Refinery 29 | Erica W. Smith

October 21, 2019 6:00 AM EDT

After Jordan Valley, 30, miscarried twice, she decided she wanted to get informed about her fertility status. After spending one year and $4,000 on testing and ultrasounds, she has a diagnosis — endometriosis, which caused ovarian cysts — but no clear path forward. She’s considering getting surgery to remove the cysts, but because of the risk of damaging her ovaries, she’d like to freeze her eggs first. The problem: her insurance only covers egg freezing as part of an IVF cycle. And even after insurance, IVF is still so expensive that she and her husband plan to continue trying to conceive naturally for a while longer.
“I’m still in this space where I don’t have a lot of clarity on what my game plan should be,” Valley tells Refinery29. “I don’t know if I would do this all over again, spending $4,000 to be in a place where we’re still like, ‘I don’t know, maybe I should do IVF, maybe I shouldn’t.’” A manager at a medical device start-up, Valley has now begun researching how much IVF would cost, but hasn’t been able to get a clear answer from either her insurance provider or local fertility clinics. (She lives in Massachusetts, one of 16 states that requires insurance to at least partially cover IVF.) “Essentially, you don’t really know what the cost is until you commit to it,” she says. “Which I think is really funny, because that’s the opposite of making good parental decisions: Jumping into something without knowing how much you have to spend on it in the first place.”
Many others face a similar decision. According to the CDC, about 12% of women ages 15 to 44 in the United States have difficulty getting pregnant or carrying a pregnancy to term. Navigating the cost of fertility treatments — let alone affording them — can seem near impossible. But informing yourself about the potential costs, your chances of conceiving, and the different financing options available can help you choose your path forward.
According to FertilityIQ, a startup that provides crowd-sourced data about fertility clinics, doctors, and the costs of various fertility treatments, the averages are this: $23,000 per round of in vitro fertilization (IVF); $15,000-$20,000 per egg freezing cycle; $500-$4,000 per intrauterine insemination (IUI) cycle; $20,000-$70,000 for a surrogate, though the total can often exceed $100,000. If these prices sound shocking, consider that most of these options require two to three rounds to be successful, doubling or tripling the final bill. Families have to weigh the financials with the benefits when planning their fertility journeys — IVF is 5-40 times more expensive than IUI, for example, but also 2-10 times more effective.
There’s no doubt that the wealthier you are, the higher your chances of successfully using fertility treatments to conceive and have a live birth. According to FertilityIQ, women with a household income of $100,000 or more are twice as likely to achieve success through IVF than women whose household incomes are less. (The median U.S. household income is $61,937.) FertilityIQ data shows that, while wealthier women can afford more IVF cycles, there are also other unknown factors influencing this disparity. “There’s no question that there’s a clear division between the haves and have-nots when it comes to the ability to access fertility treatments to build your family,” FertilityIQ co-founder Jake Anderson-Bialis tells Refinery29.
While some people, like Valley, have partial insurance coverage for fertility treatments, for the majority of people — 63% — none of their fertility costs are covered by insurance. Those who do have partial (or, rarely, full) coverage find they have to navigate a lot of bureaucratic red tape to access it. Dr. Jennifer Hirshfeld-Cytron of Fertility Centers of Illinois tells Refinery29, “If your claim is rejected, seek a review of the judgement (called an appeal) and fight for your rights. Many claims that are initially rejected can be overturned, simply by requesting the appeal.”
And there may be additional strings attached. Melissa Hobley, chief marketing officer at OKCupid, tells Refinery29 that when she first began fertility treatments — when she was working at a different tech company — she had to complete six rounds of IUI before she was eligible for partial coverage of IVF. Hobley has PCOS and wasn’t ovulating, and her doctors told her that they doubted IUI would work. But she still had to complete those six rounds. “It was really, really difficult,” she shares. “But I was like, ‘If I am going to save $20,000, I have to do this. Okay, let’s just knock these out.’” The process took eight months and necessitated such frequent doctors’ visits that security thought she worked in the building. She also had to take fertility drugs that caused severe anxiety. In the end, she and her doctors were right: the IUI didn’t work. She conceived on her second round of IVF and now has two children.
People who work in tech, like Hobley, are more likely to have insurance cover at least part of their fertility treatments, as are those working in finance, consulting, fashion, and banking. But Hobley points out that companies aren’t offering fertility benefits out of the kindness of their hearts. “Typically, these industries are fighting over the same women,” she says. “They’re under extreme pressure to have more women in their companies, so they’re stepping up and offering better benefits.” OKCupid’s fertility benefits, she says, along with the supportive and inclusive culture, were part of what made her accept the job — and they help her bring in talented new hires, too. While the majority of companies providing benefits like this pay high salaries, not all do: Starbucks, for example, recently announced a lifetime maximum of $30,000 in fertility treatments (including IVF, IUI, and surrogacy) for employees, and 85% of its workforce earns less than $40,000 per year.
But even those whose insurance covers most of the cost of IVF often find themselves faced with heavy bills. Hobley estimates she ended up paying $20,000 out of pocket for her two pregnancies, both conceived on the second round of IVF. And she knows she’s one of the lucky ones. “It’s not like you’re going to get your wisdom teeth out and there’s a chance they won’t get your wisdom teeth,” she says. “This might cost $50,000, and you still might end up without an embryo, without a pregnancy. That’s the other thing people forget, there are no guarantees.”
Fertility costs are so high that some people don’t even consider treatments. Lola Méndez recently turned 30, and she tells Refinery29, “I have family planning on my mind more than ever.” She’s currently traveling full-time and would like to visit a few more countries before she begins a family. She feels “an overwhelming desire to carry my own child” and has looked into egg freezing, but finds “the cost to be astronomical,” she says. “Freezing my eggs isn’t even an option for me financially.” If she’s not able to conceive naturally, Méndez plans to save for adoption rather than pursue fertility treatments — and adoption is often just as, if not more, expensive than IVF. (Some employers offer financial assistance for adoption as a benefit, though the range is wide, anywhere from $500 to $35,000.) According to a survey by Adoptive Families Magazine, the average cost of adoption through a private agency in the United States is $43,000.
As fertility treatments become more common, however, some companies are working to make them more affordable. Kindbody, a fertility clinic startup, keeps costs low by automating much of the process. Patients schedule their appointments online, for example. The company also bundles the process into one cost rather than billing for each individual doctor’s visit and ultrasound. They charge: $6,000 per egg freezing cycle, $12,500 per IVF cycle, $300 for a fertility assessment. “We believe that the future of healthcare looks like value-based pricing,” founder and CEO Gina Bartasi tells Refinery29. “We’ve said, wait a minute, healthcare is broken, the patient experience is poor, costs are higher. How can we make it so that the patient is getting significantly more value for their dollar?”
Kindbody is also one of a growing number of clinics offering no- or low-interest financing. Others include TrellisExtend Fertility, and Shady Grove Fertility. “People who take out loans for fertility treatments pay those loans back historically, and as a result, they’re considered safe people to lend to and the interest rates are reasonably low,” explains FertilityIQ’s Jake Anderson-Bialis. “Read the fine print, but most clinics offer ethical loan products.”
Other people have successfully crowdfunded fertility treatments through GiveForward, YouCaring, IndieGogo, and other such platforms. It’s become so common that GoFundMe even has a page sharing IVF crowdfunding success stories, and regularly highlights “trending” fertility fundraisers. As with other kinds of medical crowdfunding, reading many of these in a row can feel dystopian — why do people have to fundraise just to get healthcare? — but crowdfunding does help people who otherwise couldn’t afford fertility treatments to build the families that they want.
In fact, some states are making it mandatory for large companies to offer fertility benefits. This April, New York passed a law requiring employers providing insurance coverage to 100 or more full-time staffers to cover up to three cycles of IVF. The new law also requires all private insurance companies to cover medically necessary egg freezing, such as for chemotherapy, endometriosis surgery, or gender confirmation procedures. It’ll go into effect in 2020 and is expected to benefit about 2.5 million New Yorkers. Fifteen other states have infertility insurance coverage laws, though the specifics vary.
While New York’s new law is inclusive of same-sex couples, many other states and companies’ policies are not. Often, insurance policies and state mandates require people to “prove” they can’t conceive by having unprotected sex with an opposite-sex partner for a year — meaning that same-sex couples would not be eligible. “It automatically excludes the LGBTQ+ population,” says Dr. Mark Leondires, a reproductive endocrinologist who founded the resource Gay Parents To Be and co-founded of the American Society For Reproductive Medicine’s LGBTQ Special Interest Group. He and his husband have two children, conceived via surrogacy, which they paid for entirely out of pocket. “I thought it was too hard for me — and I know it all — to get over all the hurdles and speed bumps,” he says of navigating the surrogacy process. “When I did it, there were no resources. And I’m a doctor, and my financial situation is different from the vast majority of people who are trying to conceive.”
Some state and local governments, as well as nonprofits and private companies, offer grants or scholarships that help alleviate costs. Many of these programs specifically benefit households who earn under $100,000, while others are designed for those in specific groups, such as LGBTQ+ couples, veterans, and Jewish prospective parents. Dr. Jennifer Hirshfeld-Cytron of Fertility Centers of Illinois points out that patients may also be able to access discounted or free treatment by participating in research studies.
But although some resources exist, they aren’t available to everyone. Dealing with fertility issues is extremely taxing emotionally and, when solutions are out of reach financially for most Americans, it’s normal to feel lost. “I have no idea how women plan for this, or get an understanding of what they’re paying until they are really in it,” Valley says. “By the time you’re sitting in an office saying, ‘I want to do this,’ no matter what the cost is, it’s hard to be realistic and say no.”