Bringing Out Baby: Who Pays for IVF?

Payment for fertility procedures varies by state and insurer, locking many out.

April 8, 2008 — -- New York City councilwoman Melinda Katz began a career in public service when she was 28, but by the time she was 40 and wanted to have a baby, she learned she was infertile.

Today, at 42, neither medical technology nor being single stands in the way of Katz having that baby — only her insurance company.

Katz, who championed women's health issues while serving in the New York State Assembly, discovered she was not entitled to insurance coverage for in vitro fertilization (IVF) that might have given her a baby.

"Having a baby is an important part of life," said Katz, who told she saved her money and paid for the IVF herself. It took three failed tries, but the petite city counselor is now expecting a boy, with a donor egg and sperm, in June.

"The state doesn't cover a lot of fertility treatment and it should," said Katz, who, as a Democrat, wrote the law requiring HMOs to provide women direct access to gynecological care without forcing them to first see a primary care physician.

"It's a very expensive process and I was lucky enough to pull together tens of thousands of dollars," she said. "Many women don't have that great fortune."

Like Katz, an estimated 2 percent of all American woman experience fertility problems, but only some of them can afford the expensive advances in technology that make pregnancy possible.

Pregnancy a Luxury

Katz, who hails from the well-heeled neighborhood of Forest Hills, Queens, can afford that luxury. As a single woman, she earns $125,000 a year and is running for the city comptroller job, which pays an annual salary of $185,000.

Still, the financial burden is only a part of the pain of IVF. "It's a very emotional process, and by the end, I knew I really wanted this child, it was so long and arduous."

Only 15 states mandate fertility care, and many, like New York, do not cover IVF, egg donation or other pricier procedures.

"I worked so long, it should be available to most women," Katz said. "We have very good insurance in New York City — one of the best in the country."

States vary widely in their mandates, and so individual insurance carriers are called on to fill the gap.

In New Jersey, IVF is allowed, but not for women older than 46. Hawaii limits women to one try, but in Massachusetts, there are no limits in the number of treatment cycles. In Arkansas, payments are capped at $15,000.

But, those so-called mandates are deceiving, according to Resolve, the National Infertility Association, which advocates equal access to medical care for fertility issues or reproductive disorders. Massachusetts, for example, has the oldest and strongest mandate, but large companies with self-insured plans and small employers are exempt.

"In some states, it's not even a full mandate, and in some there is really no coverage at all," said Barbara Collura, executive director of Resolve. "It's a relatively large number of people who do not have access to care. As high as 50 percent of those diagnosed with infertility would benefit from medical intervention and are not getting the care that they need."

Of the approximately 62 million women of reproductive age in 2002, about 1.2 million, or 2 percent, had an infertility-related medical appointment within the previous year, and 10 percent had an infertility-related medical visit at some point in the past, according to the Centers for Disease Control.

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.

High Demand

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."

Bankrupt Having Child

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.

"Some of that has always been that way — if you have a disability or heart disease or cancer," he said. "If you have money and power you get better care than others."

But Florida psychologist Judith Horowitz, who counsels couples who undergo fertility treatments, challenges the idea that insurance companies should have to pay for expensive treatments for older mothers.

She supports a public information campaign to educate women before they make the tough choice to delay childbirth for a career. Many of her own patients are shocked when a doctor brings up the topic of "waning fertility."

"It heightens one's awareness and one's fear," she said. "It seems as if physicians are pushing children to become mothers and reversing the trend — that education and career are less important."

She added women need to be "armed with the facts" to make intelligent choices about when to have children.

Meanwhile, Katz told the New York Post, that her decision to be a single — and older — mother was one "that I felt if I didn't do, I would regret for the rest of my life."

The city councilwoman said she hoped her experience would be a help to others with fertility struggles. As for inequities in insurance coverage, she said she hopes to take the issue with her on the campaign trail.

"The comptroller is a good bully pulpit," she said. "It's good to set an example for other folks."

Still, even after the painful and grueling IVF treatment, being a single mother seems simple, according to Katz.

"I am simply having a baby," she said. "People have been doing it for generations."

For more information on fertility treatments and insurance, go to RESOLVE.

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