The Financial Side of [In]Fertility

One of my goals for National Infertility Awareness Week was to make a transparent post about the financial commitment that comes along with the other highs and lows of infertility. I'm a few days after when I said I'd post this, but fortunately I don't answer to advertisers or sponsors on this little blog. One reason for my tardiness is that I've been busy busy with lots of other stuff, but another piece is that talking about money can be extremely awkward and uncomfortable. I haven't quite reached the point of "getting comfortable being uncomfortable," but maybe I will be there someday. I have said before that as difficult as IVF and other fertility treatments have been, I am at least grateful that we have been able to swing them financially. Not everyone has the chance to try once or twice, much less...at least five times? Plus three IUIs?...but we have. So, I try to appreciate that. However, others also remind me that it's okay to be grateful for the opportunity and detest needing it all at once.

On the day of the great spicy chicken sandwich incident in December 2019, over a year before we met our RE, one of my sisters-in-law mentioned that there are lots of options to help people get pregnant. My immediate response was, "But they're so expensive," and my sister-in-law Maryanne said, "But you have money." 

But you have money.

When framed that way, the solution seems so simple. And really, problems that you can fix with money are easier than many other problems. It turns out that infertility isn't a problem that is necessarily fixed with money, but money can certainly solve the problem of access to fertility treatments. Richard and I are fortunate that we can both work, and he earns more money than a lot of people do, but we also have considerable debt for his training. While we were fortunate that we could financially swing fertility treatments, it is incredibly frustrating that we're paying so much to achieve what some people achieve for free (and sometimes on accident!), and we haven't crossed the finish line. But, we remain hopeful. 

Anyway, I've thought for a while about how to broach this topic and have not arrived at what I felt was a perfect solution. So, forgive me for any missteps in disclosing this information. My intention is 100% to spread awareness to what [in]fertility treatments can cost and not to flaunt my financial circumstances. If it helps, my car is 17 years old. 

To get started, here are a few things to know:

1. Our insurance does not cover anything related to [in]fertility.
2. Our insurance DOES give us a totally fair price for the therapist that I see largely due to needing assistance coping with infertility and the emotional roller coaster that comes along with that journey. I am grateful for this.
3. I do have records of all fertility-related expenses we've paid since 2019, but I'm focusing on 2021 because that's where the bulk of the money has gone, and I already have that information in a spreadsheet thanks to filing our taxes recently.

I mentioned last week that we itemized our taxes for 2021, which was a first for us. I used H&R Block, and the software gave me a message along the lines of, "To deduct your medical expenses, they must be more than 7.5% of your adjusted gross income (AGI) and paid by you out of pocket - not reimbursed by insurance." Then, it says, "Since your entries show your AGI is $X, your expenses must be more than $Y. Are your out of pocket expenses more than or close to $Y?" I actually laughed, took a photo of my computer screen, and texted it to Richard. If only our medical expenses had been $Y! Yes, $Y is more than I expected to spend attempting to get pregnant and birth a live baby, but it's way less than what we spent in 2021.

The final amount we deducted was $81,002.82. Not all of that was [in]fertility-related, but most of it was. What's the breakdown? Good news, I've got that too.

IVF Cycle 1

The first IVF cycle (March 2021) was the most expensive because we purchased 14 days worth of medications for stims. I tend to be on the shorter side of stims, which has caused some issues but has saved us a little money over time. 

• Eluryng (birth control ring not covered by my insurance through Richard's hospital): $123.60
• Clinic Procedures (ultrasounds, bloodwork, physician costs, retrieval): $6,648.00
• Laboratory Procedures (preparing the sperm sample, fertilizing the eggs, monitoring the embryos, doing a biopsy of the embryos that make it to testing, freezing the embryos): $5,844.80
• Anesthesia (for the egg retrieval): $525.00
• Specialty medications (not covered by insurance): $6,674.29
• Pain management meds (covered by insurance): $5.11
• Genetic testing of 1 embryo: $475.00

Total for IVF Cycle 1: $20,295.80

Long-time readers might recall that we only stimmed for 7 days this cycle, and our RE gave us the option to convert to IUI rather than going for the retrieval. By skipping the retrieval, we could save the costs of anesthesia, some of the clinic procedures, the laboratory procedures, and the genetic testing. However, we'd be out the clinic costs plus about half of the meds, which would be roughly $10,000. We went forward with the retrieval and ended up with one embryo that tested highly aneuploid.

IVF Cycle 2

We jumped straight into IVF Cycle 2. We had some medications leftover, which meant this cycle was about 20% cheaper than the first one.

• Birth control pills (not covered by my insurance through Richard's hospital): $25.15
• Clinic Procedures (ultrasounds, bloodwork, physician costs, retrieval): $6,648.00
• Laboratory Procedures (preparing the sperm sample, fertilizing the eggs, monitoring the embryos, doing a biopsy of the embryos that make it to testing, freezing the embryos): $5,844.80
• Anesthesia (for the egg retrieval): $525.00
• Specialty medications (not covered by insurance): $1,981.49
• Medicine to make my ovaries chill out because my estrogen was high at the retrieval (covered by insurance): $15.00
• Genetic testing of 3 embryos: $1,025.00

Total for IVF Cycle 2: $16,064.44

Two embryos came back euploid, and one was highly aneuploid. With that, we headed into a third IVF cycle. 

IVF Cycle 3

Knowing we would like 2-3 children and feeling excited about the better results from the second cycle, we felt optimistic about going for another round. We had to buy more medications than the second cycle but still not as many as the first cycle.

• Clinic Procedures (ultrasounds, bloodwork, physician costs, retrieval): $6,648.00
• Laboratory Procedures (preparing the sperm sample, fertilizing the eggs, monitoring the embryos, doing a biopsy of the embryos that make it to testing, freezing the embryos): $5,844.80
• Anesthesia (for the egg retrieval): $525.00
• Specialty medications (not covered by insurance): $4,835.38
• Pain management meds (covered by insurance): $5.13
• Genetic testing of 1 embryo: $475.00

Total for IVF Cycle 3: $18,328.18

Out of six mature and fertilized eggs, one made it to be genetically tested, and it came back highly aneuploid.

IUI Interlude

The news that we didn't have any euploid embryos from our third cycle really crushed me. Noting that we had two euploid embryos in the freezer and wanted 2-3 children, our RE suggested trying IUI to see if we could achieve a pregnancy that way. We agreed and did three IUIs (the maximum he would do) over the summer. None of them worked, but it sure would have been cool if they did. All three of our IUIs were the same cost:

• Clinic procedures (ultrasounds, bloodwork, physician costs): $1,144.00
• Laboratory procedures (preparing the sample for insemination): $208.00
• Clomid (covered by insurance): $34.92

Total per IUI: $1,386.92

• Trigger shot (only used for IUI #3): $133.90

Total spent on 3 IUIs:  $4,294.66

FET 1

After the IUIs were a bust, it was time to put one of our frozen embryos to work. In September, we started a frozen embryo transfer (FET) cycle. The expenses are a little different for these.

• Clinic Procedures (ultrasounds, bloodwork, physician costs): $2,288.00
• Laboratory Procedures (thawing and culturing the embryo): $1,144.00
• Specialty medications (not covered by insurance): $709.70
• Non-specialty medications (estradiol tablets and patches, methylprednisone, etc.): $64.65

Total for FET 1: $4,206.35

IVF Cycle 4

After the FET ended with a chemical pregnancy, we were back to retrievals. The discrepancy in amounts here is testament to how at some point we were just like, "Here's my credit card for whatever you tell me I'm supposed to pay because I don't really have another option but to say yes to that amount if I want to hopefully have biological children or, you know, at least the chance at biological children." According to my records, I only ("only") paid $5,608 in clinic procedures this cycle.  I might've paid an additional $840 some other time, but I don't have the receipt. My clinic says I don't owe a balance, and I'm good with that.

This cycle ended a little differently because we did a fresh transfer and didn't have any embryos to freeze or test. We actually have a credit of $701.19 with our RE's office that we can use for a future cycle, BUT here's what we paid. The birth control ring cost $0 through my insurance with Penn State.

• Clinic Procedures (ultrasounds, bloodwork, physician costs, retrieval): $5,608.00
• Laboratory Procedures (preparing the sperm sample, fertilizing the eggs, monitoring the embryos, doing a biopsy of the embryos that make it to testing, freezing the embryos): $5,844.80
• Anesthesia (for the egg retrieval): $525.00
• Specialty medications (not covered by insurance): $3,723.68
• More PIO after our embryo transfer appeared to work, and my body was producing HCG (the pregnancy hormone): $159.80

Total for IVF Cycle 4: $15,861.28 ($15,160.09 if you take out the $701.19 credit.)

Other Stuff

I've talked about embryos in the freezer. Well, they don't get to chill (pun intended) in the freezer for free. After 6 months, we started paying rent on those babies (pun not intended...is this even a pun when you're talking about embryos?) Starting in September, we paid $41.67 per month for the safe storage of our embryos. 

• Richard's semen analysis in February: $156.00
• Embryo storage ($41.67 x 4): $166.68
• Therapy ($25 per session, but I eventually hit the deductible, which was cool): $725.00

Total other stuff: $1,047.68

In total, we paid $80,098.39 out of pocket for medical expenses related to infertility last year. That's about what Richard and I earned in combined income when he was in residency and I was working in residence life at Centenary. 

Again, talking about money is awkward. Richard and I have chosen to spend money in this way at this point in our lives because it aligns with our current priorities, and we are so, so fortunate that we are able to make that choice. Some employers and insurance plans offer coverage toward fertility treatments, so not everyone who walks this road makes the same financial commitments we have. Prices also vary from clinic to clinic, but I have not really explored other options because we have been satisfied with our care.

I didn't think I had a great photo for this post, but then I found this screenshot of an e-mail from American Express that I got last May after we spent $50,000 on my card. Previously, I hadn't spent more than $25,000 on it in a year, so this was quite the achievement. (Actually, it made me a little sick.)

Something that made today great: We celebrated the BRYC seniors tonight, which was so much fun!

Time I woke up: 9:15 am