When conceiving isn’t going as quickly as you’d like, couples are recommended to seek a fertility consultation to diagnose and treat the underlying cause of the problem. Oftentimes, a fertility specialist will advise a course of action that requires some expense, which can vary depending on which fertility treatment you seek and what your health insurance covers.
How do fertility treatment costs vary from procedure type and technology used?
From Clomid to intrauterine insemination (IUI) to in-vitro fertilization (IVF) and everything else, the costs of different fertility treatments can vary greatly. Although the cost may not be the same for everyone due to different insurance coverage and medical needs, Clomid (a widely used drug that treats infertility by inducing ovulation) is generally available under insurance coverage for about $15 for a month’s course. Clomid may also be combined with IUI, which might add another $600 to the cost per month.
Injectable hormones are more expensive than oral medications like Clomid, and may cost in the neighborhood of $3,000. Hormonal therapies can greatly increase the likelihood of conception for women with hormonal imbalances or other disorders, including PCOS.
In vitro fertilization (IVF) is likely the most expensive fertility procedure. With IVF, a sperm cell fertilizes the egg in a lab before it is implanted into the uterus, where if it is successful, it will grow and develop as normal. IVF is also usually coupled with Clomid or other treatments to extract the greatest number of eggs for the best chances of conceiving possible. In vitro fertilization is ideal for women with conditions like endometriosis, or for men with blockage problems. You may also use donor sperm and eggs to increase the likelihood of conception. Using IVF with your own eggs may cost about $15,000 for each cycle, and this figure is likely to be even higher when using donor eggs.
How do insurance policies cover fertility treatment costs?
Insurance coverage of fertility treatments differs by provider, treatment, state, and fertility clinic, so it’s important to have a good understanding of what your provider does and does not cover before deciding on a course of action. There are four main ways that insurance providers handle infertility coverage:
- No coverage: Many insurance plans do not provide any coverage for advanced fertility treatments and procedures, so it is critical to know if this restriction applies to you. However, even if your policy does not specify any infertility coverage, treatments of conditions like endometriosis and PCOS are still likely to be covered.
- Diagnosis covered: Some insurance providers will cover the diagnosis of conditions of infertility, which often includes the surgical procedures required to diagnose, but they won’t cover the treatment that’s later required or any Assisted Reproductive Technologies.
- Limited treatment covered: Some insurance providers will cover limited treatments, like Clomid and IUI, but stop short of paying for IVF or other expensive procedures.
- Full coverage: Full coverage for infertility diagnosis and treatment, including in vitro fertilization, is generally only included in insurance plans when a state mandates it. Currently, there are 15 states that mandate coverage for IVF.