For Elizabeth Cameron, the question was never whether she and her husband, Spencer, would have children. The question was how many.
But after an ectopic pregnancy, her ability to become pregnant without medical intervention was severely limited. Cameron, 32, a special-education teacher living near Philadelphia, was considering the advice of her obstetrician-gynecologist when she heard an unusual contest announcement on her local radio station, Q102 FM.
The prize? A $15,000 voucher for in vitro fertilization. Hopeful parents would just need to submit a video.
It had to be a sign, she thought. The day before, Cameron’s OB/GYN had informed her that her best chance at conceiving was through in vitro fertilization. But her insurance would cover only preliminary testing and bloodwork; the crucial steps of egg and semen retrieval, injections and embryo implantation would be an out-of-pocket expense for the pair of public school educators.
Now was the chance to potentially afford the treatment.
As many would-be parents have found, it’s nearly impossible to know ahead of time what the price will be.
Even on paper, the in vitro fertilization process is complex: Meet with a specialist at a reproductive medicine clinic. If you’re a candidate for in vitro fertilization, begin daily injections of multiple hormones timed to your ovulation cycle. Visit the clinic for follow-ups on your ovarian reserve, the quality and quantity of your remaining eggs. Wait for the eggs to mature before beginning the retrieval process.
Then, if any of the eggs are fertilized with the provided semen sample, wait another three to five days before your doctor can implant the embryos.
The American Pregnancy Association says that a single cycle of IVF can cost as much as $17,000, although other organizations cite prices between $10,000 and $15,000. Most figures, however, tend to exclude the cost of hormones and tests that aren’t required but are highly desirable for many would-be parents, such as genetic screenings.
An exact breakdown of the average cost of each step doesn’t exist, says Barbara Collura, president of the National Infertility Association, also known as Resolve. Compiling such a breakdown would require an immense allocation of both time and money, and Collura isn’t aware of a private medical or academic institution that is undertaking such research.
There is information available, but it takes some digging to find. The website FertilityIQ, for example, offers patient-written evaluations of fertility clinics, some of which include information about cost.
“There is no such thing as a typical couple, so [costs are] going to vary widely,” Collura said. “It’s based on where they live, who they work for and where they’re getting their health insurance from.” Two patients could have dramatically different journeys depending on factors such as age, their general health outside of their reproductive concerns and the number of potentially functional eggs they have. Rarely should a patient expect or budget for just one cycle.
“Someone at age 40 may require five cycles, and it’s very hard to generalize because it depends on the particular medical condition, particular medical situation, ovarian reserve and age,” says Lusine Aghajanova, a doctor with Stanford University’s reproductive endocrinology and infertility division. Even with two very similar individuals or couples in terms of age or general health, one may end up requiring more clinic visits, more testing, more expensive medications or more cycles.
In 2017, the Centers for Disease Control and Prevention counted 284,385 assisted reproductive technology cycles at reporting U.S. clinics, the majority of which were IVF treatments. These cycles resulted in, according to the CDC, 78,052 live-born infants. (An additional 87,535 cycles were done with the intent to freeze the eggs or embryos.)
The cost of IVF is a topic that those who have undergone treatment say they knew little about before they were confronted with their fertility reality.
After years of struggling to determine costs for herself, Jennifer Lannon, 27, founded Freeze, an online clinic pricing database and education platform for certain fertility treatments, with her friend, Sidonia Swarm, last year. After learning about egg retrieval and embryo implantation, Lannon spent several years playing phone tag with clinics, trying to pin down procedural cost estimates without having to spend hundreds of dollars on an out-of-pocket consultation expense.
“A lot of that time was really wasted finding information on clinics in our cities that offer the procedure,” said Lannon. “Specifically, it was really frustrating that none of the clinics posted prices on their website.”
“You would have to call and play phone tag with these clinics to try to get a full quote on how much it would cost, and a lot of times they didn’t want to give you that information over the phone.” Lannon estimates that her co-founder, Swarm, spent about $800 on consultation charges alone for one clinic where “it was very obvious within the first five minutes [of her appointment] that she wasn’t going to freeze her eggs there.”
Lannon, who lives in Miami, ended up selecting a clinic in New York City because of how few clinics there are where she lives — a dearth of options that Lannon says limits competitive pricing, forcing her to look elsewhere.
Although Freeze is free for patients (the company pays the bills by inviting medical professionals to sponsor and write reproductive-health-related content), the site has its limitations. Lannon hopes to eventually include the costs for the full in vitro fertilization process, but for now the site lists consultation and egg freezing fees — a step that primarily is taken by younger women who intend to undergo embryo implantation at a later life stage — for approximately 150 clinics in the United States and abroad.
Cameron says she feels fortunate that at least some portion of treatment will be covered through her insurance. But she still feels slighted.
“It’s not something that is my fault, it’s not something that I did wrong,” she said.
Only 16 states require a health insurer to offer individual and group plans that cover some portion of one or more forms of fertility treatment. In the few states that mandate any coverage, the guidelines can be distinctly different. Several states, including New York and Ohio, require insurers to offer health insurance plans that cover little more than diagnostic testing.
Other states, like Maryland and Rhode Island, cap the amount that an insurer is required to cover at $100,000. Hawaii requires a five-year history of infertility before coverage is required, years longer than most states’ condition of one or two years of continued infertility.
Collura says that she knows of families who have moved to a more IVF-friendly state in search of better coverage for treatment. Of course, she added, “that’s not always easy to do.”
Presidential hopeful Sen. Cory Booker (D-N.J.) introduced a Senate bill last year that would require that infertility treatments — including in vitro fertilization — be covered by private health insurance plans. It would also provide coverage to federal employees, active-duty military members and veterans. Booker reintroduced the bill in May with Rep. Rosa L. DeLauro (D-Conn.) and Sen. Robert Menendez (D-N.J.).
With any luck, the Camerons won’t have to incur any medical debt. After about 150 videos were submitted to the station’s website, the couple found out, live on-air, that they had won the contest.
“We can’t really put into words what this means to us,’” said Spencer Cameron, Elizabeth’s husband, on-air when they found out that they had won. (A representative of the station responded to a request for comment by saying it was not doing interviews about the contest.)
“This is truly life-changing, it really is,” he added.
The combination of the voucher and their insurance has covered everything so far, the couple said. But if they do end up needing to spend more, or need more than just one cycle, it still won’t be the end of their journey.
“I think in our minds, we would sell our house if we had to,” said Cameron, later adding that they would look at medical loans.
Bridget Reed Morawski is a freelance writer and reporter based in the District.