Delayed childbirth helps push a boom in LI's fertility business

Fertility clinics are booming, buoyed by women who are waiting longer to have children, same-sex couples who want families and technological advances that have led to higher success rates.

The major health care systems on Long Island are pouring millions into the effort, hiring top fertility experts to expand departments. 

Independent fertility clinics are growing throughout the region, too. Many of them are bringing in increased revenue from in vitro fertilization, or IVF, a procedure in which an egg is combined with sperm outside a woman’s body to create an embryo that is later transferred into the woman’s uterus.

"Certainly today many couples delay starting a family and require treatment," said Dr. Michael Nimaroff, senior vice president and executive director of obstetrics and gynecology services at New Hyde Park-based Northwell Health. “There is also a greater acceptance about seeing a fertility doctor and it is no longer taboo.” 

The popularity of in vitro fertilization in New York is expected to climb further after Jan.1, when a provision takes effect requiring many employers with at least 100 workers to cover some fertility treatments, including three IVF cycles. In vitro fertilization can cost up to $20,000 per cycle, which most patients now pay out of pocket, experts said.

The new rules were introduced in 2016 by Assemb. Aravella Simotas, (D-Queens), who said she pushed for better IVF coverage after hearing from “so many constituents who had issues with fertility. This touches so many lives.”

The new regulations also require companies of all sizes to cover  "medical fertility preservation," which includes freezing sperm for men and eggs for women because of medical reasons, such as cancer treatment with chemotherapy.  

Dr. David Kreiner, of Melville-based  RMA Long Island IVF, said: “It’s hurtful to speak with a couple, knowing that they need IVF and they can’t afford to have the procedure. It’s terrible. This will be a good step, as it will relieve financial barriers for New Yorkers.”

Critics of IVF, however, said the procedure is expensive, and often not the most effective way to help a woman become pregnant. 

“The IVF world is lucrative," said Dr. Paul Carpentier, medical director for Catholic Health Services’ Gianna Center of Long Island for Women’s Health & Fertility in Babylon. Catholic Health Services doesn't perform IVF because of church teachings against such intervention. 

Putting the focus on IVF means some reproductive endocrinologists are no longer "focused on finding the reason why someone isn’t getting pregnant," Carpentier said. "In 30 years, there hasn’t been an instance that I couldn’t tell a couple why they were not getting pregnant. On average we find 4.5 reasons per couple.”

Many issues that keep a woman from getting pregnant can be solved through lifestyle changes, corrective surgery, medication and supplements, said Dr. Anne Nolte, director of the Gianna Center.

But other doctors said that for some, in vitro fertilization is the only way to get pregnant. 

“Maybe 25 percent of my patients turn to IVF, and more than 90 percent of them tried every other method before turning to it,” said Dr. Linda Sung, a reproductive endocrinologist and infertility specialist and division director for Reproductive Endocrinology and Infertility at NYU Winthrop in Mineola. 

About one-third of American adults report that either they or someone they know have used fertility treatment in order to have a baby, according to a Pew Research Center survey released in 2018. 

About 75,000 children were born with the assistance of fertility treatments in 2016, the most recent year that data was available. That's up more than 25 percent from 2006 and nearly four times the number in 1996. 

Pew said the percentage of babies born with fertility medical help is highest in the Northeast. That’s partly because the treatments are costly, and the Northeast has more high-net-worth families. Nearly half of families with income over $75,000 said they or someone they know has used fertility treatment to have a child. The number drops to 19 percent for families with income below $30,000.

Seventeen states require some level of infertility insurance coverage, according to McLean, Virginia-based Resolve: The National Infertility Association, a patient advocacy group.

In addition to IVF and egg and sperm freezing, New York's new law requires coverage for surgery to treat endometriosis, which occurs when a woman's body produces scar tissue that can prevent her from getting pregnant. 

The new rules apply to companies with so-called fully insured plans — those where a company pays a New York State-regulated insurance carrier to cover employee health claims. They do not apply to companies that self-insure their plans. 

About half of New Yorkers with health insurance would gain the benefits, according to the state Department of Financial Services. 

"I recommend, 100 percent, to talk to your human resources group and find out where your insurance is issued," said Christopher Kutner, general partner at Uniondale-based Rivkin Radler, who comanages the law firm's health group. 

 "This is the time of year where companies are offering open enrollment," added Joanne Libraro, executive clinical director at RMA Long Island IVF. "Every year at this time, we get calls from patients inquiring about costs, managed care plans and treatment inclusions." Patients are looking for advice "since the plan cost and coverage vary so much," she said.

“Infertility is a disease, and should be treated as such,” said Dr. Beth McAvey, the medical director at RMA Long Island IVF  and an assistant clinical professor at the Icahn School of Medicine at Mount Sinai.  “It is not plastic surgery.”

McAvey added that many cancer patients want to freeze eggs, but don’t because of the cost.

“This is good news for women who want children but face challenges,” she said.

Millicent Ramos of Copiague was diagnosed with Hodgkin's Lymphoma, a cancer of the lymph nodes about seven years ago when she was 23 years old. She had her eggs frozen at Northwell Fertility. 

She said, "Once I did that, my mind was clear of my worries for my future. My mind was free to just think about what I had to endure at that time."

Using the frozen eggs and IVF, Ramos, now 31, is due to deliver a boy on Dec. 27. She paid $6,800 for the egg freezing.

Retrieving eggs for IVF or egg freezing is not easy, doctors said. Women must inject themselves daily with hormones for up to two weeks to stimulate their ovaries. A surgical procedure that includes anesthesia is required to retrieve the eggs.

Egg freezing has become increasingly popular since the American Society of Reproductive Medicine removed the “experimental” tag from the procedure. The decision was made as more effective ways to freeze eggs were rolled out.

Before 2012, eggs were frozen using a slow freeze process, using substances that can be toxic to eggs. Now the industry uses vitrification, which is an instant freeze and has less damage to the eggs, Sung said.

The removal of the experimental tag also led to clinics marketing it as an option for any woman who wanted to freeze her eggs for a pregnancy down the road. 

Nationwide, 25 percent of employers cover in vitro fertilization, according to the Society for Human Resource Management. The Alexandria, Virginia-based workplace management group said cost is likely the main reason many employers don’t cover treatment. 

Dr. James Stelling, a reproductive endocrinologist and infertility specialist at Stony Brook Medicine, said the procedure is not guaranteed to produce a pregnancy. 

The odds are more favorable for a woman in her 20s, but even then “it can be a flip of the coin," he said.

“My average patient isn’t 25. She’s 37 or 38, and then it’s less likely they get pregnant,” Stelling said. 

He added that about half his patients don’t have insurance coverage.

“A woman who is 25 is more likely to have success, but a woman well into her 30s is more likely to have money to pay for this,” Stelling said.

Between 35 percent and 40 percent of IVF cycles lead to pregnancies for women under 35, according to Centers for Disease Control statistics. The percentage drops to 22 percent for women between 38 and 40, and 12 percent for women who are 41 or 42.

But with growing demand, health care systems are investing in the business of fertility.

Northwell in November plans to open a $20 million infertility lab in Manhattan that will include embryo testing and egg freezing. The health system is also investing to expand its current lab at North Shore University Hospital. 

Stony Brook Medicine in April opened its $6.5 million reproductive endocrinology and fertility center, Island Fertility. The Commack-based center serves 60 to 80 patients a day, Stony Brook said.

“We have all the services there,” Stelling said. “In the future we will have other offices, including in Nassau County.”

NYU Langone owns NYU Langone Reproductive Specialists of New York, a Mineola-based practice that also has locations in West Islip, Stony Brook and Brooklyn Heights. Reproductive Specialists of New York joined NYU Langone in February.

Independent practices are also growing.

Manhattan-based New Hope Fertility in September opened its first Long Island location, in Jericho. The group offers conventional IVF, but also other types of IVF treatments, including what is known as needle-free IVF, which uses pills and nasal spray instead of injections.

RMA Long Island IVF, formed earlier this year by the merger of Long Island IVF and Reproductive Medicine Associates of New York, has six offices on Long Island, and performs its reproductive surgeries and egg freezing in Melville.

The clinic’s patients include women who wait to have children and then have difficulty getting pregnant, younger couples with fertility issues, single women who want to have a child, women who want or need egg freezing, and an increasing number of LGBTQ+ couples wanting to raise children, RMA Long Island IVF said.

“In the last 10 years, the LGBT community has become a much bigger part of what we all do,” McAvey said. “It may be as much as 20 or 25 percent of my practice. It wasn’t close to that high before.”

The practice holds seminars and support groups with the Hauppauge-based LGBT Network, an association of nonprofits that serve the LGBT communities of Long Island and Queens.

“Our families program is among the fastest growing programs we have,” said David Kilmnick, CEO of the LGBT Network. “About 25 to 30 people show up at each one of these events.”

Sung at NYU Langone Reproductive Specialists said the legalization of same sex marriage has offered these couples health insurance, which often helps them explore fertility options and get financial support to do so.

While the new state law will give fertility benefits to lesbian couples and single women, it does not offer help to gay men because it doesn't include benefits for gestational surrogacy, she said.

New York is one of only three states in which it is illegal to pay a woman to carry a child as a surrogate. People looking for a surrogate — a woman to carry a child for them — often cross state lines to find someone.

"Surrogacy is incredibly expensive, upwards of $150,000," said Dr. Christine Mullin, director of fertility on Long Island for Northwell. "For gay men who want a lineage to a child, this is a viable option."

Mullin added that heterosexual couples who use a surrogate still go through IVF to get the woman's egg and fertilize it with the man's sperm, before placing it in a surrogate.

"If a woman has certain issues, like she is born without a uterus, or she puts her health at risk by carrying a child, surrogacy ends up as the option," she said.