Starting a family often comes with big financial changes: Among couples in their 30s, 27% pointed to having a child as a recent financial milestone, according to a 2018 Ameriprise survey. And for the 1 in 8 couples in the U.S. who struggle with infertility, the costs can be especially steep.
Each cycle of in vitro fertilization, or IVF — one of the most popular fertility treatments, in which an egg is fertilized with sperm in a laboratory and then implanted in the uterus — costs an average of $12,000 to $17,000, according to the University of Iowa Stead Family Children's Hospital. For some couples, it can take multiple cycles to get pregnant, if they're successful at all.
The journey to parenthood is even more challenging and expensive now, during the coronavirus pandemic. With many doctors' offices and clinics closed under state stay-at-home orders, patients may find they must delay procedures, or pause midtreatment. The delay can add thousands of dollars to their bill and it may also reduce some couples' chance of having a biological child.
"It's been devastating at a lot of different levels," says fertility finance coach Devon Baeza. "What I'm hearing underlying the complaints about the money they spent is, the hope they have is diminishing."
Use this time while you're home during the pandemic to improve your physical and financial health, she advises, "so you can hit the ground running when clinics open." Many doctors are still taking phone calls, so you might be able to get a free phone consultation, compare prices, and negotiate.
"Now is the best time to go in and say, 'Hey, what can you do for me?'" Baeza says.
She and other experts say you don't need to be daunted by the potential costs. "I don't want people to give up, thinking that they're not making six figures so they just can't have a family, and that's the end of it," says Baeza, 35, who spent more than $30,000 on her own fertility treatments during her 20s. She suggests that coming up with the money for these treatments is possible but it requires you to explore all of your options.
"You can't let money be what stops you from motherhood," Baeza says. "If you're determined, there's absolutely a way."
Here's a look at how fertility treatments can change the cost of having a baby, and some expert-recommended options for navigating the financial toll.
It can be hard to determine what kind of costs you may face, if any, related to infertility. That will depend largely on the root cause of infertility, your insurance coverage, any of the drugs or procedures to treat that cause, and how your body responds to treatment.
"From a financial planning standpoint, you have to stop and understand what is going to be enough, financially," says Carolyn McClanahan, a physician-turned-financial advisor who serves as the director of financial planning for Life Planning Partners in Jacksonville, Florida. "Having a baby that takes, let's say, three IVF cycles, could very well be over $20,000 per cycle."
Medical professionals define infertility as not being able to get pregnant after one year of trying, or six months if a woman is 35 or older, according to womenshealth.gov.
But infertility can affect both men and women and can happen for a variety of reasons including lifestyle and age, explains McClanahan. That can lead to a wide range of treatment options — and costs.
"It could be something as simple as losing or gaining weight, or there's a blockage preventing the eggs from getting to where they need to be," says McClanahan. "I tell people not to stress out until they know the problem, because sometimes it can be a simple fix."
Complicating matters, insurance coverage for fertility treatments isn't a given. In 2019, 19% of employers offered IVF coverage as part of their healthcare benefits, down from 26% who did so in 2017, according to a Society for Human Resource Management survey of 2,763 HR professionals.
Coverage has been expanding. A total of 16 states — Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia — have passed laws in recent years that require insurers to either cover or offer coverage for an additional cost for infertility diagnosis and treatment.
In general, there are ways to bring down the costs and save up to cover them.
Baeza says she wasn't prepared at first for the kind of financial undertaking IVF would be.
"I vividly remember the moment I was sitting in my doctor's huge office, and it was like half the size of my house and I'm staring at her giant diamond ring and listening to her say, 'Yes, the only option left is IVF,'" says Baeza. "And I asked, 'What does that cost?' and she said, 'You know, around $20,000,' and I thought, 'I'm gonna have to win the lottery.'"
At that point, Baeza says, she and her husband Larry were juggling student loan debt, car payments, and a mortgage — and they had already depleted their savings trying other fertility treatments. "It was impossible. We were totally broke," she says.
Yet Baeza describes this moment as one where she "turned her desperation into determination."
To come up with the cash, she scrutinized every expense, selling her home for a tiny, cheap apartment and cutting out expenses like dining out. She made every effort to earn more, too. She banked money from every raise in her job as a salon manager and eventually went into business for herself.
"It's really kind of a challenge because you're not looking to cut in one area, you're looking to cut in every single area," says Baeza. "It can feel overwhelming, but you need to really go through your entire budget and know where every single dollar is going and see what you can do to trim."
Three years and $30,000 later, Baeza successfully got pregnant.
Arielle Spiegel, founder and CEO of CoFertility, a platform dedicated to providing information about fertility health, treatment, and options to families who are struggling with infertility, says it's important to also figure out what you're entitled to, and learn to be your own advocate.
Spiegel, 31, says personal experience motivated her to start her business. She started her fertility journey in 2017 at age 28, and estimates she spent about $70,000 over two years of active fertility treatments.
"I don't think anyone who starts off on this journey really thinks that they're going to have trouble getting pregnant," says Spiegel. Undergoing IVF treatments was never part of her plan, but she and her husband decided the process was worth the time and money.
She describes spending countless hours on the phone with her insurance provider to get answers about her coverage, and combing through her employer's insurance plan to figure out if they provided some sort of coverage, which they did.
Still, Spiegel says constantly wrestling with her insurance company and making do with less was worth it. "It meant living in a less nice apartment or going out for fewer nice dinners or maybe holding back on a vacation or two, but we've always been on the same page that this is our top priority. Building our family was the top priority."
In October of 2019, Spiegel found out that she was expecting. She has continued to work with families who are still on their journey.
"At the end of the day, the benefit [of IVF] outweighed the risk for me," says Spiegel. "Despite the tens of thousands of dollars, it was worth it if it helped me — It helped bring me closer to my child."
Before you start trying to have a baby, McClanahan, Spiegel, and Baeza agree, it's smart to examine your budget and weigh your financial priorities.
Start adding to your emergency fund, for example. "If you're thinking about having a baby, whether you're having fertility issues or not, you should be putting money aside, because babies are going to cost money," says McClanahan.
The average out-of-pocket costs of childbirth and maternal care among women with employer health insurance increased 49%, from $3,069 to $4,569 from 2008 to 2015, the latest year for which statistics were available, according to a study published last week in the journal Health Affairs.
Raising the baby through its first year can tack on an extra $12,000 to the bill, according Parenting.com.
The staggering costs make it essential to explore every avenue, from your doctor's office to your insurance provider, to make sure you're getting all the financial assistance you're eligible for. "The most important people to talk to are your insurance company, your reproductive endocrinologist, and the finance department of your doctor's office," says Baeza.
Here are five of the avenues to explore:
- Insurance. "Finding out what is covered by insurance is a great first step, so I would question your insurance company about more than just IVF: Ask them about labs, ultrasounds, and medications," says Baeza. "Things like that are worth knowing because those costs can add up." Look into state mandates related to fertility coverage, too, Spiegel says. Understanding your coverage options is important, especially when you're selecting an insurance plan at open enrollment.
- Employer benefits. Check to see if your company offers any kind of financial assistance outside of insurance coverage. Companies like Starbucks, Bank of America, and Intel have all started offering fertility benefits under their employee benefits plans. Starbucks, for instance, offers a $20,000 IVF benefit to all employees — even its part-time baristas. Plus, employees who want to adopt can receive up to $10,000. "Take a step back and figure out what you're entitled to," says Spiegel. "Really carve out the time."
- Doctors' offices. "When treatments are covered by insurance companies, they have pretty set prices on how much it will cost," says McClanahan. "But when the insurance doesn't cover it, there's room to negotiate the cost." Oftentimes, clinics will offer financing plans for treatment costs. If the price still isn't manageable, it can't hurt to shop around and try to find a clinic with more affordable options.
- Financial aid. Grants and scholarships for fertility treatments are also on the rise. The National Infertility Organization, better known as Resolve, offers grants and scholarships for families seeking to cover the costs of infertility treatments. And CoFertility has a "Find a Grant" tool with state and national opportunities.
- Trial options. "Talk to your clinic about those free opportunities, whether there's treatment or medication alternatives, or see if your clinic is running any trials or programs or offers any grants," says Spiegel. She also suggests checking with your clinic to see if you qualify for any donated medication.
Finding a community of like-minded people to help you get through, and who can share their stories and tips with you, was also a helpful resource for Spiegel. "It always helps to have people to talk to who are kind of in the same boat, who really understand what you're going through, because your doctor, your insurance provider, and your HR rep, they're all going to talk to you in their own way, but no one is really going to totally understand you, except for somebody who's been in your boat," she says.
Spiegel, Baeza, and McClanahan all agreed that there is no step-by-step instruction manual for battling infertility, but despite this, for a lot of families, the journey is worth the destination.
"Anytime you're infertile, it's going to infringe on your other financial goals," McClanahan says. "You have to decide what's more important to you. There's no wrong answer, but you have to be prepared for whatever the outcome is."
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