Money Over Medicine: 86% of Couples Say No to Fertility Treatment Due to Costs

Doctor bills. Lab invoices. Medication co-pays. Days spent out of work. Nights spent huddled over the dining room table, trying to make sense of insurance paperwork. The cost of fertility treatments is staggering for hopeful parents-to-be in the U.S. 

When Cofertility asked those currently or previously undergoing fertility treatment what kept them up at night, 86% of respondents said they have forgone a fertility treatment option recommended by their doctor, or they would consider it, due to its cost. Another 69% of respondents have had to cut back on expenses, borrow money, or take out loans to try to afford their out-of-pocket costs for fertility treatment—which many respondents estimated will equal upwards of $100,000 by the time they’re done with their fertility journeys.

If that sounds super stressful, that’s because it is. And with 65% of respondents cutting out vacations and 48% cutting back on socializing and spending time with friends, the age-old “just relax, it will happen” advice for those affected by infertility doesn’t exactly cut it. On the contrary; it can be completely unrealistic.

Some respondents said they had no idea what sort of state protections they had for demanding insurance coverage or what grant and funding options are out there for people in their situation. Of those lucky enough to have some sort of fertility insurance coverage, 37% of respondents said they spend three-to-nine hours talking to their insurance company about infertility coverage and expenses. 15% reported spending 10 hours a month or more on these conversations with their insurance provider. 

It’s clear that the true impact of infertility in America is not just financial, but also affects the time, emotions, and relationships of those facing treatment. Here’s a deeper dive:

Key findings

Money over medicine

Medical decisions are supposed to lie between a patient and their doctor. But finances for fertility treatments can easily get in the way of medical decisions.

• 86% of respondents say they either have forgone a fertility treatment option recommended by their doctor, or would consider it, due to cost
• 62% said their health insurance fertility coverage has a cap, which means the insurance company will stop paying for treatment at a certain price point
• Of those who do have a coverage cap, 84% have a limit of $20,000 or less—which at many clinics only covers one round of IVF, potentially excluding medication  

Paying the emotional toll

Isolation is just part of the emotional hit that comes with struggling to fund fertility treatment.

There’s long been a reputed link between stress and inability to conceive, and would-be parents are told to “just relax” if they want to conceive. But trying to juggle the costs are “mentally exhausting,” one respondent told Cofertility. “It is very draining on emotions and mindset,” said another. Not exactly conducive to reducing stress.

• When they’re looking to save money to pay for treatments, Cofertility respondents say the first things to go are relaxing social opportunities, with 65% cutting vacations and 48% cutting back on socializing and spending time with friends.

• For 19% of respondents, the costs of fertility treatments have also added the stress of taking out loans to help cover the bills...and all with no guarantee that they’ll end up with a successful pregnancy in the end.

As one respondent told Cofertility, “I know one couple personally that has gone into major debt and were unable to conceive. They spent so much on fertility treatments and then could not afford a surrogate. So heartbreaking, because she and her husband would be incredible parents.”

Insurance coverage is non-existent at worst, confusing at best

For the less-than-half (45%) of respondents who are lucky enough to have some form of insurance coverage for infertility treatment, it is still a major cause of stress and confusion. 

• 44% of respondents do not have any insurance coverage for their fertility treatments

• 11% didn’t know if their insurance would cover fertility treatments at all

• More than a third (37%) who do have insurance coverage for fertility treatments estimated spending anywhere from three to nine hours every month on the phone with their insurance companies—fighting approvals, appealing denials, pricing out medications and trying to make sense of their coverage

• 15% of those with insurance coverage for fertility estimated spending 10 hours or more each month on the phone with their insurance providers re: the above 

The lack of coverage from insurance can be isolating for couples as they watch friends and family whose own medical issues (and pregnancies!) are fully covered. As one respondent told Cofertility, “I wish it was fully covered under normal family insurance.” 

“It should be covered like a normal health bill,” said another. 

Out-of-pocket expenses require deep pockets

Families facing fertility treatment—even those with health insurance coverage—can expect to spend tens of thousands of dollars out of their own bank accounts on their path to parenthood.

• 44% of people told Cofertility they’ve already spent more than $25,000 of their own money on IUI, IVF, egg/sperm/embryo donation, or surrogacy. 27% have already spent $50,000 

• 20% estimate that by the end of the road they’ll have spent more than $75,000 out of pocket on fertility treatment expenses (including medications, procedures, and more)

• 8% said they expect to spend more than $100,000 of their own money footing the bill of their fertility journey. That number increases to 13% when talking only to those who’ve undergone third party reproduction

“[The costs make] me feel like only the wealthy are allowed to have children,” one survey respondent told Cofertility.

So, what’s going on? 

There’s no question that fertility treatments are expensive.

By American Society for Reproductive Medicine estimates, the median cost for medications alone in 2010 (the latest year for which information is available) was more than $1,000. At that time, median IVF costs with a donor egg topped $38,000. Add multiple medications, successive rounds of IUI or IVF, and the costs skyrocket. 

Just who gets to have a baby can easily come down to who has financial means...or at least a generous employer. 

Unfortunately, the number of employers offering fertility coverage is dipping—it decreased to 27% for non-IVF treatments and 25% for IVF services in 2018, according to the Society for Human Resource Management. The fact is: workplaces don’t have to offer fertility coverage, at least not in most of America. Fertility treatment coverage is mandated in just 16 states, and what exactly that means varies. Some coverage may extend to IVF, but not all. 

That leaves even patients with health insurance coverage struggling to find coverage for what’s classified as medically necessary treatment. As one woman told Cofertility, despite having been diagnosed with polycystic ovarian syndrome (PCOS), a condition commonly linked to fertility troubles, her insurance still won’t cover fertility treatment at all.

For those who do have fertility coverage, the gap can still be substantial. One respondent reported maxing out her health insurance’s fertility coverage over seven year’s worth of treatment. She spent $100,000 out of pocket to get pregnant with her twins. Others reported running into hidden fees that weren’t covered, such as the storing and freezing of embryos used for IVF.

And yet, despite the crippling cost, the most common feedback we received from respondents? They’d do it all over again to have their children. 

Some help exists—awareness, not so much

There is some good news. Fertility grants exist, and they can help some people fund their journey. And there are those insurance mandates that exist in some states, which folks can use to advocate for themselves.

There’s just one teensy problem...awareness:

• 31% of Cofertility survey respondents didn’t know if their state has a fertility insurance mandate or not
• 44% didn’t know that fertility grants existed, even though they’d apply for them

What can we do?

So, what can we all do to cut luck out of the equation and make fertility treatment more accessible to all, not just to couples with enough income, who live in the right state, with the right employer insurance program? 

Speak out

If your state doesn’t have a mandate, call your legislators and share these numbers. Explain why everyone deserves the right to fertility treatment, not just people who have a fat bank account or “good” health insurance.

And while you’re at it, if you are comfortable speaking out about your fertility struggles, turn to social media, turn to your friends, turn to others in your community. Speaking out is not for everyone, but if it’s for you, it can help break the cycle of silence that keeps fertility treatment from getting the attention (and funding) it deserves.

Support advocacy groups

Advocacy groups like RESOLVE are fighting for folks struggling to build their families. You can donate. You can volunteer. You can share your story to help their lobbying efforts.

Consider crowdfunding 

You know what they say about raising a child? “It takes a village?” Sometimes, it takes one to build a family, too. A GoFundMe or other crowdfunding page may help cover some of those treatment costs. It can also help open up conversations and break down the stigma of infertility. 

Bottom line

The hurdles to accessing fertility treatment are piling on emotional, physical, and mental costs for people already facing the stress of fertility struggles. Breaking down those hurdles means leveling the playing field and giving all families a chance.

Methodology

For this study, Cofertility surveyed 858 American men and women who have had to undergo infertility treatment (IUI, IVF, etc.), including third party reproduction (egg/sperm donation, surrogacy) and/or exploring adoption. This study was conducted in April 2019.