In vitro fertilization — the most common type of assisted reproductive technology — was pioneered in 1978 by doctors in the United Kingdom, and has been used in the United States since 1981. In a survey of the 411 fertility clinics in operation in 2004, the CDC reported 127,977 cycles performed, resulting in 49,458 infants — some multiple births.
The average cost, according to the American Society for Reproductive Medicine (ASRM), is about $12,400 a cycle, but "accessory procedures" — such as sperm injection and hatching the egg — can up the price tag. The cost of a donor egg can exceed $5,000.
In states like California and New York, where demand is high, prices can be much more. And the best success rates are about 40 percent, according to experts.
"It's not necessarily the wealthiest women [who seek IVF]," said Eleanor Nicoll of ASRM, which supports insurance mandates. "There are payment plans and a lot of middle class people manage to pull their resources together. But we hear about people running up credit and taking out loans."
Fay Johnson of Los Angeles, Calif., spent more than $10,000 on her first failed in vitro try back in the mid 1980s. Her 103-year-old grandmother paid for Johnson's second one, which also didn't take.
"I was strapped putting my husband through law school as a second career," said Johnson, who was 39 at the time. "But we knew what our priorities were."
Desperate to have children, the couple later had two children — now 18 and 14 — through surrogacy. They paid for one with a second mortgage and the second through an inheritance.
"After spending this pile of too much money, I still wanted to be a mother," said Johnson, now 61 and working as a counselor at the surrogacy organization, Creating Families. "It's the best thing I ever did."
Ellen Lerner, a 43-year-old life coach from Naperville, Ill., underwent three rounds of IVF treatment with no success. Through state mandated fertility coverage, her plan covered all but a "couple of thousand dollars" for a couple of special procedures.
She and her husband are now adopting. "I had enough and my body had had enough," she said. "There was no guarantee and my doctor wanted to do more invasive procedures. I decided against it. I was tired."
But, Lerner said she had friends who "went bankrupt having a child."
Doctors say infertility — and consequently, IVF — is on the rise largely because women are deferring childbirth to have careers. As women age, so do their eggs and fallopian tubes, and they are more prone to miscarriage and endometriosis.
After six inseminations and three IVFs, Liz Owen of Valley Village, Calif., finally gave birth to twins. "Nobody expects to have problems with pregnancy when you are 16 and your mother says, 'Do it once, and you'll get knocked up.'"
The total cost exceeded $100,000, according to Owen, but luckily, her husband worked for a Massachusetts company, and all but a few thousand dollars was covered by his health plan.
Owen's care underscores the discrepancy in fertility treatment between those who have gold-plated coverage plans and those who do not.
"It's always been a concern among people in the [medical] profession that we have a two-tier medical system where [wealthier] people can get something that poor people can't get," said Dr. Ronald L. Young, director of gynecology at Baylor College of Medicine.