In vitro fertilization is a common reproductive process that entails a short and painless procedure to implant a fertilized egg into the uterus. Patients freeze embryos for various reasons, including fertility preservation, avoidance of ovarian hyperstimulation syndrome, and allowing a genetics lab time to examine the embryos for genetic defects.
The article explains how medical insurance, laws, and regulations affect the pricing of IVF drugs for fertility medications. The author also provides insights into why Japanese women are so interested in getting pregnant through IVF, a commonly used Assisted Reproductive Technologies.
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What is the pharmaceutical industry’s power?
Big Pharma is one of the world’s most powerful industries. Pharmaceuticals generated over $1 trillion in revenue worldwide in 2014. Shkreli was CEO of Turing Pharmaceuticals (then Vyera), which raised the price of Daraprim from $13.50 to $750 per tablet. It is used to treat a parasite infection that affects pregnant women, cancer patients, and people with AIDS. He justified the choice as an example of capitalism at work, claiming that insurance and other programs would ensure that those in need of Daraprim would eventually receive it. The decision, however, provoked uproar from medical facilities to Congress to the 2016 presidential campaign trail, where candidate Hillary Clinton dubbed it “price gouging” and future President Donald Trump referred to Shkreli as a “spoiled brat.”
Why are drug prices high?
Drug costs are not controlled by any federal government agency in the United States. Prices for brand-name prescriptions and specialty treatments are typically determined by how much the market will bear, except for generic medications, which face a lot of competition. For example, the cost of pharmaceuticals used to treat and cure Hepatitis C (for example, Sovaldi and Harvoni) often exceeds $150,000 per treatment. There are two reasons for the high cost of these medications: 1) Recoup R&D investments (the United States being the world’s backbone of R&D returns); and 2) Set medicine costs at a value point below the eventual cost of not treating. (A liver transplant for untreated Hepatitis C can cost up to $750,000.) By 2020, pharmacy expenditures are expected to account for 31% of total healthcare costs, making it the leading driver of client expenses.
Who sets the price of a drug?
Because the pharmaceutical business is so wealthy and powerful, its lobbying has a significant influence on Congress and the FDA, and because the sector profits tremendously from publicly financed research, it can shift healthcare spending toward its most costly drugs. No excellent innovation gets off the ground without the support of a pharmaceutical firm, but current pricing is unjustifiable in my opinion since the pharmaceutical industry’s focus is now profit, not patients. It’s a terrible business model because if you can’t afford it, you don’t get it. The fight against COVID-19 has piqued the pharmaceutical industry’s interest, and their drive for profit has become a danger to their public health systems.
In line with this, the cost of drugs in the United States has risen and led to inflation that could affect the treatment and drugs used in IVF treatment.
What is the insurance coverage for infertility treatment?
Many women who are having trouble conceiving turn to IVF, only to be surprised by the cost when they pick up their medications and get their medical bills. IVF is not only expensive, but the cost of therapy and related drugs is sometimes not covered by insurance. In addition, prices for fertility medications (IVF drugs) have increased by 50% since 2014, partly due to the unavailability of inexpensive generic options for reproductive treatments.
Depending on the clinic and the patient’s particular drug needs, a single IVF cycle—defined as ovarian stimulation, egg harvest, and embryo transfer—can cost $15,000 to $30,000. Up to 35% of the expenses can be attributed to medications.
However, there are methods to at least cut IVF’s out-of-pocket expenditures. Some of the treatments or drugs used in an IVF cycle may be covered by insurance. There are also grants, discount programs, and clinical trials available to assist qualifying individuals in paying for all or part of the procedure. Low-dose IVF, also known as micro IVF, is a less expensive alternative to consider, while it is not appropriate for everyone.
Medicine isn’t the only expense. The IVF process is loaded with medical appointments, counseling, and other treatments from beginning to end. IVF seldom works on the first try, and it generally takes two or three rounds. It’s simple to understand how prices might spiral out of control because the process is so personalized and can take so many cycles.
Chances of success during IVF cycles
Most women have 20-35 percent success rates per cycle, but the chances of becoming pregnant diminish with each subsequent round while the expense rises. Three full rounds of IVF improve the odds of a successful pregnancy to 45-53 percent.
Taking fertility medication for several months can help your ovaries produce a variety of eggs ready to be fertilized. It is possible to take regular vaginal ultrasound testing or a blood test for hormone levels or to see the eggs you’re producing. Egg retrievals are usually performed under the supervision of the doctor in your home or clinic. Medications will aid your relaxation during the procedure.
Risks and possible side effects associated with IVF and embryo transfer
1. Multiple births.
You’re more inclined to have several children if you have more than one embryo implanted in your uterus through IVF. Compared to a single-fetal pregnancy, having multiple fetuses increases the risk of early labor and low birth weight.
Two of the most prevalent issues are premature delivery and low birth weight. According to studies, IVF raises the chances of a baby being delivered preterm or with low birth weight by a small amount.
2. Ovarian hyperstimulation syndrome through the IVF cycle.
Using injectable fertility drugs like human chorionic gonadotropin (HCG) to enhance ovulation can lead to ovarian hyperstimulation syndrome, which produces swollen and painful ovaries.
Mild stomach pain, bloating, nausea, vomiting, and diarrhea are all frequent symptoms that continue for a week. However, if you get pregnant, your symptoms may linger for several weeks. Rarely, a more severe type of ovarian hyperstimulation syndrome can occur, resulting in rapid weight gain and shortness of breath.
3. Miscarriage.
The rates of miscarriage for a woman who conceives through IVF with fresh embryos are comparable to those for women who conceive naturally, ranging from 15% to 25%; however, the rate rises with maternal age.
4. Complications of the egg retrieval process
There is a danger of bleeding, infection, or harm to the gut, bladder, or blood artery while obtaining eggs using thin needle. In addition, sedation and general anesthesia, if used, come with their own set of dangers.
5. Ectopic pregnancy
An ectopic pregnancy occurs when an implant is placed outside of the uterus, generally in the fallopian tube, in around 2% to 5% of IVF women.
6. Birth defects.
No matter how the kid is conceived, the mother’s age is the greatest risk factor in developing birth abnormalities. More study is needed to see if kids conceived through IVF are more likely to have specific birth abnormalities.
7. Cancer.
While some early studies suggested a link between egg-stimulating drugs and a certain type of ovarian tumor development, more recent studies contradict these findings. Breast, endometrial, cervical, or ovarian cancer risk does not appear to be significantly increased after IVF.
8. Stress.
IVF may be costly, physically demanding, and emotionally stressful. However, counselors, family, and friends can support you and your partner as you navigate the ups and downs of infertility treatment.
Why IVF is So Popular in Japan?
Japan’s experience will be used as a model for industrialized economies experiencing dropping birth rates. While IVF procedures are currently offered for free or almost free in a few countries, such as Denmark and France, Japan is the largest economy to cover most of the costs for such therapies.
It already has one of the highest numbers of women undergoing IVF treatment globally. In 2019, one in every 14 infants, or around 7% of all births, were conceived by IVF, compared to 2% in the United States. Despite this, its birthrate is still about 1.3, much below the 2.1 required by the OECD to maintain a stable population.
This is the most recent attempt to persuade young people to have children. During the last decade, it has increased financial support for childcare and monthly allowances to families with children. Japan’s childcare leave rules are already among the most generous in the world; however, due to social and job pressures, few dads take full use of what is available.
The government has provided financial aid to low-income couples seeking fertility therapy. Still, the current reform intends to make IVF more accessible to a wider population, including procedures like injecting sperm into the uterus during ovulation and using stored embryos.
Low Birth Rate Issue in Japan
Economic instability, migration limitations, and couples opting for smaller families are all harming the world’s population. As a result, Japan’s birthrate is declining quicker than previously expected. The Asian daily predicted that in 2021, Japan’s birthrates would fall to roughly 805,000, a number not expected until 2028, using the health ministry’s calculating algorithm and preliminary birth statistics. The Japanese government estimated that 840,832 babies would be born in 2020, down 2.8 percent from the prior year and the lowest when records began in 1899. Japan isn’t the only country with dropping birth rates. With an estimated 1.07 children per woman, Taiwan, and China, were revealed in 2021 to have the world’s lowest fertility rates. At the onset of the pandemic, lockdowns were projected to result in a baby boom, but global economic turmoil had the opposite effect on birth rates. According to the Brookings Institute, 300,000 babies died in the United States due to this.
Laws and Regulations When Seeking IVF in Japan
It is illegal for a single woman or a same-sex couple to use donated sperm from a third person for IVF in Japan. The surgery may only be performed on a legally married heterosexual couple in Japan.
Married couples with an annual household income of less than 7.3 million can get up to 300,000 Yen for first-time IVF or micro insemination under the existing system. After that, from the second time onward, it’s up to 150,000 Yen. For some fertility-related operations, men can get up to 150,000 Yen.
Cost of IVF in Japan
You can contact ordinary ob/GYN doctors or fertility specialists if you’re having trouble becoming pregnant. The initial step is to seek advice from a general obstetrician/gynecologist. They will refer you to a specialized facility if you require more sophisticated treatment. Fertility experts can often perform common testing for guys. Male fertility clinics do exist, however, in modest numbers. Japanese health insurance does not cover fertility operations (some parts may be covered). Artificial insemination via husband, for example, costs around 200,000 yen or more, while IVF (In Vitro Fertilization) costs between 300,000 and 500,000 yen or more. The cost of these services varies based on the clinic. The local government subsidizes the expenses of reproductive procedures such as AIH and IVF. For first-time applications in Tokyo, they will repay up to 300,000 yen. To qualify for this subsidy, you must meet several requirements, and the documentation procedure is lengthy.
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