Cost Infertility Treatment Fertility Care

Infertility therapy can be emotionally taxing and financially burdensome. The “necessity” of such therapy is the source of much debate, since not having children is not, by itself, considered a disease, and therefore many insurers consider treatment for subfertility a luxury, rather than a pathologic condition requiring treatment. The field of third-party insurers is filled with seemingly arbitrary decisions on what deserves reimbursement. Anyone who has ever signed up for a health plan is familiar with “in network” physicians or benefits. In addition, some prescribed medications may be covered, but others are not – and the group of medications “on formulary” vary from plan to plan.

Since economic criteria are not required for natural conception, a long debate has ensued. Does the expense of fertility treatments unfairly limits access to treatment only to individuals or couples with significant financial resources? Medicaid, for example, does not cover infertility treatment, raising ethical questions about access to health care and questions pertaining to patient rights.

Given the costs associated with establishing an IVF laboratory, the cost of an IVF cycle is remarkably low. An office, a laboratory, a reproductive endocrinologist, an embryologist, an anesthesiologist, microscopes, pipettes, ultrasonography equipment, media for embryo culture, incubators, ventilation systems, blood tests, surgical equipment and medicines are just some of the numerous elements required. The total cost, unfortunately, can exceed many budgets.

Although an increasing number of third-party insurers provide infertility benefits, coverage is not universal. In some states, infertility coverage is mandated by law, but this is an exception, by far. In any case, insurers usually limit treatment at a defined number of attempts or cap allocations for fertility care. In some cases, additional hurdles can have significant impact on the success of treatment, such as requiring a 2-year history of fertility problems, or requiring a minimum number of inseminations before IVF may be pursued.

Patients may seek loans or second mortgages to finance fertility treatment. Some clinics provide “money back guarantees” if a patient is not successful, but a patient should understand the probabilities of cycle success before entering any financial agreement based on cycle outcome: caveat emptor.

There is one additional less well-known option that is, luckily, available to New York State residents: The New York State Infertility Demonstration Program. Beginning in 2002, New York State has provided a yearly grant to selected medical centers in order to help eligible patients meet the cost of infertility treatment. This grant can cover such costs as: initial patient assessment, medications, egg retrieval, anesthesia, embryo transfer, radiology and laboratory fees, in addition to urology services, intracytoplasmic sperm injection, testicular sperm extraction and even cryopreservation of embryos.

Coverage for these services is based on household income (less than $200,000), age requirement (21-44 years), and private insurance – although the private insurance is not required to provide any fertility coverage. Exclusions include 3 prior failed or cancelled IVF cycles, and medical conditions that would contraindicate pregnancy. The amount covered by the grant is scaled, but in some cases up to 97% of IVF treatment costs can be covered by the grant.

Patients should inquire whether their fertility center has been selected to participate in this grant, and whether they may be eligible for benefits.

Undergoing treatment for infertility can be burdensome, and every avenue of help, whether emotional, medical or financial, should be used to help women achieve their dream of motherhood.