Smart Money Podcast: The Price of Parenthood: In Vitro Fertilization and the Future of Parenthood
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Welcome to NerdWallet’s Smart Money podcast, where we answer your real-world money questions.
This week’s episode continues our Nerdy Deep Dive into the price of parenthood. This week we’re focusing on in vitro fertilization, or IVF.
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Our take
We’ve come to the last episode of our series on the Price of Parenthood, and we’re diving into in vitro fertilization, or IVF. IVF is one of the most effective forms of assisted reproductive technology and is one possible solution for couples who are experiencing infertility or those opting for surrogacy. Research by the Society for Assisted Reproductive Technology found that more than 73,000 babies were born via IVF in 2020 in the U.S.
To learn more about the IVF journey, Ronita chats with Tess, a teacher who lives in New York. (Note that guest Tess is not the Tess in the byline.) Tess and her husband went through IVF after trying to conceive for some time, and she talks about how they made the decision. Tess’s journey is unique because she is an IVF baby herself, and she talks about how the procedure has changed since her mother went through it. Tess shares her own recent experience with IVF and how she sought support during this time. She also mentions the one thing she stopped doing to make the process easier mentally and emotionally.
Ronita changes gears to bring back Melissa Ellis from the last episode. Melissa is a certified financial planner and founder of Sapphire Wealth Planning in Overland Park, Kansas. Ronita and Melissa look at the cost of IVF, what payment options exist and questions to consider before starting the process.
Sean and Ronita wrap up the Price of Parenthood series by looking at what it means to become a parent today. And although the series looked at the price tags of adoption, egg freezing, IVF and raising a child, how these costs are all extremely personal. The duo then considers what it means to now have options to be a parent, often for those who thought they may never be able to or never had a choice in it.
More about personal finance and parenthood on NerdWallet:
Have a money question? Text or call us at 901-730-6373. Or you can email us at [email protected]. To hear previous episodes, go to the podcast homepage.
Episode transcript
Sean Pyles: So you want to have a baby, but it's not happening for you in the traditional way. You have options, but hopefully you also have insurance, especially if you're going for IVF.
Tess: I knew I had three chances where I would only be paying a copay, and I had in-network coverage. So I had to find ... I couldn't just pick the doctor that was available, or nicest, or that I felt most comfortable with. It had to be someone on my insurance, because otherwise it's like $35,000 if you pay out of pocket, for one round.
Sean Pyles: Welcome to NerdWallet's Smart Money podcast. I'm Sean Pyles.
Ronita Choudhuri-Wade: And I'm Ronita Choudhuri-Wade.
Sean Pyles: We're onto the final episode of our Nerdy Deep Dive into the cost of parenthood. We've explored adoption and egg freezing, and today we go full implantation.
Ronita Choudhuri-Wade: You got that right, Sean. We are bringing it home with in vitro fertilization or IVF.
Sean Pyles: All right. How common is IVF in this country?
Ronita Choudhuri-Wade: So, according to the most recent numbers from the Society for Assisted Reproductive Technology, more than 73,000 babies were born via IVF in 2020, and those 73,000 were out of just over 300,000 implantation cycles.
Sean Pyles: OK, and that's out of how many overall births?
Ronita Choudhuri-Wade: So, according to the CDC, about 3.6 million.
Sean Pyles: So a small percentage of that, but still a lot of people turning to IVF to have a child.
Ronita Choudhuri-Wade: Definitely, and the IVF figures for 2020 were down from the year before. As we've noted in previous episodes, that's likely due to the pandemic. So we're going to take a look at what this process looks like, and what it does to your bank account.
Sean Pyles: And speaking of, is there an average cost for this treatment?
Ronita Choudhuri-Wade: Honestly, it's almost impossible to find an average. It's different from state to state. It's different depending on your insurance. It's different depending on the medications you take, and it's different depending on how many cycles you go through. But we'll try to give folks an idea of how much they might need to save for it if they choose this option.
Sean Pyles: All right. Listener, we want to hear what you think, too. We love to get your stories around the decision to have a kid, especially around your finances. Leave us a voicemail or text the Nerd hotline at (901) 730-6373. That's (901) 730-NERD. Or email a voice memo to [email protected]. And, Ronita, where do we start today?
Ronita Choudhuri-Wade: Well, last week we heard from Alexa who had decided to freeze her eggs. Today we're going to hear from someone who's undergone IVF treatment. Her name is Tess, she's 33, and she lives in New York. She's also asked that we not use her last name for privacy reasons. Tess actually has a really interesting history with IVF. I'll let her tell her story. Tess, welcome to Smart Money.
Tess: Thank you. I'm happy to be here.
Ronita Choudhuri-Wade: We'll kick off the conversation with just asking when did you know you wanted to be a parent?
Tess: I think I've always known. I never even considered that to be something I had to decide because it was just like, obviously I want to have kids. I'm also a teacher and I kind of knew early on that I'd want to work with children, and that stems from just a love of kids. It seems like while there are many teachers that obviously don't have kids, for me that was one of the reasons I wanted to be a teacher.
I just like being around children. Even when I met my husband it wasn't like, "Oh, are you someone that wants to have kids?" I think he was kind of in the same boat. It was just obvious he wanted that.
Ronita Choudhuri-Wade: Can you tell us a little bit more about that journey to parenthood?
Tess: I'm 33, and my parents actually had me through IVF. I didn't find that out until I was in college. I have an older sister as well. She's two years older, also born through IVF, and it was not done a lot here at the time. I guess my parents wanted to wait to tell us until we could really understand, in their words, what a miracle it was.
I knew that it took my parents a very long time to have kids. It took them 10 years, but I just didn't know the details or how it ended up working. So, I had that information. I knew that it was possible that it could be hard to have kids. I didn't think that I would have that experience. And then, my sister, when she was ready to get pregnant, it happened immediately and I was like, "Great, this isn't something genetic. I'll get pregnant immediately, too."
And then, my husband and I started trying. It was about a year, maybe six months before the pandemic started. And then, once we were not getting pregnant, and then everything shut down and it was kind of like, OK that we weren't getting pregnant because the thought of getting pregnant during that time seemed terrifying.
But also, it was a little bit strange that we weren't, I thought. So we went to a doctor and did some tests, and they didn't get that much information. They said that I had a slightly low egg count, but that wouldn't necessarily mean I couldn't get pregnant. We did a bunch of rounds of IUI. I did get pregnant after the fourth one and had a very early miscarriage. We switched to another doctor. I did more rounds of IUI, and then ... yeah.
Ronita Choudhuri-Wade: What is IUI?
Tess: IUI [intrauterine insemination], they basically inject sperm into you. They kind of monitor you. It's much less invasive than IVF. I had to do one injection each round rather than a thousand. And in retrospect, I should have just probably gone to IVF, but I actually think ... I mean, IUI was free for me, it was fully covered, and I think you actually have to do a certain number of them in order to even qualify to do IVF covered by insurance. Unless you have some glaring diagnosis.
I didn't think I would have to do IVF, so I wasn't rushing towards it until our third doctor. She was just like, "You should absolutely do IVF, otherwise this could take a very long time, and particularly if you want more than one child," which we do, "you should start right now with this process," and we started the next month.
Ronita Choudhuri-Wade: Yeah, so what were those factors that went into that decision? Was that a conversation between you and your husband after seeing the third doctor? Was it something that had already been in your mind?
Tess: I was learning more about IVF, and also, I learned ... My parents' experience was so different because it was early on, and my mom ... They lived in New York. My mom had to live in Virginia for a few weeks so doctors could do her injections and everything. I got an updated lesson about what IVF was, and it seemed much more manageable than that.
I was eager to just ... I wanted to do something that not only would have a higher chance of getting me pregnant, but also IVF is sort of diagnostic. They're analyzing. I know exactly how many eggs they took from me. I know which ones were good and bad, and which ones fertilized. And then they were able to do genetic testing on the embryos. You get so much more information, and then it worked.
Ronita Choudhuri-Wade: What were the other factors that played into that decision? I mean, was the financial, the emotional cost of going through it as well?
Tess: Yeah. I'm a public school teacher in New York City. My insurance covers three rounds of IVF. And, when it says a round, that could be a retrieval where they take the eggs out, and a transfer where they put the embryo back in. Or that could just be a retrieval if the transfer doesn't work. I knew I had three chances where I would only be paying a copay, and I had in-network coverage. I couldn't just pick the doctor that was available or nicest, or that I felt most comfortable with. It had to be someone on my insurance because otherwise it's like $35,000 if you pay out of pocket, for one round.
Ronita Choudhuri-Wade: That's a lot of money.
Tess: It's a ton of money, and I guess we were lucky. We found a doctor on our insurance, and there are still parts of it that you pay for, like the copays or certain ... Like the anesthesia when I did my retrieval was not covered, and I think that was a couple hundred dollars. But going into it, I didn't know exactly how much it would cost, but I knew that enough was covered that it wouldn't be a massive financial burden.
Ronita Choudhuri-Wade: How long was this entire process for you?
Tess: I think we had our first appointment in February 2021, and then my son was born March 9th, 2022. It was quick because nine months of that was also a pregnancy for us. It was…once we started IVF, it was a month of monitoring, and then I had two weeks of injections where I was making all the eggs that they were going to take out. And then, they took them out in, I think mid-May or something.
And then, there's this really agonizing process where you're waiting to see how many of them will fertilize, and then the ones that do fertilize, which will develop into five-day embryos, or six-day, or seven days. And then once they have a good number of embryos or a group of strong embryos, they send them out to a lab for genetic testing.
That took weeks to find out, because they won't implant it if it's not genetically strong. So then ... Actually, I remember it was on June 1st, which was our anniversary, is when I got the call from my doctor that we had some good, viable, genetically strong embryos. And then, I had my transfer where they put one in me on June 21st. Two weeks after that is when they were able to determine that I was pregnant.
Ronita Choudhuri-Wade: Just to clarify, so you did one round?
Tess: I did one round of IVF, yes. In that round we still have a couple of embryos that were ... We paid for them to be stored, frozen, and that's not covered. It's not cheap. I think it's like $700 a year. And we're now sort of thinking about another round.
Ronita Choudhuri-Wade: How did it affect your work and career?
Tess: The fact that I was teaching remote, I was able to have my appointments really early in the morning and sit on a heating pad if I needed to, or take a minute. In the classroom, at my job, you can't just go to the bathroom. You have to find coverage to go to the bathroom. And you can't just be like, "Wow, I'm really emotional, or hormonal, or in pain from these injections. I need to go cry, or ice it, or something."
But remotely you can. I was online with my students all day, but there was plenty of time where I could be like, "OK, you're going to go do these math problems, and we're going to check in, in 10 minutes," and then I have time to myself. I might be in a situation in our next round where I'm teaching in person and doing this, and I'll make it work.
I think I'll be a little less emotional about it because I've done it before. But I mean, I don't know how people do it, because you're also in pain. I mean, I had a horrible stomach ache for weeks. Also, I didn't want to go to baby showers and celebrations of friends' pregnancy. I wasn't up for it and I didn't have to because everything was shut down, and no one was doing that. In some ways the pandemic made it easier for me.
Ronita Choudhuri-Wade: Right. But I'm so happy to hear the happy ending that we have. So yeah, tell us a little bit about your firstborn.
Tess: Yeah. Well, his name is Noah after my mom's father, and I have a picture of the embryo. It's in my favorites on my phone. Every now and then we'll look at it and we're like, "How is this the baby that we made with the doctors?" And it was, I think because I had a hard time getting pregnant, all through my pregnancy I didn't quite believe that I would actually have the baby.
And then, of course I ended up having an emergency C-section, and everything was fine afterwards. But when that was happening I was like, "Yeah, of course this wasn't going to work. This is too good to be true." And then he came out on March 9th, and he's wonderful. I think it is the absolute best change, becoming a parent, for us.
And it comes with ... We're exhausted, and after this I'll go to bed because who knows when he'll wake up, but it's like a dream come true. And I'm just so glad that we had the means, and the access, and the resources to make him.
Ronita Choudhuri-Wade: And, Noah is how old now?
Tess: 14 months old.
Ronita Choudhuri-Wade: Lastly, just what advice would you give to someone who's considering IVF?
Tess: If you think that there's a problem, get to a doctor, and do it. Because it's hard, but it's worth it. And the other thing, and I actually have been talking to a friend of mine who's going through it now. I think just allowing yourself to feel miserable. It's really hard. It's grueling on your body, and it's terribly depressing when you think you might not be able to have a baby. I think you can skip those baby showers, and you can be happy for the people in your lives that are having babies without spending all your time with them.
Because you do need to protect yourself. You're very vulnerable. And then, to just believe that it'll work, because ... I don't want to sound naive, because I'm sure there are situations where it doesn't. But it's an amazing science, and very smart people are still working on it. You have to have faith in the science and in your body. And then, I guess if it takes a toll and you need a break, give yourself a break, too.
Ronita Choudhuri-Wade: That's amazing. I feel like I've learned so much. Thank you so much for sharing your story with us.
Tess: Thank you for giving me the opportunity to. I'm honored to share it.
Sean Pyles: Tess's story is the fourth that we've heard from folks who are working to have children in whatever way is best for them. One through line that I'm hearing from all these experiences, including your own, Ronita, is how much the process of becoming a parent can require folks to be really vulnerable, and also ready for a long complicated journey. But in the end, the trials and heartaches and medical bills are all worth it when folks are finally able to have a kid.
Ronita Choudhuri-Wade: And how cool is it that this technology is no longer new, that we're now in our second or third generation of IVF, and that finally the costs and the way to get it done is getting easier.
Sean Pyles: I feel like one of the lessons to take out of Tess's story is to really know your insurance coverage. It's almost like you're under the gun there. You're covered for three rounds, and beyond that you're on your own.
Ronita Choudhuri-Wade: That's exactly right. And again, it really varies depending on your situation. So, I asked Melissa Ellis to join us again. Listeners may remember we spoke with her last episode about the cost of egg freezing. So we brought her back. Melissa's a founder of Sapphire Wealth Planning in Overland Park, Kansas. And she has numerous clients who have gone through this process. Melissa, thanks for joining us again.
Melissa Ellis: Well, thank you for having me. I appreciate it.
Ronita Choudhuri-Wade: So, last episode, we talked with you about egg freezing, and this episode we're going to explore IVF. First off, are the costs similar or different between egg freezing and IVF?
Melissa Ellis: The procedures and the costs are very, very similar. The added cost to IVF is actually fertilizing the egg. So if you are just freezing your eggs, a single person can do that on their own without having a partner. With IVF you obviously need a partner of some sort. Whether it's a sperm donor from a bank or your own partner. That would be the added cost. But you're right, the procedure is about the same.
Ronita Choudhuri-Wade: And so, how does it actually work?
Melissa Ellis: So, there is initial testing, and of course I'm not a medical professional, I'm a certified financial planner, but I have several different clients who have looked into either egg freezing or IVF to get their family started.
We've really explored the whole procedure. And what they have to do first is they do have to take some medications to prepare them for the egg harvesting. Fertility testing has to be done so that they know that it will be a good viable procedure once it's completed, and that they will have viable embryos to implant. And then, of course, there's the actual procedure to implant the eggs, to actually get it completed.
Ronita Choudhuri-Wade: Let's get to the cost aspect here. What are you typically going to pay for an IVF cycle, and what exactly are you paying for?
Melissa Ellis: The initial cost of course is that testing and medications that might be needed, which will vary from patient to patient. But that's about $5,000 on the preparation side. And then, the actual procedure for one cycle, meaning that would be the one collection time of collecting eggs and fertilizing them, that cycle is going to cost around $11,000. So it’s being implanted at that point in time. You have your medical cost ongoing for that pregnancy and childbirth. So that's what you're looking at in total.
Ronita Choudhuri-Wade: I know that some couples also do look at IVF plus surrogacy as well, right?
Melissa Ellis: Right, and that is going to be a lot more expensive, because you have to pay the surrogate, and that price is going to vary depending on the person that you hire to be your surrogate.
Ronita Choudhuri-Wade: And so, if we do look at IVF on its own, can we expect insurance coverage?
Melissa Ellis: Yeah, that's a great question. I have seen where some companies are helping their people either through IVF, or for adoption, that they will help subsidize that cost because they want them to be able to have a family. They don't necessarily cover for egg freezing though, which we talked about last week. I think that's a really nice thing that they've added in the IVF along with adoption.
Ronita Choudhuri-Wade: Are there any other financing options available for patients who can't afford the upfront cost of IVF, and they don't have insurance coverage?
Melissa Ellis: Right, of course you can save money for it. If you have high income, it might be easy to save that pretty quickly. If income is a little bit lower, that might not be possible, so then you're looking at different ways to finance. You can always use a home equity line of credit, not the best option, because you're putting your house at risk. You could use a personal loan. The interest rate's going to be quite a bit higher, especially now with our current interest rates.
Ronita Choudhuri-Wade: If someone is doing IVF, it's not even just about doing it once. Often people do more than one cycle of it, correct?
Melissa Ellis: Correct. And so, you have that added cost each time. A lot of times when the egg is implanted it's not a viable egg. Well, really it's beyond an egg at that point, it's an embryo. If it's not a viable pregnancy, you have to go through this however many cycles. So you have that added cost for each cycle. Plus, there's the emotional toll it takes each time as well.
Ronita Choudhuri-Wade: So if you have two treatments, you're paying that full amount twice?
Melissa Ellis: Right. And I've talked to people, they've gone three or four cycles. It's taken them that long to end up having a viable pregnancy. That's a lot of money.
Ronita Choudhuri-Wade: I can't help but think, is it a luxury treatment?
Melissa Ellis: I would say so, yes, because it's not readily available to someone who doesn't have money, simply because insurance doesn't usually cover the costs. And that's a major decision to go through everything that it takes to complete one IVF cycle, if you think about it. So yeah, I consider that a luxury purchase.
It's something that you really need to consider deeply. I think it needs to go into your financial plan, obviously, so that you plan for at least two cycles because from what I hear, one cycle isn't usually enough. So you want to plan for two or more just for that extra added dollar cost into your plan, and know that you're able to do everything else you want to do.
And prioritize it. If having a family is priority, then maybe that takes precedence over purchasing a home or a bigger home perhaps. And just consider what your life is like with all of that in it. Are you able to do everything that you want to do by adding this large cost into your plan? But I think that's the important key, is to have it in your financial plan.
Ronita Choudhuri-Wade: Any final advice for patients who are considering IVF? What's the best way to prepare as an individual or as a couple?
Melissa Ellis: I think that's something that ... A couple really needs to have that discussion. Make sure that this is what you want to do, that you've considered the cost, you've considered the emotional risk of it. Because what if it doesn't work, and you've put the money into it, and it doesn't work for you? That's an emotional side that you have to be able to address. But if you're preparing in advance financially for it, and I think that takes a lot of the stress off, which is probably going to help you have a more successful IVF experience.
Ronita Choudhuri-Wade: Melissa Ellis, thank you so much for your help, both this episode and the last. Thanks for being on Smart Money.
Melissa Ellis: Well, thank you so much for having me. I appreciate it.
Sean Pyles: This has been quite a journey, Ronita. Going through all of the various ways to become a parent, and all of the associated expenses makes me think of that cliche “personal finance is personal,” but that has really never felt more real to me. Or maybe it's that this whole process is so personal that involving money at all seems almost crass. But for many parents having cash, good insurance, a generous benefits package from their employer can mean the difference between becoming a parent or not. And it's all really heavy.
Ronita Choudhuri-Wade: It absolutely is. I think one thing that became clear through doing this podcast and talking to everyone is that becoming a parent isn't something that people nowadays take lightly. Everyone we spoke to, whether it was Edgar, Alexa and Tess, really had deep thoughts on when, and how, and what kind of parent they wanted to be.
And for me, I think that's really special. I mean, we did talk a lot about money and the amount is staggering that you can pay. But for women in my family, going back to the start of time, no one ever had a choice about when they were going to have kids.
Or I had a friend in high school in the '90s who identified as LGBTQ who never thought that he could be in an relationship that was out in the public, and consider being a parent. And of course, things are not perfect in this world, and you still require a lot of money, and having and raising kids is not easy. But I have to say it does soothe my soul that people are having options that they never could have considered before.
Sean Pyles: Yeah. Well, I want to thank you, Ronita, for putting this series together for us. I really appreciated hearing you and your husband Jeremy share your story back in episode one, and I wish you much good luck in your quest to become parents.
Ronita Choudhuri-Wade: Thank you. We'll let Uncle Sean know when we have some news to share.
Sean Pyles: I'm looking forward to it.
Ronita Choudhuri-Wade: Until then, we have Mo.
Sean Pyles: Yes. For now, that's all we have for this episode. Do you have a money question of your own? Turn to the Nerds and call or text us your questions at (901) 730-6373. That's (901) 730-NERD. You can also email us at [email protected]. Also visit nerdwallet.com/podcast for more info on this episode. And remember to follow, rate and review us wherever you're getting this podcast.
Ronita Choudhuri-Wade: This episode was produced by Tess Vigeland and myself, Sean Pyles helped with editing. Kim Lowe helped with fact checking, Kaely Monahan mixed our audio. And a big thank you to the folks on the NerdWallet copy desk for all their help.
Sean Pyles: Here's our brief disclaimer. We are not financial or investment advisors. This nerdy info is provided for general educational and entertainment purposes, and may not apply to your specific circumstances.
Ronita Choudhuri-Wade: With that said, until next time, turn to the Nerds.
