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Budgeting for Infertility Authors Sterling, Best-Boss Offer Help for Couples

by Michelle Andrews,  U.S. News & World Report,  Mar 17, 2009

Fertility treatments are an often expensive gamble but one that a growing number of would-be parents are willing to take. In their new book, Budgeting for Infertility, coauthors Angie Best-Boss provide hopeful moms and dads with a manual for managing the one part of the fertility treatment process they can control: Paying for it. I spoke with Evelina Weidman Sterling, who has a Ph.D. in public health and has conceived two children with assisted reproductive technology, about the book.

What made you decide to do this book?
Infertility treatments can be exorbitantly expensive, and 70 percent of people pay for them completely out of pocket. In vitro fertilization can cost anywhere from $15,000 to $70,000 per attempt, and it can take several attempts. People can spend as much on family building as on a car or a house, and there are books out there on how to be a smart consumer in those areas. But not for fertility treatments. We wanted to tell people how to be a smart consumer and mitigate costs.

In your book, you discuss cost-effectiveness. Can you identify the most cost-effective fertility treatment?
The big thing is to make sure that you get accurately diagnosed.

You could do IUI (intrauterine insemination), but if you have blocked fallopian tubes or a partner with a low sperm count, then the money for IUI wouldn't be cost-effective. At the same time, if a doctor pushes you toward in vitro fertilization when something else might have worked, it might not have been necessary. The reality is that 90 percent of the time, with appropriate treatments, families can go home with a baby, and 50 percent of the time that's with something lower tech than IVF, like IUI or medication. Finding a good doctor, getting an appropriate diagnosis, and good communication—that's what's most effective.

Is there a treatment that you consider least cost-effective?
In vitro fertilization, if you're not a good candidate for it. That would mean someone who's under 35 and has no reason to believe that some of the lower tech options may not be good for her.

Doctors make a lot more money if you do IVF than if you do anything else. Some doctors have IVF goggles on and that's all they see. On the flip side: If you're an older woman, the chances of success are not as high with IVF, but many docs don't educate women about their chances of success and they let them go through it again and again. Still IVF can be hugely successful for the appropriate candidate.

Where are the biggest opportunities for cost savings?
There are a variety of different protocols [treatment plans] with IVF. Some of the medications are cheaper than others, and it's important to talk to your physician about the protocol you're on and if there are other options. Most physicians don't know how much these medications cost, so it's up to the patient to do their homework. Ask if there's a less expensive alternative. The three major pharmaceutical companies that manufacture fertility medications all have medication assistance programs, and pharmacies vary their prices as well.

In addition, there are many blood tests that are required, mostly looking for hormone levels. If you get it done under the assumption that it's for fertility treatments, insurance may not cover it. But if you just get it done at your local gynecologist's office it will probably be covered. The same with screening for sexually transmitted diseases: You can have those done by your primary care doctor or Planned Parenthood. Every little bit can help.

Ask your doctor: Do you really need these tests? An ultrasound, for example. You have to have one. But a lot of doctors will do repeat ultrasounds to see how your ovaries are responding. At $300 per ultrasound, how many do you need?

How typical is insurance coverage?
Seventy percent of people pay completely out of pocket. Fifteen states have some sort of mandate for fertility coverage. But it varies. Some insurance companies will cover fertility testing, but won't cover treatment. Or some will cover medications but not the whole IVF cycle, or they'll have limitations based on age. Or they say you have to be married, or they won't cover gay and lesbian couples.

Even in the best-case scenarios, insurance will most likely have a limit of one or two treatment cycles, or a $10,000 cap.

Has the economic downturn affected fertility treatments?
It's hard to get that information, because the business is so highly competitive and no clinic wants to say they're seeing a drop-off in business. But credit, cashing out 401(k)s, and home equity loans are the top ways that people pay, and all three of those have been devastated, so I think the answer has to be yes.

How much should someone have squirreled away for fertility treatments?
At a minimum you need a few thousand dollars to get through all the testing. If you do IVF, you'll need at least $10,000.

Let's talk about financial limits. Can people spend too much on fertility treatments, and how do you gauge how much that is?

The first thing you have to do is to talk with your partner and establish limits. A lot of people get into the gambling mentality: 'It's going to happen the next time.' And a lot of people want to think the sky's the limit when they want a child. It's important after each cycle to think about it, and talk about it with your partner. We've talked to a lot of people who exhaust all their resources and are left with no baby and no financial resources. It's important to make a plan, write it down, be concrete about it, and after each cycle evaluate where you are.

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