If you’ve been trying to get pregnant for a year or more without success, particularly if you’re over 35, your doctor may suggest you explore infertility treatments. Infertility is surprisingly common in the United States. Twelve percent of women ages 15-44 experience trouble getting or staying pregnant according to the CDC. And twelve percent of women will pursue infertility services in order to try to become pregnant.
The types of treatment they pursue are many fold because there are several causes of infertility. About half of infertility in couples is due to problems with women’s reproductive organs, thirty-five percent is due to men’s reproductive organs. An additional five percent are due to uncommon issues. Ten percent of issues remain a mystery to doctors.
Fertility treatment can range from medication to surgery to In Vitro Fertilization (IVF). For women’s reproductive issues, several medications are available, from Clomiphene to encourage egg release to Metphormin for polycystic ovarian syndrome to hormone injections. Surgery may be performed to clear fallopian tube blockages, repair tube damage, or remove tissue growth in the case of endometriosis. IVF is typically pursued only after one or more of the above methods is attempted, unless the mother is of an advanced age, or a doctor believes the treatments are unlikely to be effective, in which case she may be able to pursue IVF earlier in the treatment. Fertility treatment can have side effects as well, which can include headache, nausea, bloating, hot flashes, and blurred vision.
What is most astonishing, however, is the heavy price tag that comes with fertility treatments. The cost of a single round of IVF can cost upwards of $12,000 according to the American Pregnancy Association, and success rates hover between 13 and 43 percent depending on the age of the mother. Unfortunately, these treatments are not commonly covered by American health insurance. Only 60 percent of employers with more than 500 employees cover any kind of infertility benefit, which can be as little as a meeting with an infertility specialist. Just 23 percent cover artificial insemination and 24 percent cover IVF. If you work for a smaller company, your odds of having infertility coverage diminish greatly. Just four percent of companies with 50 or fewer employees had any kind of infertility coverage.
Another way of saying this? Most women pursuing fertility treatment aren’t covered by their insurance, meaning they bear the burden of costs on their own.
Jayne, 40, from Phoenix, AZ knows how expensive treatment can be all too well. “The testing and IUI [intrauterine insemination, often the first step in infertility treatments] were about $2,000. The sperm was $3,600 for 3 vials and shipping. Insurance paid for none of it nor would they count the sperm towards my deductible,” she told me. Not having success with IUI, she’s now exploring egg donation. “The egg donation will be $2,500 per egg (it's the cheapest I could find) from a frozen egg bank. Again no insurance coverage,” she said. She reached out to people to find a donated embryo but didn’t match with anyone. She is now more than 6 months into a waiting list at her doctor’s office for one.
But even with insurance, treatment is still incredibly expensive. Kate, 39, from New York, has tried just about every type of fertility treatment. She’s spent at least $8,000 on medication and her insurance has covered around $30,000 in other treatments. Her insurer has a lifetime cap of $25,000 for IVF. “I'm grateful to have any kind of coverage but as you can probably gather it basically doesn't last long at all,” she told me. “Someone was preparing to start the other day and asked if the injections were the worst part and I said nope, the bills, the insurance, the misinformation, the lack of information. That's the worst. The needles are a breeze comparatively.”
After spending thousands of dollars, neither of these women’s treatments have resulted in a live birth.
The cost of infertility and lack of insurance coverage may also be forcing women into health decisions they wouldn’t otherwise choose. For example, many uninsured women choose to “stack the odds” and have several embryos implanted because they won’t be able to afford another round of IVF. This choice can lead to multiple births - more than 40 percent of IVF births are twins or higher - which can lead to even further higher costs, as multiples often have more health issues like prematurity and low birth weight.
What’s more, IVF insurance coverage increases the chance of a successful live birth. And the sky-high prices are not like this everywhere. Fertility treatments in India cost around $3,000 compared to the U.S.’s $12,000 plus, although experiences vary. The cost is so high that many American patients are seeking treatment abroad. US News reports that for $13,000, one couple flew to Barbados, stayed in a local AirBnb, and had a full round of IVF as well as a vacation.
Christina, 35, from New Jersey, stayed in the U.S. to go through infertility treatment. She and her husband had insurance but still spent $38,000 out of pocket on fertility treatments, IVF and genetic testing. She’s now 36 weeks pregnant. “The entire process of IVF is a roller coaster,” she told me. “We are proud to say we are IVF survivors and will be proud to tell our daughter about the beginning stages of her journey.”
To try and solve the problem, fifteen states, starting with Massachusetts, have gotten involved by mandating that insurers in their marketplace cover infertility benefits, though the requirement varies and many don’t cover IVF. State and federal law may be the only way forward to get insurance coverage for fertility treatment and to help to drive down costs.
For now, women and couples continue to make hard, often expensive decisions about how to begin their families. “I've pretty much given up on my own eggs and am now moving in to the space of donor eggs,” Kate told me. In addition to working toward her own pregnancy, she’s also become active in online infertility communities and tries to spread information about the reality of treatment. “It’s funny to think you spend a lot of your early adult life trying to avoid getting pregnant only to realize how damn hard it is later on.”
Colleen Stinchcombe is a writer living in Phoenix, AZ. She writes for publishers, brands and individuals. Her work can be found on SheKnows.com, Green Living AZ, the Brandless blog, Canadian Pharmacy Blog and elsewhere.
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