Concern about high cost is one of the top two reasons for not going to see a reproduction specialist (the other reason is fear of having multiple babies at once). Many couples believe it will take tens of thousands of dollars to get them pregnant. They have heard horror stories of friends of friends who spent $50,000 on fertility treatments. While infertility treatment can get expensive, it doesn't always have to be so.
If you are considering going to see a fertility specialist (reproductive endocrinologist), one of the first things you should do is check with your insurance company. You may be surprised to find out that you do have coverage. Several states, for instance, have laws that mandate insurance coverage for infertility diagnosis and treatment for all but the smallest of companies.
These states include Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia.
What does your insurance cover?
Ask your insurance company whether infertility diagnostic testing and/or treatment is covered. If you do have coverage for treatment, find out the details. Many plans will cover some treatments, but not others. They may have requirements before you can start a specific treatment, or you may need to sign up for a special program within your insurance company.
Do you have a deductible or maximum amount they will pay out? Ask if the doctor you are planning on seeing is in their network or not. Learn as much as you can about your coverage. Your doctor's office may be able to help, but you are ultimately responsible for knowing your insurance coverage.
Insurance question for your doctor
There is one more question you should ask, but this one is of your doctor. Even if your doctor is in your insurance network, sometimes they have a lab or IVF center that is not. This could mean that your insurance pays for you to see the doctor, but not your testing and treatment.
Ask your doctor's office whether they will send your lab tests to a lab that your insurance covers and whether procedures such as IVF will be done through a center that is covered by your insurance. This will help you avoid unpleasant surprises when you open up your bills. If you are wondering, the answer to both questions for our office is yes.
Usually, the first step a reproductive endocrinologist will want to take is to do some testing to see why you are not conceiving, and this is often covered by insurance. Even if you do not have coverage for fertility testing, some of the tests may get billed out with another diagnosis such as ovulation dysfunction, pelvic pain, etc. This may increase the chance that insurance covers it.
Many fertility centers also have special deals with laboratories such as Quest or LabCorp to get very good pricing on the common fertility blood tests for couples who do end up having to pay out of pocket. For instance, the common blood tests only cost $50-$60, if you have no insurance coverage.
A semen analysis to look at the sperm may also be needed. If your partner has different insurance, don't forget to check and see what his insurance will cover. A semen analysis, if it is not covered, is usually about $75-$100.
There is one test that usually does get billed out as fertility testing and therefore may be denied by your insurance company if you don't have coverage for fertility testing. That is the hysterosalpinogram or HSG. This is a test to see whether the fallopian tubes are blocked. Not all women will need this test; so if your insurance does not cover fertility testing, ask your doctor whether you need the test done or not. If you have no risk factors for blocked tubes like pelvic surgeries or infections, then he or she may be willing to forego the HSG or order a blood test for Chlamydia antibodies instead.
Chlamydia is a silent cause of blocked tubes, and a negative test lessens the chances that you have blocked tubes. You may also want to ask about a FemVue procedure instead, which may be less expensive.
Many hospitals also have special deals for couples who pay up front rather than wait to be billed. At most hospitals, an HSG ends up being about $800, though. So even with the discount, it is on the expensive side.
Clomid and beyond
Fertility treatment varies tremendously in cost. The simplest treatment is Clomid or clomiphene citrate. Clomid is one of Walmart, Sam's Club, Target, and Kings Sooper's $9 per month prescriptions. If you don't have one of those stores near your, call around. Your local grocery store or pharmacy may have a similar deal.
Clomid is sometimes combined with intra-uterine inseminations (IUI). This is a procedure that deposits sperm at the top of the uterus to get it closer to the egg. An IUI usually costs about $400, depending on the center. An ultrasound may also be used to monitor the ovaries response to the Clomid, and that will probably cost about $200. Oftentimes insurance will pay for the ultrasound.
Beyond Clomid, things get more expensive. Injectable medication can be as little as $600 a cycle and as much as $4,000 a cycle depending on the dose and how long you end up having to take it. When using injectable medication with IUI, a typical cycle would run about $1,000 - $1,500 in medication.
Several of the manufacturers of injectable medications have samples or programs for couples struggling with the cost of medication. Therefore you may be able to get free or at least reduced price medication for a cycle or two.
There are ultrasounds and blood tests needed, and the cost will vary depending on how many are necessary. Again, insurance will often cover these as testing. A good estimate would be $1,000 in blood tests and ultrasounds if insurance does not pay a thing.
When using injectables with IVF, the costs are going to be more in the $3,000 to $4,000 range. An entire IVF cycle will typically cost about $14,000 - $16,000 with the medication.
Egg donors and gestational carriers
The most expensive options involve egg donors or gestational carriers. If another woman's eggs or uterus is needed, then the costs are probably more in the $30,000 (for egg donors) to $100,000 (to hire someone to carry the baby for nine months) range.
So, again, infertility treatment can range from $9 for Clomid to $100,000 for an IVF cycle with a gestational carrier. Many more couples will end up in the few hundred dollar range than in the hundred thousand dollar range, so don't panic.
Do a little homework first to see what insurance coverage you have, but then at least go talk to a specialist. You may find that you have a condition that's easy and inexpensive to treat, and, in any case, you will at least get some answers. Don't be afraid to talk to your doctor about any concerns about costs.
If your doctor is not receptive to these discussions or seems to be trying to "sell" you an expensive treatment, you may want a second opinion. There are lots of great doctors out there, and we would love a chance to help you get pregnant!