The women in the waiting area come from as far as North Carolina and Michigan. Employees usher them into rooms decorated in earth tones. Elevator music plays and the beds are warmed.
The stirrups are the only sign that this isn’t a spa.
CNY Fertility Center is one of the busiest fertility clinics in the country, with four locations in Upstate New York and another soon to open in Atlanta. It’s also among the most affordable.
CNY is part of a small number of fertility clinics that charge a fraction of what other clinics do for in vitro fertilization (IVF). Doctors at these clinics argue that a high-volume, low-cost fertility program can make money, help start new families and open the market to people who otherwise couldn’t afford IVF. Insurance usually doesn’t fully cover these types of procedures.
Cost is a huge issue when it comes to who can access fertility treatments. “Fertility patients want options,” says Jake Anderson, a former venture capital partner who co-founded FertilityIQ, a San Francisco-based website that lets patients evaluate IVF clinics. “For years we thought there had to be trade-offs between price, volume and quality, but maybe we’ve been wrong all along.”
Robert Kiltz, the 62-year-old owner and director of the fertility clinic, says CNY charges $3,900 for one cycle of IVF. That’s about a third of the national average cost.
CNY patients must also pay for medications, monitoring and sometimes a frozen embryo transfer, bringing the total average cost to about $8,000 a cycle. That compares with a U.S. average of $20,700, as calculated by FertilityIQ, which has verified patient reviews of more than 400 fertility clinics. Its data come from more than 10,000 patients who have had IVF performed over the past 18 months.
The more than 190 IVF patients at CNY report a household income of $85,000 a year, compared with $182,000 nationally, according to FertilityIQ. Nearly 20% earn less than $50,000 a year, compared with just 4% nationally.
CNY’s birthrates, as reported to the Society for Assisted Reproductive Technology, a national organization of fertility specialists, are in line with national average by most accounts. In some age groups they are below average.
Dr. Kiltz says CNY has been profitable every year since its 1997 opening. Business has grown roughly 20% to 30% a year in recent years. “I believe we are opening up the market and making it more accessible and affordable to more people who don’t have access where they’re at,” Dr. Kiltz says.
Many outside experts say the clinic’s outcomes are respectable.
“He’s got very effective pregnancy rates for basically half the cost,” says David Adamson, a past president of the American Society for Reproductive Medicine and CEO of ARC Fertility, a national network of fertility clinics.
Dr. Kiltz says patients have few barriers at his clinics. Some clinics restrict fertility treatments if women are obese or too old or have a lot of previous failed cycles. He will take most anyone.
“Who deserves to have a baby? I don’t have any restrictions,” he says.
Not everyone agrees with that philosophy.
“Most fertility centers draw lines around people that they think intervention is futile based on age or hormone measures or other tests that make them say you don’t have the biology to become pregnant,” says Arthur Caplan, head of medical ethics at NYU School of Medicine.
Though there are no age cutoff guidelines for fertility clinics, Dr. Caplan has advocated a limit of 60 for single parents. “You want to protect the child’s best interest,” Dr. Caplan says.
CNY has had one medical malpractice judgment against it in its 20-year history. A couple sued the clinic, Dr. Kiltz and another doctor there for breach of contract, medical malpractice and negligence.
Donald W. Boyajian, the attorney representing the couple, says the suit revolved around the clinic’s failure to screen an egg donor for genetic diseases. The couple had a daughter born with cystic fibrosis six years ago after using an egg donor for IVF at CNY. A jury issued a verdict in 2016 awarding the couple $8.2 million in damages and interest. CNY’s spokesman declined to discuss the case because the verdict is under appeal.
While CNY is among the longest-established low-cost, high-volume clinics, at least two others have similar models. In Colorado, High Quality Affordable fertility centers charges $5,800 for an IVF cycle, or about $9,000 to $10,000 all-included.
In Arizona, Mark Amols says he started an affordable fertility clinic after experiencing firsthand how unaffordable treatments are. He and his wife spent close to $20,000 on fertility treatments 11 years ago. Dr. Paul Magarelli, medical director and CEO of High Quality Affordable centers, helped Dr. Amols when he started New Direction Fertility Centers in Gilbert, Ariz., three years ago.
When he opened in 2015 he decided to charge patients $4,800 for a cycle of IVF, plus the cost of medications. High-volume clinics have more purchasing power and can negotiate better prices for materials and equipment, he says.
CNY patients gave the clinic a 2.5 out of 5 for how frequently they see a doctor, which is a low score, Mr. Anderson says. Dr. Kiltz acknowledges that he may have fewer reproductive endocrinologists on staff than other clinics. Nurse practitioners consult with and monitor women trying to get pregnant. “Some people might not like that model,” he says.
Norbert Gleicher, medical director and chief scientist at the Center for Human Reproduction in Manhattan, says of Dr. Kiltz, “He’s running a very tight ship. He’s doing a ton of cycles with a few physicians. So he’s delegating a lot of stuff to non-physician staff.” (Dr. Gleicher and Dr. Kiltz have no business relationship.)
At Dr. Gleicher’s clinic, three reproductive endocrinologists oversee about 800 IVF cycles a year. Last year CNY had five REs and oversaw roughly 2,500 cycles.
CNY’s flagship Syracuse clinic takes up 20,000 square feet. Most of the clinics also have a spa, called CNY Healing Arts. The spas offer acupuncture, massage and yoga for fertility patients and the general public.
About three years ago the clinic started offering payment plans and in-house financing. More than half of CNY’s patients end up with a one-to-two-year payment plan, for which they are charged a monthly $40 administrative fee.
Dr. Kiltz’s patients give CNY high ratings. It has an average ranking of 9.3 out of 10 with 193 reviews, placing it in the top 5% of clinics nationally, according to FertilityIQ. The average clinic on the site has a 7.4 rating.
Melissa Randazzo, a 32-year-old Michigan resident, paid nearly $25,000 to a local fertility clinic seven years ago to have her now-5-year-old daughter. She knew her family couldn’t afford that again. Through some research she found CNY. After two transfers, she had twin girls, Violet and Izabel, now 8 months old. The Randazzos used a two-year payment plan to pay for the IVF, spending a total of about $7,500, plus $1,000 in travel costs.
Ms. Randazzo, who runs a jewelry business from home, says of Dr. Kiltz, “I know he’s busy and I know he has a million patients, but when he came in the room, it was like we were the only people he was seeing that day.”
—Jim Oberman contributed to this article.
Write to Sumathi Reddy at firstname.lastname@example.org