Having a baby isn’t cheap in any circumstance. But making a baby? For people who can’t conceive naturally, the price tag can be daunting. Each cycle of in vitro fertilization (IVF) treatment averages around $12,000 — and it can take several cycles. Then there’s the drugs, which are also several thousand dollars each time. Oh, and by the way, your insurance may or may not cover any of this.
So what makes IVF so complicated and costly? With the help of Barbara Collura, president and CEO of Resolve: The National Infertility Association, we’re delivering some answers.
Why is IVF so expensive in the U.S.?
As the leader of an advocacy group that campaigns for greater access to medicine (meaning, via insurance), Collura actually takes the opposite view. “Most of us don’t pay for a knee replacement or C-section birth out-of-pocket, but I’m sure if we did, we’d think they were very expensive!” she says. In other words, many major medical procedures are expensive, yet consumers don’t put the same mental price tags on them because their insurance will cover it. With IVF, it’s less often the case.
But isn’t the cost of all of these things vastly inflated?
Well, yes. Medical care in America is an absurd and grotesque scam. But the point here is that IVF feels even more prohibitively expensive than other operations because they still charge the same extortionate rates as other ops, but without any kind of coverage to make up the difference.
Lovely. What goes into IVF, then?
When you think about it, it’s a scientific miracle. First, the patient is given hormone drugs that trigger hyperovulation, meaning their uterus releases more than one egg at a time. Then they’re put under general anesthesia while the eggs are collected. Those eggs are scanned for genetic diseases, then fertilized with sperm in a petri dish, then implanted back into the uterus, where they hopefully stick and pregnancy ensues.
But that’s an extraordinarily basic summary. The drug cocktail alone is intense, tedious and regimented, and it’s a long, physical, emotionally draining process — especially since people often require several cycles of all of this in order to get pregnant, with hopes being dashed repeatedly before (in many cases, at least) a successful pregnancy occurs.
What’s the deal with insurance and IVF?
The short version is that insurance doesn’t always cover it. Seventeen states have passed laws for coverage to be required or offered to wildly varying degrees, but that still leaves people in 33 states exposed. The finer points of the law can get political, too: A few states require marriage to a man in order to receive treatment, for example.
What’s behind insurance companies’ refusal to cover what seems like a basic human right?
“That’s a great question,” Collura says. “If you can get them on the line, I’d love for you to ask them that. I’m serious — I beat my head against the wall wondering that same thing.”
Do some insurance companies view it as not strictly “required”?
Yes — those companies tend to consider it an elective procedure, and not medically necessary, Collura says. Which isn’t the point of view that Resolve takes — they and others do indeed see the ability to start a family as being a human right. Others have pointed out the hypocrisy of insurance companies covering birth control or hysterectomies, but denying coverage for IVF. In other words, they’ll cover the prevention of babies but not the creation of them.
Health-ethics experts raise some thorny points regarding IVF and insurance coverage: That it increases the risk of premature births and congenital health issues, which make health care more expensive for everyone. Then there’s the obvious and enormous matter of an increased health risk to the babies themselves.
Why do some insurance companies cover IVF, even in states where they’re not required to?
Basically, because of demand. Collura says the insurance situation is actually more nuanced. For example: If Amazon, Bank of America or some large corporation that gets its employees’ insurance in the private market says they want to add this benefit, their insurers will. In fact, Collura says, many of the larger insurance companies are happy to add IVF to their benefits plan for most any company they provide health insurance to. But smaller insurance companies? That’s a different story. They take on more personal risk, which means they end up calling the shots: They decide what’s covered and what’s not, and for how much.
How the hell do uninsured people pay for IVF?
The internet is full of stories: People take out loans, borrow against their retirement plan, borrow money from family and relatives or even start crowdfunding campaigns. In fact, a GoFundMe representative said they’ve gotten 2,500 IVF campaigns in a single year recently.
Are there charities?
Yes — grants are available from many different charities and foundations. The amount they offer runs the gamut, from a few hundred dollars into the tens of thousands. Most only give to a few people a year, and so, Collura says that very few people get this kind of financial assistance. There are about 150,000 cycles of IVF a year, and perhaps 150 to 200 people receive grants.
What other costs are involved?
It’s such an intense process — and not always easy to access — that there are a number of downstream costs, Collura points out. Between the drugs and the intensity and the emotional toll it takes, some people seek mental-health counseling, or an acupuncturist, a nutritionist or whatever other kind of support they need, which are usually out-of-pocket. If people live far away from their IVF clinic, there may be transportation costs (for example, North Dakota and Montana each only have one IVF clinic in the state, Collura says). Then, of course, even if you are covered, you’ve got to cover the copays and pharmacy costs yourself.
What will it take for more insurance companies to cover IVF?
Two things, really: One is political action and lobbying, because the insurance industry is already a powerful lobbyist, as you may have noticed. Collura says, though, that now that more people have gone through IVF firsthand, like politicians and staffers, it’s something they’re more familiar with than ever, and more willing to tackle.
The second thing is that everyone can simply talk to their employer, if they get health insurance through their work, and request that their company benefits plan include IVF coverage. If your business wants it enough, the insurance company will provide it.
In short, then, IVF is expensive partly because it’s a very long and involved process, but also because our hopelessly broken system generally prioritizes helping people after making sure insurance companies make a profit. Is that about it?
Essentially, yes. Now, you could just keep hoping for America to do the right thing and introduce universal health care — but I wouldn’t hold your breath.
Adam Elder
Adam Elder is a writer in San Diego. He's also written for Esquire and WIRED magazines, VICE, The New York Times, The Wall Street Journal, The Guardian, newyorker.com and elsewhere.
