Over the past eight years, one Los Angeles-based prenatal health coordinator has helped thousands of women during their pregnancies. Yet working in the field didn't help much when it came to her own pregnancy, which proved to be a costly challenge.
Anna, who asked to be identified by a pseudonym to protect her privacy, is one of thousands of women each year who opt to travel to clinics in other states (and sometimes other countries) in search of affordable in vitro fertilization, or IVF, procedures. She and her husband found that it was cheaper to travel across the country, from Los Angeles to Albany, New York, to receive treatment, than move forward with clinics closer to home. Yet they still spent about $20,000 in total to get pregnant, she tells CNBC Make It.
Each year, millions of American families struggle with infertility. For every 100 couples, 12 to 13 report they've experienced trouble getting pregnant, according to the Centers for Disease Control and Prevention. And about 7.3 million women of childbearing age in the U.S. have used fertility treatments to get pregnant.
IVF is one of the most popular routes. It's a multistep procedure where a medical team removes eggs from a woman's ovaries, and then fertilizes the eggs with sperm in a laboratory. The fertilized embryo is given a few days to grow and then implanted into a woman's uterus. In total, the process generally takes four to six weeks.
Last year, the average patient paid more than $22,000 for a single IVF cycle, according to FertilityIQ, a database that provides information about costs and treatments. Many times, that price does not include the necessary fertility drugs and testing, which can add up to an additional $3,000 per cycle. Not to mention the expenses associated with pregnancy and a hospital delivery.
Anna, however, didn't qualify for the basic IVF, which isn't uncommon. Women using an egg or sperm donor or those seeking genetic testing or specialized treatments such as intracytoplasmic sperm injection should expect to pay more.
In her case, Anna sought out preimplantation genetic diagnosis, or PGD. This is a specialized procedure where doctors test the fertilized embryos for chromosomal or genetic abnormalities before they are implanted. Anna has a genetic nerve disease and, after undergoing multiple surgeries and treatments throughout her life, she didn't want to pass that onto her children.
But that extra testing increases the cost of treatment. At CNY Fertility, the clinic Anna and her husband opted to use, a basic round of IVF costs $3,900. The facility estimates that PGD costs roughly an additional $300 to $600 per embryo including biopsy and third-party lab fees. In Anna's case, she and her husband chose to pay for testing on 17 viable embryos collected.
In the U.S., about 34% of IVF procedures performed in 2017 resulted in live birth among women ages 35 to 37, according to the Society for Assisted Reproductive Technology. But that success rate drops as women age — those ages 41 to 42 only have a 10% chance.
To help increase families' chances of a successful IVF treatment, many clinics offer "guarantee" programs and pricing packages. The programs differ slightly clinic to clinic, but these tend to be money-back guarantees for if the IVF does not result in a successful pregnancy and birth. Patients pay more for the guarantee than they otherwise would if they were successful after just one IVF cycle.
"I'm pretty risk averse," Anna says, adding she would have definitely paid more in advance because she was expecting to undergo several IVF cycles. But only certain patients qualify, and Anna wasn't eligible because she chose to do PGD IVF.
The reason IVF is so expensive isn't that it's a cutting-edge technology — in fact, the first successful procedure took place in 1978 — it's that for many women, the cost of the treatment isn't covered by insurance. About 71% of the women who went through IVF last year had no fertility treatment coverage, according to FertilityIQ.
Only 16 states — Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia — require insurance companies to have some sort of coverage for families seeking infertility treatments, according to the National Conference of State Legislators. Fourteen of those states require insurance companies to actually cover infertility treatment, but California and Texas have limitations. California specifically excludes IVF from the mandate. Meanwhile, Texas law requires insurance companies to let employers know the coverage is available, but insurers are not required to provide the coverage and employers are not required to include it in their health plans.
"The only reason we're talking about the cost of IVF is because it's not covered by insurance," says Betsy Campbell, chief engagement officer at Resolve, the national infertility association. "Infertility is a disease and should be covered by insurance just like other diseases," she adds.
Anna's insurance did have a policy for PGD, so initially, she thought the procedure would be covered. But after seeing a reproductive endocrinologist, her claim was rejected. The insurance company only covered diagnosis, not treatment. So while her pretesting, such as the saline sonogram and hormonal testing, was covered, the IVF and PGD procedures were not.
So she "scoured for months and months" to find the most affordable out-of-pocket option. Initially, she looked into travelling to the Caribbean for care because the clinics there offered cheaper basic IVF, but the "logistics of traveling further to go abroad were too overwhelming," Anna says.
In the end, she settled on CNY Fertility because it was the cheapest after a countrywide comparison, even with the additional travel costs.
Typically, IVF patients have many expenses beyond the procedure itself that can add significantly to the overall cost, including medications, blood tests and ultrasound monitoring.
To keep her expenses as low as possible, Anna ordered the priciest medications from Israel and purchased others through discounts she found using GoodRx. Plus she paid for her IVF using a newly acquired credit card to snag a promotional points offer. Those points paid for the flights to and from New York, as well as accommodations and a rental car.
During the egg retrieval phase, Anna rented an Airbnb and a car, staying for about 10 days. Her job provides "pretty good benefits," she says, so she was able to just take vacation time, but her husband was only able to join her for the last few days of the trip.
Once both Anna and her husband donated the eggs and sperm, the doctors went to work. Of the roughly 40 eggs retrieved from Anna, 17 were successfully fertilized. Those embryos were then biopsied and tested, but just one turned out to be chromosomally normal. That surprised and disappointed Anna, who was hoping for a few embryos in case the transfer was not successful. "I was pretty prepared for failure, but I went back [to the clinic for the transfer]," she says.
Anna flew back to Albany by herself for the frozen embryo transfer process, staying at a hotel near the clinic for three days. From there, Anna opted to do monitoring with an OBGYN in LA.
Thankfully, Anna's IVF process proved successful. "I was really, really lucky, because if it didn't work, I would have had to pay that approximately $20,000 all over again," Anna says. Today, she is the mother of a happy, healthy 18-month-old son.
"It could have gone a totally different way," she says. More than half of patients have to undergo a second IVF cycle, FertilityIQ reports, and almost a third must seek three or more.
Anna and her husband could only afford to try one cycle without going into debt. And they had already waited years to start a family. "We waited until we were in a financial position that we could afford it," Anna says.
While Anna was able to rely on savings to pay for her fertility treatments, many women are not so fortunate. Over half of women, 52%, who were planning to undergo IVF this year say they will pay for treatment with a credit card, according to a poll of 776 women from Student Loan Hero. And many go into debt.
For those living in states that do not mandate coverage, employers are typically the best resource for financial help. And the ranks of companies offering fertility options is growing. In the past year, major companies such as Cisco, and MassMutual have added fertility benefits. Starbucks and Chobani even offer coverage to hourly employees. Many tech companies, such as Apple, Facebook and Microsoft have even gone beyond basic benefits, offering egg harvesting or freezing services to employees as well.
This year, 66% of employers plan to offer fertility benefits, according to a Maternity, Family and Fertility Survey from Willis Towers Watson. If your employer does not currently offer this benefit, Resolve has a Coverage at Work program, which is designed to empower employees to ask their employers for fertility coverage.
"You need to be an advocate for yourself when it comes to you and your family," Campbell says. "This journey affects people physically, mentally, spiritually, financially and socially."
Fertility treatments are definitely a "high-pressure" situation, Anna says, one that should be easier for families to navigate. "It shouldn't be as hard for other women as it was for me," she says. "Even though it worked out for me, it was a great challenge — definitely a life challenge."
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