The Cost of IVF Treatment in the US

LONG before we started trying to conceive. Hell, long before we were even thinking of starting a family, we knew that (out of pocket) medical costs can reach a-stro-no-mi-cal levels. You might hear: “I don’t have insurance and now I’m out $1,000 for a few simple blood tests”, or more in line with our personal situation: “Shit, does insurance even cover this? And if it does… “I still have that $6,000 deductible!”.

Infertility treatment is just one of those things health insurance companies don’t have to cover, and since they don’t have to cover it, they certainly don’t want to.

We get our health insurance from the ACA Marketplace. In our state, fertility treatments are never covered with open market health plans, meaning, we will have to pay for every last cent of treatment.

Many would say that’s fair enough. It’s our choice, and… I’m not here to argue with that. Being able to have children is a privilege, not an urgent medical condition society has agreed upon to cover (as of yet, at least). We know it’s gonna be expensive, but, how expensive? 

 

Number of IVF attempts

The biggest issue is that there are a boatload of factors that influence the cost of infertility treatment. When we limit ourselves to just in vitro fertilization, the big unknown is: how many IVF cycles do you need?

That number could be anywhere between one and infinity!

We take a closer look at success rates per IVF cycle based on the latest CDC numbers in this post

Dice - The Cost of IVF

The big question: how many IVF cycles do you need?

There are a couple of neat calculators researchers have created based on the data from hundreds of thousands of people undergoing IVF. This calculator is based on data from the UK, and this is the US version. When plugging in my wife’s details (who is statistically speaking a good IVF candidate), we see a cumulative success rate of around 50% for one full IVF cycle in both calculators. Why is this number a lot higher than the average success rates, as discussed in this post? That’s because these are cumulative success rates per cycle.

To give an example, let’s assume that your first stimulation cycle leads to the collection of 10 eggs of which 8 are fertilized and 5 make it to day 5. You might choose to freeze 4 and transfer 1 embryo. If the first transfer fails, you’d still have up to 4 tries left. All those tries are counted towards the success rate of one full cycle. In this example, this would basically be up to 5 separate attempts. The first 4 attempts could fail, but if she’d become pregnant on the 5th try and go on to deliver a child, that would count as a successful cycle. You would be part of the cumulative success rate statistics.

The UK based calculator has another cool feature showing you the cumulative success rates of up to 6 full cycles. Plugging in my wife’s numbers, the live birth rate jumps to around 70% at two full cycles, and the odds are above 80% with three full cycles. Not bad, but it’s easy to see how the number of cycles (and thereby the cost of IVF) can add up quickly.

 

Estimating the cost of IVF

It’s not that easy finding accurate estimates of the cost of an IVF cycle since the price can depend on many different factors. A clinic may present you with a quote based on just the bare minimum, without taking into account extra treatments, treatments that may be advisable or even necessary.

Bear in mind too that you need to factor in the cost of medication, which is expensive and usually has to be paid 100% out of pocket.

Those extras can really add up:

What is the underlying cause of your infertility? Do you have a diminished ovarian reserve?
You might need additional cycles to get enough eggs retrieved (easily $8,000+)!

Is there male factor infertility?
Better open up that wallet! Here comes the intracytoplasmic sperm injection (ICSI: ~$1,500+)! With a bit of bad luck, you might even have to fork over more for expensive testicular sperm extraction (TESE, ~$1,000+)!

Does a hereditary disease run in the family or have you had multiple miscarriages, or are you of advanced maternal age?
Cha-ching, better get that preimplantation genetic screening/diagnosis (PGS or PGD: $6,000+)!

 

Hard as it may be, let’s try to estimate what it could all cost.

The median cost of a single IVF cycle including medication is about $17,000.2 But as you know by now, you’ll more than likely need multiple cycles or at least multiple transfers, so you can likely multiply that amount by a few times.

A scientific paper looked at the cost of treatment until a patient was pregnant and found that the average IVF patient spent $61,377 on IVF treatment until success was reported. On average, it took 3.4 attempts (which includes both fresh and frozen cycles).

Whoa! That sucks… but that’s not even the most depressing part yet…

The majority of patients in that study (52.7%) failed to conceive (patients gave up after an average of 3.9 cycles). The authors didn’t find any differences in dollars spent between the group that was successful and those that were not successful.

So while it definitely sucks to spend over $60,000 on IVF treatments to have a baby (not including delivery costs by the way), it sucks even more to spend that much and end up empty-handed.

 

Digging even deeper. The cold hard numbers.

Imagine: You’re dealing with infertility and your doctor recommends IVF treatment with ICSI. You naturally agree, since you read online that ICSI vastly increases the chance of fertilization. Almost 80% of all IVF cycles are done with ICSI, even though only 33% of patients are dealing with male factor infertility (according to the latest CDC report). You decline all expensive genetic tests and are one of the lucky ones that get pregnant with just one full cycle and a total of 2 transfers. 

Based on this paper2 and adjusted to 2017 dollars, this sets you back:

  • 1x Fresh transfer procedures, including meds: $17,259
  • 1x Frozen transfer cycle (FET):  $4,186
  • 1x ICSI: $2,242
  • Cryopreservation + storage: $1,569

For a grand total of $25,256Your IVF Doctor's yacht. Is it worth the cost of IVF?Add in the cost of pre-testing (hormone panels, semen analyses etc), supplements and IUI attempts, and it starts to look like a McMansion down payment.

We knew it was going to be steep, but seeing these numbers sure made for a crappy date night. 

Needless to say, IVF is expensive. Very expensive. But that’s OK, right? Your doctor’s yacht doesn’t buy itself! (can you tell I’m a bit bitter?).

 

Cost of IVF in our corner of the world

The average treatment cost in the whole country or even in our state doesn’t mean a thing if your local clinic charges through the nose. Turns out, our mid-sized city has only a single infertility clinic. A large city nearby has another 3 clinics serving a population of millions!

You’d think that with a direct-to-consumer market like infertility treatments it’d be standard practice to be upfront about prices. But alas, out of these four clinics, only one publishes their prices for all to see. My guess is that uninformed patients are exactly what they’re after, but maybe I’m just being cynical.

I’ve been wondering. Could the fact that IVF treatment is outrageously expensive be related to a lack of competition? Given that infertility is common (about 1 in 6 couples deal with it), my gut tells me there should be a lot more demand for infertility treatment than there is. And with more demand, I would expect there to be more infertility clinics.

My gut also tells me the financial burden stops many a patient from even attempting to seek treatment.

Anyway, I’m getting off track here. Basic IVF at our local clinic costs about $9,000 for a fresh cycle, not including any pre-testing, medication or ICSI. This clinic has a reputation for being the cheapest in the area (and not necessarily the best!). Add in medication, and we’re bound to end up around $13,000-$16,000 for a single, basic, fresh cycle! With cryopreservation, ICSI, and another fresh cycle or frozen embryo transfer, the price leaps way past $30,000 for 2 cycles.

Pretty demoralizing if you ask me. Going through the treatments itself will be hard enough for my wife, adding financial stress to the mix? No thanks!

In short: We agree that it just doesn’t make any financial sense.

 

Does it get better elsewhere?

Surely, this is a worldwide phenomenon? Infertility treatment is out of financial reach for many, no? Indeed, for many it is. But, other developed countries have health care as good as back here in the USA, and there, IVF costs are a fraction of what they are in the US. In Canada, a fresh cycle costs 68% of the price in the US. And in Japan, the cost of IVF is barely 31%!3

Something that sounds even more crazy to the American mind, is that many countries offer infertility treatment as part of their universal health care system. Yes. That means “free” or very cheap treatment (courtesy of Mr. and Mrs. tax-payer, of course).

Most of Europe operates this way. Clearly, not all is sunshine. IVF rounds funded by public sources are often limited to 3 or so cycles, there’s usually an upper age-limit, and waiting lists are common.

Of course, knowing IVF is covered for free elsewhere doesn’t help us or anyone else reading this in the US.

 

So, where does that leave us?

Would we even consider spending $25,000 to $100,000+ for treatment? Of course we would, that goes without saying. But would we be happy about it? Hell no! 

At this point in our journey, we really started digging the idea of medical tourism. If we could just get the same high-quality treatment for a fraction of the cost in exchange for some minor annoyances, wouldn’t that be pretty sweet? Well, except of course the “minor detail” of traveling around the world and not being able to sleep in our own bed every night. But hey, we love an adventure and would try to treat it as such.

All that money saved can do a lot of good when it comes to pregnancy-associated (medical) costs and raising a kid. Plus, being the frugal people that we are, it just feels terrible overpaying when you know there is an equally good alternative.

As with many things of value in life, all it takes is some research and effort!

 

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Footnotes:

1. Some states do mandate some form of infertility treatment coverage, but in essence with little exception, coverage is limited in scope. Some employers do offer coverage but that’s rather unusual as well. Fertilityiq.com estimates that only about a quarter of Americans have fertility treatments paid for by insurance.
2. Costs calculated from 2006 dollars as published by Chambers et al. 2009, adjusted for medical inflation rates to 2016 dollars using “Tom’s inflation calculator” http://www.halfhill.com/inflation_js.html
3. Chambers et al. 2009. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril. 91(6):2281-94.

 

4 Comments

  • Melissa

    March 26, 2018 at 8:59 pm

    I’m in a similar boat and definitely considering IVF medical tourism because the cost is so ridiculous here in the USA. Did you guys consider low cost US options like CNY in your search? Though I can understand if you have to hang out somewhere for a few weeks I would rather be in Prague! 🙂 Best of luck!

    Reply
    • Mrs Frugalcrib

      March 26, 2018 at 9:31 pm

      Hi Melissa, it sucks to be in this boat, doesn’t it! I remember reading about CNY back when I was looking at cheaper options in the US but it was still more expensive than doing a cycle in Prague including the cost of travel. Meds were a lot cheaper over there too compared to the US or online. So we figured we might as well turn it into a vacation lol. I just looked up their success rates as reported by the CDC (latest data from 2015 can be found here) and noticed that their success rates are slightly below the national average, and the majority of patients gets 2 or more embryos transferred instead of just one. Clinics that have a low elective single embryo transfer rate are always a bit of a red flag in my book (are they just not confident in what they’re doing, are they pushing for the highest success rates without taking into account the risk that comes with carrying multiples etc.). That being said, their prices are very competitive and I’m definitely going to check them out in closer detail in case I need another full round of IVF. Best of luck to you too 🙂

      Reply
  • Melissa

    March 27, 2018 at 10:21 pm

    I have similar concerns about their success rates, but they (allegedly) don’t turn people away due to age or other health issues like many clinics do to keep their success rates high, so that might explain both the lower success rate and single embryo transfer rates! But yeah, tough decision either way.

    Reply
    • Mrs Frugalcrib

      March 28, 2018 at 9:33 am

      That could explain at least part of it! It’s hard to know if we’re comparing apples to apples when other clinics might not take patients with a certain health issue, for example.

      That being said, the donor live birth rates with frozen embryos are pretty low compared to the national average (23.6% vs 42.3%), which seems kinda odd and can’t be fully explained by the difference in sub-populations between clinics. The live birth rates per frozen transfer are also lower in the non-donor egg group (age <35 years) at 36.7% vs 48.7%, while the latest data generally show higher success rates among frozen embryo transfers compared to fresh (all data from latest report). I wonder why that is!

      I would definitely consider them and wouldn't even mind a slightly lower success rates (cost/benefit ratio still seems pretty good) but would hope they'd be able to answer some of these questions first.

      Reply

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