The executive decree reinstating the right to in vitro fertilization, or IVF, in Costa Rica went into effect three months ago, but only one private clinic has applied and received authorization to perform the procedure here.
Centro Fecundar, a clinic in Escazú which also operates in Panama, received the approval in June, according to Allan Varela, the Health Ministry’s director of health services. There are no other pending applications from private hospitals or clinics, Varela said, and the ministry has not received any other inquiries about the IVF authorization process.
The ministry published the requirements for offering the fertility procedure on April 1, just a month after the Inter-American Court of Human Rights (IACHR) ordered Costa Rica to approve IVF using the legal framework outlined in an executive decree issued by President Luis Guillermo Solís in September.
To obtain authorization to perform IVF, a clinic must comply with a series of requirements ranging from infrastructure to specialized physicians and equipment. Upon receiving a request for authorization, the Health Ministry has 30 days to conduct an inspection of the medical facility to verify compliance with all requirements, Varela said.
Alexis Castillo Gutiérrez, president of Costa Rica’s Doctors and Surgeons Association, said he’s not surprised there has been little interest from private doctors and hospitals.
“Implementing the procedure entails a serious investment in professional and technical staff as well as in infrastructure and equipment,” he said.
Castillo noted that the government gave itself two years to get public hospitals prepared to offer IVF: proof that it’s no easy task.
Lack of IVF professionals
The lack of professionals qualified to perform the fertility procedure is one reason, Castillo said. The Doctors Association, the official licensing entity in Costa Rica, includes just 16 fertility specialists. Castillo said most stopped practicing IVF when the Supreme Court banned the fertility treatment in 2000.
He also noted that IVF requires the involvement of other professionals, including microbiologists, lab technicians and nurses, who need special training in human reproduction that currently is not available at Costa Rican universities.
Couples wishing to undergo an IVF procedure here must meet a series of requirements outlined in the government’s decree. Primarily, they must be over 18, have an authorized infertility diagnosis and have a doctor’s certificate stating that the patient is unable to overcome infertility problem by using another technique or procedure.
Castillo believes interest in offering IVF will likely increase as the number of qualified professionals begins to grow. He said local clinics and hospitals could also form alliances with international health care firms that could help them lower the required investment.
According to the Centro Fecundar clinic website, the basic cost of undergoing an IVF cycle is around $7,000, including consultations and medications. Add another $8,000 if a couple needs an egg donor and around $500 for a sperm donor.
By comparison, the average cost of an IVF cycle in the U.S. is $12,400, according to the American Society for Reproductive Medicine.
The clinic states that its success rate is 47 percent when transferring two embryos obtained from the patient’s own eggs. The odds increase to 65 percent with embryos come from donated eggs.
IVF at public hospitals
The government’s decree granted the Social Security System, or Caja, a two-year period to implement IVF procedures at public hospitals.
Caja Executive President María del Rocío Sáenz Madrigal said that’s the minimum amount of time needed to build and equip the future National IVF Center, and to train all required staff to perform the procedures.
Preliminary estimates indicate that each basic cycle would cost Caja about ₡1 million (some $1,800).
Sáenz has said that IVF will be the last resort for infertile couples; Caja’s protocols state that couples must first try other fertility treatments.
According to data from the Caja, some 15 percent of Costa Rica’s population, equivalent to some 730,000 people, face some kind of infertility problem. Of these, only 15 percent would likely require IVF to have children, according to the Caja.
The government’s decree allows transferring a maximum of two fertilized eggs. Any additional eggs extracted during the process must be frozen and may not be sold or discarded.