Deciding to start a family is a thrilling decision filled with happiness and dreams of the future, but adding a bundle of joy to the family doesn’t come easy for everyone. Having a baby can require medical intervention in some cases, with some people risking all they have or taking out a personal loan to make their family plans come true.
Couples today face a slew of obstacles standing in the way of conceiving naturally, including male infertility, polycystic ovary syndrome (PCOS), endometriosis, prior surgeries and cancer diagnoses. Age is also a factor, as 50% of millennials delay starting a family to do things like pursue careers, focus on education and build financial stability.
However, insurance carriers don’t cover expenses unless there’s a proven fertility problem. Almost all of the couples seeking fertility preservation, or single mothers by choice, carry the financial burden of fertility treatments entirely by themselves.
Same sex couples also face unique challenges in their quest to bring new life into the world. Some LGBT families deal with medical infertility on top of the situational infertility that comes with being in a same sex couple. Transgender adults, for instance, risk permanently losing their fertility after starting hormone therapy or transitioning. As a solution, some couples consider alternatives to LGBT fertility clinics, such as adoption or surrogacy, to begin their family.
Fertility implications from radiation therapy, chemotherapy and surgery may also be serious considerations for some families looking to conceive. According to the latest data from World Cancer Research Fund International, there were over 17 million new cancer diagnoses in 2018 alone.
A sudden cancer diagnosis can bring up discussions for future fertility and family planning. Some families turn to egg or sperm preservation prior to starting their cancer treatment. Aggressive cancers requiring treatment right away and can leave families gasping for air as they come to grips with the diagnosis and make decisions on ensuring their ability to conceive without breaking the bank.
What to expect
More than 85,000 people seek fertility treatments annually. Many of them struggle financially to afford treatment, and some give up on having a family completely due to the price tag. In Florida, for example, Jan and Glenda Knight* (names have been changed to protect their identities) are a lesbian couple who used intrauterine insemination (IUI) to conceive their baby boy. They were taken by surprise by the cost of sperm vials.
“For an IUI, [it] was only a few hundred. The sperm was the expensive part though. Depending on the cryobank, one single-use [sperm vial] can average to about $1,000 per month for only 0.5 milliliters! That’s basically like a drop of water,” said Jan.
Knowing the different treatment options available and the costs can help you decide your best course of action. Jan said it’s important to do your research beforehand because both she and her partner felt doctors “sort of just expected you to know everything and what your plan was to have a baby” when they were going through the process.
Average cost of infertility treatment
Some of the more common infertility treatments and their average costs include:
- Consultation — $200 to $400
- Medications — $3,000 to $5,000
- PDG genetic testing — $3,000 to $6,000
- IUI insemination — $300 to $1,000
- IVF — $12,000+
- Egg preservation — $8,000+
- Surrogacy — $90,000+
- Injectable fertility drugs — $2,750
Some in vitro fertilization (IVF) clinics have money back guarantees ranging from 70% to 100% refunds for unsuccessful treatments or unused cycles. Others offer discounted multi-cycle programs to make repeated attempts more budget friendly. Ultimately, refund programs are designed for younger people with higher chances of success.
Eligibility requirements usually include:
- Age limitations
- Minimum number of IVF cycle attempts
- Body mass index (BMI) restrictions
- Blood level requirements
If you’ve already undergone several failed IVF cycles and would like to try again, you may not be eligible to participate in the refund program. Some programs also have restrictions on refunds after a miscarriage.
The expense of fertility treatments leads many couples consider alternatives like adoption, which is a chance to add to the family while also giving a loving home to a child in need. Many are caught by surprise at the average $20,000 to $40,000 cost attached to private adoptions in America, and the $20,000 to $50,000 price tag for international adoptions. In contrast, adopting from foster care runs between $0 and $2,500.
Any type of adoption process can be fraught with parenting challenges, frustrations and risks, but people who successfully adopt a child are the first to say it was worth every penny and every struggle to have their child in their lives.
Dealing with the implications of infertility is devastating for some. Linda Mata* (the name has been changed to protect her identity), a soon-to-be mom in south Florida, is currently pregnant with her first child and said it took over two years to conceive.
“It was taking an emotional toll on us, but I kept reminding myself, when the right time comes, it’ll happen,” she said.
Mata said that the possibility of needing fertility treatments is tough for many couples to accept.
“I avoided going to the doctors about it because I was worried there was something wrong with me, and I didn’t want to face it,” Mata said.
Fortunately, the stigma associated with fertility treatments is vanishing as the number of people seeking treatments increases. According to a Marketdata report, the infertility services market is up 21% from 2016 and has a forecasted average annual revenue growths of 7% through 2023. The U.S. market for fertility drugs is also growing at 6% annually and is presently worth $600 to $700 million.
The explosive growth is likely due to an increasing number of millennials choosing to put off having children until they are in their 30s. They are waiting to be in a better position personally, professionally and financially to give their offspring the best chances in life.
As businesses recognize their employees’ desires to delay having children, companies like Apple, Facebook and Google are offering egg freezing as an employee perk to cater to women choosing to delay pregnancy to focus on other pursuits.
With more women looking to preserve their future fertility, investors are hearing the cash registers ring to signal the sound of an untapped market, and they may be right. Marketdata’s report states 75% of potential clients don’t use infertility services.
Private equity firms and venture capitalists are hoping to stake their claim on the market by persuading women in their 20s to take proactive steps to ensure their future fertility. To raise awareness and increase accessibility, they’re plunking millions into national fertility clinics, frozen egg banks and fertility assessment products. Female-focused health startups received $392 million in funding capital in 2019 alone, which is almost four times the amount from just six years ago. Some startups are using the money to develop fertility products like tests to show women in their 20s and 30s where their fertility stands.
Evaluating the cost
Fertility treatments are time sensitive. A woman’s greatest reproductive years occur in her 20s, with gradual declines in her early 30s and significant decreases every year after 35. A 35-year-old woman undergoing IVF has a 39.6% chance of conceiving while a woman over 40 has an 11.5% chance. Success rates improve as technologies advance, but most people feel that waiting until they’ve saved up enough money isn’t an option.
Does my insurance cover this?
The vast majority of states don’t have infertility insurance coverage laws. Of the 18 states that do, only half mandate insurance coverage for fertility preservation resulting from iatrogenic, or medically-induced, infertility. These states include California, Connecticut, Delaware, Illinois, Maryland, New Hampshire, New Jersey, New York and Rhode Island.
Elective fertility preservation procedures like egg and sperm freezing are rarely, if ever, covered — unless there’s a medical diagnosis that jeopardizes future ability to conceive.
States like California and Louisiana also explicitly exclude IVF coverage. Others like Montana, Ohio, Utah and West Virginia have restrictions on infertility services or fail to define the scope of services qualifying for coverage.
The map below gives a quick overview of coverage in all states with mandated fertility insurance coverage. For a complete list of laws, refer to the American Society for Reproductive Medicine’s patient education website, ReproductiveFacts.org.
If you live in a state with coverage laws for infertility and have health insurance through your employer, check with human resources to determine whether your plan is fully insured or self-insured. Only fully insured plans are required to follow state law. Your company size, where your employer’s policy was written and other factors could affect whether your insurance carrier is required to comply with state infertility coverage laws.
Always verify with your health insurance provider directly to make sure the type of fertility treatment you’re seeking is covered under your plan. You can speak with the billing department and request a copy of your explanation of benefits (EOB) to review what you’re entitled to. Some other questions to consider asking are:
- Is fertility testing covered, and what types are covered?
- How many cycles of infertility treatment are covered?
- What coverage do I have for surrogacy and adoption?
- Are there any age restrictions on fertility testing or treatment?
- What are my coverage limitations when it comes to infertility treatments?
- Is coverage any different for same-sex couples or single parents by choice?
Special insurance considerations for same-sex couples and single parents by choice
Those with situational infertility are hit especially hard by insurance limitations. Jan and her partner said the best thing to do was “put money aside before starting or look into payment plans because insurance doesn’t cover much, if at all, for some people.”
While health insurance providers offering infertility benefits can’t withhold coverage for services because of sexual orientation or gender identity, many have rules in place stating there must be an infertility diagnosis to qualify. Insurance providers won’t cover purchasing sperm, and very few policies pay for surrogacy. As with heterosexual couples, elective fertility preservation is generally not covered.
The majority of adults with situational infertility presently have limited choices for a biological child, but the future looks promising. Some employers are stepping in as they recognize the coverage gap and are looking for better insurance plans and alternative solutions to offer all their employees.
How to cover out-of-pocket costs
Since insurance may only partially cover expenses, and coverage may depend on your plan and the services needed, many people look into other options to pay for treatments and procedures. The table below lists popular financing options and their benefits and considerations.
|Credit card||Many cards offer 0% intro APR for specific period. –
Can earn points, miles or cash back rewards, depending on the credit card.
Cards geared toward fertility treatments and adoption offer higher credit limits.
|Standard purchase APR applies to remaining balance after intro period.
Standard APRs for credit cards are significantly higher than personal loans.
Credit limits may not be high enough to finance entire treatment.
High debt-to-credit ratio can negatively impact credit scores.
|Personal loan||Interest rates are fixed and are lower than many other financing options.
Can refinance in the future for better rates or repayment terms.
Lending limits are often $50,000 or more.
May have a cosigner for better rates or approval.
No restrictions on use of borrowed funds.
Approval times as little as one day.
|Hard credit pull may temporarily lower credit scores.
Some lenders charge percentage-based loan origination fees.
|Home equity loan||Can get lower APRs since home is used as collateral.
May qualify even with bad credit.
Can draw money only as needed.
|Risk losing home if can’t pay make payments.
Must pay closing costs on loan.
May have high upfront fees.
|HSA/FSA||Uses pretax money to pay for fertility treatment expenses.
Most health insurers offer HSAs or FSAs.
Putting money in HSA or FSA reduces your taxable income.
Uses your cash to pay for treatments so no worries about paying back.
|– Only an option if fertility treatment costs are an eligible expense. – Accounts have annual contribution limits and are most likely not enough to fund entire treatment.|
|Retirement savings/401(k)||Can withdraw all contributions to the account.
Qualified distributions from traditional IRA can be taken without penalty.
|Borrowed funds don’t enjoy market growth rates.
May owe early withdrawal penalties and fees.
Money taken from 401(k) must be returned within five years or immediately if you leave your job.
Organizations that can help
Several organizations also offer funds to make fertility treatments more affordable. Many are open to all permanent U.S. residents and are not location-dependent.
|Organization||What’s Offered||Eligibility||State Available|
|Baby Quest Foundation||Funds a range of procedures including egg and sperm donation, egg freezing, artificial insemination, in vitro fertilization, embryo donation, and gestational surrogacy.||Open to all genders, singles, same-sex couples and all who are permanent residents of the U.S.||All|
|The Tinina Q. Cade Foundation||Helps with costs medical infertility treatments and domestic adoption.||Open to all; applicants must have a diagnosis of infertility from their doctor and must be legal, permanent U.S. residents.||All|
|Cleveland Clinic||Offers emergency and other medically necessary hospital-level services free of charge.||Currently an eligible recipient of the General Assistance or the Disability Assistance Programs and income is at or below 100% of the Federal Poverty Guidelines.||OH, FL, NV|
|The Fertility Foundation of Texas||Gives one time grants to qualifying uninsured infertility patients of up to $10,000 toward embryology services, laboratory services, medications and hospital or facility fees.||Must be a Central Texas resident.||TX|
|The Hope for Fertility Foundation||Awards grants of up to $5,000 to be used toward a variety of treatments like IUI, IVF, embryo adoption and cryopreservation.||Available to couples who are married, are legal residents of the United States and have been officially diagnosed with infertility by a medical professional.||All|
|Parental Hope Family Grant||Has an IVF grant and frozen embryo transfer grant covering the full cost of treatment.||Open to all; at least one applicant must have an infertility diagnosis. Grant requirements also dictate all medical services must be conducted at the Institute for Reproductive Health in Cincinnati, Ohio.||All|
The bottom line
While a large segment of people seeking fertility treatments are struggling to conceive, a growing portion of women are choosing fertility treatments to keep their future options open. Millennial women are holding off on having children in their 20s and early 30s to achieve their goals and build a stable home. Investors and venture capitalists are recognizing the opportunity and are making fertility treatments more accessible to the public.
Health insurers and policymakers, on the other hand, have been slow to join the trend. Only a handful of states have infertility insurance coverage laws, and mandates vary vastly by state. People with situational infertility like LGBT couples or single moms by choice, or who undergo elective fertility treatments for reasons other than a medical necessity, have to pay for costly fertility procedures and treatments out of pocket.
While fertility treatments can total tens of thousands of dollars, financing choices offer affordable opportunities. Personal loans, for instance, have lower interest rates than credit cards, don’t require your home as collateral and have no restrictions on how funds are used. Several organizations also offer fertility grants for anyone struggling with infertility but are unable to afford treatments.
Together, financing and grants options can be just what’s needed to make your current or future dream of conceiving come true without risking your financial stability and well-being.