The cost of infertility- Part 1
As mentioned in a prior post, my wife and I underwent fertility treatments to have our beautiful son. While this was not the plan when we started dating years earlier, life often throws curveballs. I may at some point write about the emotional roller coaster that we and other couples go through when undergoing infertility treatments. I know at least 7 couples who underwent fertility treatments and no one enjoyed it. However, at the end you get a beautiful child. Lets discuss infertility costs.
Now before there are people out there in the web saying in vitro fertilization (IVF) is selfish as there are plenty of kids to adopt…well I won’t disagree. IVF is selfish and we are able to live in a country where it is accessible, albeit not affordable. The problem is that adoption also is unaffordable for many. We looked into it, spoke to a lawyer, and I have included those costs in an upcoming post. This post is in 3 parts: 1) Initial infertility costs, 2) Adoption costs, and 3) in vitro fertilization treatment and costs.
As a disclosure, all costs below were based on our health insurance and your rates will be different. Hopefully your employer will cover more of the fertility medications, tests, and treatments. I know my current employer does. The below is just an accounting of how expensive it can be and out of reach for most working class Americans.
The beginning
Okay, so before getting into IVF, there are steps to be taken. It is rare for a doctor to go straight to IVF without good cause. Presumably you have been trying to get pregnant for a few months to a year (we waited 6 months before aggressively trying to figure out what was going on). Luckily most of the early stuff is covered by insurance. This includes hormone levels, semen analysis, etc. There are typically no medications at this stage. Options for other tests include measuring luteinizing hormone (LH) through an over the counter test to find out if there is ovulation but it’s not necessary. If all the tests look good then it’s time to try and procreate the natural way again. It is up to you and your physician how long you wait to progress.
One cost we did not expect at this stage was higher co-pays from our insurance. This occurred because our Ob/Gyn billed the visit as a infertility consultation. The visit did not take any more time then a regular visit, but because it was coded at a more complex level of care, the co-pay was higher ($150 approximate). Another cost that came out of pocket on the initial visits was a genetic test, which cost us $99. This was used to screen for genetic abnormalities that could decrease the likelihood of pregnancy, etc.
All in all, our visit co-pays, blood tests, and analysis cost us about $249.
Next up, the pill…and not the kind you are thinking
So if you don’t get pregnant the way humans have been doing it for thousands of years, then the physician may try Clomid. What is Clomid, well this is neither a medical blog nor my expertise so I will keep it short. Clomid is an oral medication for infertility. It inhibits estrogen receptors in the hypothalamus making the body perceive low estrogen levels (similar to day 22 in a woman’s menstrual cycle).
This leads to various changes in hormones such as gonadotropin releasing hormone (GRH), follicle stimulating hormone (FSH), and LH that will hopefully lead to growth of more ovarian follicles and subsequently rupture of follicles resulting in ovulation. Clomid is an oral pill but in our case we went to a fertility expert. Therefore the total cost for the visit and medications, along with ultrasound monitoring was $800.
Total cost for Clomid was approximately $800. So 9 months in we spent a total of approximately $1,049.
Then come the shots
After Clomid our physician tried to up the game and improve our odds of pregnancy. This typically leads to injection medications. In our case she recommended progesterone to induce menses, Letrazole for off-label ovarian stimulation, and then blasted them with Follistim (a FSH hormone that regulates ovulation). This is a subcutaneous injection much like insulin. For those not too excited about needles it is another stress on top of the other emotional stressors of infertility. This is a cost that cannot be really quantified. We ended up using a GRH antagonist requiring an even bigger needle. Follisum controls ovulation and rapidly suppress the production of LH and FSH. After ovulation you give Crinone, a progesterone hormone, topically to prepare the endometrium to receive the fertilized egg. That is it. Simple right…no wonder the fertility doctors make an average of $317,000 as reproductive endocrinologist.
Then we waited to see if she was pregnant. We did 3 rounds of these injections and never had a positive pregnancy test. The 3 cycles in total cost us $3,200 for the physician visits, ultrasound fees, and medications out of pocket. During this period the doctor performed further lab tests running us another $209 and another $81 for over the counter ovulation and pregnancy tests.
So 12 months in and another $3,490. Now our total was up to $4,539. Plus now we had the emotional stress of my wife receiving frequent injections and having hormonal imbalances due to injecting high levels of hormones into her body.
And now the tubes
At this point in the game, 1 year in, there were not many more things I thought the doctor could do to my wife…but I guess I was wrong. In between the 2nd and 3rd cycle of the above injection treatments the doctor decided to test my wife’s Fallopian tubes. She actually should have probably done this 2 cycles ago, but somehow it got missed. Annoying yes, end of the world, no.
The Fallopian tubes are basically the road down which the eggs travel to get from the ovaries to the uterus. The sperm can inseminate the eggs anywhere along the road. If there is a problem with the tube, say it is blocked or shaped strangely, then there can be no baby. The ovary may release an egg, but the egg cannot get to where it needs to be for its date with the sperm. So checking this is important. The process for checking it is quite quick and relatively non-invasive but costs about $450.
So after 1 and a half years of initial fertility evaluation and treatment our total cost was $4,989 in 12 months.
What do you think, should infertility treatments be available for all? What are your experiences with infertility?
