the cost of making a baby

Having a baby is not cheap.  Hospitals and birthing centers charge an outrageous amount during the nine months of pregnancy and for labor and delivery. So unless you want to have your baby on the kitchen floor in a blow up bathtub with your cousin Debbie as your midwife, prepare to start saving your pennies. But I’m not even here to talk about that expense. For many people like myself, the years of infertility treatments will put a huge dent in your wallet long before you ever see a + sign on a pregnancy test.

With each infertility diagnosis there comes an enormous amount of tests, lab work, ultrasounds, monitoring, medications, and procedures. It’s enough to make some hopeful parents stop and even reconsider. And for some families, the cost might be the difference between having a child and not. To give you an idea of the amount of money I am talking about, I decided to write this post. I wanted to write it all out and share what we paid for our most recent IVF. And I know all clinics and all insurance companies are different, but hopefully this information will help guide some of you as you prepare for your own IVF procedures.

Our Insurance

Although we have been told that our insurance is “one of the good ones,” I don’t know if I would necessarily agree with that. I do however know how lucky we are to have some coverage, as many women I spoke with through the county in preparation for writing this, do not have any insurance at all. We have Blue Cross and Blue Shield of SC. Their policy is 70% of services covered after meeting a $400 yearly deductible, with a lifetime maximum of $15,000 or 3 cycles (aka 3 attempts at an IVF retrieval).   I find it less than amusing that the insurance company has a max coverage of 3 cycles. As if they are “cutting me off” after 3 attempts. So basically some man in a suit somewhere decides how many times I am allowed to try and grow my family.

2018: In-Vitro Fertilization with Intracytoplasmic Sperm Injection with Freezing all and subsequent frozen Embryo Transfer

Here is the breakdown of what we paid out of pocket listed by visit dates, all within the four month process.

February 27, 2018: consultation with MD, ultrasound, lab work: $364

March 8, 2018: IVF payment due in advance: $5729 (includes ultrasounds, embryologist, all further MD visits, ect. **breakdown of these costs below)

March 14, 2018: Medications: $6,097 ($103 for HCG/Pregnayl, $134.89 for Lupron, $5839.20 for 6 Gonal-F pens)

April 9, 2018: day of egg retrieval: Anesthesia $400 cash, not covered by insurance, $9 pain meds covered by insurance

April 10, 2018: follow up lab work, visit: $46

April 23, 2018: Saline Sonogram and Trial Transfer: $266.30

June 4, 2018: Medications: Valium and Doxi meds to prep for implantation: $18

June 5, 2018: Medications: Lupron for day of transfer, Estridol, Progesterone:  $27

June 12, 2018: Medications: refill of Progesterone and Estridol: $18

June 30, 2018: Storage of frozen embryos: $525 per embryo per year (we only have one left frozen)

**The breakdown of the IVF costs are listed as follows. Reminder this is what my clinic charges and every clinic might be a little bit different and each insurance company might pay differently. 

• Cycle mgmt fee: $2800 (not covered by insurance)
• Estradiol check x 8: $720
• Progesterone level: $602
• Venipuncture cost: $80
• Ultrasounds x8: $1652
• Quantitative HCG: $80
• Physician Charge for Retrieval of Eggs: $1400
• Ultrasound Guided Retrival: $170
• Physician Charge for Embryo Transfer Fee: $470
• Ultrasound Guided Transfer: $170
• Facility Charge/Room charge for retivel and transfer: $1000
• Embryology Charges: (including cryopreservation, ICIS, prepping for transfer, etc): $5110
• Embryo Freeze Charge: $500 (not covered by insurance)
• Thawing of Embryos: $625 (not covered by insurance)

Total: 14,879 out of pocket

Thoughts on Medication Costs

When you can get your medications covered by insurance that makes a huge difference. Remember earlier when I said our insurance covers 70% of the cost? That sounds great, right? And it is. The problem was that I have that “lifetime max of $15,000.” And I was nearing the finish line. So our financial consultant told us we should pay for the medications out of pocket and not go through insurance. That way we would still have enough coverage for the procedure itself. So out of pocket we paid $6,160 for our medications and refills. Which if we had filed insurance for all of our meds it would of been closer to $1,100. Big difference.

I also needed Valium and Doxycycline, which I was able to get from CVS or Walgreens through my insurance. Insider’s Tip: if you are worried about the insurance company “cutting you off” like they wanted to do to me, have your nurse send the script for Valium, Doxycycline, Progesterone, and Estridol/Estrogen to CVS and Walgreens but not to have it filed as a “fertility medication.” These drugs are used for women for a variety of reasons, not just infertility. The only meds that are truly for infertility are the egg growing medications (Lupron, Gonal-F, ect). Just a little technical loophole my nurse was happy to help me out with. 😉

Here is how I shopped around for out of pocket costs of medications from a variety of pharmacies throughout the country: (note: this was in spring of 2018, prices may have changed by now)

• Encompass Pharmacy: Lupron $165, HCG $103, Gonal- F 900 pens $973.20 each. Free shipping
• Freedom Fertility: Lupron $569, HCG $159, Gonal- F 900 pens $982.80 each. Free shipping.
• SMP Fertility: Lupron $134.89, HCG $145.89, Estridol: 89.67, Progesteroine $119.98 for two Gonal- F 900 pens: do not carry. also $20 shipping charge.
• Schrafpt 2.0: Lupron Compounded 2 week Kit $300, Estridol $36, Progesterone in Oil: $89 per vial
• Metro Drugs: Lupron Compounded 2 week Kit $229.97, Estridol $117, Progesterone in Oil: $99.98 for two vials
• Mandells Pharmacy: did not call

What Others are Saying

I recently surveyed women from a national wide infertility support group to gain some insight on thier recent IVF costs. Women from Missouri, Chicago, California, Seattle, Illinois, Ohio, New York, DC, Maryland, Wisconsin, Arizona, Colorado, Georgia, Oregon, New Jersey, North Carolina, Pennsylvania, Michigan, and Canada all responded and here is what some of them had to say:

1. Kansas City: insurance did not cover IUI or  IVF. IVF, meds, PGS testing was $20,000.
2. California: insurance did not covered IVF and one round of ivf was $18,000 plus $6,000 for meds which totaled $24,000.
3. Chicago: insurance covered one round of IVF but did not cover $11,100 for PGD, biopsy and freezing, and storage
4. Seattle: insurance did not cover, IUI was $1000,  IVF was $34,000
5. Ohio: Insurance only covered diagnostics (HSG, bloodwork, ultrasounds), insurance did not cover IVF, $34,000 for IVF out of pocket.
6. NYC: Clinic costs ranging from $15,000- $22,000, medications ranging from $3,000- $8,000 for total of $18,000-30,000
7. NYC: insurance covered 85% of the treatment cost for 2 cycles
8. Maryland: insurance did not cover IVF: $28,500 not including $9000 medicine for total of $37,500
9. Wisconsin: insurance did not cover. IVF fresh transfer $20,000 or $13,500 with ICSI. $6000 for meds
10. Colorado.  Insurance only covered about $350 in medication. insurance did not cover IVF, out of pocket paid $17,000.
11. Arizona: IVF $30,000 out of pocket
12. Georgia: insurance did not cover.IUI $1300 including meds out of pocket.
13. Chicago: insurance did not cover. IUI $1600, $500 meds = $2,100.
14. Pittsburgh. IUI $400 (insurance paid for scans, not procedures or meds)
15. NJ:  insurance covered one round of IVF but out of pocket costs would be 23,000 without insurance
16. Canada: IUI is covered by Canada’s universal health care system, minus meds and a $500 fee. one IVF is covered by the universal healthcare system minus $7,000 meds. For my second round we paid out of pocket $13,000 IVF plus the $500 and $7,000 for meds.
17. Florida: IVF $23,000 and my insurance paid $10k. My policy has a lifetime 10k max on fertility coverage
18. North Carolina: insurance has lifetime max of 10k, after that paid OOP $25,000
19. Colorado: insurance did not cover, paid $25K OOP per IVF
20. Michigan: insurance did not cover.  IVF OOP is $4050, $3000 for meds, $450 per FET.
21. Michigan: IUI with sperm donor out of pocket $1,400 total
22. Colorado: IVF insurance covered some, payed $6,000 total plus $5k in Meds
23. California: insurance did not cover IVF $20,000 total
24. Arizona: insurance covers 80%  We pay out of pocket $3,000 for drugs and $4,000 out of pocket for IVF
25. Northern California: insurance did not cover all out of pocket.  Each IVF $23, 000 (plus $8k in meds)

The themes I continued to see over and over was 1) a lot of insurances out there don’t cover anything at all. 2) it doesn’t matter what state you live it 3) the out of pocket expenses ranged from $7, 000 to $37,000.

Do I think all this money is worth it? Absolutely. Would I do it all again in a heart beat? Yes yes and more yes. Maybe one day we will live in a world where the insurance companies and pharmaceutical companies will not have as much control over our healthcare as they do, but unfortunately that day is not today. So until then, you do what you have to do.  You budget, you take out a loan, you fundraise, you take hand outs, or you hope to God that your American Express card has an extended limit. But the feeling you get when you finally have your babies in your arms: priceless.