- Many women are choosing to have children later, and increasingly turning to fertility treatments.
- At least 20 states now require insurance to cover some infertility treatments.
- Pending FDA approval, a DIY product may soon be available that enables basic fertility treatment at home.
The more conversations my colleague Sima Bernstein, EdD, and I had with women, the more we realized the fertility industry had grown both in the number of people seeking help and the high costs of infertility, emotionally and financially. We discovered some promising changes already in effect or on the horizon that could be a boon for so many. Here’s what she and I learned:
Mary Ellen, whose name has been changed to protect her privacy, confides to us why she only had one child. It was a chain reaction, she said. She delayed motherhood because of her career, then needed in vitro fertilization (IVF), and was so wiped out physically and financially from the experience that, at age 47 when her son was born, she decided: That’s it! She was having just one.
Abbey Sangmeister, a 42-year-old a therapist and coach in New Jersey who recently gave birth to a daughter and used IVF, was 40 when she began fertility treatments. She had always wanted kids but was waiting for the “right guy to come along.” Sangmeister found the pain of treatments tolerable, but the cost—$50,000 in her case—prohibitive. As a result, she decided a second child is out of the question. “My insurance covers nothing because I work for myself,” she says.
Rachael Jones, a registered nurse, mother of a child conceived with IVF, and director of clinical client implementation at WINFertility—a Connecticut company that coordinates and manages fertility benefits for employers and health care plans—didn’t experience the same financial struggle personally. The health plans she and her husband had provided coverage for fertility treatments, so out-of-pocket costs were minimal. But in her role with WINFertility, she’s encountered many who found the financial burden crushing.
“I definitely know people [who] put a second mortgage on their house or sell their car … to get through this,” Jones says. “It can be a very hard journey.” For Jones, the biggest challenge wasn’t money but the sheer amount of time invested before fertility treatments worked. “It took two-and-a-half years, and I was not expecting that,” she says.
Fertility treatment is both science and art, not a one-size-fits-all protocol, Jones explains. That includes making difficult choices like how many embryos to freeze, as those undergoing treatment decide how many children they hope to have. The protocol may also call for more than one attempt and can be a difficult emotional journey.
If these narratives ring familiar, they should. They reflect some clear demographic and healthcare trends. Multiple studies tell us that first-time American moms, as a group, are more likely to be older today and to turn to IVF or other fertility treatments to help them conceive.
A 2022 U.S. Census Bureau report put the median age of first-time mothers at 30, marking a gradual but almost steady rise in age since 1990. Unsurprisingly, there was also a substantial drop in fertility nationwide over the same time period.
The fertility rate in the 35 to 39 age group, though, moved in a completely different direction. It rose sharply—from 31.5 to 52.7 births per thousand in 2019—an increase of 67 percent.
We also know from financial data that Americans’ expenditures on fertility treatments are growing rapidly, wreaking havoc on the finances of many people struggling to become parents.
Growth in Assisted Reproductive Technology (ART)
The sharp rise in the number of women undergoing fertility treatment is similarly well documented. Since the first birth of an American baby as a result of IVF in 1981, the use of assisted fertility treatment, or ART, has been steadily rising.
One-third of Americans have undergone fertility treatment or know someone who has, according to a Pew Research Center poll. Among those with a college degree, that number rose to 43 percent.
Many of the women undergoing fertility treatments are older mothers because fertility declines with age. “When you’re older, you don’t have as many beautiful embryos that lead to healthy children. You may only make one or two,” explains Shahin Ghadir, a physician in Southern California who is double board-certified in obstetrics and gynecology and reproductive endocrinology and infertility. Age-related fertility challenges are “the number one reason we see patients in my clinic,” Ghadir says. “People are putting their work-life first.”
Egg Freezing: A Turning Point
Sangita Jindal, President of the Society for Assisted Reproductive Technology (SART) and Professor, Department of Obstetrics, Gynecology and Women’s Health, Albert Einstein College of Medicine, agrees that some norms in childbearing have changed. And she believes that new technologies may be at the root of it.
“Egg freezing is the biggest achievement in ART in the last decade in a field that has been around for 40 years. It's become standard,” Jindal reports. “Now women are much more comfortable deferring motherhood if they can freeze their eggs.”
Increased Coverage Means More Options
People coping with fertility concerns in the near future may face a landscape quite different from the one navigated by the mothers we interviewed, as more states require insurance coverage for fertility treatments. More people are getting coverage—either through their employers, or because of the state mandates. Twenty states have already passed laws mandating fertility insurance coverage. Of these laws, 14 include IVF coverage.
That’s bringing cost into an affordable range for many. But it’s not the only market force putting fertility treatments within reach for more people who are seeking to overcome difficulties having children.
Less Expensive Treatments
Less expensive fertility treatments could also provide another option for some having trouble getting pregnant.
One new product that’s expected to be on the market by this summer or early fall is designed specifically to reduce costs for infertile couples. The creator behind this new product is Jennifer Hintzsche, CEO and founder of PherDal Fertility Science, who has a Ph.D. in bioinformatics, a field that combines the study of computer science and biology. With assistance from her husband, a mechanical engineer, Hintzsche designed the first, sterile, over-the-counter, assisted reproduction kit, which women can use at home. Hintzsche estimates the kits will cost $200, compared to the $300-$4,000 cost of a cycle of Intrauterine Insemination IUI, or the $12,000 clinics typically charge for a cycle of IVF. Hintzsche is in the process of getting FDA approval.
Hintzsche knows the struggles of fertility treatment from personal experience. She and her husband underwent treatment for 16 months before her daughter was conceived. She said it caused a strain not only on their marriage but also her finances, and that having a second child using clinic-based treatments would have required taking out a substantial loan.
“We decided that if we were going to have a second child we were going to apply to adopt—because we didn’t feel like we could put our marriage through infertility [treatments] again.”
Hoping to spare other women the same anguish, Hintzsche developed a kit that allows women to conduct a basic, first-step fertility treatment themselves. Although not a cure-all, she tells us her preliminary data reflects the same live birth rate as IUI. (Note: The authors have no relationship with Pherdal.)
Certainly, anything that eases the financial burden of fertility treatments—whether increased insurance coverage or new options—is welcome. For many struggling to get pregnant, accessible, affordable help can’t come soon enough.
Related: "Should Young Women Freeze Their Young Eggs?"
Copyright @ 2023 by Sima Bernstein & Susan Newman