Welcome to my short guide!
We all know how babies are made, right? Woman finds man, wine and romantic evening occurs, then those bright little lines announce your impending life change. Or, you know not. Because some of us? We’re the same sex as our partners. Or that romantic wine sex happens, and nothing happens. (Then the non romantic, “my app says we need to” sex happens, and nothing happens there either). Or we get pregnant, but miscarry. (Again. And… again). Or we don’t have a partner, but want to build a family on our own.
Whatever path brought you here, not all of us get free sex babies. And you know what? By and large, insurance and government and the whole goddamn world doesn’t really seem to care that much, so we’re left holding the bill to try and make our dreamed of families happen. Well I’m here to be your wizened, cynical tour guide to the wide world of alternative ways of building a family.
Biases starting out: I’m US based. I’m in a straight marriage. I have female factor infertility (I’m young, but my ovaries think I’m 42). I’m about to do my third cycle of IVF. I have no insurance coverage for any of it. I’ll do the best I can, but please feel free to pipe in on any additional information, corrections, or questions you have, and I’ll do the best I can to learn, correct, etc.
First section: using money and science to try and MAKE a baby.
How much does infertility testing cost
This depends. Luckily, many insurance companies do cover many parts of infertility testing. (Ahem, especially if, as the woman, you go in and say “I’m worried I have PCOS because (my cycles are long/my cycles are short) and OH BY THE WAY I can’t get pregnant”. Then it’s coded as ovulatory dysfunction and not infertility. Just FYI).
Usual testing for women who haven’t conceived includes sex hormone testing: estrogen, FSH, LH, testosterone. Should include AMH, but if you’re young you usually have to ask for it. Other hormones: vitamin D, prolactin. Thyroid hormones like TSH. And then often structural scans like an HSG (dye shot through fallopian tubes under xray) and internal ultrasound of the uterus and ovaries.
Like all parts of this “how much does it cost” very much depends on insurance. ACA plans (holla obamacare!) have a yearly thyroid testing covered for women. Most of the hormones testing is covered under most insurances, but what is virtually never covered, unless you have fertility benefits, is the AMH blood test and the scans- HSG and ultrasound/follicle count.
On my costs: AMH has cost $75-125 per time I’ve had it done. My HSG was $500, but they can go up to ~$1000-1200 depending on facility. Ultrasounds and follicle counts are often around $300-400 anywhere I’ve been.
Testing phase total, if you get the whole shebang: usually ~$1k-2k.
What about interventions?
So now you’ve been tested. Maybe they found something, maybe they didn’t. Either way, now you’re getting some treatment. For the sake of ease, I’ll price out the usual ‘progression of treatment’ for your standard unexplained infertility couple.
Step 1: Ovulation induction via Clomid or Letrazole
This is often used even in people who are ovulating, FYI. It’s just a pill, really easing you in to interventions.
Cost depends on dose and insurance. It’s usually not covered. However, clomid has been around a long time now, so it’s usually cheap as hell. I think my courses were like $15 cash price at Costco. Letrazole tends to be more expensive, since it’s newer, but it’s still like $30 a course. For all of this stuff, this site is a best friend: https://www.drugs.com/price-guide/letrozole The rest of the cycle cost depends on if you’re having “monitored” cycles or not. (Ie, are they doing ultrasounds also). Either way you’ll have some blood draws (usually a post-ovulation progesterone draw to make sure they worked). That blood draw depends on the lab, but for me was either $30 or $125… price check your labs guys =\ The ultrasounds in these cases are the same as diagnostic ones, $300-400 generally.
Total cost: $45 low end for an unmonitored clomid cycle, up to ~$500 for a monitored cycle with an expensive lab bill.
Step 2: Intrauterine insemination, aka IUIs!
This is the step where many people will start, actually. If the issue is the male partner has ‘weak sperm’ (like low motility), or if you need to use donor sperm, or if you’re doing single motherhood by choice, you’ll likely begin at this point. IUI pricing varies depending on where you have it done (OB/GYN vs RE/Reproductive Endocrinologist). It also depends on if you’re on any medications along with it. IUIs are sometimes paired with clomid or letrazole, or with gonadotropins- bringing us to our first injection in this guide, oooohlala.
IUI, all in, is generally $1500-3000 per try. It’ll be more if you need donor sperm as well. If you go through a bank, like California Sperm Bank, you’re looking at like $800 per vial.
The general recommendation is to try 3 IUIs, and if they don’t work, move on to other interventions like IVF. This varies though, and I do know people who have done 10+ IUIs.
Step 3: The big one, In Vitro Fertilization, or IVF
IVF is a super complex process. You take a ton of medications first to quiet your eggs, then to grow a bunch. Then a surgery is done to remove the eggs. Then the eggs are combined with sperm, in a lab, and allowed to grow in special incubators for 5 days. Then the survivng embryos are put back into the uterus, cells are taken for testing and they’re frozen, or they’re frozen to be put back once the woman has recovered. Alternately, embryos are made from the eggs of one female partner and transferred to the uterus of the other female partner. There’s lots of options, and IVF allows for them. So it kinda makes sense, when you see JUST how much goes into an IVF cycle, that it is so goddamn expensive. But like really guys. It’s really goddamn expensive.
HOW goddamn expensive you ask? Well. It depends on where you go! (Are you getting tired of “it depends” answers yet?) It also depends how much medication you need, etc. But if you want a ballpark: $6k is a low low price. You generally only get this abroad, or at a couple clinics in massive cities like new york. More ‘normal’ prices are in the $15-35k range. An important thing to note is that the price is made up of several parts. You need to meet with an RE (~$400-500). You need additional testing (SIS or hysteroscopy- usually another ~$400-1000). Then there’s the “clinic fee”. Then there’s your medications. Then there’s any testing, like if you’re having the embryos genetically tested.
For my part, I’ll say- for relatively high doses of meds at my first, cheaper clinic, with genetic testing, it cost around $17k for each of my first two cycles. My new clinic, it’s projected to be around $28k.
There are organizations, like BabyQuest, that provide grants for fertility treatments. I highly recommend people look into these!
Second section: using money and red tape to try and acquire a baby(slash child).
“Why don’t you just adopt?” Setting aside my visceral desire to hit people when they ask me this, let us proceed. (To be clear. I have ZERO problems with adoption. But anyone who says “just” adopt clearly knows nothing about the process, financially or emotionally). I get a little preachy in this section, and I apologize. I have had too many friends start down this path without eyes wide open and be deeply, deeply hurt. I just want people to have more of a realistic view of the challenges before jumping into the following ways of building their families. My caveats on this one: at this point in time, we are not pursuing this path. However, my work has me working in a care capacity with medically complex foster children, and many of my extended family have come out of and/or gone into the foster system. Let us begin.
First off: the “hollywood adoption” idea we see in movies is… well, kinda bullshit. There’s not a massive crop of healthy white infants that young unwed christian mothers are putting up for adoption. That isn’t reality. Domestic adoption looks different now. Anyone who wants to pursue adoption as a path has some hard questions to ask. “Am I okay with a baby who was exposed to drugs in utero?” “Am I okay with a baby with a different ethnic background?” “Am I okay (if straight) with adopting from an organization that refuses to adopt children to gay couples?” But most pressingly for this piece: “Am I okay with spending $45k and an average of 2-3 years waiting in order to adopt a domestic infant?” (It is shorter for older children). Because those are our averages. However, what does help diffuse the cost on this is that there is an up to ~$13,800 tax credit per child for adoption.IRS stuff
Other misc considerations about domestic adoption: many groups will NOT allow you to adopt if you are still undergoing infertility treatments. They do not want adoption to be your second option, they want it to be your PATH. Because really, that’s what is fair to the child. Important to know that. The figure I often see is 6 months after your last failed fertility treatment.
Another option: international adoption.
This gets… tricky. Assuming you’re a bleeding heart sort like me, you’re probably really fucking uncomfortable with the idea of babies being bought from desperate poor brown women to give to rich white women in other countries. Sadly, as many reports have shown, this has been an ongoing problem. This is why many countries have CLOSED their international adoption rights entirely. There’s a whole bunch of investigations on this, and luckily, there ARE monitoring groups about this internationally. A key one is the “Hague Convention on the Protection of Children”. Here’s a link about that: Hague Convention International adoption is expensive, it takes a long time, often is older children only (18 months being the average age), and often involves prolonged travel abroad to meet the child and go through paperwork etc. In the words of adoption.com, “Slow is good. You know what moves fast? Child trafficking”
Price varies greatly by country, but you’re looking at $35-45k. This also qualifies for the above ~$14k tax credit.
Other misc considerations: countries all have their own adoption requirements. Many require married straight couples only. Many have upper age limits, particularly for the mother. Some have income requirements. This is a long path, so do your research carefully.
Another option: adoption from foster care
Foster care is wonderful. Adoption from foster care is wonderful. It’s also MUCH MUCH cheaper than any other option on our list, as low as $500 in legal fees for some states. What’s not to love?! This is where we realize there is no free lunch. the purpose of foster care is NOT to create families via adoption. The goal of foster care is to reunite biological families if possible. That is why I wish people wouldn’t place this in the same category as all other options and interventions I’ve discussed. Because I have immense respect for foster parents, but I would argue in many cases, foster to adopt more than makes up for in emotional cost what it saves you in financial cost. If you’re fostering to help the children, KNOWING it’s very likely that child could be sent back to arguably a far worse life for them? Then that’s fine and I respect you massively. But if you’re fostering with the expectation that the child is yours for sure… well, life is likely to be a rough road.
You can only use the above tax credit when you are past the fostering stage and actually going through the adoption process with the child.
And you actually are paid money while fostering. For example, in Oregon, for a child 0-5 years old, you are paid $595/month.
First glance financially, foster to adopt is obviously the most economically sensible. I highly encourage anyone taking this road to meet other foster parents and learn about the challenges before embarking on this path.
Conclusion
So. After this massive wall of text. I hope this helps anyone looking down the road of “what the fuck now” to see their options and the costs and some of the considerations. Apologies if anything reads as ignorant or insensitive- that of course is not my intent. Let me know if you have any specific questions. Being infertile long enough, and in this community, I know people going through many iterations of building a family, and what I don’t know I’ll try to reach out and learn =)
If you made it this far, well done and thanks for the read!
