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Fertility on a Budget

Lesson 1 of 6

Where to Get Treated

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Introduction

For those hoping to expand their families with the help of fertility treatments, the costs involved can be staggering. In this course, we unpack the financial implications, explain the role insurance plays, and explore avenues for paying for care.

The information in this course does not constitute medical or financial advice, and some information may not be applicable in your region. As you consider your options, we encourage you to consult with your own doctor, clinic billing specialists, and financial advisors.

Country-to-Country

The cost (and quality) of fertility treatment varies globally. In many countries, the cost of fertility treatment is covered by a national health agency, and patients have minimal, if any, cost responsibility.

In other countries, fertility coverage barely exists or doesn’t exist at all.In these instances, patients need to cover most or all of the associated costs “out of pocket”.

However, in nearly every country, there is a “private” clinic option where patients pay out of pocket, they typically are seen more quickly, and their doctors often have more flexibility in treatment approach.

As a result, it’s common for patients to consider seeking treatment in, or temporarily relocating to, a country where costs are lower and the level of disruption (e.g. similar region, language, heritage) is manageable. This can be especially true for patients considering the use of donor eggs or surrogacy where costs (and laws) vary dramatically across borders.

Before seeking treatment across borders, it’s vital to get a clear sense for the local legal frameworks and how your treatment path, objectives, and constraints comport.

Region-To-Region Within the United States

Within the United States, roughly 10 states passed legislation that requires insurers to cover treatment unless the plan is provided through an extremely small or extremely large employer.

Hopeful parents living in these 10 states are much more likely to have a plan that covers the cost of treatment which is reflected in the higher percentage of babies born (per capita) via treatment, according to CDC data.

It’s common for patients to consider relocating to be in a region where they’re more likely to have access to a plan that covers care. The degree to which they’ll be eligible for coverage (e.g. based upon age, diagnosis, orientation), or the extent of that coverage, often varies by how the law is written in each state.

This intra-country heterogeneity in treatment coverage also exists in the U.K. and Canada, as two examples. Again, it’s crucial that you get a clear sense for the local legal frameworks and your ability to access care and coverage all in the context of your personal circumstances medically, financially, culturally, employment-wise and more before considering any form of relocation.

Clinic-to-Clinic Within the United States

Selecting a clinic for treatment is a critical decision and we suggest you consult our pieces on selection criteria (here) and lab quality (here) before settling on an option.

Needless to say, for many hopeful parents, cost is a significant factor in their ability to access treatment, especially since even the most effective treatment (e.g. IVF) tends to require multiple cycles. Below you can see this is true regardless of where a patient gets treated.

In the United States, there are clinics that have begun to price their services at rates far below the regional or national averages.

The savings can be partially attributed to their altogether skipping certain interventions and add-ons (e.g. ICSI) but also by simply charging less for the same approach.

A major question is whether these clinics provide respectable enough quality care to make the lower-cost approach translate into good value.

Below we breakdown national IVF success rates (top line) with an example of how one low-cost provider compares (bottom line), isolating out the variable of female age.

In this example, the rates of success for the “low cost” clinic tend to be one third lower than national averages (e.g. for 35–42 year old women) while their costs tend to be about two thirds lower.

Again, we believe clinic quality is tantamount in selecting a clinic, but provided a patient is satisfied in that regard, there may be flexibility to allow cost to become a useful factor.