Do you get what you pay for?
I’m an Embryologist. I have worked in many laboratories across multiple countries as a full-time embryologist, as well as a traveling temporary embryologist to help other labs out when they are short staffed or didn’t have experienced enough embryologists for a high-complexity procedure. All fertility clinics and laboratories are NOT created equally.
When looking for a clinic to trust with your fertility, it’s important to consider these elements when comparing their pricing structures:
Having a trained and experienced staff is critical. It’s one of the highest costs associated with running a fertility clinic. Salaries, along with employee benefits, cost money and reflect what a fertility center can charge their patients. Fertility centers staff doctors, nurses, medical assistants, sonographers, laboratory directors, embryologists, andrologists, phlebotomists, and lab techs for the clinical duties. They also employ administrative and management staff. Think about this for a moment. Here is a current ASRM document about staffing and guidelines and qualifications: Minimum standards for practices offering assisted reproductive technologies: a committee opinion (asrm.org)
We all know there is a wide range in salaries for any job… especially specialty groups. Let’s take the embryologist for example. Salaries for embryologists can be drastically different, seasoned embryologists are known to make triple what a newly trained embryologist does. In my career, I’ve known very talented embryologists with top salaries. The difference between the lowest paid embryologist and the highest paid one usually has to do with experience, level of proficiency, and individual success rates. The most successful centers seek out the most talented embryologist to give the best chances of high clinical pregnancy rates. Employing the best possible team usually translates into high success, and it also translates into higher costs for the center. This makes your fees for services greater. A center that can offer fewer patients exceptional services with high rates can afford to charge more. The benefit to the center is having happier employees working normal, reasonable hours. The benefit to the patient is fewer attempts to succeed. Multiply this with all staff members critical to a successful outcome and you begin to understand why costs can be so high. Many times, a patient can search employee satisfaction ratings. This can tell you a lot about the service you are getting with your embryos. Overworked and underpaid staff members generally do not produce the best results.
2. Staffing and Cycle Volume:
Typically, IVF laboratory staffing is correlated with how many IVF cycles a center performs in a year. It has been published that there should be one full-time embryologist per 150 cycles per year in a laboratory. So, if your clinic performs 450 cycles per year, expect there to be 3 full-time, experienced embryologists on staff in that lab. There are labs performing over 500 cycles a year with only a single embryologist. This creates exhaustion, and mistakes. It is not possible for even the most qualified embryologist to perform their best in these conditions, and that most certainly will translate into the overall success rates of the resulting embryos. Couple this with a lower paid embryologist, with less experience and talent levels, and you can see where success rates can plummet.
3. The Lab:
Embryology laboratories vary greatly in size and construction as well as the equipment within it. Human embryos are delicate. When constructing an embryology laboratory, building materials normally used must be avoided to eliminate toxicity that can result in arrested or slowed embryo development. Special embryology-safe materials such as paints, insulations, and furniture material must be used, and these things are typically more expensive. Because of the increased cost and limited availability, not all labs are willing or able to stay 100% within recommended guidelines. Those that do, pay the price with a higher possibility of lower success rates.
4. Laboratory Equipment:
Main large equipment in an IVF laboratory includes incubators, microscopes, centrifuge machines, cryopreservation storage tanks, and lasers. These high-tech items also have a wide range of costs associated with them. There are box type incubators that are reasonably priced ($2500-$6,000) that are used in scientific laboratories and universities that can culture a human embryo (I have seen these in IVF labs.) Other incubators can cost over $20,000 and some have the ability to take pictures and monitor embryos without moving them. These incubator costs can skyrocket above the lesser-quality ones with fewer capabilities. Studies show embryos can thrive in some and barely survive in others… Why then do laboratories not have the best possible incubator available? Because they are expensive, and this will translate into higher costs of treatments to the patients. This is usually the case with all equipment.
Microscopes, micromanipulators, and lasers are used for embryo grading, as well as ICSI and embryo biopsy. A microscope setup can range from an older, lower-quality scope of $1500 to one fitted with micromanipulators, pneumatic injectors for ICSI, and high-tech lasers used for embryo hatching and biopsy costing over $150,000. As you may have guessed, these advancements make the procedure much easier and more efficient for the embryologist performing it, many times offering higher success, less damage, and less time the embryo spends out of the incubator due to improved efficiency. Typically, it takes a more skilled and experienced embryologist to perform these procedures without the modern technology, which is not something many smaller centers can afford.
Equipment in the laboratory needs to be serviced and calibrated on a regular basis (monthly/annually) to ensure it is working properly. Service and calibration can run into the thousands of dollars and not all labs stay on schedule with it. In my experience, those who extend significantly past the recommended service time also can offer services to their patients at lower prices.
5. Embryology Materials and Media:
When your eggs are retrieved, they are handed to the embryologist in a tube filled with follicular fluid. This fluid is poured into a dish and the eggs are then picked up from the fluid and rinsed through a liquid to remove any blood or debris. They are then moved to a culture dish, into a culture media usually overlayed with oil and placed in an incubator for fertilization and culture. There are a multitude of different dishes, media (the fluid the eggs and embryos are placed in), and oils. There is expensive dishware that has been tested for toxicity, tested for embryo development and engineered to maintain a customized footprinted position in the incubator for optimal temperature conditions. As you might guess, some dishes have proven to aid in better embryo development and are also more expensive. The same rings true with media. Even the oil can range from a low-cost mineral oil to an expensive, filtered, specialty oil designed for embryos. While this information is typically not shared with patients, it varies greatly between centers.
6. Air Quality:
Air quality is a huge factor in embryo development and their ability to thrive. In laboratories I have worked in, there have been specialty air handlers with filters in them built with artificial anodes that protect developing embryos from toxins and particles that can harm them. These filters must be replaced every 3-6 months and can cost over $6,000 per filter. Many labs also have standalone air filters inside the lab, helping to circulate clean air. These filters also need regular replacement and can be $1500-$2500 for each filter. I have seen labs with both types and the highest quality of each. I’ve seen a lab with only a small residential bedroom-type air filter that had not had a filter change for over three years. When questioned, they admitted to cutting costs where they could, to keep their prices the lowest of all the competition.
7. Safety Alarm Systems:
While embryos are culturing in their incubators, precise pH and temperature must be maintained at all times. If these conditions change even slightly, it can be deadly to developing human embryos. High-quality laboratories have many systems in place to ensure the best possible culture environment, including regular system and conditions checks. These can be done manually or mechanically (or both) and vary from once a day to multiple times a day, depending on the laboratory and its policies. Laboratories typically have backup generator systems in place in the event of a power outage and many have an alarm system that will automatically call a lab member to alert them of any condition change, power failure or deviation from optimal conditions. Some laboratories have only an alarm system that sounds, which can be disastrous if the emergency occurs after hours, and no one knows until morning. Liquid nitrogen tanks, where frozen embryos and gametes are stored, have similar systems available, but they are costly and not all centers can afford them. Most patients assume all labs have safety measures to the highest extent, but this is not always the case. Of course, the best systems are expensive, and most have ongoing, monthly fees to maintain them.
There are establishments that provide certifications to centers and laboratories that meet criteria and maintain quality assurance levels. These are typically not required but recommended for the success and safety of fertility patients. For a lab to be certified, it will be evaluated on a regular basis. Evaluations can include laboratory success, individual technologist performance, education and proficiency evaluations, FDA records maintenance just to name a few. There are many certifications available, and some labs have them all, others have none. With so much at stake, it is a good idea to make sure your clinic has the best certifications.
There are so many factors that go into providing the best possible condition for a successful outcome. Clinics that do not go above and beyond the most basic standards are able to pass on the savings from all the corners they have cut in the process. Wherever you plan to go for fertility treatments, do extensive homework before selecting the clinic that will provide you with your desired outcome.