So stage 2 is the area in
which the largest financial burden lies for the couple pursuing
infertility treatment. Often times, these infertility treatment
expenses are incurred by couples just starting out together, making it
a particularly inopportune financial hardship. And even though stages 4
and 5 represent by far the largest child-rearing expenditures, a family
typically has many years to anticipate and plan for these expenses -
not to mention that a variety of financing options are often readily
available, particularly for college. Conversely,
expenses associated with infertility treatment may often come as a
complete surprise and because of the relatively limited window of
opportunity available for women to conceive, there may not be a whole
lot of time in which to save up these funds. This,
coupled with a lack of comprehensive insurance coverage or accessible
financing options, can make an infertility diagnosis financially taxing
for any couple.
Younger couples have an
advantage in this area, however, as the option of postponing treatment
to save up or wait for improvements in coverage is more realistic. They
benefit from being diagnosed early and still having the time to get
their finances in order without significantly hurting their chances of
conceiving through ART because of advancing age limitations.
Postponing treatment can still be
a gamble, though, since further infertility complications can arise
suddenly and increase the severity of the situation. For
many, the prospect of postponing treatment is simply not an acceptable
alternative. Due to patients’ age, diagnosis, or
out of an understandable desire to realize the dream of parenthood as
soon as possible, many couples are inclined to pursue treatment
immediately. If this is the case for you, now is
the time to seriously weigh the pros and cons of infertility treatment,
come to terms with its uncertainty, and talk with your doctor about the
specific costs associated with the treatments he will likely recommend.
Once all the facts associated with
your diagnosis are gathered and you have committed to a treatment
strategy specifically tailored to your situation, you will be relieved
to know that there are some tangible things that you can do to today to
begin taking control of the costs associated with your impending
treatment.
Understand Your Odds...Plan Your Expenses
In your
efforts to stay on top of your infertility treatment costs, it is
important to start by grounding yourself with a realistic sense of how
long treatment may last and what your odds of conceiving may be in any
given cycle. This is important not only because it
will emotionally prepare you for what may lie ahead, but also because
it gives you some realistic insight into possible expenses you may
incur over the total course of treatment. Because
there is no accurate way to predict how many cycles you will need, you
may want to decide ahead of time how many cycles you are willing or
able to try. Ask questions about your diagnosis and
understand the approximate treatment costs you are likely to incur at
each cycle (in addition to the cost of the actual procedure,
investigate physician fees and lab costs you may incur in preparation
for each procedure). This information will help you
to build a budget with designs on satisfying the financial aspects of
your treatment. Note: Although
they can vary widely from one couple to the next, a discussion of some
of the common costs of infertility diagnosis and treatment can be found
in the Frequently Asked Questions section of this site.
First, to help you get an
understanding of the time horizon involved in your potential treatment
we’ll take a quick look at what the odds are at conceiving from ART in
any given cycle. Let’s start with some of the
latest statistics on assisted reproduction currently available: the CDC
report “1997 Assisted Reproductive Technology (ART)success rates.”
Released in 1999, it states that
the odds of conception are between 24% and 29.5% per cycle in U.S. ART
facilities. The report also provides the per cycle
success rate of ART by 4 different measurement standards. Overall
pregnancy outcomes are placed at 29.5% for "fresh, non-donor" ART
cycles with the overall statistic for a positive outcome (live birth)
at around 24%. Granted, this report reflects data
that is already 2 years old with improvements in ART technology
constantly being made. As a result, current three
year data here at GYFT is significantly higher than the 1997 data,
placing the odds of conception at between 40% and 50% with the
likelihood of a live birth outcome at near 35%. These
odds may vary depending on your particular situation, e.g. age,
severity of infertility, etc. (see ART
Success Rates in the ART section for more details on the
nature of the data presented in the CDC/SART reports).
At first glance, especially
given the expense involved, anything short of 100% may seem to some
like disappointing odds. This may be primarily
because it paints a clear picture that your dreams may not be fulfilled
in any one cycle or because it highlights the fact that the chance of
failed pregnancy, natural or assisted, always exists. You
must remember, however, that the human reproductive process is very
complex and even under the best of natural circumstances
(i.e. couples with no infertility), the typical odds of conceiving are
only 25% in any given cycle. These statistics indicate that, on the
whole, ART can go a long way toward closing the gap for most infertile
couples. Psychologically, it is also helpful to
keep these figures in mind should any given cycle not result in
pregnancy – it’s common for many hopeful parents to throw statistics
aside once treatment has begun and are often overly disappointed
because they have set unrealistic expectations. Worse
yet, unrealistic expectations can have a devastating effect on your
budget. The statistics are there for a reason, so
use them to emotionally and financially prepare yourself for the
possibility that you may not get pregnant the first or even second time
you attempt an ART procedure. Odds are currently
better than 1 in 2.5 that you will conceive and better than 1 in 3 that
you will give birth from any given ART cycle. That’s
pretty good, but it’s not perfect, either. So try
to keep it all in perspective. Roughly one third of
you sitting out there will have a baby from IVF on your first attempt,
while another third will require two attempts, and another third 3
attempts. This is not to say that every couple is
assured to conceive if they would only make three attempts at IVF, but
does account for the majority of our patients. Although there are a
number of couples who only try IVF once or twice and fail to get
pregnant, it is a rare occurrence for couples who make a full
three attempts not to conceive at some point. If
only we could determine in advance which third each couple would fall
into, it would make budgeting for treatment so much easier.
Taking Control: Seven Things You
Can Do to Help Control Costs
1. Familiarize yourself with State
regulations about your rights to fertility coverage in your state
(there are currently no federal guidelines mandating fertility
coverage). Visit asrm.com for more information. You might wish to let your state representatives know
that you feel insurance providers should be required to provide
fertility coverage. You might also consider joining RESOLVE or
contributing to federal lobbying efforts dedicated to promoting the
best interests of hopeful parents. Several states
(Arkansas, California, Connecticut, Hawaii, Illinois, Maryland,
Massachusetts, Montana, New York, Ohio, Rhode Island, Texas, included)
have regulations requiring varying degrees of coverage. Checking
with your state to better understand your existing rights is perhaps
the most important first step.
2. Review your insurance coverage.
If you and your spouse have access to different plans, review both
plans carefully and evaluate which plan offers the best coverage. If
necessary, request a benefits booklet that outlines your coverage or
speak with your employer’s human resource department.
3. Speak with your doctor about
your condition and understand its cause. Some insurance policies may
have strict rules about what is covered and what is not, so it is
important to know the specifics and details about your condition before
undergoing treatment or making a claim. Do your homework before
submitting a claim and ask your fertility doctor or pharmacist if he or
she is willing to go to bat with you when seeking coverage.
It is also possible to have some
of the specialty pharmacies provide a free fertility medication
insurance evaluation. Your doctor or pharmacist will likely have much
experience interacting with insurance providers and filing claims, so
don't be afraid to ask what can be done on your behalf.
4. Develop a realistic treatment
strategy with your specialist taking into consideration what treatments
and/or medications might be covered by your insurance and what the cost
to you might be. Discuss the pros and cons of amending your strategy in
response to your coverage or in response to changing financial
circumstances. Be prepared, as financing those
procedures that are not covered may ultimately be the most prudent
decision.
5. If you have a confirmed
fertility problem, it’s good advice to start slow and work with your
physician to explore all options and associated costs especially if
budgeting is an important issue. Next you will want
to thoroughly review your insurance, review all rules and ask for
clarification when needed - be persistent and thorough. Even
if you have terrific coverage, it may still be necessary to cover some
costs yourself. Do your homework, be prepared for
the unexpected, and look for ways to keep costs down, often by simply
asking questions. For instance, in the chart at the
top of this page you can see that simpler, "low-tech" treatments are
often less expensive. Unfortunately, many
individuals’ diagnoses may preclude the use of such low cost
alternatives, but you won’t know unless you ask.
6. Be persistent, ask questions,
and don't be too willing to take "no" for an answer. Make sure you have
explored every alternative - especially when dealing with insurance
issues.
7. While it is generally not
recommended that financing options such as second mortgages or dipping
into retirement funds be considered (of course it is ultimately your
choice), alternative sources of credit may be available by exploring
financing options through your financial institution or other lenders.
For some couples, financial
assistance may be available from The Fertility Foundation, an
organization that seeks to provide financial assistance to needy
couples struggling to afford fertility treatment.
