If there’s one thing that everyone seems to know about fertility treatment, it’s that the costs can be very high. And though there are changes and upgrades coming to many company fertility benefits programs and insurance plans, as well as options for supplemental fertility coverage insurance, the out-of-pocket costs for this type of health care can still be costly.
While fertility treatments cannot fix every reproductive health problem, there is a lot that can be done with the help of science. Here, we’re going to break down why this help (in the form of reproductive medicine) can be costly.
When most people think about medicated fertility treatment, they think of in vitro fertilization (IVF). Yes, IVF treatment is one of the biggest parts of assisted reproductive technology (ART), but there are other services and practices that can boost fertility, pregnancy, and live-birth rates. IVF does typically have the highest success rates. However, of the fertility treatment options, it is more expensive. It’s been found that compared with intrauterine insemination (IUI), IVF is much more effective with a success rate that is 3-5 times higher, but also much more expensive with a cost of 5-40 times more. Plus, because most people have exhausted other options, once a person or couple arrives at IVF, generally the emotional stakes are also significantly higher.
The first step in fertility treatment is a consultation with a fertility specialist (or reproductive endocrinologist). Costs for a fertility specialist can vary based on location, taking into consideration that while large cities sometimes attract higher profile doctors, the supply and demand in a given city can also drive the price of medical treatment, keeping it more competitive if there are a plethora of doctors to choose from.
Once you’ve chosen the best medical provider for you, there are three main stages of treatment that can take place: pre-embryo creation, creating embryos, and transferring embryos.
Diagnostic testing (fertility testing to see what’s going on) is crucial to the fertility journey. Some people have nothing diagnosable, which can be especially frustrating and lead to even more costs to determine a method of treatment that will lead to success. The cost to diagnose can vary greatly by country, and also by standards of fertility treatment plans offered by insurance companies.
When looking for all the infertility treatment costs, sometimes there’s a wide range listed. The reason these gaps in costs exist is that sometimes we don’t know how in-depth or complicated a procedure will be until it’s started. Once started, if more research or testing has to be done, the price can go up in real time.
Sometimes an issue is identified before attempting to make embryos: this could include something like a fallopian tube that’s blocked, low sperm count, or diminished ovarian reserve. Here are some of the more standard diagnostic tests that we look at, along with a breakdown of what they do.
Basic blood test:
There is a panel of blood drawn on day three of the menstrual cycle (“cycle day 3”) that measures two important hormones: AMH and FSH. AMH, or anti-mullerian hormone, is an indicator of the number of follicles a woman has on reserve that may turn into eggs for fertilization. FSH, or follicle-stimulating hormone, is the hormone that signals to those follicles to grow and mature into an egg and to release (during ovulation). These blood tests can be run through an RE or an OBGYN if there’s a concern that pregnancy isn’t happening in a desired timeline. It’s important to understand that these hormone test results don’t necessarily give any definitive answers. They provide a general snapshot of what may be going on inside a woman’s body at a given moment in time. They also don’t necessarily require specialized fertility insurance coverage. Regular health insurance may cover these basic blood tests, so be sure to check with your insurance plan or benefits provider to see if you’re covered.
Number, shape, and movement of sperm are all factors that contribute to sperm insemination success rates. A semen analysis can be one of the easier tests to undergo when trying to conceive because it’s conclusive and not overly invasive. Semen analysis costs can vary.
The HSG test is a procedure that uses a special dye, and while it can be done at some fertility clinics, it’s usually performed at a hospital or outpatient facility. The dye helps to show if there are any blockages in the fallopian tubes. Like all else, the cost of an HSG ranges.
This is where the higher costs can come into play. As hard as it can be from the patient side, it makes sense from the medical side that this part of the process is more pricey, because it starts to involve embryologists, labs, clinicians, fertility medications, and ideally creating human life.
Once past the diagnostic phase, there are two primary courses of treatment to create an embryo, depending on the diagnosis: IUI or IVF. Each of these comes with a lot of nuance and some gray area—there’s no one-size-fits-all course of action, and (it bears repeating) no guarantees.
Intrauterine insemination (IUI):
IUI can target specific concerns, or it can be a good starting point for unexplained infertility. It may also be recommended for couples experiencing male factor issues, sperm delivery issues, or ovulation timing issues. By better helping the sperm to reach the fallopian tube, it encourages the sperm and egg to interact in closer proximity. IUI combines better sperm delivery (with easier targets for the sperm) and optimal timing. The typical procedure costs for one IUI cycle aren’t so far apart in range, but medication costs can vary significantly depending on the use of oral or injectable medications. The costs also depend on whether you have fertility insurance coverage or are paying out-of-pocket.
Again, the range is vast. The reason is that sometimes the basics work, and sometimes they need some fine tuning, which adds up. For example, a standard first approach to IUI may be for the woman to take an inexpensive oral medication that stimulates an increase in the hormones that support the growth and release of a mature egg. They’ll also likely go through monitoring with an RE. If all goes according to plan, at a specific time, the male’s sperm will be washed to produce the strongest sample and then inseminated directly into the female (intrauterine). An embryo will (hopefully) be created internally, and a pregnancy test will be taken two weeks later. This approach is typically on the lower end of the IUI cost spectrum.
The costs go up once the “basic” plan isn’t working, which is sometimes only realized once treatment has started. At that point, injectable medications may be added to increase egg production, and more medical monitoring appointments might be needed. Thus, this approach would end up on the higher end of the IUI cost spectrum.
In vitro fertilization (IVF):
The cost of IVF at fertility clinics in the United States is typically quoted at around the same price for one cycle. However, depending on your individual need, one IVF cycle may cost more than the original quoted price because there are parts of the process that clinics treat as “add-ons.”
Usually, the overarching price of IVF doesn’t take into account other costs like the price of:
- ICSI (intracytoplasmic sperm injection), or manually injecting sperm into an egg (not always needed)
- Preimplantation genetic testing of embryos
So yes, IVF can be costly. One of the hardest parts to consider is that many first rounds of IVF do not work, and therefore additional rounds may be required.
Pricing also varies if you’re using your own egg and sperm or not. When necessary, third-party reproduction costs are added as well. Third-party reproduction can include donated eggs, donated sperm, donated embryos and/or surrogacy. Even though “donation” is used as a catch-all term here, most of the time and given specific circumstances, nothing about these donations is free. Even with a known donor like a friend or family member, the medical costs for egg or sperm extraction apply.
Third-party reproduction costs may include the following, and each has its own varying price range:
- Donor sperm
- Donor eggs
- Surrogate use and compensation
- Surrogacy agency and legal fees
- Embryo/egg storage
After creating embryos, we get to transfer. Simply put, this is when the embryo is transferred into the uterus with the hope that it sticks to the uterine lining and becomes a fetus, and then a baby.
These costs will vary depending on whether you’re doing a fresh embryo transfer (soon after the retrieval) or a frozen embryo transfer (later on). With a frozen embryo transfer, additional fees might accrue for things like storage fees and genetic testing of the embryos.
Long-term considerations of fertility treatments and associated costs
One final thought: in the United States and other countries where a majority of people don’t have health insurance that fully covers fertility treatment, and patients must spend out-of-pocket financial resources, a clinic or RE may recommend a more aggressive protocol to attempt better outcomes and prevent a couple having to spend more or do multiple rounds of treatment. This means that standard insurance care or coverage sometimes dictates medical moves, as opposed to what’s medically best for the patient.
The hardest part of these costs is that they come with no guarantees of a positive outcome. And they can unfortunately come with a whole lot of resource depletion in many areas: emotional, physical, and clearly, financial. But the hope is that it’s money well spent, money towards the goal of growing a family.