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The desire to have a child has been characterized as an illness for couples unable to have a child of their own. Infertility presents a significant health problem in numerous social and cultural settings. Therefore, social pressures on women who are unable to have children may contribute to psychological distress associated with critical levels of psychiatric morbidity. Infertility has been associated with cases of isolation and eventual suicides of affected women. Hence in vitro fertilization provides a definitive solution to this problem. IVF presents a relief, especially in situations where men are the ones diagnosed as having fertility problems. In light of the costs associated with in vitro fertilization, it is apparent that in vitro fertilization services are only available to financially independent individuals (Ombelet, 2007). On the other hand, those in critical need and in danger of social- cultural stigmatization are unable, in most instances, to afford in vitro fertilization services. Hence publicly funded health care services should include assisted reproduction services like in vitro fertilization.
The establishment of adequately equipped facilities and services offering in vitro reproduction in most developing countries are at universities, specialized clinics and public health insurance units. These are funded through international or governmental projects and funds. However, these facilities are faced with significant financial deficits, potential complications during the in vitro fertilization process and significantly reduced success rates. Hence in vitro fertilization represents a service which is paid for by the client without any financial assistance derived from public health insurance (Ombelet, 2007). In most instances, in vitro fertilization costs may include clinical fees, drugs, media costs and indirect costs like travel, food and leave from work. However, these costs should not be suffered by the patient alone but should be collectively borne by the patient, the clinics and national health funds or organizations. The sharing of costs would enable an increased number of people to have access to in vitro fertilization services.
Natural cycle of in vitro fertilization is preferable in contrast to stimulation cycle in vitro fertilization because it offers low costs, low risk alternative. The preference of natural cycle has the effect of reducing the costs associated with treatment cycles by approximately 75%. While the cost of un-stimulated in vitro fertilization is estimated to be less than 400 pounds, in comparison to 1717 pounds estimated for stimulated cycles, hence the difference is accounted for by extra drugs of up to 625 pound and additional monitoring to prevent Ovarian Hyper-Stimulation Syndrome (Shahin, 2007). Therefore, these benefits act as an encouragement for patients to make attempts at consecutive cycles, based on indications of pregnancy rates nearing those of stimulation in vitro fertilization. However, existing stimulation protocols face problems of in vitro fertilization complications and poor responders.
Ovarian Hyper Stimulation Syndrome, which affects from 5% to 10% of in vitro fertilization cycles, may put the patient’s life in danger. In most instances, multiple gestations present significant complications of in vitro fertilization; hence translating to significant costs in acquiring health services (Shahin, 2007). These indicate high medical costs for twin pregnancies in contrast to singleton pregnancies which have significantly lower costs (Ombelet, 2007). Multi-pregnancies and Ovarian Hyper Stimulation Syndrome indicate the most prevalent problems of in vitro fertilization; thus, they increase the medical costs associated with in vitro fertilization (Ombelet, 2007). The cost of drugs and media used for in vitro fertilization create significant financial barriers for people willing but unable to cover these costs. These represent social, medical and financial problems to the means for solving the infertility dilemma facing financially unstable individuals. Therefore, modern in vitro fertilization trends should focus on reducing the financial burden without compromising the integrity of stimulation cycles. Hence, making the possibility of having children for financially unstable individuals become a reality.
The cost bearing issue of in vitro fertilization can be perceived as a matter of justice, schools of thought of policy makers in health care and social-cultural dynamics of the infertile individuals. The egalitarianism theory suggests that infertility is a devastating aspect in the life of the affected individuals or couples; while utilitarianism suggests that individual’s actions ought to optimize the well being in the universe. Infertility has the potential for increasing chances of suffering depression. Different societies and cultures have significantly differing interpretations of infertility, particularly for women. Therefore, these aspects of social-cultural stigmatizations may have detrimental consequences for infertile women despite their social status. In a 2006 study, Devroey and Pennings found that discounted in vitro fertilization treatments was a critical motivator for over two thirds of women donating their oocytes. This raised a justice issue since only women who were unable to afford in vitro fertilization would make donations; hence they called for additional funding of in vitro fertilization for families indicating financial need. Mild stimulation and natural cycles represent an alternative to stimulated cycles; hence minimizing the complications associated with in vitro fertilization which include multiple pregnancies and Ovarian Hyper Sensitivity Syndrome (Shahin, 2007).
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The low costs and high pregnancy cumulative rates have acted as motivators for patients to make attempts consistently. In vitro fertilization for first time couples becomes agreeable with the provision of cheaper affordable drugs, indicated minimized side effects and lower possibilities of getting pregnant in subsequent attempts. In light of these, advocating for in vitro fertilization trials funding from the government should not be restricted to stimulation cycles. This is as result of the natural cycle in vitro fertilization being still costly in terms of media used, laboratory charges and medical fees. On the other hand, the existing cost effectiveness of utilizing natural in vitro fertilization, which indicates a 46% cumulative probabilities of pregnancies with an inherent birth rate of 32% after an average of four in vitro fertilization cycles (Hovatta & Cooke, 2006); hence still warranted to be financed by publicly funded health insurance.
It is difficult to quantify the actual cost of service provision, given that medical charges are determined by market forces. Therefore, to a client’s mind, medical charges reflect the actual cost of health care provided. In lieu of this fact, a significant percentage of patients believe it is worthwhile to pay exorbitant amounts of money in respect to the expected outcome and medical services provided. However, a number of patients believe that the inherent financial burden is a prevalent inconvenience. Despite the success rates of the procedure patients fail to reconcile the cost of in vitro fertilization against the benefits of successful pregnancies. It is critical to note that a significant number of patients in need of assisted reproduction techniques are negatively affected by financial constraints and the heavy costs associated with in vitro fertilization. Hence, the cost of in vitro fertilization significantly exceeds the ability of patients to finance these procedures.
Therefore, patients make decisions to discard their desire to procreate. On the other hand, infertile individuals fail to see the cost of in vitro fertilization management in lieu of expected outcome and side effects. As much as natural cycle is highly utilized especially in developing countries, counseling should be inclusive of information on progressive debate on its effectiveness. Thus, improved cumulative pregnancies and drug safety in light of side effects can be adequately addressed. The participation of health care policy makers is critical in offering solutions to the cost effectiveness of mild and natural stimulation methods (Hovatta & Cooke, 2006). The advocacy presenting infertility management to the international forums and agendas will facilitate the implementation adequate funding policies which make in vitro fertilization available to all individuals in need.