Greg Bales

On Paying for IVF

Last week National Public Radio aired this story by Jennifer Ludden about the International Council on Infertility Information Dissimenation (INCIID), a Virginia-based organization that offers grants (it calls them scholarships) to couples seeking infertility treatments. INCIID is introduced through two of its grant recipients, Carla and C. J. Van Devander, of Staunton, Virginia. They had gone through several failed infertility treatments—probably intrauterine insemination, or IUI—before trying in vitro fertilization (IVF). Having no insurance coverage, the Van Devanders took out a $15,000 second mortgage to pay for it, but the resulting pregnancy ended in a miscarriage; they tried again, this time with a high-interest personal loan—another failure. The Van Devanders found themselves deep in debt with no options left when they found INCIID, which approved the couple for a grant for a third—and finally successful—IVF try.

I sympathize with the Van Devanders’ story. In 2007, K and I learned that having a baby without help wouldn’t be impossible, but our luck would need to be extraordinary. The only realistic chance we had was IVF. But like the Van Devanders, we didn’t have insurance coverage. Like most states, Iowa doesn’t mandate it.¹ So we tried other means. We tried moving to a state that did.² We went to a RESOLVE conference in Minneapolis to enter our names in a drawing for free IVF treatments. We even briefly considered doing IVF in the Czech Republic. Those efforts failing, we forged ahead in Iowa City and took out a loan. In July of 2009, we went through our first IVF treatment at the University of Iowa. It failed. We tried again four months later.³ Gabriel—conceived in a petri dish and transferred to his mother three days later—is the result of that procedure.

Embryos 9 and 10 (marked with stars) were transferred Nov. 20, 2009. The doctors cooed over No. 10: “That one’s perfect,” they said. Needless to say, this is the earliest picture we have of G (whichever of the two embryos he was). The eight remaining embryos were cultured for several more days in the lab, but none thrived enough to be cryogenically preserved.

It was all very, very risky—at no time moreso than after the failed round of IVF. We spent days, weeks agonizing about our options, considering carefully what we would do if the next try failed, too, or God forbid, the time after that. I even made a (sloppy) flow chart to map out all of our choices—I have it still in a notebook that I carry with me. We were forced to confront our financial and emotional limits then, to decide at what point we were willing to accept defeat. I’m grateful we never reached that point. I’m happy the Van Devanders were able to reach it and persevere.

Because of the cost of infertility treatments, too many couples are pushed to and even beyond their breaking points. Many more don’t even get to try. INCIID is a good organization. I wish we had known about their grants two years ago; we might have applied. But infertility is a much bigger medical problem than a small nonprofit can possibly address on its own. For that reason, it’s worth supporting policies that help couples afford infertility treatments, such as the Family Act of 2011 (S.965), introduced in the United States Senate this month by Kirsten Gillibrand of New York, which offers up a tax credit for treatment costs. (Contact your Senators and get them to co-sign!) But a tax credit is a half measure. In the health care system we have in the United States, the only way to really minimize the risk of seeking infertility treatments, much less make treatments affordable, is to mandate insurance coverage. For that to happen will take a lot more work.

¹ Fifteen states mandate some form of infertility coverage; of those, three exclude IVF. (Looking back at that list, I’m struck anew by Arkansas’s mandate, which, except for the fact that it excludes HMOs, is reasonably strong. For some reason, that surprises me.) The great irony of the coverage we had then (and still have) is that get-a-boner pills like Viagra are singled out as exceptions to the “No infertility treatments” clause in the policy.

² Our favorites were Illinois, Maryland, and Massachusetts. We spent a year applying for jobs in those states; I even interviewed for one in Chicago in 2008. Had we been just a little more clear-headed, we might have taken a closer look locally. We learned later, after we had already set off down the path I describe in this post, that the University of Iowa’s group insurance policies have rather strong infertility coverage.

³ We were lucky. Because we qualified for a warranty program, we received a substantial refund from the first IVF procedure. Unlike the Van Devanders and too many other couples, we didn’t have to consider taking a second loan.