When your friend mentions that he and his wife have cut back on eating out, and stopped buying new clothes – do you assume it’s because they are saving up for a home down payment? Maybe a tropical vacation? Or for infertility treatments?
Infertility treatments have a lot of financial implications, combined with a race against time. Most private insurance does not cover the treatments, and the difficulties increase with age, leaving a couple dealing with infertility in a bind. The average cost of one cycle of in vitro fertilization (IVF), the most common type of assisted reproductive technology, is currently around $12,000, and the success rate per cycle is about 30 percent.
“Few people understand the overwhelming costs of fertility treatments. We spent over $70,000 on treatments and we were 100 percent out of pocket,” said Candace Fox, 34, from Virginia Beach.
“When it came time to actually have treatments, they ended up going on a credit card. I’m ashamed to say that, but there just was not enough money left over each month after paying bills and everything to be able to afford expensive medicines and treatments on top of it,” says Anne Nowinski, 31, from Virginia Beach.
When it comes to infertility and money, nearly all the choices are tough. Adding to that is the perception that infertility is a “cosmetic” condition and infertile couples should bear the heavy costs themselves since it’s “their choice.” The World Health Organization defines infertility as a disease, based on the fact that one of the major bodily systems is not working.
Lee Rubin Collins, a RESOLVE board member, feels that “being involuntarily childless can fundamentally alter the course of one’s life.”
“To me, the question boils down to this: ‘What is important?’ Some people may not think that having children, that creating and raising families is important. But we, people who deeply wish to have children and who have a medical problem that prevents it, we believe that being able to have children is monumentally important. A social worker around here used to say that if everyone eventually got heart disease or cancer, it would be tragic. But if everyone got our disease, the human race would end,” Collins said.
Uncovered
Why don’t insurance companies cover infertility treatment? While they do cover the tests to determine infertility, coverage ends there, unless the state requires it (15 of them do.) The federal government insurance plans (including the Department of Defense, Veterans Administration, Medicaid and Federal Employee Plan) do not cover IVF. Self-insured employers (about 50 percent of U.S. companies) can dictate types of coverage for their employees.
“About 30% of self-insured plans cover infertility, and the main reason they do offer coverage is because employees asked for it,” says Barbara Collura, President/CEO of RESOLVE: The National Infertility Association.
“With fully-insured plans, insurance companies are reluctant to offer an infertility benefit as a routine part of their insurance plans because they believe it is a costly benefit with high risk. Our field in general has done a poor job of providing information and data to insurance carriers on benefit design that reduces costs and risk, but provides with healthy outcomes for mom and baby. We believe it is possible to do all those things, but we need better data and information to convey that,” she says
RESOLVE works to encourage lawmakers and insurers to cover infertility treatment because they “believe that couples should not have to spend their life savings, second mortgage their home, or incur thousands of dollars of debt to treat a disease and to fulfill a fundamental aspect of life the desire to bear children and raise a family. Decisions made during infertility treatments must be strictly medical decisions…”
In the meantime, couples dealing with infertility make a lot of personal sacrifices.
“For years, we’ve operated on a strict budget. For dinner, it was more spaghetti and less grilling a steak on the grill. We haven’t had a vacation since 2009. My first cycle cost roughly $20,000 and then $5,000 on medication,” says Fox.
Besides the actual costs of treatment, there are prenatal vitamins ($200 a year) and supplements. There are ovulation tests, and then many hopeful pregnancy tests (about $8 each.) Alternative treatments include acupuncture ($100 a session) and yoga classes (around $15 a class).
“I also went natural with my approach. I spent money on guided meditations, essential oils, good luck charms and cleansing rituals. Each failed cycle I was willing to try one more thing I’d heard of being necessary for success,” says Fox.
Travel expenses and time off of work are another factor.
“My clinic was two hours away so I was often away for five hours at a time driving there and back—that was a lot of gas money. During a full cycle, I drove back and forth 10 times,” Fox says.
Fundraising so you can raise a baby?
“After that cycle failed, I found a multi-cycle program. That cost around $25,000 and then the medications for each cycle being separate,” says Fox.
Multi-cycle programs are part of the numerous options offered by fertility clinics, with “shared risk” programs that offer refunds for self-pay patients. An example would be six in vitro fertilization cycles, with a 100-percent refund unless you have a live born baby. Many clinics have financing programs to help with the costs.
Although this guarantee helps with the financial risk, “no one wants the money back.”
Private foundations offer grant applications for infertility treatments, and video contests where potential parents submit their reasons for wanting to have a baby.
Online fundraising for medical expenses is becoming more common. There a number of sites for medical fundraising, as well as in-person events to help with expenses.
Other options include moving to a state with insurance (but the coverage required varies), deducting the costs on your taxes, using a flexible spending medical account or enrolling in a clinical trial.
Costs for Society
Having genetically-related offspring rather than adopted ones, is part of the crux of the arguments against universal insurance coverage. The argument against it is that adoption is a more desirable good for society, and that having a genetically-related child is not quantifiably better for the cost.
Infertility advocates argue that adoption has just as many moral and ethical considerations against as for. Adoption is also time-consuming (placement time ranges from 14 to 28 months) and expensive (between $20,000 and $40,000 for counseling, medical care and agency fees.)
The high costs of infertility treatment also creates a disparity in who can have children. People who have lower incomes (or who can’t subsidize the costs at that time in their life) experience infertility at the same rate, but they are much less likely to be able to have a child due to cost. Infertility affects up to 15 percent of reproductive-aged couples worldwide.
“Very few people truly understand infertility unless they have experienced it. We are sympathetic to cancer patients even if we haven’t had cancer, but we are still too often dismissive of infertility patients. I cannot explain the difference,” Collins says.
