Too Many Sperm Being Injected in Rhode Island

Anecdotal evidence of the unintended consequences of insurance mandates and bureaucratically-set healthcare pricing, courtesy of the Associated Press…

Fertility clinics are overusing a laboratory technique and costing infertile couples and some insurers hundreds of extra dollars, a new study suggests.

At issue is a procedure that injects a single sperm into an egg. The method is considered the best option for couples in which the man has defective sperm or extremely low sperm counts.

But many clinics are using it for other infertile couples, even though it often doesn’t work as well as the standard lab dish method, according to a study in Thursday’s New England Journal of Medicine.

Sperm injection adds about $1,500 to the $12,400 average cost of an in vitro fertilization treatment cycle, the authors said.

“This paper is particularly troubling because we’ve got a major shift in practice that isn’t evidence driven. The paper suggests it may be driven by money,” said Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics and a contributing writer for MSNBC.com's Breaking Bioethics column....

The research team reviewed a decade of results that hundreds of fertility clinics reported to the federal government. In 2004, about 58 percent of treatment attempts included sperm injection — up from 11 percent in 1995.

But the proportion of couples who have trouble conceiving because of the man’s sperm has stayed constant, at around 34 percent. This suggests that the sperm-injection technique is being urged on many couples who do not need it and might be better off with traditional lab dish, or in vitro, fertilization, Caplan said.

Sperm injection does not increase overall success rates for healthy births. The researchers found that among infertility treatment attempts with successful egg retrievals in 2004, about 31 percent of those involving sperm injection resulted in a live birth. The percentage was higher — 33 percent — for those that did not use the sperm injection....

They also noted that sperm-injection rates were higher in three states — Illinois, Massachusetts and Rhode Island — that mandate coverage of the technique than in states without such a requirement.

Prices for medical procedures in America today are set by a mixture of private and public insurance bureaucracies. (And if you don't like the price specified by your insurer, too bad; you have little opportunity to go elsewhere, because of our employer-based healthcare system). Since insurance companies set the reimbursement rates, it’s doubtful that doctors can be blamed for conspiring to establish a bigger profit margin for the injection versus the lab dish procedure. And since the insurers don't provide the actual service, they can't be making more money by encouraging higher-priced treatments.

That leaves at least two explanations, in the absence of evidence of medical necessity, for the growing preference for injection treatments...

1. There are different profit margins for the two procedures, resulting from the fact that bureaucratically established prices have not responded efficiently or rationally to the true costs of providing treatments, and some doctors are indeed getting greedy.
2. Alternatively, note that the AP story states only that the price of the injection treatment is higher, not that the profit margin is higher. The increase in injections could also result from the fact that some patients figure the higher-cost treatment must be the better treatment, and since they're paying the same amount for either treatment (assuming the price of both treatments exceed their deductible), that's the treatment they choose.