As a logical consequence of two recent national developments with profound new implications for egg donation in the U.S, and because rising costs increasingly price patients out of fresh donor egg cycles, CHR decided to radically reorganize structure and costs of its Standard Donor Egg Program (SDEP). In full disclosure, we here describe changes made in the program, their motivations and the new cost structure. The two national developments creating the impetus were:
Following settlement of a class action suit, the American Society for Reproductive Medicine (ASRM) withdrew its previous recommendation as to how much IVF centers should pay egg donors for their services per donation cycle. The suit claimed the right of egg donors to let the market determine donor reimbursements. The legal settlement reaffirmed this principle, and CHR, therefore, feels legally obliged to consider market pricing in reformatting its donor egg/recipient cycle program.
Within a very short time period, frozen egg banks by 2015 have already been supplying eggs for ca. 20% of donor egg cycles in the U.S., even though frozen eggs reduce donor cycle pregnancy chances to a minor degree in comparison to fresh donor eggs. In CHR’s SDEP, patients in return for a $8,000.00 fee used to receive all eggs a donor produced in her cycle, whatever the number was. Donor egg banks, however, have established “commerce” in donor eggs by charging per “sold” mature egg(s).
Donor egg banks have established a market value for donor eggs. Considering this fact and the legal settlement, CHR’s past cost structure no longer appeared fair to either donors or recipients: Instead of a fixed fee per donation, donors should be paid proportionally to their egg production, while recipients should be responsible for fees proportionally to the number of eggs they receive in a cycle.
In reorganizing its SDEP, despite these developments, CHR still considers the commercial trade in human oocytes with considerable ethical concerns. As till now, CHR will forego profit from managing the process of egg donation between donor and recipient, and will continue to offer donor matching services as an unreimbursed courtesy to the center’s patients. CHR, therefore, will price the anonymous exchange of eggs between donors and recipients in its program at cost, and without profit margin. In full disclosure, we here offer a detailed description of the new financial structure for oocyte donors and recipients.
Principles of the pricing changes
The principal change in CHR’s revised SDEP is that egg donors will now be reimbursed based on the number of eggs they produce, and recipients will pay for donor eggs based on the number of mature eggs they receive. This, of course, immediately raises the questions, what does an egg donor receive per egg, what are the cost to the recipient per fresh donor egg, and how did we come to those numbers?
Let us start with the last question: CHR came to the new donor egg cost structure by looking at the center’s historical data, and determining the historical average number of mature oocytes in fresh donor egg cycles (n=~10). Considering that CHR for over 10 years has maintained a reimbursement rate of $8,000 to egg donors for egg donation, independent of egg numbers produced, this established an average historical reimbursement of $800 per egg to donors. We then calculated CHR’s overhead costs in maintaining an independent donor pool of over 200 egg donors, and came per matched donor to approximately $2,000 ($200/egg) to $2,500 ($250/egg), depending on egg numbers. Combined, these numbers then established a cost for recipients of $1,000 – $1,050 per oocyte.
CHR, thus, in principle has not changed the pricing of fresh donor eggs but now distributes benefits and risks more fairly for donors and recipients.
What egg donors need to know
In practical terms this means that, with starting date August 1, 2016, the following donor reimbursements and recipient cost schedules will be implemented: Unchanged from prior procedure, recipients will, once they choose an egg donor, still be required to deposit $8,000 in anonymous escrow for donor reimbursement. For this reimbursement, they will be entitled to 8 mature oocytes. Should they wish to receive more, they will have to make a balance payment to CHR for those additional mature eggs per below listed recipient charges prior to cycle start. If a donor produces fewer than 8 mature oocytes, the recipient will be entitled to a proportional refund.
Egg donors, in turn, will still be guaranteed $8,000 for a donation, as long as they produce at least 10 mature oocytes (the average number of eggs donors have produced at CHR in the past). If they produce fewer mature oocytes, their donor fee will be reduced proportionally in accordance with below listed donor reimbursements. If they, however, produce more mature oocytes, they can increase their cycle reimbursement to up to $12,000 for 15 or more mature oocytes. We hope that this new reimbursement schedule will motivate CHR’s egg donors even more than in the past to maximize their cycle performance.
Donors will be informed about the number of mature oocytes they produced on the day after egg retrieval since some immature oocytes may still mature overnight. The timing of donor payments remains unchanged. The table describes the new donor reimbursement schedule and recipient charges for varying oocyte numbers.
|Number of Mature Oocytes||Donor Reimbursements||Recipient Charge|
|≥15 / 15||$12,000||$15,500|
What recipients need to know
It is important for recipients to understand that under this new pricing scheme, they too, will be subject to a fairer fee structure, with all cycle fees being normalized to the number of mature oocytes a patient chooses to “purchase.” In practical terms this means that a recipient who, under the previous program would “purchase” all mature eggs her donor produced, now has the option to “purchase” as few as 4 eggs or, still, all the eggs the donor produces in the cycle. If she purchases only 4 eggs, she will greatly reduce her cycle costs, while, because of high pregnancy chances with fresh embryos from donor eggs, still experiencing an excellent pregnancy chance. At the other extreme, recipients who want to purchase all of the donor’s eggs in a given cycle, likely, will have higher cycle costs than in the past but will not only have the advantage of a higher cumulative pregnancy chance but also the chance of having frozen embryos for future siblings to a first child.
Potential additional egg donor income & recipient expenses
Cost reimbursements for travel and maintenance in New York City for long-distance donors will remain unchanged. Long-distance donors will remain marked in CHR’s donor pool, so that recipients will be aware of these additional donor costs for travel.
To further recognize varying “market values” of donors, CHR also introduces a new option, already widely used by many donor agencies and donor egg banks, by designating the so-called “high demand donors” (HDDs) who will be allowed to charge additional donor fees of either $1,000 or $2,000. Once donors are designated as HDDs, they, at their choosing, will be permitted to charge these additional fees, though, based on market forces, some donors may choose not to in order to be matched more quickly.
Eligibility for the designation of HDD will be determined by CHR, based on successful prior completion of at least one IVF cycle and/or special educational or other demand-enhancing achievements and/or qualities. To make recipients aware of these designation, donors awarded the HDD designation are also marked accordingly in CHR’s donor listing.
All other donor egg cycle costs remain unchanged. Please do not hesitate to contact us if you have further questions about our reorganized SDEP.
This is a part of the July 2016 VOICE. Read the issue in PDF.