The Priceless and Expensive Journey of Infertility Treatments

After my struggle with pregnancy issues, I was surprised by how quickly I found out I wasn’t alone. Friends, relatives and co-workers came out of the woodwork to share their own stories — people I’d known for years suddenly telling me a vital part of their journey that I’d never heard.

I also hear some of these whispered conversations when I tell people what I do for a living. “Oh, you’re a financial adviser? Can we go somewhere and talk?” I quickly become their confessor for some very personal parts of their story.

Infertility and finance — two topics we talk about with hushed tones, if at all. But what happens when these two streams come together? The cost of infertility, purely on a financial level, not to mention the emotional burden, is a painful reality made even sharper by its polite secrecy.

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One in eight couples struggle with infertility, according to the CDC. Chances are, someone at your holiday table has been through this expensive and exhausting journey, is in the middle of it or is just getting started. Gatherings centered around new grandbabies and seeing the generations all together can be difficult.

The financial cost of this brutal trial-and-error process is a taboo aspect of a taboo subject and compounds the pain for many families.

The High Price Tag of IVF

Infertility takes many forms and has many treatments, but I want to focus specifically on IVF, or in vitro fertilization, which is one of the more effective and common treatments. As with many medical procedures, the cost of IVF can be deceptive and difficult to account for.

The treatment itself is no small bill, nationally averaging around $12,400, according to the American Society for Reproductive Medicine. This may not seem insurmountable, but look closer. Most couples end up needing two if not three treatments before one “takes,” so that multiplies your bill right away. In addition, other estimates put the price much higher. Data from FertilityIQ peg the cost of one IVF cycle at over $23,400, depending on where you live.

Add to that the cost of time off from work, and even lodging if you don’t live near your clinic, while you undergo medical monitoring and procedures, potentially for many months. That’s a big bill, and an even bigger bill considering you may have to go through it three times. And there’s never a guarantee that IVF will work. It’s not uncommon for an American couple to spend around $50,000 out-of-pocket on their treatment journey.

But We Have Insurance …

This is a dubious comfort to the American mind: Thinking that somewhere in our wallet is an insurance card that will make the scary price tag disappear.

Unfortunately, most IVF patients find themselves footing the bill. Only a handful of states require workplace insurance to cover fertility treatments, and coverage is often limited. Remember, it’s only in the past 30 years or so that insurance covered childbirth at all.

Many insurance companies won’t touch infertility treatments, categorizing them somewhere near voluntary and therefore outside coverage.

In a recent survey of 10,000 infertility patients, 71% said they had no insurance coverage on their treatments and the remaining 29% said they had “some coverage.”

When a couple must use donor eggs or sperm, it becomes more complicated. As one woman described in Self magazine: “My husband’s insurance covers fertility treatments, but only if we were using my eggs and his sperm. Because we had to use donor eggs, they considered it to be voluntary and they wouldn’t cover it.” If the infertility journey is long and complex — as most are — using donors is not unusual.

Infertility was once considered a “niche” issue, and treatments, including IVF, were not covered, because they were classified as experimental. That attitude remains among some people and insurers. Today, with more than 8 million kids born through IVF since the first in 1978, any “experimental” and “niche” labels on the treatment seem hardly fair, but here we are.

Your Wealth, Your Journey

We have to keep in mind the life stage of the infertility struggle for most. If you’re reading this as a middle-aged person with a healthy retirement gathering interest, you may have $50,000 in liquid assets for a crucial expense. But did you have that when you were 30 and ready to start a family?

The age when most people seek treatment, the 20s and 30s, are the years when people are laying the foundations of wealth. The house down payment and student loans probably dominate financial life. Freeing up a year’s salary for medical treatments is unlikely, and by the time people have that much capital, a few years later, the childbearing window might be closing.

It’s no great surprise then that the success of IVF treatments often follows the money. Most IVF success stories look that way you might think: white, upper-middle-class, in households making $100,000 and up. The math is straightforward here. If you’re wealthy, you have the income to invest in more treatments, whereas those who make less may not be able to afford treatment at all.

Think about your holiday table again. You most likely saw people seated there who wouldn’t be able to afford this journey. Or they may be in the midst of moving around important pieces of their financial plan — depleting savings, cashing out retirement plans — to make it happen. All this in the awkward situation of paying for something that seems easy for everyone else.

Strategies for Paying for IVF

The options for couples journeying through IVF are complex but doable. We can “mimic” insurance coverage in some sense by utilizing some programs available.

HSA

Your Health Savings Account (HSA) is a triple-tax-advantaged fund, a powerful financial tool for protecting your wealth from medical expenses. IVF is considered a qualified health expense for an HSA, which is great news for couples trying to conceive.

However, keep in mind that an HSA is a fund you build through your contributions, and it can only grow at a certain rate. In the prime childbearing years, couples have only had a couple of decades at most to build their HSAs, and the 2021 contribution limit for a family is $7,200 per year.

One recent statistic said the average HSA account held $2,803, and users spent an average of only $1,500 annually from these accounts.

In the end, your HSA can be extremely helpful for defraying the cost, but it won’t begin to cover the entire $50,000 bill for most couples. It’s also a qualified expense for an FSA, but the story is much the same.

Tax Deductions

If you itemize your taxes, you can receive a tax deduction for any medical expense over 7.5% of your adjusted gross income. A tax deduction can work within your plan to help you protect and free up other income for expenses. You can also add the cost of IVF to other medical bills to take you over the threshold — it’s 7.5% total.

Again, this can help defray the cost and soften the blow, but it’s far from fully replenishing the expense. The 7.5% total looks generous but is a not substantial amount at the end of the day, especially if you have a higher income. Also, since the Tax Cuts and Jobs Act, the minimum standard deduction is set at $25,100 (for 2021), meaning that many Americans aren’t itemizing to begin with.

Other Support

Infertility financial programs have emerged where insurance is lacking. Specialized loans — such as EggFund and Future Family — and shared-risk groups are two options. Grants also exist, through channels such as the Nest Egg Foundation, for those who qualify. Again, these aren’t simple solutions — you’re looking at an extensive application process and a waiting list, but they make things more possible.

Bottom line: Financial help for IVF exists, but it takes extensive planning, patience and, to be honest, a little luck to get through the process. It’s nowhere near as simple as throwing down your insurance card for the vast majority of couples, at least not yet.

A Priceless and Expensive Journey

Journalist Elizabeth Holmes described her IVF journey, which was ultimately successful but very long, this way: “In our blind determination we doubled down with dizzying back-to-back attempts. After a second unsuccessful transfer, a second full round of IVF, and then a third unsuccessful transfer, my body’s response tanked.” When they finally conceived, it was a long time and a lot of money later.

Nothing is simple, especially nothing worth doing. I can hear my daughter in the next room as I write this — it’s the sound I wish I could have heard while all those years ago, alone in the operating room, crying my eyes out. Every bit of stress, and every last cent, was worth it, of course.

I think of friends and relatives who I know are going through this journey now, and my hope for them is to have a safe space when they see friends and family this season. Whether it’s someone to talk to, or maybe more importantly not to have to talk to, I want to dispel any rumor of shame or anxiety from their minds. I know firsthand the emotional toll and some of the costs involved.

One in eight. Think about that statistic and the complexity and expense of the journey. One of the best gifts you can offer is a listening ear — not balking at price tags or squirming at medical discussions, but simply being there and being present.