Many of our clients are women in their 30s and 40s, married or not, who are successful in their careers and thinking about having a child (or going for a second one).
But life is busy and time marches on. Each time another month goes by, you may start to wonder if motherhood is going to happen after all. Should you seek medical advice? How much will this cost anyway? Does anyone else hear that ticking?
As a mom of 3 (first born when I was 35, followed by twins at 41), I have totally been there. And as a financial planner, I recognize (and tend to keep track) of the costs and tradeoffs involved.
I learned a lot from my experience with the fertility “industry” and enough time has passed that it is no longer such a sensitive topic for me. This also means that some of my experience is out of date, but I hope my advice can help anyone reading this message. We keep it real around here!
Are You Ready to Commit?
If you know that you want a baby (and I highly recommend a supportive partner in all this), you’ve been doing the things that result in pregnancy (wink wink), and nothing has come of it, you need to rule out any medical issues. (Your partner also needs to rule out a medical issue, by the way!)
Obviously, I am not a medical professional, but I will say that your regular OB/GYN may likely have no advice to give and will instead refer you to a fertility specialist. (This surprised me at the time). So there is little point in waiting for your next annual appointment or making an appointment if there is a long lead time to get one.
To find a fertility specialist, check your health insurance website to hopefully find someone “in-network” at your insurance plan. If that person doesn’t exist, you can ask your primary care doctor or look around online. Frankly, if your insurance does not cover any of this, it may not matter if your doctor is out of network. I recommend you also consider location – if you end up needing treatment, it may be extremely helpful to have someone you can get to easily.
You also need to do your own research and understand how your body works. Tracking your cycle to determine your fertile days and generally helping your body be at its most healthy can only help.
I am also a big believer that stress is the enemy when you are trying to get pregnant. If work or life-related stress is an issue for you (and trying unsuccessfully to get pregnant is pretty stressful!), you need to find ways to manage your stress through exercise, meditation, therapy or whatever works for you.
How Far Are You Willing To Go?
So let’s say that you are ready to make this happen, with medical assistance if necessary. What comes next?
I think of fertility treatments as being on kind of a continuum. From easy to hard, low-cost to expensive.
Easy and Low-Cost
Please don’t hesitate to talk to a doctor if you are concerned about your ability to get pregnant, as it might be fairly simple to resolve the issue. The longer you wait, the less likely this is to be true.
There are generic prescription (clomid) and over the counter (guanfacine) medications which are inexpensive and may give your process a boost. Basic bloodwork to rule out any issues such as a hormone or thyroid imbalance are all pretty standard and likely to be either covered by your health insurance or at least very inexpensive.
Your man should also get a sperm test – best to rule out any issues there as well. Also, not a particularly difficult or expensive procedure.
The first time around, I was lucky. My first consultation with a fertility doctor involved an ultrasound to check out the ovulation situation. I remember very clearly that it was a Thursday. He said eggs look good and you are about to ovulate – have some baby-making activities with your hubby this weekend and if you aren’t pregnant in two weeks, make another appointment.
Welp, I didn’t need to make that appointment, and our son was born about 38 weeks later.
Egg-Freezing technology has become more advanced and is certainly more popular (and likely to be covered by your health insurance) in recent years. The idea is to collect and freeze some eggs while they are healthy and plentiful so that they can be used in an IVF cycle when you are ready down the road. The average cost seems to be around $7,500.
Intra-Uterine Insemination (IUI). My insurance at the time covered some high percentage of this three times. According to the internet, this runs around $1,000 per try, plus the cost of any medications. It’s not super high-tech (think turkey baster) and could be effective as much as 25% of the time (less the older you get, unfortunately).
The drugs involved to stimulate hormones and such start to get expensive at this point and are delivered by injection. The national average cost seems to be around $1,500-3,000 per cycle. I will also say that it may be a time commitment to go to your doctor on a nearly daily basis of monitoring for some period.
We tried this too, but it was not successful. If I remember correctly, our insurance covered 70% of this this treatment, but there was a limit on the number of times that would be covered.
In Vitro Fertilization or IVF seems almost commonplace to many professionally ambitious women, but it is a complex endeavor. The process includes ovulation induction with medications, egg retrieval surgery, fertilization, and embryo transfer surgery. Clear your schedule for lots of doctor appointments.
The average “all-in” cost these days is around $25,000. IVF may also be a possibility using donor eggs or a surrogate. These options will also add to the cost. Keep in mind that success is not guaranteed – it can feel terrible to throw this much money at something with no result.
I’ve been here too. It was the right thing for us to do, but I can’t say I recommend it. My health insurance at the time covered a high percentage of it the first time. I went back to the same doctor 2 more times. It was depressing to hear the number of harvested eggs decrease each time.
Then we switched doctors. At this point I was 40 and probably starting to freak out just a bit. We decided to go nuclear and take on every “extra” offered part of the treatment for this final round. And I (finally) did get pregnant. Huzzah!
What About the Cost?
The treatments described above may cost many thousands of dollars, and you may need to do some or all of them more than once. Where will this money come from?
First of all, don’t count on your health insurance. Check the fine print in your plan but prepare yourself for the fact that many health insurance plans will not cover any of these treatments. If yours does, count yourself lucky.
Your clinic or health care plan may offer a financing arrangement. If it is a way to spread out the payments to better manage your cash flow, it may very well be worth doing. But if it is more like a high interest credit card, you should avoid that it you can. We depleted our emergency fund savings and accumulated a lot of credit card debt during this rather intense time.
If I could have gone back in time, I would have chosen the high-deductible health insurance plan in my 20s and maxed out my Health Savings Account (HSA) every year. Back in the day, I (thankfully) had no medical issues and hardly ever saw a doctor. If I had done that, there could have been a solid 5 figures in that account that we would have put on the IVF rather than on a credit card. Now I know that I paid for the more expensive health plan when I barely used it.
This is a large expense for which most people don’t save. (Of course not, you hope to never need it!). Using a HDHP (High Deductible Healthcare Plan) with a Health Savings Account (HSA) could be a tax-advantaged way to build a saving that is there if you need it for medical expenses like fertility treatments.
Finally, I don’t mean to sound like your mother here, but my general advice is to seek medical advice sooner rather than later. I will also say that my body recovered MUCH faster from one child at 35 than from twins at 41. Best wishes to anyone on this journey.
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