about the costs of these treatments. To our knowledge previous studies have not addressed the direct out-of-pocket costs to couples. We characterized these expenses in patients seeking fertility care.
  
  
  METHODS
  Couples were prospectively recruited from 8 community and academic reproductive endocrinology clinics. Each participating couple completed face-to-face or telephone interviews and cost diaries at study enrollment, and 4, 10 and 18 months of care. We determined overall out-of-pocket costs, in addition to relationships between out-of-pocket costs and treatment type, clinical outcomes and socioeconomic characteristics on multivariate linear regression analysis.
  
  
  RESULTS
  A total of 332 couples completed cost diaries and had data available on treatment and outcomes. Average age was 36.8 and 35.6 years in men and women, respectively. Of this cohort 19% received noncycle based therapy, 4% used ovulation induction medication only, 22% underwent intrauterine insemination and 55% underwent in vitro fertilization. The median overall out-of-pocket expense was $5,338 (IQR 1,197-19,840). Couples using medication only had the lowest median out-of-pocket expenses at $912 while those using in vitro fertilization had the highest at $19,234. After multivariate adjustment the out-of-pocket expense was not significantly associated with successful pregnancy. On multivariate analysis couples treated with in vitro fertilization spent an average of $15,435 more than those treated with intrauterine insemination. Couples spent about $6,955 for each additional in vitro fertilization cycle.
  
  
  CONCLUSIONS
  These data provide real-world estimates of out-of-pocket costs, which can be used to help couples plan for expenses that they may incur with treatment.
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California.
authors.forename: Alex K
authors.initials: AK
authors.lastname: Wu
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California.
authors.forename: Anobel Y
authors.initials: AY
authors.lastname: Odisho
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Washington
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California.
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California. Electronic address: smithjf@urology.ucsf.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Smith
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D005249:Fees and Charges; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics; D006801:Humans; D007246:Infertility / Q000191:economics* / Q000628:therapy*; D007247:Infertility, Female / Q000191:economics / Q000628:therapy; D007248:Infertility, Male / Q000191:economics / Q000628:therapy; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D027724:Reproductive Techniques, Assisted / Q000191:economics*; D012959:Socioeconomic Factors
keywords: ART; IUI; IVF; OOP; assisted; assisted reproductive technology; fertility; health care costs; intrauterine insemination; in vitro fertilization; out-of-pocket; ovary; reproductive techniques; testis