It’s no longer a secret (thankfully): According to the Centers for Disease Control and Prevention, more than 10 percent of women in the United States aged 15 to 44 have difficulty conceiving or carrying a child to term. That’s more than 6.1 million women in America. So, if you’ve been trying for a year or more to build your family (or six months if you’re over the age of 35) without success, what should you do? Doctors recommend looking into fertility options at this point. But what are the options, and what kind of price points are we talking?
We reached out to reproductive experts for their advice on the cost of expanding your family — whether through fertility treatments, surrogacy or adoption.
Acupuncture is a good first step in the world of fertility treatments. It is a natural solution that has helped many women attain success conceiving. Of course, that success depends on coming up with a consistent plan and sticking to it through multiple visits. Depending on the location of your acupuncturist and whether it’s in a community setting, the cost of treatment can vary widely, ranging from $15 to $300. Insurance may help cover the cost of these visits, especially if the treatment is recommended by your primary care physician.
To increase the odds of acupuncture working for you, acupuncture physician Dr. Kym Caporale of Beyond the Needle says you need to find someone who specializes in infertility. “To increase your success with acupuncture for fertility concerns, you must first find an acupuncturist who understands what you are going through physically and mentally,” Caporale explains. “Not only should you find one who is board-certified and licensed, but also they should have a specialty in the field of infertility.”
Likewise, Caporale says the keys to success include going for more than one visit and having an open discussion about your history, concerns and goals. “A patient should not just go in and have needles put in them and then pay and walk out. Discuss what your concerns are. Discuss what you think you need help with and, most importantly, discuss what your fertility protocol and plan is. The infertility journey can be emotionally draining. The acupuncture should be as relaxing and stress-free as possible. You should find that the acupuncturist will listen and walk with you during this journey.”
How many times have you been told by friends and family to “just relax and you will get pregnant”? Even though this sentiment is frustrating, there is a therapy that takes that advice literally — and women have used it to help improve the success of their medical fertility treatments. Mind-body therapies are techniques to improve the health of the body through a variety of approaches that help you slow down, find calm, remove yourself from stimuli and observe the body to channel thoughts and feelings from negative to positive. According to Kathy Fountain, licensed mental health counselor at Kathy Fountain Fertility, women who complete structured mind-body classes report a 33 percent higher rate of pregnancy on average.
“The No. 1 reason women drop out of fertility treatments is because they couldn’t handle the stress,” Fountain explains. “The relationship between stress and conception is the subject of intense research in the reproductive field. We do know that research has found that women who try IVF and fail are more likely to experience depression and anxiety afterwards. Experts agree that there is an urgent need to help women decrease their stress while trying to conceive. Studies have found that women struggling with infertility have levels of depression equal to that of women suffering from cancer, heart disease and HIV. In other words, the psychological toll of infertility — and the role that stress plays in the treatment process — cannot be underestimated. This is not ‘just relax.’ Mind-body techniques are a proven series of techniques designed to teach stress-reduction strategies and tools to cope with depression and negative thinking.”
The cost of mind-body courses can range from free for certain podcasts to about $600 for a multi-week, in-person group session.
Intrauterine insemination is a common first-step fertility treatment before moving on to IVF. The procedure involves placing sperm inside a woman’s uterus to facilitate fertilization with the goal of increasing the number of sperm that can reach the fallopian tubes. According to Baby Center, studies have found that the success rate for natural IUI cycles for couples with unexplained infertility is 4 to 5 percent. When fertility drugs are used, the pregnancy rate is about 7 to 16 percent.
However, according to Dr. Mark P. Trolice, director of Fertility Care: The IVF Center, women who have an ovulation dysfunction and whose partner has normal sperm analysis do not need an IUI. Likewise, one IUI achieves the same pregnancy rate as performing two in a row, which is good news for your budget since the cost ranges from $1,000 to $2,000.
In vitro fertilization is a fertility treatment in which eggs are extracted from the woman to manually combine with a sperm sample in a laboratory to create an embryo. The embryo is then transferred to the uterus of the woman. IVF is an option for people with unexplained infertility as well as blocked or damaged fallopian tubes; ovulation disorders, including premature ovarian failure, uterine fibroids or various genetic disorders; or women whose partners have decreased sperm count or motility. According to the American Pregnancy Association, the birth rate for IVF cycles is:
- 41 to 43 percent for women under age 35
- 33 to 36 percent for women ages 35 to 37
- 23 to 27 percent for women ages 38 to 40
- 13 to 18 percent for women over age 40
While these are great success rates, the cost of IVF can reach up to $20,000 per cycle based on medication and preimplantation genetic screening. According to Trolice, there are a couple of ways to increase the success of your IVF investment. The first is reducing the use of gonadotropins (a stimulating medication) to see less negative effect on egg quality. Also, while there is little to no difference in success rates with using fresh vs. frozen embryos, frozen embryo transfers reduce the risk of ovarian hyperstimulation syndrome. Trolice provides a couple of sound pieces of advice for women considering IVF for fertility treatments:
- If you are under 38, single-embryo transfer will reduce the complications of multiple pregnancy.
- Choosing to undergo preimplantation genetic screening may increase the time to pregnancy but reduces the miscarriage rate.
- Ovarian aging should not be used to exclude a patient from IVF. However, older women will have a higher percentage of chromosomally abnormal embryos. So the fewer eggs retrieved will significantly limit the percentage of normal embryos available for transfer.
Egg donation is an option for women who cannot use their own eggs. During this process, an egg is removed from a fertile woman and is then fertilized in a lab to create an embryo before implantation in the woman trying to conceive.
The success rate for egg donation is fairly high. The CDC states that over 55 percent of transfers utilizing fresh embryos from donor eggs result in a birth. However, egg donation can cost anywhere between $37,000 and $65,000, which includes compensation for the egg donor, agency fees, IVF treatment for implantation, travel expenses and legal fees.
Gestational surrogacy is when IVF is used to implant an embryo of the mother’s eggs and the father’s sperm (or donor gametes of either or both). Although the surrogate’s uterus is used, none of her genetics are transferred to the child. Success rates using IVF are around 75 percent in the U.S. with a 95 percent success rate of birth once the surrogate is pregnant. Costs vary depending on a variety of factors, including whether donor eggs and/or sperm are required. Overall, costs range between $80,000 and $120,000, which includes agency fees, legal fees, medical costs of the surrogate, IVF implantation, embryo fertilization, travel and more.
Donor surrogacy, when the surrogate is both the gestational carrier and the egg donor, is actually still an option in many states (although not all). If someone is working with an attorney who specializes in third-party reproduction, that attorney will strongly discourage this form of surrogacy. But some people nevertheless try to go through the surrogacy process “on their own” in hopes of minimizing costs — and that’s more often when they might try it with the surrogate also being the egg donor.
Although it’s certainly not a fertility treatment, adoption is also an important family-building option to consider. There are many modes of adoption, including domestic, international and fostering. Each of these has pros and cons, so make sure you do your research before making a decision. Due to sensationalized news and celebrity stories, I spend a lot of my time as an adoption consultant helping prospective adoptive parents separate fact from fiction.
Adoption costs vary widely depending on the type of adoption you choose. Foster adoption is virtually free but is not guaranteed, whereas domestic adoption and international adoption can range from $8,000 to more than $50,000 once you factor in consultant fees, agency fees, legal fees, pregnancy expenses and travel. However, as I frequently remind my clients, you don’t want to select your route solely based on the cost. It’s important to also factor in what is right for your family in terms of the child’s age and ability, the potential wait time and the amount of information available about the child’s medical background.
Sticking with what you can control
Therapist Ellen Glazer, author of The Long-Awaited Stork, has some wise words. “I offer simple advice: Try to approach expanding your family with balance and with awareness that so much is out of your control. You should make decisions not based on ‘making it work,’ but on helping ensure your sense of well-being. Acupuncture, mind-body approaches, fertility diets, etc. can all be health-enhancing, but they may not ‘make a baby.’ I think so much of this is maintaining a perspective as to what you can control (good diet, exercise) and what you can’t (external stress, poor egg quality, disappointing fertilization). I also encourage you to try as best you can to make decisions that will help avoid the pain of regret. You don’t want to look back and feel, ‘I should have done X; or I shouldn’t have done Y.'”
A version of this story was originally published in March 2018.