Most people are familiar with the high cost of in vitro fertilization (IVF). But what many don't realize, at least not until undergoing IVF themselves, is that the clinic's price doesn't include the cost of medications. The average IVF cycle costs between $10,000 to $15,000, according to Society for Assisted Reproductive Technology, with medications sometimes costing just as much depending on your treatment protocol. For most people, getting pregnant requires more that one IVF cycle, which means these costs can double, triple, or even quadruple if you don't have embryos frozen or need multiple egg retrievals.
Most IVF treatments require injections of follicle stimulating hormone ($971 a cartridge), medication to stop ovulation ($61 per injection), and a trigger shot ($245 per shot). While most people typically only need one trigger shot, conventional IVF protocols require multiple vials of FSH and medication to stop ovulation, and can include other prescriptions such as estrogen and progesterone to prep your uterine lining for an embryo transfer.
Calculating the cost of your medications can feel downright nauseating, but seasoned IVF veterans know there are ways to bring down your bill. After six IVF cycles, and $75,000 spent across three fertility clinics, Ashley Howard-Heimbuch, 35, gave birth to twin boys in 2020. Though Howard-Heimbuch, who lives in Detroit, was quoted more than $15,000 for her medications, she managed to obtain them for one-third of the price.
"We were very fortunate because between ordering internationally with major discounts and getting meds donated to us, we probably only spent $5,000 on medications," says Howard-Heimbuch. When ordering her medication, the new mom used her local pharmacy and IVFmeds.com, a website that allows people to order medication internationally. Before looking overseas, Howard-Heimbuch called three different U.S. specialty pharmacies to find a more affordable option than the $1,400 she was quoted for one medication. Unable to find a cheaper option, she decided to order it from an international pharmacy for $249, plus $50 shipping.
Howard-Heimbuch is far from alone when it comes to ordering prescriptions internationally to save money. A study published in the Journal of the American Medical Association found that about 2.3 million people in the U.S. personally import medication each year because of cost. These savings are not without risk, though, as importing medication for personal use is technically illegal. This is due, in part, to rules and regulations maintained by the FDA in the U.S.—that the agency cannot enforce internationally.
Roohi Jeelani, MD, a reproductive endocrinologist at Vios Fertility in Chicago and an IVF patient herself, says she always reminds patients who order medications internationally that they are not cleared by the FDA. "I always give a warning that they're a fraction of the price, likely because they're not manufactured here." she says. "I've had patients use them successfully, but it always comes with a little 'buyer beware' warning from me."
According to the Kaiser Family Foundation, current law directs the FDA to allow personal importation when the medication is "clearly for personal use and does not appear to present an unreasonable risk to the user." Those who order fertility medications abroad can do so without fear of legal reprisal, Gabriel Levitt, president of PharmacyChecker, says: "Despite the technical illegality of most of those purchases, individuals are never prosecuted for importing prescription medications for their own use; that includes FDA-approved drugs and foreign versions of FDA-approved drugs." Levitt adds that though you won't be charged for a crime, the FDA can refuse and destroy your order once it lands in the U.S. Though, he stresses, such import refusals are rare.
Because fertility treatments need to be timed perfectly to your menstrual cycle, if you decide to order medication internationally, plan ahead to order them well ahead of time. Some drugs also need to be refrigerated, which means unforeseen delivery issues could end up spoiling your meds. To avoid online scams, ask your fertility clinic what international pharmacies their patients have had success with. Reputable pharmacies will require a prescription to place an order. You can also use services like PharmacyChecker to make sure the pharmacy is licensed.
"The key to safety with international purchases is finding a licensed provider, whether it's a pharmacy in Canada or another country," says Levitt. "In some cases, 'rogue' online pharmacies intentionally sell counterfeit drugs, don't require valid prescriptions (even for addictive prescription drugs), and steal people's financial and personal information."
Of the medication used during her six IVF cycles, Howard-Heimbuch estimates she only paid for around 25 percent of it. The remaining 75 percent was leftover medication donated to her from other people doing fertility treatments. Because dosages can change depending on how your body responds to the medication, and because medications can take time to arrive—even if ordering from a specialty pharmacy in the U.S.—sometimes more medication is prescribed than needed to avoid running out mid-cycle.
Instead of letting leftover medication go to waste, many people undergoing fertility treatments donate their meds to their clinic or those in need. If your clinic doesn't have donations, you can try looking on social media. Platforms routinely try to crack down on medication donation since giving or selling prescription drugs to others is illegal—but the donation market is there, if you know where to look for it. People often purposely misspell medication names or use abbreviations like "ISO" ("in search of") to avoid detection. There are also hashtags such as #IVFcandy, which people use when making requests.
Crystal Leftridge, 37, has both received and donated medication. Leftridge was contacted by someone who had leftover medication that was going to expire soon. Unfortunately, that was at the start of the COVID-19 pandemic, when many IVF cycles, including Leftridge's, were canceled. Not wanting the medication to go to waste, she donated it to someone who was able to use it. "I've also benefited from medication donated to my fertility clinic," says Leftridge. "In a last-minute pinch, I needed something and they had it on hand because somebody had donated it." So far, she says she's spent $35,000 on IVF, with $8,000 of that going toward medication.
Before using donated medications, Jeelani recommends asking the donor how the medications were stored—and if they are partially used. Some medications need to be refrigerated or kept at a certain temperature. "You don't want to get product that has not been appropriately stored and is not going to work for you," she says. "There's also certain meds that, after you puncture the seal, are no longer valid, so you want to ask if it's been punctured or used. And if it has, then don't use that medication."
Buying medications internationally and seeking out donations internationally are the biggest ways to cut costs, but there are other ways to potentially save. Jeelani recommends asking your fertility clinic if they have package deals with specialty pharmacies, as many clinics do. Some drug companies also offer financial assistance based on need, prior cancer diagnosis, and to veterans and their spouses. Even if you don't think you'd qualify for financial assistance, apply, Leftridge says. "I didn't think I would be eligible for any of those, and I was pleasantly surprised that we were eligible for discounts through different pharmacies at different points in time."
And don't be afraid to shop around. Though Leftridge lives in Kansas City, the best deals she found were at Southern Miami Pharmacy in Miami and EncompassRx in Atlanta. "Call around—there are a lot of IVF specialty pharmacies, and they all have different prices on different medications," Leftridge says. "I think between insurance companies and pharmacies, I've probably spent about 20 hours on the phone over the last year."