Nicole Lawson and her husband desperately wanted biological children, but in 2009, after several attempts to conceive through in vitro fertilization (IVF) ended in miscarriages, Lawson's mother suggested the couple consider surrogacy.
Between attorney and agency fees and medical and insurance costs, gestational surrogacy can range in cost from about $70,000 to well over six figures, which Lawson and her husband didn't have after paying for several rounds of IVF. Fortunately, the couple's parents agreed to help, and the Lawsons now have a two-and-a-half-year-old daughter.
Lawson says she and her husband wouldn't be parents without financial help from their own parents. Paying for fertility treatments is an obstacle that countless other couples face.
According to the Centers for Disease Control and Prevention, an estimated 6.1 million women in the United States between ages 15 and 44 have difficulty getting or staying pregnant. The American Society for Reproductive Medicine lists the average cost of an IVF cycle in the United States to be $12,400. Surrogacy, as mentioned above, costs even more. Here's a look at several ways to pay for fertility treatments.
Consult your OB first. Some work can be performed in your obstetrician's office, so do as much of the diagnostic and blood work as you can before stepping foot inside a fertility clinic. "For the lower-end services, like artificial insemination, a lot of OBs do perform those services," says Leticia Uribe, the business office supervisor at Reproductive Science Center of the San Francisco Bay Area. "There are times that I advise patients to go to their regular OB office, because the way they're coding it, your insurance would cover it under OB."
Check with your insurance provider. Fifteen states have infertility insurance laws requiring healthcare insurers to cover or offer some form of infertility diagnosis and treatment, but the extent of that coverage varies by state. Some employers purchase additional packages to cover IVF, which would further reduce your out-of-pocket costs.
In fact, Robert Dowling, a wealth manager at Modera Wealth Management in New Jersey, says some people apply for jobs with this in mind. "If you work for New York City, for instance, they have a very broad health insurance policy where a lot of the blood work is typically covered." Uribe says some employers she's seen in Silicon Valley also offer this type of coverage.
Look to family. Dowling says using gifts or loans from family members is a common strategy for couples who've depleted their own resources. In addition to helping children build a family of their own, would-be grandparents might consider it as an estate planning strategy. Gifts over $13,000 would trigger the gift tax, but "if someone wanted to reduce their estate and gift it to their child, they could pay that medical bill directly to the facility," says Dowling. "It makes sense because the grandparents want to provide for their family and don't want to pass away with all the money in their pockets." It also gives them the satisfaction of seeing the impact of a gift during their own lifetime.
Take out loans. Some clinics offer payment plans or financing through third-party companies. Dowling says some couples go to great lengths to start a family, including depleting their savings, racking up credit card debt, taking out a home equity loan, or cashing out their 401(k). Going into debt may seem like a last resort, but people do it. "Yes, you can approach it quantitatively and have a plan about how much you'll spend, but people become determined and after an unsuccessful trial, they'll want to keep going," he says. "It's very difficult to say, 'this is what you should do.'"
Dowling knows how emotionally charged the issue can be; he and his wife spent between $30,000 and $50,000 on the fertility treatments which led to the birth of their daughter and twin sons. Their fourth child was conceived naturally. "It's an emotional decision," he adds. "Whenever someone says, 'how much should you allocate?' it's impossible to say. Some folks would incur debt in order to achieve their goal." Uribe says she's seen patients spreading payments over multiple credit cards or using a combination of check, credit card, and cash.
Apply for grants. As Pamela Hirsch, Lawson's mother, put it, "infertility treatment has become a privilege relegated only to those who can pay." That realization prompted the pair to found Baby Quest, a nonprofit foundation that grants financial help to couples who cannot afford fertility treatment. "We look at financial information, job situation, and we have the medical advisory board look over the medical documentation to say who would be the most successful candidate in this," explains Hirsh.
Baby Quest accepts applications from individuals and couples throughout the country, and few other organizations offer funding to couples in specific geographic areas. If you're willing to post your story online instead of quietly filling out an application, sites like GiveForward.com and YouCaring.com allow users to crowdfund money for medical costs, including fertility treatment.
Ask about refund or discount programs. "Some of the fertility pharmacies offer discount programs or compassionate care for patients depending on their income," adds Hirsh. At Reproductive Science Center of the San Francisco Bay Area, where Uribe works, eligible patients have the option to pay for multiple cycles of IVF upfront for a discount (however, they don't get a refund if they conceive before using all cycles) or participate in the refund program, which offers a 70 percent refund if they do not bring a baby home from the hospital. "That was designed for patients to have another option, whether it's adoption or getting some money back," explains Uribe.
Before paying for multiple cycles, Dowling suggests getting information on the clinic's success rate and discussing the likelihood of your own success with your doctor.