Saturday, October 27, 2012

Fee Comparisons

I've been having a discussion with Leah over at Ignitum Today on her essay "Embryo Adoption:  Is it OK?"  My responses got a little long and I thought I'd bring them over here for greater ease in posting. 

IVF costs an average of $13,000.  Prices will vary by clinic and by location, but this seems to be a reasonable average.  That 13k does not include medications, ICSI, freezing, or the possible use of gamete donors.  While the latter three are not necessary per IVF cycle, medications are.  Without insurance, medications for one IVF cycle run anywhere from $2000 to $5000.  Some insurance companies will cover the medications, but it seems most people pay out of pocket for all these procedures and medications.   At any rate, I’d say a potential IVF couple is looking at a minimum of $15,000 for one IVF cycle.


As I mentioned in my previous blog links, one may acquire (for lack of a better word) a set of embryos through a variety of avenues.  (A set could be anywhere from a single embryo to twenty, two to four is the average.)  There is a wide range of services available and a similarly wide range of prices.  The Embryo Adoption Awareness Center has a webpage that provides a matrix of some of the available agencies that describe themselves as offering embryo adoption services.


Nightlight Christian Adoption Agency is an adoption agency that does international, domestic, and embryo adoption (they are the pioneers of embryo adoption in the United States).  Nightlight’s Snowflake Adoption Program costs $8000.  Adoptive parents need a home study, which will cost anywhere from $1000-$4000.  There are frozen embryo transfer (FET) fees which run from $2500 - $5000 depending on the clinic.  Plus there are the medications needed for the transfer, which are normally covered by insurance.  Nightlight’s grand total, when one includes the estimated FET fees, is a minimum of $11,500


The National Embryo Donation Center (NEDC) is a Christian fertility clinic in Knoxville.  They offer both matching services and the FET on location, but require the adoptive couple to travel to Knoxville twice.  Their fees (include the matching and FET) start at $5022.  A home study is necessary from an outside source, so add another $1000 - $4000.  Plus add the price for two trips to Knoxville ($250 - $1500) and all required medications.  NEDC’s grand total is, at minimum, $6,272.  Note:  In the past, NEDC has partnered with Bethany Christian Services for home studies.  Bethany’s home study, available in many states, costs about $3500.  This would bring the total to a minimum of $8772.  Also important to note is that if one desires an open or semi-open adoption through NEDC, there is an additional fee increase.


The Embryo Adoption Services of Cedar Park (EASCP) is essentially a smaller version of Nightlight’s Snowflake Program.  This program does offer an in-house option for a homestudy.  Total program fees including the homestudy are $6575.  EASCP's adoption services alone are $5175.  Additional fees include the FET for $2500 - $5000 and medications.  EASCP’s grand total, when one includes the estimated FET fees, is a minimum of $9075.


Miracles Waiting (MW) is rather like a confidential classified advertisement service for both families donating embryos and those families wanting to acquire embryos.  It costs $500 to sign up for the service.  No home study is needed.  The FET is $2500 - $5000 plus medications.  MW’s grand total is, at minimum, $3000.


Many fertility clinics have donor embryo programs.  This is very similar to their other donor programs (flip through a book to find anonymous donors with ideal characteristics).  No home study is needed, though some clinics do require counseling if donors are used.  I don’t believe there is any charge for the embryo matching services, so the only fees would be the FET and medications.  Grand total is, at minimum, $2500.


The United States Bishops in “LifeGiving Love in an Age of Technology” state that the use of egg, sperm, and embryo donors violates the integrity of the marital act (p.5).  Embryo adoption (p. 12) is referred to as distinctly separate concept from embryo donation yet is still referred to as a source of serious moral concerns.  While no hard and fast definitions of embryo donation and embryo adoption have been provided by the Church, it’s clear that one is in the “no-go” category while the other is in the “proceed only with extreme caution” category.  In my mind, working strictly with a fertility clinic and using their leftover embryos counts as embryo donation.  On the reverse end, working with one of the embryo adoption agencies in existence (like Nightlight, Cedar Park, and NEDC) seems to count as embryo adoption.  I’m not entirely sure how matching forums like Miracles Waiting and Embryos Alive (not profiled above because I couldn’t find pricing info) would be described.  Personally I think they fall more towards the “embryo donation” range of things. 


Miracles Waiting is doing everything required by law – embryos are “property” so the exchange between donors/recipients is practiced as an exchange of goods while being mindful of state specific human tissue laws.


As a Catholic, however, one must do everything within one’s power to treat said embryos in a way that reflects their full human dignity.  Which means to go beyond the legal mandates.  Beyond to what?  Well, that’s where one can reasonably disagree.  I would argue, though, that as much as possible normal adoptive steps should be followed.  These steps allow not only for the proper disposition/handling of the embryos, but also for the education of both placing and receiving couples on the necessary roles within an adoptive setting. 


What is the easiest route is not always the best route to take, especially in such a hotly contested grey area of Church bioethics.  The extra mile must be traversed.  This does not mean the most expensive is best, just that all options must be weighed equally.  One must look beyond the attraction of a cheap price.


In general, there are many benefits an agency can provide that other matching sources cannot. 

·         Agencies provide detailed background information on the genetic parents, regardless of the openness of the match (Nightlight specifically provides three generations of family medical history plus pictures and a written family profile). 

·         Agencies demand accountability for each embryo with strict stipulations – no selective reductions; some say no surrogates; only thaw what you are prepared to carry – thus honoring the dignity/health of both embryos and adoptive mother.

·         Agencies exist as a mediator between placing and adoptive parents.  This mediation is available beyond the match.  Nightlight, for example, will mediate communication at least until any resulting children are eighteen years old.

·         Agency adoptions have a set contract that all placing/adoptive parents use.  The language in the contract is modeled off of existing infant adoptions (as applicable) which further protects both parties.

·         Agencies act as intermediaries between adoptive parents and the fertility clinic.  All clinics require contracts.  All contracts will ask something along the lines of what happens to the embryos in the event of a disaster.  Our specific contract provided limited options – destroy embryos or donate to science.  Both are morally unacceptable.  Working with an agency allows one to designate a moral option – return the embryos back to the agency’s supervision.

The long and short of it is IVF is more expensive than embryo adoption and embryo donation.  Some forms of EA/ED can be very affordable.  However, for a Catholic, I’d argue that not all available forms are acceptable.

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