Read an Excerpt
It Costs How Much?:
Make a Fertility Budget Before You Begin
"Like many newly married couples, we had a vision of what our future was going to hold. We had an idealized picture of summer barbeques, holidays surrounded by friends and family, and the sounds of children's laughter filling our home.
"I remember sitting in the doctor's office as he discussed the options, and with each word, those dreams and plans were being taken away from us. Compounding the issue of our diagnosis was the financial obstacles. We were faced with concerns from family and friends, assertions from doctors, and decisions and sacrifices to make."
The desire to have a baby is one of the most powerful forces in life, but for one in six couples, having a baby is no easy task. No one ever dreams of having to pay to get pregnant. It may be small comfort, but if you are struggling to conceive, you are not alone. According to the American Society for Reproductive Medicine (ASRM), more than 7.3 million women in the United States have difficulty getting pregnant or carrying a pregnancy to term. While infertility does not discriminate with regard to gender, ethnicity, religion, education, income level, lifestyle, or even family size, access to effective infertility treatment is often grossly unequal.
Infertility is a medical condition with a variety of effective treatment options. With appropriate diagnosis and treatment, nearly 90 percent of individuals struggling to become pregnant are able to bring home a baby. But many women are surprised to find that the costs for the medical treatments necessary to get pregnant are much more expensive than they'd originally planned for.
Several factors can place an undue financial burden on patients, but the most important cause is that infertility treatments are not usually covered by insurance. Some insurance plans cover a few of the expenses related to infertility testing and/or treatment, but most people (more than 70 percent) should expect to pay for the bulk of these costs out of pocket. Given failed IVF cycles, repeat attempts at treatment, and trying for additional children, the overall costs get expensive fast.
The infertility business is a $4 billion-a-year industry. As a result, fertility clinics are not required to provide the most cost-effective and streamlined care. After all, waste is profit. If a clinic can get you to come in for onemore appointment, one more test, or one more treatment, it earns more money. It's hard to tell if you received a good standard of care or if you just got ripped off.
Cost is a real impediment to treatment. In fact, less than half of the women and couples in the United States who experience infertility seek help from a doctor. Of those seeking treatment, about half become pregnant using treatments costing between $1,000 and $5,000 per cycle. While this isn't cheap, it's a relative bargain compared to the costs many other families face. Once you start with assisted reproductive therapies (ARTs) like IVF, expect to spend an average of $12,000 per cycle. Because many women don't become pregnant in one cycle, average costs per baby can easily range from $38,000 to $85,000 or even more in some cases.
For some, the path to parenthood is straightforward and short. For others, the road is long and rocky. For all, infertility takes its toll on time, energy, emotions, and finances. The good news is that you have a great chance of becoming pregnant, but be prepared to plan and be involved with all aspects of your infertility care. You will have many tough decisions to make throughout the process, so you need to fully understand your choices and their related consequences. In some cases, you will need to stand your ground, while other circumstances will require a great deal of flexibility.
As with all important money-related decisions, it's critical to start thinking ahead. You have already made an important step by picking up this book. First in this chapter, we're going to talk you through the typical costs for the various forms of fertility treatment that are available to you. Then we'll start to create a financial plan to help you determine how much money you have available to you for this process. In the rest of the book we'll investigate ways to cut the costs of the treatment, so you can be an informed consumer of your health care just as you would be with any other expense in your life. Regardless of your own personal financial situation, we will show you how to get the best quality care for your dollar. You can bring home that beautiful bundle of joy without going broke.
How Much Do Different Treatments Cost?
"At the beginning, the expenses were merely irritating. Since we had no previous experience with infertility, we assumed they were reasonable. Both my husband and I were working and had no children yet, so we expected that the procedures we were paying for would have results and eventually pay off. After eight months of no success and another miscarriage, my doc suggested IVF. By this point we were spent. We had no idea infertility would be so expensive, invasive, and medically affecting as it was. In hindsight, I think there was a lot we could have done to prepare ourselves better."
How much does it cost to get pregnant? It depends on many things age, cause of infertility, your and your partner's general health, your doctor's skills...even good old-fashioned luck. What's the short answer? Once you open the door marked "Fertility Treatment," getting pregnant will cost more than you expect.
Just because you are beginning infertility treatment doesn't necessarily mean you are going to undergo a $20,000 procedure. You have a lot of power and resources that can affect your course of treatment. With the right knowledge and skills, you can positively influence both your overall experience and ultimate outcome. First, let's focus on the basic progression of your baby-making journey starting from the very beginning.
Most of us entered adulthood thinking we could have a baby whenever we wanted. The reality is that, biologically speaking, it is amazing anyone gets pregnant. Conception results from a complex chain of events. A woman must first release an egg from her ovaries, the egg must travel through the fallopian tubes toward her uterus, and a man's sperm must join with the egg for fertilization to occur. Finally, the fertilized egg must implant itself into the uterus. Of course, next the embryo needs to grow. Infertility can result from problems that interfere with any of these steps.
Educate yourself about fertility. This can be done through doing your own research and through regular conversations with your gynecologist or other primary care physician (PCP). Don't be afraid to bring the topic up (multiple times if you have to) and talk openly about your family-building plans and concerns. There is no such thing as a stupid question. Your doctor can help you understand your fertility and address any problems as soon as possible.
As we will discuss in more detail in chapter 2, age is a huge factor for women trying to get pregnant. While infertility can strike at any age, with age comes decreasing fertility. The younger you are, the more fertility options you have and the greater the chances for success. If you want to have a baby, trying at thirty or thirty-five is more effective than waiting until after forty. Advanced age is not an impossible obstacle to overcome, but it may well include more time, more money, and more complications so it's important to plan accordingly.
Recognize, too, that lifestyle factors can affect fertility. Being unhealthy, including being overweight or smoking, can also decrease your fertility. If you want to get pregnant, it's never too early to start focusing on these issues and trying to get yourself as healthy as possible. Sometimes losing a little weight, stopping smoking, or adopting a more health-focused lifestyle can allow you to become pregnant without any further interventions.
Initial Evaluation and Therapy
When do you seek help? You may be considered to have impaired fertility if pregnancy has not occurred after one year of unprotected, well-timed intercourse. If you are a woman over thirty-five and have been trying unsuccessfully for over six months, you should consult your gynecologist. Your gynecologist can offer initial testing and information but may then recommend you see a fertility specialist known as a reproductive endocrinologist.
Routine infertility testing will be conducted, including a semen analysis for the male partner and hormone testing and an ultrasound of the female's reproductive organs. Initial treatments will probably include a prescription for fertility medications. This is often coupled with an intrauterine insemination (IUI) where either your partner's sperm or sperm from a donor is placed directly inside your uterus using a small catheter. The good news is that many women become pregnant with these measures, which can cost as little as a few hundred to a few thousand dollars per attempt.
Intermediate Testing and Therapy
If still nothing is happening, then it's time to try another tactic. More extensive testing will be recommended to assess your reproductive organs in more detail. Most likely, your fertility specialist will be looking for any problems that are prohibiting sperm and egg from meeting. For example, fibroids or endometriosis may be blocking your tubes. If this is found to be the case, your doctor could recommend minor outpatient surgery to check out your uterus and fallopian tubes as well as open up any blockages. Because this is surgery, this will most likely be covered by insurance. Testing and surgery can add thousands to your cost, but probably not out of pocket.
Advanced Reproductive Technology (ART)
If the sperm and egg are meeting without fertilization or if any blockages cannot be cleared through surgery, in vitro fertilization (IVF) will be considered. With IVF, the doctor is able to facilitate fertilization by putting the eggs and sperm together in a lab. Once fertilization has occurred, your fertility specialist will place the growing embryo into your uterus.
IVF is no longer considered a high-tech or experimental treatment. The first successful IVF cycle was performed in 1978, resulting in the birth of Louise Brown. Since then, more than 1 million babies have been born through IVF worldwide. More than 70,000 cycles of IVF are performed each year in the United States alone. Today, IVF is often combined with intracytoplasmic sperm injection (ICSI), which allows a single sperm to be directly injected into the egg with a small needle in order to maximize fertilization. IVF is expensive (the average cost ranges between $6,000 and $25,000 per cycle), but success rates are encouraging, with about 40 percent of women bringing home a baby.
Third-party reproduction (also known as collaborative reproduction, or surrogate reproduction) is used only as a last resort. Third-party reproduction includes egg donation, embryo donation, sperm donation, and traditional surrogates/gestational carriers. For families who have tried previous options without success, or for families who know from the beginning that they are unable to use their own eggs or uterus, third-party reproduction offers promising hope. Because fertile women are enlisted as donors, surrogates, or gestational carriers, success rates for these treatments are significantly higher although they are also much more expensive, usually topping $30,000 to $60,000.
Important Treatment Terms
ART (Assisted [or Advanced] Reproductive Technology): ART procedures involve surgically removing eggs from a woman's ovaries, combining them with sperm in the laboratory, and returning them to the woman's body or donating them to another woman.
Egg Donation: Donation of an ovum (egg) by one woman to another who attempts to become pregnant by in vitro fertilization (IVF).
Embryo Donation: Rather than destroy the embryos originally created through ART by an infertile couple or donate them to science after that couple completes their family building, the parents decide to donate their frozen embryos to another infertile couple in hopes of giving them a chance at parenthood.
Frozen Embryo Transfer (FET): FET involves IVF with an embryo that has been frozen or cryopreserved.
Gestational Carrier (Gestational Surrogacy): A woman who is not the genetic parent of the baby carries the pregnancy to term. Eggs are extracted from the intended mother or egg donor and mixed with sperm from the intended father or sperm donor in vitro. The embryos are then transferred into the surrogate's uterus.
ICSI (intracytoplasmic sperm injection): A laboratory procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems.
IUI (intrauterine insemination): A medical procedure in which sperm is placed directly into a woman's uterus to facilitate fertilization (formerly called artificial insemination).
IVF (in vitro fertilization): An ART procedure in which eggs are removed from a woman's ovaries and fertilized outside her body. The resulting embryos are then transferred into the woman's uterus through the cervix.
PGD (Preimplantation Genetic Diagnosis): PGD is a technique that can be used during in vitro fertilization (IVF). After removing a single cell from each embryo, embryos are tested for a variety of genetic disorders. PGD testing is done in the laboratory before the embryo is transferred to the uterus.
Sperm Donation: The practice by which a man donates his sperm to be used by a woman or a couple to achieve a pregnancy.
Traditional Surrogacy: The surrogate mother is artificially inseminated with the sperm of the intended father or sperm donor. The surrogate's own egg is used, thus she will be the genetic mother of the child she is carrying for another family.
The Hidden Costs of Infertility Treatments
"I wish they had a cot for me at the fertility clinic. I get up at 5:00 a.m. to shower and drive thirty minutes away to be at the clinic by 6:30 so I can be first to see the fertility specialist when he comes in at 7:00, because I need to leave by 7:15 to get to work an hour away from the fertility clinic by 8:30 a.m. The driving alone costs an extra $200 a month!"
In addition to the infertility treatments themselves, there are the indirect costs involved consider everything from lost wages to unexpected medical complications to travel costs. Direct nonmedical expenses can vary and are dependent on how close you are to a reproductive center. These nonmedical costs can be substantial, particularly for highly specialized procedures. Travel expenses such as gas, meals, and lodging can add up, as can other costs such as missed work or lost wages.
Did we mention the hormones? Besides feeling like a pincushion, you may experience the medications' side effects, which can include severe bleeding, lightheadedness, headaches, and nausea. Depending on your reactions and responsibilities, it may affect your ability to maintain your normal work schedule. Plus, all these medical appointments take up a lot of time many women say that their infertility treatments feel like a part-time job in itself! You have to be at the clinic first thing in the morning for blood work and ultrasounds, and you won't be able to plan more than a day or so in advance of when your eggs will be ripe and ready to start your retrieval or insemination procedure.
With some infertility treatments, there is a higher chance of complications during pregnancy or childbirth, such as preterm labor. You will have a higher chance of multiple births, which further complicates the pregnancy and can lead to long stays for babies in the neonatal intensive care unit. Depending on your insurance coverage and deductibles, you might be responsible for more than you think.
And if you are successful, it's never too soon to think about what you plan to do in the future in terms of growing your family, especially if you have already spent a small fortune on just trying to become pregnant. Is your ultimate goal two children? If so, how does that factor into your decision-making process?
Your Fertility Financial Plan
Because there is no way to predict how long it will take you to get pregnant or exactly what it will involve, before you begin the process, you need to determine how much money you can realistically afford to spend on family building. We know, we know easier said than done, particularly since money is the last thing you want to think about right now. But here's why this is so important: "A lot of people drop out of care and don't end up with their family primarily because they weren't able to plan in advance how they were going to spend their money to end up getting a baby," says Dr. G. David Adamson, Director of Fertility Physicians of Northern California. "What couples should do is look at all the different choices and decide how much time, how much money, how much emotional energy they are prepared to spend on each one of these choices."
Before you call the closest fertility clinic, you must create a financial plan. A financial plan is a road map that helps you stay on course to reach your financial goals. A sound financial plan is a comprehensive outline dealing with a variety of goals such as retirement, educational funding, insurance, cash flow, tax liabilities, and estate planning, explains Gary A. Howard, an attorney and certified financial planner. "A financial plan includes specific ways to achieve financial goals, and the rationale for the plan. Because a goal can be achieved in many ways, a well-thought-out analysis may include alternative, or 'what if,' scenarios along with the pros and cons of each option."
Your path through infertility may look very different from your best friend's. You have different problems, different resources, different insurance policies, and (hopefully) a different partner! Creating your plan means not just deciding how far you can go financially, but reviewing your emotional, spiritual, and physical limits as well. Your decisions will have long-term effects and need to align with your personal value system. With your partner, if applicable, start the process of creating your own fertility plan.
- Think about your timeline. How long are you willing to try on your own before moving on to a fertility specialist? How does age affect your treatment decisions?
- Think about your own values. How do you feel about infertility treatments? How does each type fit with your personal and religious beliefs? Do you and your partner agree? What type of emotional toll will these decisions have on you and your partner?
- Think about your treatment options. How far do you think you want to go? Are there any treatments that you would be unwilling to try? How will you know if you need to reconsider your original plan? How will you communicate any changes in plan to your partner?
- Think about limits. How many cycles are you willing to try? How many cycles can you afford? How will you know if you need to move on to another option? What options are acceptable to you?
- Think about your finances. What is (or isn't) covered by your health insurance? How will you pay for treatments? Do you have a monthly or yearly limit on how much you can spend on treatment? Do you have friends or family who can help out?
"It wasn't until I began to crunch the numbers that I realized we had been living pretty much paycheck to paycheck for the past several years. Oh, we both had good jobs. And we had plenty of money for all the bills and then some, but we hadn't exactly saved anything, nothing substantial anyway. When we found out we needed to undergo IVF, we had to come up with several thousand dollars within a few weeks in order to get started. I guess I always assumed we had more money than we actually did."
You may suddenly find you need to cut down on your basic expenses and start putting money aside specifically for your baby quest. (Refer to the appendices for helpful information on how to create a budget and spending plan.)
If you want take control of your finances, it is essential you make a budget. A budget allows you to get a handle on the flow of your money how much is coming in and where it goes out. Once you have that information, you can make intelligent choices about how to spend. Inevitably, every person's budget will be different, but there are some basic guidelines that everyone should follow.
The first step in making a realistic budget is figuring out how much money you have coming in. You need to add up your monthly income. On a blank sheet of paper, list the jobs for which you receive a salary or wages. Then, list all self-employment for which you receive income, including farm income and sales commissions. If you are in a salaried position, simply divide your yearly income by 12. Finally, list other sources of income, such as child support or bonuses.
Next, you'll need to know where your money goes during a set period. While some expenses remain constant and are easy to figure out (rent, car insurance, car payments, phone and cable bills), other expenses such as utilities, gas, food, and entertainment may change from month to month. The best way to figure them into your budget is to come up with a monthly average for each one.
By looking at your spending, you can make special note of any nonessential spending that you may be doing and make cuts as necessary.
"I admit it...merely keeping tabs on every expense is enough to make anyone spend less. If I have to 'fess up to the number of trips I make to Starbucks a week, I get a little squeamish. But I want to have enough money to do whatever we need to get a baby, but I didn't realize how much money I wasted, particularly when I'm feeling blue."
Many financial planners suggest living by the 60 Percent Rule. The basic idea is that all your "essential" spending taxes, food, shelter, clothing and the rest comes out of the first 60 percent of your total, pretax income. The rest, in 10 percent chunks, is devoted to retirement savings, emergency savings (or debt repayment), short-term savings for irregular expenses (like holidays and car repairs), and fun money.
Add up your essentials. You may not spend more than that percentage of your income. That's nonnegotiable. Your wiggle room is in the other 40 percent. Your infertility expenses may take up more than 10 percent, but they cannot take up more than you need for essentials.
This is only the beginning of a long journey of maintaining financial health for your family. If you're going to stop working after your baby arrives, now is the time to start practicing living on less. The same goes if you're going to take an unpaid maternity leave, even if it will only be temporary. If you aren't covered by disability insurance, get it now, since you won't be able to once you become pregnant.
Focus on both your short-term and long-term goals. "Funding the costs of infertility treatments or adoption are for the most part short-term financial goals. Long-term goals include retirement, appropriate and affordable insurance protection, maintaining adequate cash reserves, and minimizing consumer credit card debt. Comprehensive financial planning encompasses a variety of goals and priorities," says Howard.
Once you know how much you have to work with, start evaluating which infertility treatments best fit with your budget and are most realistic for you and your family.
Money and Your Relationship
Dueling over dollars is a common problem in marriage and a common cause for divorce. If you don't take the time to talk about money, it could end up taking a major toll on your relationship. Money is a leading cause of marital strife. Pile on the stress of going through infertility, and this is a disaster waiting to happen.
When considering your finances, look for underlying issues. Perhaps there are other problems going on, such as concerns about security and control. Or maybe the impending overwhelming responsibility of becoming a parent is adding to the stress levels. Rather than becoming irritated with your partner, recognize that arguments over money may indicate other problems as well.
Realize that both partners must be involved with the decision-making about money and how to pay for family-building options. And understand that you both may have different money styles. You may view money differently, so you will need to talk openly about how you think about money and how it should be spent. Always listen to your partner. A key to developing a good financial plan is having both of you fully involved at each step.
Establish some ground rules about your money. You will need to set some boundaries so you both feel in control of your financial future, especially how it pertains to growing your family. Compromise is a necessity. You will need to set your financial goals together. This includes the short-term family building goals as well as the longer-term plans as to what you will do after your child or children arrive.
Together draft a budget and cash-flow statement. "It's like going on a diet," says Victoria Collins, financial planner, psychologist, and author of Couples and Money: A Couple's Guide Updated for the New Millennium. "You hate to step on the scale, but if you come up with a concrete action plan, it's easier to follow through."
"Put it on paper," she advises. "Just having an agreement helps."
If money is a problem now, the financial stress is not going to go away once you have succeeded in building your family. Money doesn't have to ruin your marriage. Instead, it can strengthen the bond by teaching you how to work as partners. What might have once torn you and your partner apart can actually bring you together as you work toward a common goal.
Weigh Your Options
"We took out a loan to start the IVF process for the first time, and my son will be six years old this winter; we just paid for him in full last year. Every day I look at him and see our very own miracle. I also have a seven-month-old, thanks again to IVF and our miracle worker doctors. This time we were lucky enough to get pregnant on our first try. When you look into their eyes for the first time, the money, shots, stress, tears, all the not-so-fun stuff is forgotten. Some people have expensive trucks and vacation cruises...we have Corey and Kate."
Infertility will affect you in ways you never imagined from trying to come up with cash as fast as possible to completely losing your sense of privacy and modesty to feeling emotionally drained for months or years on end. These raw feelings and emotions can be overwhelming. As you can, maintain a sense of composure and control, believing you will make it through! The more active you are in conscious decision making, the better off you will be in both the short term and the long term.
Now is the time to start thinking about these complex issues. If you're reading this book, you're well on your way to trying to make a baby. As uncomfortable as it can be, you and your partner must sit down and closely examine your goals and finances. The last thing you want to do is to welcome a baby into your home with no money and worries about how you are going to pay the bills.
No one wants to put a limit on how much they will spend on a baby. But you need to think carefully about this or you will get caught up in the vicious cycle of making a baby and not realize how much you are actually spending. Before you know it, you could be deep in debt with fewer options and an unforeseen impact on your future ability to raise and educate the children who come into your family. Keep track of your goals and prepare carefully for your decisions. It's never too early to think ahead. Ask yourself:
- Should you get pregnant and give birth, how much money will you need to pay for your child's basic needs, for day care, or for potential medical issues the child may experience?
- Should you reserve funds for pursuing other paths to parenthood?
- How many children do you want to have?
For most of us, sacrifices are inevitable. We might suddenly realize we don't have time to waste and must get started trying to have a baby sooner than we would have liked. We might have to give up on Plan A to move to Plan B or Plan C. Some might choose to give up their time and take second jobs to make extra money to spend on family building. Others opt to slash away at any perceived extras in spending to save money. It may seem difficult at first, but keep your eye on the prize: you are investing in your family's future. How far are you willing to go? Ask yourself:
- Are you willing to take out a loan? If so, for how much?
- Are you willing to move to another state or accept a job that offers better fertility benefits?
- Are you willing to sell your nice new car and drive a used model?
- Are you willing to downsize your lifestyle?
- Are you willing to ask friends and family for assistance?
- Are you willing to tap into your savings account or use your retirement money?
"As the medical bills swarmed the mailbox, it was crucial we had some tough conversations about what was considered a like-to-have and a need-to-have item. We both traded in our cars to get junkers so we could increase our monthly cash flow. We also cut our food budget in half and went out only on special occasions. Although it felt like punishment at first, it quickly turned to a positive thing. We were both looking to our future."
Planning Your Family's Future
"If you can't afford to have infertility treatments, then how are you going to afford a child? I swear to God, if one more person utters those words in my presence, I may not be responsible for my actions."
What does it cost to raise a child? According to the U.S. Department of Agriculture, it's about $165,600. Expenses include housing, food, transportation, clothing, health care, education and child care, and other miscellaneous expenses (personal care items, recreation expenses, et cetera). Costs do not include college expenses or indirect costs (such as a parent taking work leave to raise the child). Kids are expensive no argument there.
But when you leave the hospital with your baby, nobody is standing at the door demanding a check for $170,000. Or even $25,000 to cover the first few years. That's why paying for infertility is so difficult you are expected to pay a lot of money up front. You will want to make financially sound decisions so you don't compromise your family's future, but don't let those child-rearing numbers scare you.
Trying for Number Two
"After I miscarried, someone said to me, 'Children are expensive, at least with only one you'll save money.' Unbelievable. I really want a playmate for my daughter. I know she'll enjoy being a big sister. I remember how much fun it was growing up in a big family. But sometimes I worry I must be a horrible mother for investing my energy and money! on trying anything possible to have another child that it takes away from my first born."
What if you already have one child but can't get (or stay) pregnant with number two? Statistically, secondary infertility is more common than primary infertility. While the causes of secondary infertility are often similar to those for primary infertility, second and third babies can be harder to conceive simply due to the passage of time. In other words, your eggs and your partner's sperm are older than they were the last time you tried baby making.
Whether or not it was easy to get pregnant the first time, dealing with secondary infertility is difficult. Besides the physical and emotional toll, trying for another child isn't cheap. Couples often feel guilty about spending so much money trying to conceive a second child when they already have a child on which they could be spending those resources. Is it better for Johnny to have a college account or a baby sister?
Carefully consider the consequences of your financial plan. If either you or your partner want to be a stay-at-home parent, can you afford to do so if you continue to pursue infertility treatment? Look at the long-term consequences for each of your possible options. For example, if you do not try at least one IUI for a second child, will you always have regrets? What if you go into so much debt you spend the next five years living paycheck to paycheck? Will you regret not having enough money for vacations, ice cream out, or even preschool?
And if you're just thinking about number two after having trouble conceiving number one, then seek help early. Remember, the longer you wait, the more it can cost.
Once you decide how much you have to spend on family building, the next decision is how to find the best and most cost-effective medical care. We are going to walk you through all the steps to help you be your own best advocate. We'll give you plenty of valuable advice about how to best prepare yourself for the financial challenges you will encounter. You have a lot to consider, and with appropriate planning, you will be able to have a baby.
Five Things You Can Do Right Now
1. Gather all of your pay stubs and records of other sources of income.
2. List your expenses.
3. Create a budget and commit to living by it.
4. Decide how much money you are willing and able to allocate for family building.
5. Consider how you will divide and allocate your financial resources.
Copyright © 2009 by Evelina Weidman Sterling and Angela Best-Boss