The Infertile's Guide to the Cost of Building a Family
If I asked a parent how much their children are worth, I'm sure I would hear one thing over and over. People will tell you children are priceless. I am likely to believe their assessment, since I yearn to become a mother. But, in the world of infertility, the dirty reality is children come with price tags. The truly heartbreaking part is that so many people are priced out of the market. I know money is one of those things that isn't polite to talk about, but that's one of the big problems. We don't talk about the realities of family building because it makes us uncomfortable. But, everyone needs to understand these implications and what they mean for the average infertile couple. People outside of the infertility bubble need to understand that infertile couples are doing a balancing act and cost-benefit analysis in order to have a shot at building a family.
Everyone knows I'm no math teacher ( I leave that in the expert hands of my husband), but I can balance a checkbook. So, follow along as I take you through the basic math of infertility.
The Warm Up
When I was diagnosed with PCOS (polycystic ovarian syndrome) more than two years ago, I had several tests done to confirm the diagnosis. Luckily, most of mine were covered by insurance. However, even with good insurance, I spent nearly $2,000 on diagnostics and out-patient surgery out of pocket. That's before the word infertility ever appeared on my chart.
The Shallow End
Dr. S talked to me about the progressions of treatment and the odds that accompany them back when we started on this journey. The general population of healthy women has about a 10% shot of getting pregnant in any given month, if all the circumstances are perfect. Thinking about that blows my mind. Getting pregnant really is miraculous.
When you start adding fertility drugs to the equation, a woman with my issue usually has about the same odds as a healthy woman of getting pregnant any given month. Here's the difference: a healthy woman spends nothing to get pregnant; an infertile woman spends roughly $10-$50 on basic oral fertility meds. Additionally, there are blood tests to confirm ovulation, and ultrasounds to confirm follicle growth. If you're lucky, you're insurance might pay for these. If you're not, you're out another $200-$1000 per month. If you actually need to see your supervising doctor, don't forget the co-pay for the visit.
The math says your odds of any one treatment working typically max out around 3 tries. In a case like oral meds, sometimes doctors are willing to try longer because it is less burdensome financially for couples. However, eventually you will outgrow your OBGYN and move on to the Reproductive Endocrinologist. Don't pass go, don't collect $200. But make sure you're ready to pay the specialists co-pay.
Taking Off The Life Preserver
The next line is more oral drugs and inter-uterine insemination (IUI). The doctor will likely add in a "trigger" shot injection (Dr. M never did... but Dr. D is on board). The injection may or may not be covered by insurance and will run around $100 if not. However, this time, MOST insurance stops helping with the actual treatment since it's not "natural." Now, add additional ultrasounds as well as the actual procedure. All told, the procedure typically ranges from $400- $2000, depending on the doctor's office. We're lucky. In NC, we have quite a few clinics, which seems to keep the price down. For us, the basic procedure was between $500-$650 per try.
Keep in mind, we're still on the "cheap" and "affordable" infertility options. This is the shallow end of the family building pool where Jeremy and I have spent out time. Dr. D has bigger plans, so I have been figuring out where we go next.
Getting in Over Your Head
Injectable drugs paired with IUI seem to be the next logical step. Dr. D agrees. This time, the drugs cost more than the procedure. Every woman is different, so dosing is different in every case, but the drugs alone typically cost between $1000-$4000 per month. You also have to be taught how to inject the drugs, so that will cost an extra $100-200 to learn to give yourself subcutaneous injections. Fun fun fun. Then, add the procedure on top of that, as well as 3-4 ultrasounds and follow ups. In order to have the best results, you need to try three of these with about a 20% success rate per month. Want to know what's even more fun? My insurance company refuses to tell what, if anything, they will cover until I have the prior authorization paperwork from the doctor. Talk about a maddening half hour on the phone.
Jumping Off the High Dive (with your eyes wide open)
When you graduate to the highest of the high end, the numbers look like we're buying a brand new compact car. In-vitro fertilization, which is typically not covered unless you are lucky enough to live in a handful of states which require IVF coverage, is the next step. The good news is women in my age range with the same clinical levels I have typically have the best results with IVF, with my clinic's success rate in this bracket typically around 70% on an average year. The bad news is, it's the kind of expense that you really have to think through before jumping in.
Here's the price breakdown at my clinic, which is pretty typical of US clinics:
Monitoring and related services $1400
Retrieval and related services $8200
Prep of Embryo(s) $4800
ICSI (if needed) $1900-$2700
Procedure Total: $16,800- $17,600
Now, my clinic is nice and offers a self-pay discount of 40% off most of the services. As such, the self pay total is $9,100- $10,200. However, you have to add the drugs on to the total per month, which adds an extra $3000-$6000 per cycle. All of this is due before you begin the cycle.
Maybe the Low Dive this Time
Finally, if you are lucky enough to produce more than 2 embryos for IVF transfer, you will need to pay $1500 to store those embryos until you might need them. If you happen not to get pregnant from the IVF cycle and you have stored embryos, then you can elect to try a frozen embryo transfer, with a success rate close to that of typical IVF, for roughly $4000, or discounted to $2500 at my clinic. Not any many drugs this time, so the drug cost will probably be relatively low ( a few hundred dollars.)
So, people really do this?
Like I said earlier, I'm no math teacher, but I will tell you that $16,000 is a huge chunk of our family income. In fact, when you figure out how much we bring home after taxes, one IVF cycle will cost more than 25% of our combined annual salary. In the past two years, we're approaching $10,000 on the quest to have a child. Adding it all up, it's just insane. And, in order to give us the best odd of being successful with IVF, we should plan to try it three times. So, multiply that by 3. Yep. $48,000.
So, how is the average couple supposed to do it? The short answer, I suppose, is they're not. And, since my husband and I are both teachers, that puts us squarely in the middle of average people. Some folks have fundraisers or sell their handcrafted wares to make money toward fertility treatments. While I think these are great venues for people to raise funds to become parents, I don't have any particular skill in the crafty department and I would just feel bad asking people to give me money when I know so many other people need funds for a myriad of other things. What do the clinics suggest? Credit cards and bank loans are the two big solutions. So, on top of the huge cost, you can add an additional interest rate. Maybe the baby can be paid off before it goes to college.
I don't want you to feel sorry for me. I know what I am getting myself into. But, when we as a country make decisions about priorities, I want you to remember your infertile friend over here. Jeremy and I are going to tighten our purse strings and weigh all of our options before we rush into anything. Jeremy always says we'll figure it out, and we always do. But, when healthcare law is being passed, and folks are quick to make decisions about women's health, I think we should ask them to pause and really think about whether or not IVF, for an infertile couple, is truly an elective procedure. When there are no more options for having a child, when you've tried as hard as you can, it's the only solution left. Why is it viewed in the same light as cosmetic surgery?
I know some of you will scream ADOPT and that is a solution to the problem of childlessness (mind you, not a cure for infertility). So, I started to look at adoption as an option in lieu of IVF. Domestic adoptions are, on average, roughly $20,000. International adoptions start in that range and go up to around $60,000. But, you'll say, you're guaranteed a baby.
Not exactly. But, that's for another post.
Long story short, there is no affordable solution to infertility. There's costly and ridiculously expensive. But at the end of the day, if I end up with a baby in my arms, I know it will be a distant memory. So, parents, when you tuck your little one in tonight and you think about how much they're worth to you, imagine how the infertile down the block feels, knowing that the priceless child they dream of just might be out of their price range.