People still have a hard time talking about their infertility. I do see a lot more, but when you've got to go in front of your state legislature year in and year out to talk about this, it's tough. —Barbara Collura, Resolve: The National Infertility Association
When her friends complain about how expensive their kids are, Haley Hanzon laughs.
"We just show them the bills showing them how much trying to have these babies cost," she says.
Like one out of every six to eight couples in the U.S., the Hanzons are infertile. The young couple lives in West Jordan, a suburb of Salt Lake City, and has been trying to start a family without success for several years. Haley leads a local infertility support group of about 20 women, and they often commiserate on the staggering costs of family-building.
While debate nationwide centers around contraceptive access, the costs of conception are so high and insurance coverage so limited that fertility treatment is largely viewed as a luxury good. However, infertility affects rich and the poor alike, and couples like the Hanzons who pursue fertility treatment face an uphill financial battle in building their families.
The Hanzons have spent a couple thousand dollars thus far — a blow to their budget — and they know it could be just the tip of the iceberg.
"I've known people to take out second mortgages, sell cars," says Hanzon. "It can cost thousands upon thousands of dollars."
Money and more money
It's a cost that most insurance plans don't touch. Mindy Berkson is a consultant and founder of Lotus Blossum Consulting, where she counsels infertile couples on options and financial planning. While 15 states require some fertility coverage and three require it as an option, Berkson calls insurance options for infertility "limited at best."
"Most insurance companies have out-of-pocket limits, or limit the number of cycles," Berkson says. Few insurance policies cover procedures like in vitro fertilization (IVF), which, according to Berkson, range on average from $10,000 to $18,000 per cycle across the country.
Costs are even higher for egg donation ($25,000 to $30,000) or surrogacy ($70,000-$90,000). Using a surrogate and an egg donor can cost $110,000-$120,000.
According to Berkson, most infertile couples are paying for such treatment out of pocket, borrowing against home equity lines of credit, applying for bank loans or borrowing from would-be grandparents. While oftentimes tax-deductible, the costs can still be staggering, and thousands are seeking reproductive assistance, more every day.
The Centers for Disease Control reports that use of assisted reproductive technologies (ART) has doubled over the past decade. In 2010, 147,260 ART cycles resulted in 47,090 live births and 61,564 infants.
"Today, over 1 percent of all infants born in the United States every year are conceived using ART," says a report by the CDC.
Is there a right to conception?
Even with the increase, much of the U.S. population does not even attempt to access ART.
According to data from a National Survey of Family Growth, less than half of women who meet the medical definition of infertility actually seek medical treatment for their condition. In fact, lower-income women, who have disproportionately higher instances of infertility, are most likely to be directed toward contraception and resources to prevent pregnancy. Fertility treatment is by and large considered by policymakers to be "non-essential."
Barbara Collura begs to differ. Collura is the executive director of Resolve: The National Infertility Association, a nonprofit organization devoted to infertility in the U.S.
"It is first and foremost a medical diagnosis and condition. Infertility is a disease," says Collura. "If you think about your digestive system, let's say, and if something was not functioning right with your digestive system you would seek medical help. With your reproductive system, there are a lot of different medical therapies for the inability to conceive — it might be medication, a surgical procedure or in vitro, but it's very much a medical diagnosis and a medical disease."
And as such, she says, it should have coverage. Collura compares infertility to autism and diabetes: two conditions that until relatively recently were not recognized by insurance companies, until advocates went state-by-state, pursuing coverage.
The infertility community has yet to raise the money or put forth as strong of a voice, however.
"People still have a hard time talking about their infertility. I do see a lot more, but when you've got to go in front of your state legislature year in and year out to talk about this, it's tough," says Collura.
Multiples multiply costs
One of the largest barriers to fertility coverage is concern over multiple births. Multiple birth babies are more likely to have a low birth weight and/or premature birth, with risks to the mothers' health as well. One estimate puts the cost of one set of premature twins to the health care system at approximately $130,000 from birth to discharge.
But even without insurance coverage, the increased number of couples using ART to conceive has affected the system with multiple births. According to CDC data, one in every 30 babies born in 2009 was a twin, compared with one in every 53 babies in 1980. While about a third of the rise is attributable to older women having babies (older women are more likely to have twins or triplets, even without ART), the rest of the rise is assumed to be due to fertility treatments.
Ironically, however, multiple births are more likely to come from procedures such as IUI or from ovarian stimulation drugs such as Clomid — treatments more likely to be covered by insurance than procedures such as IVF.
Still, there are no guarantees that fertility treatment will end in success — another concern for those worried about costs to the system. IVF success rates vary from clinic to clinic and depend on the age of women and some other factors, but the success rate hovers around 30 percent, meaning patients often have to try a few rounds.
"At the end of the day there will be people and insurers who say this is too expensive. I think the data will show that's not really a sound argument any more," says Collura. "IVF is a very (sound) therapy with people with the right diagnosis. It doesn't need to be expensive.
"I think you've got to view it as a course of treatment; most doctors will tell you two to three cycles," Collura says. "It's like chemotherapy. You don't just go in and take one dose. With IVF, two to three cycles is generally the highest probability of that take-home baby."
However, two to three cycles could cost $20,000 to $36,000 out of pocket.
In her personal search, Hanzon hopes it won't come to that.
"I'd be very willing to do (IVF) if we could afford to. But the cost is so prohibitive that I honestly don't know if we'd ever be able to do it," Hanzon says.
If the treatments her current insurance covers don't work, there aren't a lot of options — especially since other family-building options can be just as expensive. The cost of an adoption ranges from $5,000 to $40,000 and comes with its own set of challenges, financial and otherwise.
“(Adoption) is one resolution, but it's not a Band-Aid," says Hanzon. “It won't get rid of the pain of not being able to have biological children.”
And while there are still options and treatments available, having biological children is something the Hanzons are willing to pursue — as much as they can afford.
“It doesn't feel elective,” says Hanzon. “As hard as the financial aspect is, infertility takes over every aspect in your life, not just financial.”