Infertility treatment: Selling hope

For years, patients seeking in-vitro fertilization endured long waits just to get in to see a doctor. Now, the pursuers have become the pursued. More doctors have entered the field, even as better technology means it takes fewer tries to get a woman pregnant. At the same time, baby boomers are moving past reproductive age, leaving doctors to fight for clients from the smaller Generation X. And so infertility doctors are learning the art of marketing, wooing patients like never before.

They now offer high-tech add-ons -- sperm injection, egg "hatching" and genetic diagnosis -- which cost anything from several hundred to several thousand dollars. They advertise these services on websites alongside price lists and financing packages, and many of them offer money-back guarantees.

With four clinics clustered in the Twin Cities and a fifth one in Rochester, infertility doctors are also going farther afield to find patients. Some fly or drive to remote corners of the Midwest to meet prospective patients and form partnerships with local doctors.

It's all part of a $3 billion national infertility industry that is becoming intensely competitive.

Driven by the one in 10 couples who are unable to have a child, the industry is thriving on the Internet and offering a chance at a miracle through advances in medical technology.

All in the hopes of attracting patients like Greg and Mary Fox.

The Foxes live in Kaukauna, Wis. Late last fall, they drove to Green Bay to attend an infertility seminar put on by a Woodbury clinic. This summer, they came to Woodbury and paid $25,000 for three tries at in-vitro fertilization, commonly called IVF. The clinic offered a 100 percent money-back guarantee if they don't end up with a baby. To pay, they took out a medical loan for $20,000 and cleaned out the $5,000 in Greg's flexible spending account at work.

For them, it was the guarantee that did it. "If not, then it would be a lot of money," Greg Fox said.

But in the race for patients, some clinics are questioning the tactics of rivals.

Standing out in a crowd

With IVF, success rates mean everything.

"You're either pregnant, or not," said Dr. Paul Kuneck, founder of the Center for Reproductive Medicine in Minneapolis, Minnesota's biggest IVF clinic. "There are very few things in medicine that can be measured with a positive or a negative."

These success rates -- usually defined as the number of live births resulting from IVF -- are displayed like badges of honor on the clinics' promotional handouts. Over the years, the four Twin Cities clinics have reached a point where their chances of getting a woman pregnant on any one try is around 50 percent for a woman under 35 -- second-best in the country, according to the Midwest chapter of Resolve, a national infertility association.

So clinics try to stand out in other ways. The independent clinics have generally been more nimble in their marketing than those that are part of large academic centers, such as the University of Minnesota and the Mayo Clinic.

The most enterprising clinic belongs to Jacques Stassart.

Over the years, Stassart, a Woodbury doctor, has won the gratitude of scores of patients for his ability to create life in a petri dish. He's also sparked outrage and envy among his colleagues for his willingness to market those services in new ways.

"He's very entrepreneurial," said Dr. Theodore Nagel, head of reproductive endocrinology at the University of Minnesota, who created the state's first IVF baby in the 1980s.

Stassart grew up in a small town in Belgium, the son of surgeons. At 25, he came to Columbia University in New York as a medical resident. He finished his residency in 1981, the year the first American IVF baby was born. He worked in Fridley, and then at the U.

Many doctors shy from the marketing side of medicine. Stassart embraced it.

In 1995, after leaving the university, Stassart introduced something almost unheard of at the time -- a warranty program. If he didn't send a patient home with a live baby after three IVF cycles, he handed back 80 percent of her money. By paying up front for a package of three tries, patients who got pregnant on the first try subsidized those who got pregnant on a third.

While Stassart wasn't the very first -- a clinic in the Northeast was doing something similar -- his clinic was the first here, and the first to tell the media.

Eventually every Twin Cities clinic and many others across the country introduced warranties of their own. Last November, Stassart's group upped the ante with a 100 percent money-back guarantee for women under 35.

He continues to build partnerships with rural clinics. Recently, a group of doctors and nurses from Lakewood Health System in Staples, in northwest Minnesota, took a tour of his clinic. They wanted to offer more IVF, monitoring patients in Staples, then sending them to the Twin Cities for the final steps.

Embryologist Ashley Wong showed them around the lab, with its seven incubators -- what Wong called "a giant uterus." She pointed out the closed ventilation, special lighting and work surfaces heated to body temperature.

"We've got to market more," said Chris Gooder, the clinic's associate administrator. "I tell my docs: 'They're no longer patients, they're consumers.'"

That's the sort of business talk that makes other doctors uncomfortable. "I find that a little bit sleazy," Nagel said. "But I'm also a little bit jealous."

Stassart is unfazed by criticisms of his business practices.

His mission, he said, is to bring infertility medicine to those who either don't have the means to pay or live too far away. "I think I've been successful."

A flattening industry

From the late 1990s through the early 2000s, it was common to see double-digit increases each year in IVF attempts, as reported to the Centers for Disease Control and Prevention in Atlanta.

But more recently, demand has flattened. In this tougher environment, Nagel's center at the U is losing money. He says his clinic has been hamstrung in the past by too few doctors and too little space. His is the only group that accepts insurance for the few patients who have coverage, but insurance pays at discounts of up to 50 percent.

In the Twin Cities, only the Center for Reproductive Medicine saw an increase in IVF procedures in 2005 (the latest figures available) from 2004. The three other clinics all saw their volumes shrink. That sharpening competition has kept a lid on prices.

One cycle of basic IVF costs about $10,000, the same as in 1990. Taking into account inflation, that's a significant drop in real dollars.

But now, there are a host of extras -- such as genetic diagnoses of embryos, sperm injection, and embryo freezing -- that add thousands to the bill.

What all that means for profit margins is something the clinics won't discuss.

The Center for Reproductive Medicine, housed in a red-brick building next to Abbott Northwestern Hospital, prides itself on being the first with new techniques. Several years ago, it was the first Twin Cities clinic to offer genetic screening of embryos. All the clinics now offer it.

A year ago, the clinic began sending someone on regular visits to ob/gyns in the area. Her job is to make sure the doctors have information on the clinic's most updated services, prices and success rates.

"I don't want to use 'marketing,'" said Kuneck, who started the clinic in 1987. He appears slightly pained at having to discuss money. "It's not marketing so much as let's make sure we're taking care of our people."

Even as warranty programs spread around the country, Kuneck's clinic held back. He says he isn't comfortable with the clinic acting as financier. In 2004, the clinic began offering warranties through a New York company, to maintain a wall between business and medicine.

"This is a gentlemanly way of doing it," Kuneck said. "So I never have to question a medical choice based on finance."

Dr. Randle Corfman runs a solo practice in Maple Grove. He regularly flies his own plane across the Upper Midwest to meet patients and drum up business.

Corfman doesn't like warranty programs. He thinks they're unfair since they accept only those who are most likely to get pregnant on fewer tries, screening out older women and those with medical conditions. But about two years ago, he began offering them. "Patients were going elsewhere," he said.

The pursuit of patients is likely to heat up even more with the return of a medical giant to the fray. Two years ago, the Mayo Clinic hired Dr. Charles Coddington, a former Navy doctor, to revive its infertility services, which had operated on-and-off.

Coddington says he's hiring doctors and hopes to work more with cancer patients, who may be rendered infertile by chemotherapy. He's also visiting clinics in the Mayo system in southern Minnesota, northern Iowa and western Wisconsin. He asks those local doctors what they need to set up services, so they can monitor patients locally.

Mayo doesn't offer warranties. "We try to do things more efficiently here," Coddington said.

Waiting for the news

Greg and Mary Fox, the couple from Wisconsin, met while working at Pizza Hut. Greg is now a supervisor at Gulfstream Aerospace, which builds corporate jets. Mary runs a home day care. Their son, Bret, conceived naturally, was born in December 2000.

Because she is under 35, with no medical problems, Mary Fox qualified for the Woodbury clinic's 100 percent money-back guarantee.

At the end of July, the week of their ninth wedding anniversary, the Foxes headed to Woodbury. Doctors retrieved 18 eggs from Mary's ovaries. The Foxes were elated. Lying in a recovery room, Mary heard other women, separated by curtains, sobbing because they had produced only three or four eggs. The Foxes drove back to their hotel to wait.

Three days later, the bad news came.

Her eggs did not fertilize, a rare occurrence that happens to only 1 or 2 percent of patients.

"I guess we're done," said Greg Fox, as they prepared to drive home to Kaukauna.

They'll be back in November, he said, to try again.