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The High Costs of Infertility: Women Are Risking Bankruptcy for a Baby

Ali Barton

At age 30, Ali Barton shouldn't have had any problem conceiving and giving birth to a healthy baby. But sometimes nature doesn't cooperate and things go awry—Ali's fertility in this case. Five years and two children later, things have worked out in the happiest way possible. But there were some major issues along the way, including a hefty bill—over $50,000. Her two beautiful children are well worth every penny, she says, but should it cost that much simply to have a baby? And why are fertility treatments so expensive?

Ali and her husband married in early 2012 and because he's 11 years older they decided to start their family right away. Thanks to an autoimmune disorder that required daily steroid treatments, she hadn't had a period in a while. But she was young and relatively healthy so she figured things would work out. She went off her meds and tried several hormonal treatments to kick-start her menstrual cycle. But nothing worked. By the end of the year she was seeing a reproductive endocrinologist who recommended the couple use fertility treatments.

The couple decided to first try IUI (intrauterine insemination), a procedure where the man's sperm is injected directly into the woman's uterus through a catheter. IUI is a cheaper method, averaging $900 without insurance. But Ali's ovaries made too many eggs, which increases the risk of a multiple pregnancy and can cause health risks for both the mom and babies. So, her doctor suggested she switched to IVF (in vitro fertilization), which allows for more control over risks for a multiple pregnancy. In IVF, a woman's ovaries are medically stimulated into making many eggs which are then harvested and mixed with sperm in a petri dish. One or more fertilized embryos are then implanted in the woman's uterus. It has a higher success rate—10 to 40 percent depending on the mom's age—but it comes with a much higher price tag, averaging $12,500, in addition to the $3,000 or so in medications. (IVF costs vary by region, type, doctor, and maternal age. Get a more accurate estimate of what yours would cost with this handy IVF cost calculator.)

Ali went through four rounds of IVF in under a year, but it was a risk that paid off.

"It was such a dark time, each round felt worse and worse," she says. "The last round we only got one viable egg, the chances were so slim, but miraculously it worked and I became pregnant."

In a terrifying turn of events, halfway through the pregnancy, Ali went into acute heart failure. Her son was born prematurely and she needed a heart transplant afterward, but both happily survived.

But while mom and babe were doing great, the bills kept adding up. Fortunately for the Bartons, they live in Massachusetts which has a law that mandates infertility treatments be covered by health insurers. (Just 15 states have similar laws on the books.) Still, even with the health insurance, things were expensive.

And then they decided they wanted to have a second child. Because of Ali's health problems, the doctors recommended she not get pregnant again. So the Bartons decided to use a surrogate to carry their baby. In surrogacy, fertilized embryos are created using the same process as in IVF. But instead of implanting them in the mother's womb, they're implanted in another woman's womb. And the costs can be astronomical.

Surrogacy agencies can charge $40K to $50K just to match parents with a surrogate. After that, parents must pay the surrogate's fee—$25K to $50K depending on experience and location. In addition, they must purchase a year of life and medical insurance for the surrogate ($4K), pay for the IVF transfer to the surrogate with the possibility more than one cycle will be needed ($7K to $9K per cycle), pay for the medications for both the donor mother and the surrogate ($600 to $3K, depending on insurance), hire lawyers for both the biological parents and the surrogate (about $10K), and cover smaller needs of the surrogate like a clothing allowance and parking fees for doctor's visits. And of course, that's not even counting the money needed to buy the normal stuff like a crib, car seat, and clothing once the baby arrives.

Ali was fortunate in that she was able to find her surrogate, Jessica Silva, through a Facebook group and skip the agency fees. But they still had to pay the rest out of pocket. The Bartons cleaned out their savings and generous family members contributed the rest.

Jessica gave birth to baby Jessie earlier this year and she's worth every sacrifice, Ali says. (Yes, the Bartons named their daughter after the surrogate who carried her, saying they love her like family.) Still, even though they got their happily-ever-after, it's not easy.

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"I've always been frugal but this experience taught me how important it is to spend money on things that are important, like our family," she says. "We don't live a lavish lifestyle. We don't take fancy vacations or buy expensive clothing; we're happy with the simple things."

The Bartons certainly aren't the only ones struggling with the high cost of infertility treatments. About 10 percent of women struggle with infertility, according to the U.S. Office on Women's Health. And that number is expected to rise as the average maternal age rises. While Ali's age wasn't the cause of her infertility, it is a growing cause in the U.S. In 2015, 20 percent of babies were born to women over age 35, the age when egg quality markedly declines and the need for fertility treatments greatly increases.

Many women don't understand this, thanks in part to our celebrity culture that makes later-in-life babies look easy or that highlights fertility treatments and surrogacy as entertaining reality show plot lines (hello Kim and Kanye) rather than as the financially and emotionally difficult events they are, says Sherry Ross, M.D., ob-gyn at Providence Saint John's Health Center in Santa Monica, CA, and author of She-ology.

"Due to social media, we see 46-year-olds giving birth to twins and it's misleading. Those are probably not their own eggs. You have a window of fertility that ends around age 40, and after that, the miscarriage rate is over 50 percent," she explains.

"It's become a kind of taboo for a woman to say that she wants to have a family before her career. We're encouraged to have this 'if it is meant to be it will just happen' attitude, when the reality is that it can be a lot of work, sacrifice, and money to have a baby. You have to really decide if you want kids. And if you do, you'd be better off to plan for it," she says. "We teach women plenty about how to plan to prevent a pregnancy, but then we teach them almost nothing about how to plan for one because we don't want to offend them? It's not politics, it's science."

She adds that doctors should be more upfront with their patients about all aspects of family planning, including the success rates and real-world costs for options like egg banking, fertility treatments, sperm or egg donors, and surrogacy.

But the hardest part for Ali financially wasn't the money itself, it was the emotional impact. "It was really difficult to write a check every month [to Silva] for something I felt like I should have been able to do myself," she says. "It's traumatic when your body can't do what it's supposed to."

Ali, who was a therapist before she had children, says she feels like she has PTSD from the whole fertility process, adding that someday she'd like to open a practice geared toward helping people through all the ins and outs of both transplants and fertility treatments.

To learn more about Ali's story, check out her book Against Doctor's Orders.

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