Before the birth of her daughter, Aurora, in 2016, Heather Huhman, host of the podcast Beat Infertility and founder of content-marketing firm Come Recommended, went through seven cycles of in vitro fertilization (IVF), suffered four miscarriages and gave birth to stillborn twins, Eric and Alexis. As difficult and heartbreaking as the Washington, DC, woman’s journey to motherhood was, she never stopped working—she had to foot the almost-$60,000 bill for all those fertility treatments.
Heather is not an anomaly. A survey by FertilityIQ, a fertility doctor and clinic evaluation website, found that 92 percent of women undergoing fertility treatments are employed. Of those, 68 percent work a full 40 to 50 hours a week.
One big reason? More and more women are postponing pregnancy until their mid-to late 30s while they’re furthering their careers—and this delay often makes fertility treatments necessary to start a family. But medical need isn’t the only reason working women make up the majority of fertility-care patients: The high price of help forces many women to continue earning a paycheck while trying to conceive. The American Society of Reproductive Medicine reported that the average cost of one IVF treatment in the United States is $12,400, not including the extra medications a woman might need and the added fees for using an egg or sperm donor, or gestational surrogate.
Most women pay the exorbitant fees themselves. Medicaid, which insures almost 20 percent of women in the U.S., doesn’t cover fertility treatments. And only about a quarter of employers chip in for IVF, according to a 2013 study by Mercer, a consulting firm. The good news is that number is increasing, and few companies are leading the way. Bank of America, Boston Consulting Group, Spotify, Discovery Communications, Chanel, Conair and Johnson & Johnson will pay all treatment costs, with no limit, for employees with an infertility diagnosis, according to FertilityIQ.
Kaylen Silverberg, M.D., a fertility specialist certified in both obstetrics and gynecology and reproductive endocrinology, and a founding member of Texas Fertility Center, says workers value this support so much that he’s had clients “take jobs at photocopying shops, even though they’re overqualified, just to have their fertility treatments covered by their employer.”
That’s sadly not surprising. Only 24 percent of infertile couples in the United States can access all the care they need to become pregnant, according to the American Society for Reproductive Medicine. So beyond switching employers, how can you expand your family without going broke?
1. Get Quality Care ASAP
The adage “time is money” is especially apt here. According to Bradford Kolb, M.D., an obstetrician-gynecologist at HRC Fertility in Los Angeles and assistant clinical professor in obstetrics and gynecology at the University of Southern California School of Medicine: “The problem is that people first go to their primary-care provider or ob-gyn and spend a lot of time. If you’re 39, spend a year-and-a-half at your gynecologist’s office and they do inefficient treatments, your chance of becoming pregnant has just been cut in half, and the costs now needed to achieve a healthy pregnancy have gone way up.”
Deborah Anderson-Bialis, who lives in the San Francisco Bay area, founded FertilityIQ and spent three years and more than $70,000 to become pregnant, agrees. “Make sure you’re going to a place that puts you in the best position to have a kid over the first cycle, which means doing research about the clinic’s protocols and how they’ll treat your case. Clinics are incredibly diverse, and if you go to the wrong one, you’re likely to find yourself doing cycle after cycle with the same approach and the same lousy results.”
2. Adopt an Embryo
If you need an egg donor and don’t have a male partner with viable sperm, adopting an embryo from a couple who already has completed their family could allow you to experience pregnancy and childbirth without spending tens of thousands of dollars to use separate egg and sperm donors. There are many embryo-adoption sites, such as the National Registry for Adoption (NRFA.org) and Miracles Waiting (miracleswaiting.org), which connect potential embryo recipients with couples looking to donate.
3. Seek Grants and Scholarships
After Pamela Hirsch’s daughter Nicole, of the Los Angeles area, went through multiple IVF cycles that all ended in miscarriage, Pamela helped pay the hefty fee for a gestational surrogate, which allowed Nicole to become a mother. When Pamela realized that many women don’t have this financial support, she co-founded Baby Quest. This foundation covers partial, and sometimes full, costs of fertility care for qualifying patients. They’ve given out 62 grants, which have resulted in 32 babies and 15 on the way. Other charities to try: the Tinina Q. Cade Foundation, which grants free IVF cycles, and the Pay It Forward Fertility Foundation, which provides financial assistance for a range of infertility services.
Because the competition is high for these grants, Pamela recommends applying for multiple—and staying hopeful if you don’t score one on the first try. “About half of our recipients are second- or third-time applicants.”
Also check out Resolve (resolve.org): the National Infertility Association’s infertility treatment grant and scholarship opportunities (under Family Building Options, then click on Making Treatment Affordable).
4. Take Advantage of Fianancing Options
Many clinics offer financial counseling to sort out what intended parents’ insurance does and doesn’t cover, and to get access to funds. Financing commonly applies to medications, surgical procedures, IVF and pre-implantation genetic diagnosis. Ask prospective clinics if they offer financial support, and select one you believe will work within your means.
5. Research Fertility Clinics That Offer IVF Refunds
With each failed round of IVF comes crushed emotions and budgets. The potential of an unsuccessful cycle leaves intended parents feeling stressed that this has to be the cycle because they can’t afford another one, and at a higher risk for disappointment because of the stress, which can reduce IVF success. As a result, some clinics have started offering refunds: Women pay a flat fee for a set number of IVF cycles and receive a partial refund, or money-back guarantee, if the woman doesn’t conceive. While these programs result in savings for some, caveats often lurk in the fine print; be vigilant in understanding the details.
6. Request More-Affordable Medications
Fertility-clinic employees don’t know you need the least-expensive meds unless you tell them. Be upfront about your financial circumstances with the doctors, nurses and billing department at your clinic to get the best deals.
This is exactly what Heather did to afford her IVF cycles. She discovered that her clinic had medications turned in by past clients that they could donate to her, and that she could shop around when she needed to buy new. “I had spreadsheets keeping track of pharmacies offering the most affordable meds, and I’d order based on that,” she says.
7. Be Selective with Treatments
IVF isn’t the only option. Depending on factors like your age and health, you might be a candidate for less- pricey, less-invasive options, like intrauterine insemination (IUI), aka artificial insemination, which could produce a pregnancy without IVF’s highly invasive egg-retrieval process. But use these options only if they truly fit your needs or you could end up spending more overall from multiple unsuccessful attempts.
Anderson-Bialis recommends researching carefully so you receive only the treatments you actually need: “Seventy percent of cycles use ICSI (injecting a single sperm directly into an egg), which costs [around] $3,000. Probably only about 30 per- cent need to have that done. There’s also a debate whether clients need PGS (pre-implantation genetic screening that evaluates chromosomal normality), which is about $5,000,” she notes. “Have a discerning eye on the costs,” and the trade- offs of what’s being recommended.
8. Reduce Your Income-Tax Payments
The IRS has a touch of empathy for those struggling to get pregnant, if you know how to ask for it. Alert your accountant of your costs: IVF, IUI diagnostic tests, fertility drugs, reproductive surgeries, travel expenses associated with fertility treatment, and (surprise!) pregnancy tests are tax-deductible.
9. Try Out-of-the-Box Ways to Boost Conception Odds
Lowering stress might up the chances of conceiving, and there are all kinds of free and cheap ways to do it. A small 2011 study of Israeli women found that 15 minutes of comic relief after an embryo transfer increased the likelihood of a pregnancy from 20 percent to 36 percent. (A “medical clown” delivered the giggles.) If Chris Rock isn’t available during your treatments, opt for stress relievers like complimentary counseling at a fertility clinic, meditation, journaling and other calming activities to bolster the probability of getting pregnant. Check out the International Council on Infertility Information Dissemination (INCIID) for more ideas on how to help your mental health while you’re getting care.
10. Get Political
If you can’t afford treatments, you don’t have to suffer in silence. You can advocate for receiving care by reaching out to the National Infertility Association’s Resolve initiative. This organization regularly holds marches and fundraisers, provides research and data to support positive public policy, and offers many other avenues for championing this movement.
Take heart that advocacy has yielded victories: New York recently enacted a state law that requires insurance providers to offer fertility-treatment coverage for all women, regardless of sexual orientation or marital status. (Fourteen other states have similar requirements, according to the National Conference of State Legislatures.)
“Men can get Cialis or Viagra covered, but many women can’t get their fertility medications covered,” Dr. Silverberg points out. “A woman deserves coverage for her treatments just as much as a man.”