According to a report published by the World Health Organization (WHO), infertility rates across the world are on a rise with roughly 1 in 6 people experiencing infertility. My husband and I are part of this statistic. When we first married, my husband was ready to start a family right away. I was hesitant. I wanted to build my career, travel, have freedom, and I cherished sleeping in on the weekends (which may be what I miss most). It took a few years, but when I finally embraced starting a family — it wasn’t working.
After the obligatory year of trying (and many well-meaning but awkward remarks from family and friends), we started tests to see if there was an issue. To our surprise, there was. What unfolded was a years-long adventure in the universe of treatments, prescriptions, roller coaster hormone rides, an IVF cycle, and two rounds of embryo transfers — all culminating in two beautiful pregnancies and births. We had our daughter first via IVF, a natural pregnancy and miscarriage a year and a half after, and six months later, we became pregnant through IVF with our son who thrives today.
The world of infertility is a scary and complicated place. The word itself is taboo and makes most people uncomfortable. Combine that with the challenges and discomfort people have managing their finances and suddenly you find yourself in an overwhelming sense of crisis. Coping with the treatments, terminology, and significant expenses can be genuinely stressful. But there is a path forward. Here are 10 Practical Steps my husband and I used to navigate the financial process and what I’d recommend to anyone facing down the same journey.
Step 1: Stop. Breathe. Call Your Insurance Company
Once you get the referral or recommendation to consult with a fertility specialist, that is your cue to pick up the phone and find out every detail about your coverage. What’s covered and what isn’t? Are diagnostic tests included? Prescriptions? Treatments? The consultation with the specialist itself?
You won’t have a lot of details to give your insurance provider yet (aside from possibly knowing part of the issue behind the referral), but it will help to know the amount of coverage you may or may not have with treatments.
Questions to ask right now:
- Which procedures require preauthorization?
- Does preauthorization need to be done for each cycle of treatment and how long does it take to get?
- Are there restrictions on the type of healthcare provider who can perform fertility services?
- Are there limits to the number of procedures or a maximum dollar limit on benefits?
- Is there a co-payment for medical services?
Step 2: Schedule and Attend Your Consultation (Bring Your Partner and a Notebook)
I can’t stress enough how important it is to bring a pen and paper and take copious notes during this meeting. There is going to be a lot thrown at you.
Do not attend this meeting without your partner and don’t go to any appointments or meetings without a buddy, especially in the initial weeks of appointments. You’re going to be overwhelmed with information so it’s essential to have someone else there asking the questions that need to be asked and getting clarification. My husband took most of the notes while I asked most of the questions. This helped us to cover and document just about everything.
Step 3: Ask (More) Questions
Most fertility clinics have a variety of departments they cycle you through. The doctors make medical recommendations but don’t discuss finances. The nurses and assistants do scheduling and hold appointments but also don’t discuss finances. There’s a distinct department for finance and you’ll likely need to hold your money questions until you’re shuffled into the right office.
This is where it’s incredibly important to ask your doctor the following questions about your recommended treatment:
- What diagnostic tests are needed?
- What prescriptions are specifically involved and the quantities?
- What is the breakdown of steps in the treatment?
- How many cycles are being recommended in your treatment plan before another course of action may need to be considered?
- What are the next steps if the recommended course doesn’t work?
Once you have the breakdown of recommendations, you can sit with the financial consultant and review costs. Ask about every line item and detail and ensure you have a dollar figure for each prescription, treatment, and test. Don’t worry about crunching the numbers while you’re there. You can process those when you get home.
Step 4: Call Your Insurance Company (Again) and Do That Question Asking Thing
Once you’re home and able to process, it’s time to call your insurance company again and ask more detailed questions about your recommended treatment course. (I felt like I had our insurance company on speed dial in the early months).
- Is there a co-payment for drug coverage and is prior authorization required for these medications?
- Does the plan cover self-administered subcutaneous (under the skin) or oral medications?
- Are there discounts for mail-order medications?
- Will the treatment/procedure/medication be covered under my current coverage or under my major medical portion?
- If yes, is there any limit of any kind — dollar amount or number of attempts? If no, are any portions of the charges covered for prescription medication, laboratory tests, or ultrasounds leading up to treatment?
(Note: Creating spreadsheets to track all of the numbers is totally fine and recommended. We especially did this when shopping around for the best prices on IVF prescriptions. We saved hundreds of dollars by simply making a few phone calls.)
Step 5: Have a Glass of Wine, Cup of Tea, or Take a Walk
At this point you’re probably so worked up and bogged down by numbers, recommendations, and foreign vocabulary terms that you need to unwind. Take time for yourself to get away and clear your mind, everything will be there when you return. It’s best to de-stress in the midst of all this so you can think clearly about what’s best for you and your family.
Time with friends, date nights, focusing on my physical and mental health, and traveling helped me immensely through this process. What also helped was focusing on my career and working with couples across the country to empower them in meeting their financial goals. Find out what will help you cope on the road ahead and allow yourself time to process.
Step 6: Review Your Financial Situation
Now that you have a general idea of what treatments will cost you (with and without insurance), it’s time to look at your own personal financial situation. Specifically, you’ll want to review:
- Your current savings account balances
- Your current debt load
- Your budget and places you can cut back on to make room for upcoming payments
- Amounts you’re stashing away for other goals like travel, down payments, etc.
Determine where you currently stand in these areas. If you’re not the kind of couple who has a budget in place, now is definitely the time to create one. It will be critical to understand where your money is going in the months ahead.
Step 6: Prioritize
No price can be put on building or starting your family. Each individual, couple and situation is unique, and you’ll have to determine where this step falls on your priority list. If you are currently saving for a home down payment or a big trip, is that money you’ll reallocate towards the medical payments for treatment? What are you willing to trim to go down this path and make room for new expenses? Only you can decide.
Step 7: Create a Plan
Now that you’ve reviewed and prioritized, it’s time to create a plan and determine:
- How much do you have in savings to allocate towards payments without wiping out your emergency fund? Remember, this isn’t an emergency (as much as it feels like one).
- What areas will you cut back on to save more for treatments?
- Will you open up a separate savings account to handle all expenses and treatments?
- If you don’t have the funds on hand to currently cover costs, will you continue to save and build up your cushion or will you finance the expenses?
- Should you obtain a second opinion and shop around for more affordable (but still quality) care?
Step 8: Review the Fine Print on Lending
If you go the financing route, consider whether loans from parents or family members may be feasible or affordable first. Your doctor’s office will likely have a recommended lender, but be wary of high interest rates and any kickbacks your provider may receive for recommendations. Shop around for better loan terms on your credit cards, personal lines of credit from the bank, and consider other creative ways to fund treatments if you insist on borrowing. Remember: the higher the interest rate, the higher the amount you’re tacking on to what is likely already a four or five-digit number. Do your research here!
Step 9: Get Creative, Start Saving, and Make Adjustments
Fertility treatments are not a walk in the park, but if you’re spending money and it’s money you may already have set aside, then take advantage of the costs by using a credit card that will earn you travel points or cash back. We put all medical bills on our credit card then immediately transferred money from our savings to make a payment. This let us stockpile travel points.
Now is the time to open a separate savings account for this goal and set up automatic monthly transfers. If you’re not using an online budgeting system -, consider syncing your accounts and closely monitoring the areas you’re cutting back in.
Step 10: Stay Flexible, but Know Your Limit
There’s no straight path or guarantees when it comes to what will work with infertility. Our path led us from DIY, to prescriptions, to IUIs, to more prescriptions and giving myself shots, to IVF. (Insert dollar amounts rising exponentially here.) We were flexible, but we had a limit and one round of IVF was it for me — physically, emotionally, and financially. If it didn’t work after one round, adoption was our next step and we were at peace with that.
Again, you can’t put a price on building a family, but knowing your limit is key. How much is too much money or time? If a treatment isn’t working, it may be better to take a physical and financial break and circle back when you have the funds built up again. It’s hard to keep numbers in mind around such an emotional experience, but like many things in finance — and quite literally with infertility — you shouldn’t put all of your eggs in one basket. While you may want to throw everything you can at this goal (which could work for a period of time), you can’t let it wreak financial havoc on your life. Even navigating this path, remember to keep saving for retirement, stashing away a travel fund, and take time to dream and plan for other goals you’ll always have as a couple.
Whether it’s infertility and finance or other personal journeys, Abacus is passionate about helping people expand what is possible with their money. Reach out to us today to schedule a free 15 minute call.
Sources:
Infertility Prevalence Estimates, 1990–2021. World Health Organization. 2023.04.03. https://www.who.int/publications/i/item/978920068315
