I’ve known I wanted kids since I was in my early 30s, but I wanted to wait until I was in the right relationship before I actively pursued becoming a mom. When that relationship finally arrived at 36, I realized I’d hit another snag: I’d fallen in love with someone who wasn’t sure he wanted kids. Cut to three years later. He still wasn’t 100% sure, but he was willing to try. So we did. And tried, and tried, and tried, again and again. But after a year and a half, we still couldn't conceive a baby the "natural" way, prompting me to seek outside help.
Along the way, I’d followed my gynecologist’s advice: we had sex regularly, accompanied by assorted fertility diets, teas, and ovulation tests. But by the time I went to see a fertility specialist, I was already 40, and well into what experts consider “advanced maternal age" for having kids.
After going through the various tests, my fertility doctor concluded that in-utero insemination (IUI) or in-vitro fertilization (IVF) were my only available options. IUI is the cheaper and less invasive procedure, in which processed and concentrated sperm is inserted directly into a woman's uterus, while IVF involves combining an extracted egg and sperm sample in a lab, then inserting them into the uterus. But I immediately ruled out IVF for one simple reason: cost.
While IVF costs vary by location and clinic, according to Dr. Lora Shahine, a reproductive endocrinologist at Pacific NW Fertility and co-author of Planting the Seeds of Pregnancy: An Integrative Approach to Fertility Care, the average cost nationwide for an initial IVF cycle is $12,000. This includes ultrasound, monitoring, egg retrieval, anesthesia, and basic culturing of eggs and creating embryos. There also may be additional costs involved, such as medications ($3,000-5,000), genetic screening of embryos ($5,000), or ICSI (intracytoplasmic sperm injection), a procedure in which a single sperm is injected into a mature egg, which is usually used when there’s male factor infertility ($2,000). It's also worth noting that the price can easily double or triple, depending on the number of cycles required.
If you struggle with fertility, how can you start a family without having huge stockpiles of cash in the bank?
As a freelance writer with an unstable income, I was sure there was no way I could ever afford the five-digit price tag. I couldn't help but wonder: considering that not only women of substantial means want to have kids, how do lower-income women afford IUI and IVF? If you struggle with fertility, how can you start a family without having huge stockpiles of cash in the bank?
Some insurance companies provide coverage for IVF, and 15 states are mandated by law to cover some fertility procedures. (Thanks to last week’s initiative by Governor Andrew Cuomo, New York state insurers are now legally required not to exclude same-sex or single prospective parents.) But for many, IVF is either not covered by their insurance plan, or it only covers fertility testing.
For this reason, many women opt for IUI over IVF, which Shahine said typically costs between $600 and $800. Yet according to Oregon Reproductive Medicine, IUI is much less effective than IVF, with only a 10-20% success rate for women.
For those who can’t afford to pay for IVF, credit cards are an option. Several women I spoke with stressed the value of finding a 0% APR credit card, so they didn't have to pay any interest on purchases for a set amount of time. That gave them the time to gather the funds necessary for either the full or partial cost of IVF.
For writer Doree Shafrir, who with her husband Matt Mira co-hosts the podcast Matt and Doree’s Eggcellent Adventure about their IVF journey, it cost $40,000 to pay for two rounds of IVF in California, including one transfer and the associated drugs, only $600 of which has been covered by insurance. Shafrir used her book advance and zero interest credit cards to pay for the procedure, and they've "adjusted the budget as we go."
“Both of us have freaked out at different times about the cost, and usually one person has reassured the other that everything will be fine,” Shafrir said.
Fertility is just so personal that a lot of people don’t want to put themselves out there and feel vulnerable and ask for money.
Crowdfunding for IVF is also an option for some women, such as Huffington Post writer Jessica Melcher. When Melcher found out her insurance didn't cover IVF, she turned to the internet to foot the $12,000 bill for the procedure. "When we first sought help for our struggle with infertility, I made it my mission to make sure no one knew," she wrote. “[Looking] back, my reasons for keeping our struggle a secret were the exact same reasons I refused to ask for any sort of financial help... I was too worried about what other people would think."
For Melcher, crowdfunding was effective, but it also requires couples to be open about what is, for many, a deeply personal issue. “I’ve seen a couple people do it, but fertility is just so personal that a lot of people don’t want to put themselves out there and feel vulnerable and ask for money," Shahine said.
There are also several grants available to women pursuing fertility. RESOLVE: The National Infertility Association maintains a list of infertility treatment grants for this purpose One such grant is The Cade Foundation Savannah Grant, which provides up to $10,000 for IVF patients who are permanent United States residents who’ve been diagnosed with infertility to be treated at Shady Grove Fertility Center, which has locations in Maryland, Pennsylvania, Virginia and Washington, DC.
Pamela Hirsch, co-founder of the nonprofit Babyquest Foundation, has given out 55 grants to infertile people since its founding. To qualify for such a grant, Hirsch said you must be very clear about your conception plan. “You don’t want somebody who says ‘I’ll do an IUI or I’ll do an IVF or maybe we’ll go to surrogacy,'" she told Romper. "You want people who’ve done their homework, who’ve probably embarked on this process.”
"It's almost like gambling."
According to three women who were given grants by Babyquest Foundation (who requested we not use their last names), such a grant can mean the difference between getting IVF and not getting IVF. But it doesn’t mean that you won’t ever have to pay a cent.
Amanda*, a teacher who did IVF at age 27 after three years of trying to conceive, said the process of spending money “starts really early,” noting that she probably spent $100 a month on basics like vitamins, ovulation test kits and pregnancy tests over those years. When she finally consulted a doctor, she was diagnosed with PCOS (Polycystic Ovary Syndrome), and told she didn’t ovulate regularly enough to conceive without medical intervention.
"You have to be honest with yourself about how badly you want that child. If you’re not willing to spend that money, then you don’t want it badly enough.”
She then did three rounds of IUI, which cost $1,000-$2,000 each. “After the first three, we said, ‘Oh, it’s just another $1,200,'" Amanda told Romper. "It's almost like gambling." She wound up doing six more $1,200 cycles of IUI before her doctor told her it wasn’t worth continuing and that IVF was the next logical step. At that point, she had sold almost everything she could to pay for the treatments. “We sold our Bowflex, my husband sold some of his guns and his Jeep, I sold a fur coat my great great aunt had given me, I sold jewelry—anything we could take to the pawn shop to sell," she told Romper.
The next medically advised step was IVF, which was an estimated $15,000 cost that at that point was far out of their price range. “We had just exhausted all of our resources doing other, more cost-effective treatments,” Amanda noted. Broke, she applied for a Babyquest grant and received it.
“If you’re not willing to spend the $10,000 you have in savings or bonds or whatever valuable assets you have, but you are willing to ask someone else to pay for it, you have to be honest with yourself about how badly you want that child,” she cautioned. “If you’re not willing to spend that money, then you don’t want it badly enough.”
For Lyndsay, who started trying to conceive at age 35, IVF wasn’t on her radar at the beginning. For three years, she tried everything from Clomid, a drug that tries to induce ovulation, to at-home IUI. Since she lives paycheck to paycheck and her insurance doesn’t cover IVF, she hadn’t considered it until she heard about a grant offered by New York state called the Infertility Demonstration Program, which covers one round of IVF (approximately $20,000 in her case). The remaining amount she put on a credit card.
“It’s really easy to think about how $5,000 debt is nothing when at the end of it all you get a baby,” she said. Although Lyndsay used the grant to fund a successful round of IVF, she noted that “the reality is, there is a... chance that you won’t get a baby. And then that debt is not only large, it’s painful.”
"There is a... chance that you won’t get a baby. And then that debt is not only large, it’s painful.”
Given that success rates of IVF per cycle are about 40%, with the rates decreasing as women age, the truth is that no matter how much you spend on the procedure, there’s no guarantee that it will be successful. As one-half of a same-sex couple, filmmaker Haley Jude knew she would need assistance no matter what path to having a baby she chose. She opted for IVF, and, along with her female partner, first spent $30,000 at a “fancy fertility clinic” that “badly botched” the procedure, then $20,000 in order to give it another shot at a different clinic.
Although the second procedure was successful, “it was so much money it almost felt fake to me. We had no savings, no home, I had no retirement account," Jude said. There was only one thought that kept her going: "All I could think was ‘What better to spend money on?’”
For many women, the process of trying to conceive can be incredibly emotionally draining. The stress can be even more overwhelming when financial constraints come into play. Many of the women I spoke with for this piece emphasized the emotional turmoil of having their future parenthood determined, in large part, by their financial status. “It is completely overwhelming. It feels as though you are not worthy enough to be a parent or to experience pregnancy if you don’t have an extra $10,000 dollars lying around,” said Tiffany*, a Babyquest Foundation grant recipient.
For Erin*, another Babyquest Foundation grant recipient, “the whole process made me feel less of a woman. Not having the financial security to be able to do it made me feel like less of an adult, and the stress probably didn’t help. It was a very low point in my life.”
"It feels as though you are not worthy enough to be a parent or to experience pregnancy if you don’t have an extra $10,000 dollars lying around."
Still, many parents who have undergone successful rounds of IVF feel that it’s worth it, regardless of the cost. “Our emotional well-being and the state of our marriage was so much more important than the money," Lyndsey said. We decided to get the credit card just for this because it became very clear to me that I didn’t see the point to being married or even alive at all if we couldn’t have a family. I know that’s really harsh and blunt, but it was something very real I discovered about myself.”
For my part, I ultimately realized that perhaps I'd been too quick to rule out IVF, simply because my income varied greatly from year to year. While I hate the idea that IVF and other fertility treatments are out of reach for many low-income or even middle-income women, it is heartening to know that there are creative solutions to funding the procedure, thus making my dream of starting a family seem less far out of reach.
IVF and IUI aren’t simple: they require devoting your body, along with significant amounts of your time and energy, to what is for many the grueling task of getting pregnant. But if my partner and I come to the joint decision that IVF is right for us, I’m not going to let lack of funds be the deciding factor, because I don’t think any prospective mother should have to choose being going into debt and starting a family. While it would be wonderful if more insurance plans covered IVF, until that day comes, I’m going to keep my options open.