If you’re having trouble conceiving, you’re not alone. Thirteen percent of couples in the United States have infertility problems. Infertility is common and can be caused by a number of different factors such as age, irregular period, abnormal sperm production, or an existing reproductive medical condition.
Fortunately, there’s a variety of infertility treatments but the most common are intrauterine insemination (IUI) and in vitro fertilization (IVF). In fact, nearly 2% of U.S. live births per year are a result of assisted reproductive technology—the main method being IVF. There were 81,478 babies born in 2018 as a result of these methods.
What is IVF?
IVF is a multi-step laboratory procedure that helps in the successful fertilization of an egg outside of the body, mimicking natural fertilization and encouraging a normal pregnancy and childbirth to occur.
A fertility specialist may recommend IVF in order to get pregnant for several reasons, including a history of failed infertility treatments, unexplained infertility, or risk of genetic disease.
“Sometimes [a couple] may have failed other treatments, like artificial insemination,” says Lynn Westphal, MD, the chief medical officer of Kindbody fertility clinics. “The woman could have blocked Fallopian tubes or the man may have a low sperm count. Some couples may carry a genetic disease (like cystic fibrosis) and want to test embryos so they do not have an affected child. If the woman cannot carry a pregnancy, she would need to do IVF to put embryos into a surrogate.”
How it works
- The first step of IVF usually involves taking medication that stimulates ovaries and helps eggs form for the procedure.
- Once the eggs mature, a doctor will extract them from the ovaries using a needle. The eggs are placed into a dish and incubated.
- In a process called insemination, sperm—either donor sperm or from your partner—will be added to the eggs and be monitored to ensure that fertilization was successful and an embryo has developed.
- Once the embryo is deemed ready to transfer, a doctor will insert the embryo into the uterus. From there, the embryo must implant in the lining of the uterus.
IVF success rates
The rate of success of getting pregnant after one IVF cycle varies and is highly dependent on the age of the female. Often, more than one cycle is needed for success. One fertility clinic provides the following estimates with the first cycle, based upon age:
- Females younger than 30 have a 46% chance of success.
- Females ages 30 to 33 have a 58% chance of success.
- Females ages 34 to 40 have a 38% chance of success.
- Females ages 40 to 43 have less than a 12% chance of success.
Furthermore, donor eggs can also be used and yield a high success rate (55%) of a pregnancy resulting in a live birth in comparison to many couples who turn to IVF and do not use an egg donor. This is likely at least in part due to the young average age of egg donors: 26 years old. This simply reinforces that the age of the woman’s egg used in the process translates into the likelihood of success of the process. Males are not typically affected by infertility issues until they are at least 50 years old.
The average cost of one cycle of IVF is more than $20,000, according to Fertility IQ. This figure accounts for the procedure and medication costs. However, the average IVF patient goes through two cycles, meaning the total cost of IVF is often between $40,000 and $60,000.
Here’s a breakdown of IVF costs:
- Pre-IVF fertility testing or consultations:
- $200-$400 for a new visit to a reproductive endocrinologist
- $150-$500 for a pelvic ultrasound to evaluate uterus and ovaries
- $200-$400 for fertility-related blood tests
- $50-$300 for semen analysis
- $800-$3,000 for a hysterosalpingogram (HSG), which is a test that uses dye to assess the uterus and fallopian tubes
- $3,000-$5,000 for fertility drugs
- $1,500 for ultrasound monitoring and blood work
- $3,250 for egg retrieval
- $3,250 for laboratory procedures that may include some or all of the following:
- Andrology processing of semen sample
- Oocyte culture and fertilization
- Intracytoplasmic sperm injection (ICSI)
- Assisted hatching
- Blastocyst culture
- Embryo cryopreservation
- Genetic testing:
- $1,750 for embryo biopsy
- $3,000 for genetic analysis
- $3,000 for embryo transfer:
- Laboratory preparation of embryo
- Transfer procedure, as needed to achieve a successful pregnancy, up to a total of three transfers
Does insurance cover IVF?
Coverage for IVF and its accompanying costs vary among different insurance plans, companies, and states. For example, some insurance companies cover diagnostic testing but not the treatment. Some providers cover limited attempts of IVF, and others do not cover IVF at all.
“The vast majority of people pay for IVF out-of-pocket,” says Lev Barinskiy, CEO of SmartFinancial Insurance. “Traditional fertility plans usually cover diagnostic screening and a single round of IVF or IUI, depending on the insurer.”
It’s important to do your research and speak to your insurance carrier and fertility clinic about the cost of your procedure with and without insurance.
“Currently, 18 states have passed laws that mandate businesses to offer fertility benefits with varying levels of coverage to their employees,” Barinskiy explains. “Some local governments require health insurance policies to pay for infertility diagnostic tests and treatments. Coverage differs among states, so you’ll need to read the state mandate where your employer is based.”
The International Foundation of Employee Benefit Plans released results from a 2018 survey that found 31% of employers with 500 or more employees offer some form of fertility benefits. Through the survey they also found that:
- 23% cover in vitro fertilization (IVF) treatments
- 7% cover egg harvesting/egg freezing services
- 18% cover fertility medications
- 15% cover genetic testing to determine infertility issues
- 13% cover non-IVF fertility treatments
- 9% cover visits with counselors
Since infertility involves both partners, it is important for both the man and woman to research what their plan covers including semen analysis and infertility care for the man.
Additional fertility insurance resources:
Here are some additional resource pages from top health insurance companies regarding infertility services and IVF coverage:
It is best to call and speak with your insurance carrier directly to get a clear idea of what is and isn’t covered. Some questions you may want to ask include:
- Does my policy cover diagnostics to figure out the reason for infertility?
- Do I need a referral to see an infertility specialist?
- Does my policy cover intrauterine insemination (IUI)?
- Does my policy cover in vitro fertilization (IVF)? If so, does it cover additional procedures such as intracytoplasmic sperm injection (ICSI), cryopreservation (embryo freezing), storage fees for frozen embryos, transfer of frozen embryos?
- Is prior authorization required for any covered procedures?
- Is there a maximum infertility benefit amount?
- Does my policy cover injectable medications? If so, do they require authorization or use of a specialty pharmacy?
- Can I obtain a written explanation of my benefits?
Below are billing codes (CPT codes) to refer to when speaking to your insurance carrier:
|IVF billing codes for insurance|
|Intrauterine insemination (IUI)||
|IVF vitro fertilization (IVF)||
|Frozen embryo transfer (FET)||
IVF financing options
While IVF is still costly even with insurance, there are alternative ways to reduce expenses. For example, Reproductive Medical Associates (RMA), which has 19 locations in the U.S., has an extensive IVF program and fertility financing services that connect couples to a variety of different lending and payment plans. Programs available through RMA include:
- Lending Club Patient Solutions
- ARC Fertility
- New Life Fertility Finance
- WINFertility Program
- Prosper Healthcare Lending
- Future Family
- United Medical Credit
The National Infertility Association also has a list of infertility financing programs.
There are many non-profit organizations that provide financial support for those struggling with infertility through grants.
“Most (non-profits) provide a grant in a certain amount toward treatment (i.e. $5,000), but Parental Hope’s grants cover the full cost of IVF,” says David Bross, the cofounder and president of Parental Hope. “The biggest non-profits supporting the infertility community are Parental Hope, BabyQuest, Cade Foundation, and Bundled Blessings.”
Parental Hope provides financial assistance for infertile couples through their Parental Hope Family Grant program, which includes a grant for IVF. “For the IVF and FET (grants), we have partnered with the Institute for Reproductive Health and both grants cover the full cost of those medical procedures,” Bross explains.
There are many local and national nonprofits that provide grants. Although receiving a grant is not guaranteed as there is an application process, it doesn’t hurt to apply. Be sure to read the eligibility requirements before applying for a grant because some applications have fees.
How to save money on fertility medication
Medications contribute a significant portion to the total cost of IVF. “Women need a number of medications during the IVF process,” Dr. Westphal says. “Many women are put on birth control pills first to help with the timing of their treatment. To stimulate the ovaries, women do injections of a follicle-stimulating hormone (e.g. Follistim, Gonal-F) for about nine to 12 days. As the follicles (‘egg sacs’) grow, medication is added to prevent early ovulation, most commonly a gonadotropin-releasing hormone antagonist (e.g. Ganirelix, Cetrotide).”
She explains that in the egg retrieval and transfer process, the woman gets an injection of human chorionic gonadotropin (HCG), antibiotics, and progesterone.
To save money on fertility drugs, first call your insurance company or refer to your plan’s drug formulary. Even if IVF procedures aren’t covered by insurance, some medications could be.
If your copay for fertility drugs is still too high or if you don’t have insurance, you still have several options for saving money. You can contact the drug makers and inquire about manufacturer coupons or patient assistance programs. For example, The Compassionate Care Program by EMD Serono can save eligible patients up to 75% off Gonal-F.
SingleCare brings down the price for many of these medications used during the IVF process. Use the table below to access free coupons, which all U.S. pharmacy customers can use whether they have insurance or not.
|Fertility drug costs and coupons|
|Drug name||How it works||Standard dosage||Average price||Lowest SingleCare price|
|Lupron (leuprolide acetate)||Prevents premature ovulation||0.25-1 mg subcutaneous injection daily for ~14 days||$880.98 per 14-day kit||$364.90 per 14-day kit||Get coupon|
|Follistim AQ cartridge (follitropin beta)||Stimulates growth and development of eggs, stimulates sperm production in men||200 unit subcutaneous injection daily for ~7 days. Dose may be increased to a max of 500 units daily based on ovarian response.||$2,855.19 per 900-unit cartridge||$2,187.06 per 900-unit cartridge||Get Rx card|
|Ovidrel (choriogonadotropin alfa)||Triggers release of eggs from ovaries||250 mcg/0.5 mL subcutaneous injection once||$267.99 per injection||$178.75 per injection||Get coupon|
|Ganirelix||Prevents premature ovulation||250 mcg/0.5 mL subcutaneous injection daily (until directed to administer hCG)||$512.99||$447.03 per 250 mcg injection||Get coupon|
|Cetrotide (cetrorelix)||Prevents premature ovulation||0.25 mg subcutaneous injection once daily (until directed to administer hCG)||$318.99 per 0.25 mg kit||$241.08 per 0.25 mg kit||Get coupon|
|Doxycycline||Reduces risk of infections during IVF cycle||100 mg capsule twice a day for 4 days, beginning the day of egg retrieval||$43.76 per 20, 100 mg tablets||$14.31 per 20, 100 mg tablets||Get coupon|
|Endometrin (progesterone)||Thickens and prepares the uterine lining to maintain implantation of a fertilized egg||100 mg capsules intravaginally 2-3 times daily for 10-12 weeks by a physician||$373.99 per box||$265.32 per box||Get coupon|
|Estrace (estradiol)||Supplies estrogen to the body, which is helpful in IVF for various reasons||1-2 mg tablet by mouth twice a day for 14 days||$17.69 per 30, 1 mg tablets||$6.24 per 30, 1 mg tablets||Get coupon|
Bottom line: Take your time through your IVF journey
Since many patients go through multiple IVF procedures before a successful pregnancy, it is especially important to weigh the costs and quality of the clinic so you can afford multiple cycles if needed. Here’s a checklist of questions and consideration when choosing a fertility clinic:
- Does your clinic offer an IVF refund program?
- Which insurance is accepted for IVF costs?
- Which IVF services are offered at the clinic?
- What is the breakdown of costs for the services?
- Do you recommend any fertility financing services?
- Is the location of the clinic convenient for me and my partner?
- Is the clinic and its staff highly reviewed among other patients and professionals?
- What is their success rate? The SART fertility clinic finder allows you to view fertility statistics of a clinic by typing in the zip code.
It’s also important to consider the need to take a break between IVF cycles. The standard time period between IVF cycles is one full menstrual cycle, according to Carolinas Fertility Institute. This usually translates to four to six weeks after the embryo transfer and negative pregnancy test to start another cycle of IVF.
“Generally speaking, a patient should wait in between IVF procedures until her body has returned to her pre-IVF state,” says Peter Nieves, chief commercial officer at WINFertility. “Meaning that she begins a new menstrual cycle and her baseline hormones and ovary sizes have returned to her normal resting state.”
Reasons to take breaks between IVF cycles can include physical, financial, and emotional needs. Some medications may cause inflammation, which many doctors believe should subside before starting a new cycle. The financial and emotional costs of IVF can also take a toll on your well-being and relationship with your partner, therefore taking the time to prepare for another cycle is important.