What are the indirect costs of pursuing fertility care? A pilot survey study

It is widely accepted that pursuing fertility treatment is a costly endeavor, however, there are limited reports on the indirect costs of pursuing treatment-including the impact on professional careers, and costs of time away from work or home required to pursue fertility care.

A 36-question survey was developed in RedCap and distributed to patients at the Massachusetts General Hospital (MGH) Fertility Center, following exemption from the IRB. This study included English speaking patients, aged > 18 and < 50 years old, undergoing IVF cycles between August 1 and December 31, 2024. Two hundred fifty-one survey invitations were sent through Epic Gateway patient messages with 54 unique responses (22% response rate) after trigger before oocyte retrieval. Self-reported impact of fertility care on professional lives including time away from work, additional financial burden, and workplace privacy. Distance and time spent travelled were calculated through GoogleMaps with cost estimates generated using IRS cost/mile and lost work hours.

Forty-seven respondents (90%) reported missing work to attend appointments. Additionally, 31 (60%) patients reported attending appointments affected their privacy at work and 26 (50%) had to disclose the reason for missing work to their employer, of which 14 (54%) would have preferred not to disclose this information. Thirty-four (65%) participants reported missing professional obligations and 27 (52%) reported missing personal obligations to attend appointments. A total of 8 (15%) reported changing work responsibilities to accommodate fertility treatment. When accounting for travel time and potential work hours missed, an average of 260.15 min/cycle and an average of $53.63/hour wage this amounts to $232.53 lost work hours/productivity. Total time accounted for an additional "cost" of $544.53 per IVF cycle.

This pilot survey highlights the significant indirect costs of pursuing fertility care and identifies time away from work and workplace privacy as two of the two primary drivers. There is a clear need for additional research in the area of the indirect cost of fertility care.