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The invaluable and costly journey of infertility treatments

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After struggling with pregnancy issues, I was surprised how quickly I found out that I was not alone. Friends, relatives and co-workers came out of the woods to share their own stories – people I had known for years suddenly telling me about a vital part of their journey that I had never heard of.

I also hear some of those whispered conversations when I tell people what I do for a living. “Oh, are you a financial advisor?” Can we go somewhere and talk? I quickly become their confessor for some very personal parts of their history.

Infertility and finance – two topics we talk about quietly, if at all. But what happens when these two currents come together? The cost of infertility, on a purely financial level, not to mention the emotional burden, is a painful reality made even more acute by its polished secrecy.

One in eight couples struggle with infertility, according to the CDC. Chances are, someone at your party table has gone through this expensive and exhausting trip, either in the middle of it or just getting started. Gatherings focused on new grandchildren and seeing the generations all together can be difficult.

The financial cost of this brutal process of trial and error is a taboo aspect of a taboo subject and exacerbates the pain of many families.

Infertility takes many forms and has many treatments, but I want to focus specifically on IVF, or in vitro fertilization, which is one of the most effective and common treatments. As with many medical procedures, the cost of IVF can be misleading and difficult to explain.

The treatment itself is no small feat, with a national average of around $ 12,400, according to the American Society for Reproductive Medicine. It may not seem overwhelming, but take a closer look. Most couples end up needing two or even three treatments before a single “takes,” which immediately multiplies your bill. In addition, other estimates place the price much higher. Data from FertilityIQ puts the cost of an IVF cycle at over $ 23,400, depending on where you live.

Add to that the cost of work stoppages, or even housing if you don’t live near your clinic, while you undergo medical follow-up and procedures, potentially for several months. It’s a big bill, and an even bigger bill considering you might have to go through it three times. And there is never a guarantee that IVF will work. It is not uncommon for an American couple to spend around $ 50,000 out of pocket on their treatment journey.

It’s questionable comfort to the American mind: to think that somewhere in our wallet is an insurance card that will make the frightening prize go away.

Unfortunately, most IVF patients have to foot the bill. Only a handful of states require professional insurance to cover fertility treatments, and coverage is often limited. Remember that it is only in the last 30 years or so that insurance has covered childbirth.

Many insurance companies do not touch infertility treatments, placing them in a category close to voluntary coverage and therefore outside coverage.

In a recent survey of 10,000 infertility patients, 71% said they had no insurance coverage for their treatments and the remaining 29% said they had “some coverage”.

When a couple has to use donor eggs or sperm, it becomes more complicated. As one woman described it in Auto magazine: “My husband’s insurance covers fertility treatments, but only if we use my eggs and his sperm. Because we had to use donor eggs, they considered it voluntary and they would not cover it. If the journey to infertility is long and complex, as most are, the use of donors is not unusual.

Infertility was once considered a “niche” problem, and treatments, including IVF, were not covered because they were classified as experimental. This attitude persists among some people and insurers. Today, with over 8 million infants born by IVF since the first one in 1978, all the “experimental” and “niche” labels about treatment hardly seem right, but here we are.

We have to keep in mind the life stage of fighting infertility for the most part. If you’re reading this as a middle-aged person with a healthy interest in retirement, you could have $ 50,000 in liquid assets for a crucial expense. But did you have that at 30 and ready to start a family?

The age at which most people seek treatment, the 1920s and 1930s, are the years when people lay the foundation for wealth. Home down payment and student loans likely dominate financial life. Freeing up a year’s salary for medical treatment is unlikely, and by the time people have so much capital, a few years later, the reproductive window may close.

It is therefore not surprising that the success of IVF treatments often follows the money. Most IVF success stories sound like what you might think: white, upper middle class, from households earning $ 100,000 and over. The math is simple here. If you are rich, you have the income to invest in more treatment, while those who earn less may not afford treatment at all.

Think again about your festive table. You’ve probably seen people setting there who couldn’t afford this trip. Or they might be shifting important parts of their financial plan – depleting their savings, cashing in their retirement plans – to get there. All of this in the sticky situation of paying for something that seems easy on everyone.

The options for couples going through IVF are complex but doable. We can “mimic” insurance coverage in a certain sense by using certain programs available.

Your Health Savings Account (HSA) is a triple-taxed fund, a powerful financial tool to protect your wealth from medical costs. IVF is considered a qualifying health expense for an HSA, which is great news for couples trying to conceive.

However, keep in mind that an HSA is a fund that you create with your contributions and that it can only grow at a certain rate. During the first childbearing years, couples have only had a few decades at most to build their HSA, and the 2021 contribution limit for a family is $ 7,200 per year.

According to a recent statistic, the average HSA account held $ 2,803 and users spent an average of only $ 1,500 per year on these accounts.

Ultimately, your HSA can be extremely helpful in defraying costs, but it won’t start to cover the entire $ 50,000 bill for most couples. It’s also a qualifying expense for an FSA, but the story is pretty much the same.

If you itemize your taxes, you can claim a tax deduction for any medical expense greater than 7.5% of your adjusted gross income. A tax deduction can work in your plan to help protect you and free up other income for expenses. You can also add the cost of IVF to other medical bills to get you over the threshold – that’s a total of 7.5%.

Again, this can help cover the costs and soften the blow, but it’s far from fully replenishing the expense. The 7.5% total sounds generous but is not a substantial amount at the end of the day, especially if you have a higher income. Plus, since the Tax Cuts and Jobs Act, the standard minimum deduction is set at $ 25,100 (for 2021), which means many Americans don’t itemize to begin with.

Financial infertility programs have sprung up where insurance is lacking. Specialty loans – such as EggFund and Future Family – and risk-shared groups are two options. Grants also exist, through channels such as the Nest Egg Foundation, for those who qualify. Again, these aren’t straightforward solutions – you envision an extensive application process and a waitlist, but they make it more possible.

Bottom line: Financial help for IVF exists, but it takes careful planning, patience, and, to be honest, a little luck to get through the process. It’s nowhere near as easy as throwing away your insurance card for the vast majority of couples, at least not yet.

Journalist Elizabeth Holmes described her IVF journey, which was ultimately successful, but very long: “In our blind determination, we doubled down with consecutive dizzying attempts. After a second unsuccessful transfer, a second full round of IVF, then a third unsuccessful transfer, my body’s response collapsed. When they finally conceived, it was a lot of time and a lot of money later.

Nothing is simple, especially nothing worth doing. I hear my daughter in the next room as I write this – it’s the sound I wish I could have heard all those years ago, alone in the operating room, crying. Every little bit of stress, and every penny, was worth it, of course.

I think of friends and relatives who I know are going through this journey now, and I hope they have a safe space when they see their friends and family this season. Whether it’s someone to talk to, or maybe more importantly who doesn’t have to talk to, I want to dispel any rumors of shame or anxiety from their minds. I know firsthand the emotional toll and some of the costs involved.

One in eight. Think about this statistic as well as the complexity and cost of the trip. One of the best gifts you can give is a listening ear – not to balk at price tags or squirm in medical discussions, just be there and be present.

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