What it costs, and what the money buys
In two prospective cost studies, spending more was not associated with going home with a baby.
There is no current, nationally representative, peer-reviewed US price survey for IVF, donor eggs, embryo screening or surrogacy. The figures circulated by clinics and agencies are not peer-reviewed, and this guide will not print them as though they were evidence. What follows is what has actually been measured, with its date attached.
398 women followed prospectively for 18 months across 8 US practices, published 2011, study period mid-2000s. Median cost per person: $1,182 for medications only, $24,373 for IVF, $38,015 for IVF with a donor egg. Cost per successful outcome with IVF: $61,377.
332 couples keeping prospective cost diaries at 8 US clinics, published 2014. Median out-of-pocket expense $5,338 overall, $19,234 for couples doing IVF, with each additional IVF cycle costing about $6,955.
In the authors' own words:
costs were not significantly different for women whose outcomes were successful and women whose outcomes were not, and
After multivariate adjustment the out-of-pocket expense was not significantly associated with successful pregnancy.
Two independent prospective studies. Spending more was not associated with going home with a baby. This is the single most important thing to know before being offered anything extra.
On refund and shared-risk programmes. These charge a higher fee up front covering several cycles, and refund part or all of it if treatment fails. The fertility field's own ethics opinion names four problems with them.
- Who gets in. Programmes admit only good-prognosis patients, so the guarantee is priced against a favourable group.
- Conflict of interest. The programme makes the most money when treatment works fast, and loses when it does not. Read that alongside the earlier topic on how many embryos get transferred.
- Success-rate transparency. Named as a concern by the opinion, which does not spell out what it means. Worth asking about directly.
- Informed consent. Also named as a concern. Ask exactly what is refunded, under what conditions, and what is excluded.
On insurance. Some US states require insurance to cover infertility treatment. Fewer require it to cover IVF. What is required differs by state, by employer size and by plan type, and it changes every legislative session. No count of states is printed here, because the authoritative trackers disagree with each other and any number would be out of date within a year. Look up a current state-by-state tracker for your own state.
What insurance changes is covered in the topic on transferring one embryo, earlier in this guide. In short, when patients are not paying per attempt, fewer embryos get transferred and fewer twins are born.
You may want to think about whether it might be better to pay for multiple cycles of IVF or IUI, rather than spending large sums of money on a single treatment cycle with treatment add-ons that haven't been proven to be effective.
An add-on with no demonstrated effect on live birth has, in strict terms, an infinite cost per additional baby.