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Published April 02, 2012, 11:30 PM

Funding infertility: A look at the financial implications of trying to get pregnant

FARGO – Chad and Shannon Elbert had invested thousands of dollars into their first in vitro fertilization cycle when her doctor canceled the procedure in October 2009.

By: Sherri Richards, INFORUM

About the "InDepth: Infertility" series

• Sunday SheSays looked at the medical factors and treatments of infertility, including natural treatments.

• Monday we looked at the emotional toll infertility takes on couples.

• Today we will look at the financial impact of infertility.

FARGO – Chad and Shannon Elbert had invested thousands of dollars into their first in vitro fertilization cycle when her doctor canceled the procedure in October 2009. Her body hadn’t produced as many egg follicles as hoped.

At this point, the Hope, N.D, couple had already gone through nine rounds of artificial insemination coupled with fertility medication. Elbert, whose infertility is caused by endometriosis, says she was devastated, defeated and sunk into a deep depression.

“My dream of being a mom biologically is never going to happen,” she remembers thinking.

“It took a few months for Chad to convince me to try again.”

A scheduled round of IVF was cancelled in March 2010 due to spring flooding.

When they were able to complete a cycle in May 2010, Elbert had reached the lifetime maximum for infertility coverage on her health insurance plan. With help from their families, they paid $16,000 out of pocket.

Nine months later, their daughter, Hadley, was born.

Looking back, all the physical, emotional and financial tolls seem distant and worth it, Shannon says. She’s come to embrace that this was their journey and recognize it as a blessing.

She also knows not everyone who struggles with infertility can afford the medical treatments.

As fertility treatments have become more refined and accessible, they’ve also become more expensive. This can create another layer of stress for couples experiencing infertility.

Costly treatments

On its website, the Midwest Center for Reproductive Medicine lists the costs for treatment options. One cycle of the oral medication Clomid combined with insemination costs $800 to $1,000, the site says. One cycle of Super Ovulation with insemination costs $3,000 to $3,500.

A fresh cycle of in vitro fertilization will cost $17,000 to $19,000, including medications. If an egg donor or gestational carrier is involved, costs range from $22,000 to $25,000, the site says.

Dr. Kristen Cain, a reproductive endocrinologist with Sanford Health in Fargo, says in vitro costs vary widely center to center and region to region.

She says most reproductive endocrinologists are open to discussing financial concerns and can work with the patient to reduce costs.

Insurance coverage

Since the 1980s, 15 states have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment, according to the National Conference of State Legislatures. North Dakota and Minnesota are not among them.

There is more pressure on insurance carriers to cover at least portion of infertility treatments to remain competitive, says Jack Easton, director of sales for Blue Cross Blue Shield of North Dakota.

According to information provided by Blue Cross Blue Shield of North Dakota, most people insured by the company are covered for infertility treatments.

Essentially, 100 percent of fully insured groups that are part of the Blue Cross pool have infertility coverage. Of the 200 self-funded employer groups, fewer than 10 choose to exclude fertility treatments.

About two-thirds of the 33,468 members with individual policies forgo infertility coverage. Many of these individuals are seeking less expensive plans or are senior citizens, says BCBS spokesperson Najla Amundson.

Blue Cross’s corporate medical policy covers a wide variety of artificial reproductive technologies, including insemination and IVF, if the patient has a two-year history of infertility or the infertility is associated with endometriosis, abnormal male factors, or blocked fallopian tubes. It does not cover infertility treatments in cases of voluntary sterilization, or treatments involving donor eggs or sperm or gestational carriers.

However, patients may find the company’s $20,000 lifetime maximum benefit does not go that far, especially when in vitro fertilization comes into play.

Blue Cross Blue Shield of North Dakota officials say the lifetime maximum is necessary to keep its policies affordable and sustainable. It’s a matter of balancing premiums and payouts, especially when these treatments are voluntary and the condition is not life-threatening.

“Part of the $20,000 lifetime cap is to make people think ‘How are we going to use this?’ ” says Jim Wynstra, director of actuarial at Blue Cross.

A diagnosis of infertility can affect women who seek a new, individual health insurance policy.

They are subjected to underwriting, which looks at the applicant’s medical and family history and known conditions. An applicant with known infertility would be denied an individual plan that includes coverage for infertility treatments, Easton says.

A diagnosis of infertility does not exclude women from a group plan through an employer, he adds.

Blue Cross Blue Shield of Minnesota did not respond to requests seeking information about its coverage of infertility treatments or related policies.

Elbert was told she was uninsurable through a traditional individual plan after she went through IVF. Her husband, a farmer, is self-employed, and she stays home with their daughter.

Because she had continued benefits through COBRA, they were able to purchase a high-premium, high-deductible conversion plan, which includes infertility coverage, though they are responsible for more out-of-pocket costs.

With a new lifetime maximum, Elbert went through a fresh round of IVF last December. They had started saving as soon as Hadley was born. They prepaid $17,000, with no guarantee of a baby.

Her body produced only two egg follicles this time. When her doctor suggested canceling the treatment, Elbert said no. She knew it was her last chance.

“I don’t care how much it costs. I’m trusting it will work,” she told him.

Both eggs were harvested, both fertilized and both implanted. Elbert became pregnant with twins, though she lost one of the babies at 11 weeks.

She is expecting their second child in August.

The couple still has two frozen embryos from their 2010 IVF cycle that can be implanted. She also prays one day she becomes pregnant spontaneously.

She says it’s important couples going through infertility are optimistic about the treatments.

“You want to give people the hope that no matter what diagnosis you’re given that it can still happen,” Elbert says. “But I know how that felt when people said that to me, so that’s a statement you tread lightly with.”

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