E and I pay a bit more than $12,000 out of pocket for IVF, and that is a bargain. Most of the $12,000 is for genetic testing, which is the whole reason that we are doing IVF, and which our insurance does not cover. They send us a form letter explaining why: because Lynch syndrome, the genetic issue that we are screening the embryos for, is statistically unlikely to cause cancer in children. Only adults. Hence, the insurance company wouldn’t have to pay for cancer treatment if we have a child born with Lynch, because the child would no longer be our dependent if they got a Lynch-related cancer.
It’s a cruel calculation.
But, as I said, $12,000 is a bargain. The average cost of a round of IVF in the US is over $23,000. Most people have at least three rounds before they are successful (some, of course, are sadly never successful). Many people have to pay that cost themselves, because their insurance covers nothing. I feel lucky, in a way, that I knew that I would need to pursue IVF several years before I was ready to think about starting a family, because I was able to prioritize finding a job with insurance that would support it.
That tech companies were beginning to provide this benefit became big news in the autumn of 2014, just around the time I received my Lynch diagnosis. Critics focused on the fact that these policies covered egg freezing, helping young women to postpone having families in favor of spending more hours at work. Surely, they wrote, this was a further indictment of capitalism, of the incursion of corporations into our private lives.
I share the belief that one’s access to healthcare should not be tied to employment. But given that this was the system under which I lived, I saw these benefits, which cover fertility treatment across the board, not just egg freezing, as a possible opportunity for me to have a family after all. Prior to that I thought that IVF was only an option for the very wealthy.
Crucially, many of the companies that provide this benefit do so without requiring demonstration of infertility. This means that it applies to queer people, single people, and people like me.
To me these policies seem not exploitative, but humane. I was working as a writer for a smaller tech company when these policies were publicized (some companies had been offering the benefit with little fanfare for some time). I focused on finding a new job at a bigger organization where I’d get the coverage. The job was a lateral move. I took a pay cut. I was privileged to be able to make these choices.
Many IVF patients are not so fortunate, in that they receive infertility diagnoses after some period of trying for pregnancy, when planning ahead for the cost is not possible. Sometimes they have inflexible commitments: jobs, mortgages. Sometimes they have children already. Sometimes, they’re simply too poor. Some people think that fertility treatment should not be covered by insurance or public health systems. In general, they’re people who’ve been able to make the choice about whether or not they’d like to be parents without medical intervention. To be a parent or to remain child-free is a choice that seems natural until the natural part is taken away from you.
Instead of having a wedding, E and I elope at City Hall in Manhattan, which saves us thousands of dollars. When we text friends afterwards to share our happy news, more than one asks if I’m pregnant.
I’ve completely forgotten that’s reason that people sometimes get married suddenly, I say.
Our parents contribute money to our IVF fund that they might otherwise have chipped in to a wedding. We take on extra freelance work and dig into our savings accounts and stay home for the holidays instead of traveling to see our families. These are the smallest of sacrifices compared to what most infertile couples in America have to make: many end up with tens of thousands of dollars in credit card debt. GoFundMe campaigns are common.
Without insurance, most people have to shop around for infertility treatment. Some clinics offer flat rate guarantee programs, wherein patients pay for three rounds of treatment with the promise of a refund if none result in a live birth. Others undercut the competitors in price but with lower success rates. Some offer add-on treatments that cost more money despite little evidence to support their effect. Donor eggs and sperm cost even more; a gestational carrier is in a different category altogether, depending on what state you live in. Overseas treatment is an option for some Americans, who travel to clinics in Europe that offer them private treatment for less than the equivalent cost in the US, even factoring in the expense of flights and accommodation for the weeks of treatment.
As for those who ask the infertile why they don’t just adopt?
It’s a complex question, extremely personal to everyone, and flippant to suggest it as an easy solution. But the financial bottom line is that it is just as expensive as IVF, frequently more so. E and I discuss it and agree it will be our next step if our treatment doesn’t work, if we surpass the number of rounds of treatment that the insurance will cover.
This week I learned: The pricing structure for genetic testing is opaque and variable, not just depending on which lab you use but which medical practice refers you to it.