The first child born as a result of an IVF process in the U.S. was born in 1981 and since then over a million children have been born as a result of IVF cycles. IVF procedures and techniques are available in all fifty states, but IVF treatment is only covered by insurance in 17 (only 7 have laws relating to fertility preservation). IVF in the United States plays a crucial role and is a big business – there is an IVF clinic in every state and the U. S. Department of Health & Human Services estimates there are over 600,000 frozen embryos stored in the country.
Fertility Treatment Options in the USA
Due to both the number of treatment providers and different state rules regarding what treatments can be offered to couples and individuals you can access any type of infertility treatment in the U.S. The wide availability of infertility treatments comes at a price, however, particularly for domestic patients. IVF costs are high and financing them through insurance is not possible in two-thirds of individual states. In this respect, there is a ‘postcode lottery’ of sorts with access to funded treatments via insurance being based on your place of residence. For those that can afford it, IVF treatments and for those international patients looking for treatments not available in their country IVF in the United States is an attractive option with the top clinics in the US utilizing the best available technology to generate excellent outcomes.
The states that offer some form of insurance funded fertility treatment are:
- Arkansas: Covers the costs of IVF fertility treatments up to $15,000 for eligible couples.
- California: Covers costs for infertility treatment with the exception of IVF.
- Connecticut: Covers the costs of IUI and IVF fertility treatments.
- Delaware: Costs regarding infertility treatment are offered in the same way as pregnancy- related help and therefore cover, IUI, IVF, ICSI (including donor treatments), medication and storage.
- Hawaii: Covers one cycle of IVF when a couple has been trying to conceive for a minimum period of five years.
- Illinois: Covers IVF cycles only after other treatments have proved to be unsuccessful.
- Louisiana: State laws governing insurance says that insurers are not mandated to cover IVF, but some service should be provided.
- Maryland: Covers up to three IVF cycles where a couple has been unsuccessfully trying to conceive for two years and have tried less costly treatment procedures.
- Massachusetts: Covers the costs of IUI and IVF fertility treatments.
- Montana: Covers the costs of IUI and IVF fertility treatments.
- New Hampshire: Covers diagnosis, medications and all treatments using donor sperm, eggs or embryos.
- New Jersey: Covers the cost of IVF cycles where the patient is under 46 and has tried less expensive treatments.
- New York: Covers up to three IVF Cycles including diagnostic testing.
- Ohio: Covers IVF cycles where they are considered to be “medically necessary.”
- Rhode Island: Covers IVF cycles including diagnostic testing for women aged between 25 and 42 but not for costs associated with preservation.
- Texas: Covers IVF cycles when a couple has been trying to conceive for a minimum period of five years, but the women’s eggs can only be fertilized by the sperm of the spouse (no sperm donor).
- West Virginia: Covers the costs of IUI and IVF infertility treatments.
According to a recent survey undertaken by the Pew Research Center a third of American adults have accessed fertility treatments or know someone that has. The same survey demonstrated that around 2% of babies born in the US are a result of assisted reproductive technology (ART) with the state of Massachusetts having the highest share of ART babies.
Whilst there are a number of infertility treatment options that involve medications and surgical procedures this article is concerned with the availability, financing and success rate in assisted conception. In the US patients have access to all the treatments currently in use throughout the world. These include the two most widely accessed treatments: IUI (artificial insemination where washed and concentrated sperm is placed directly into the uterus) and IVF (when a laboratory fertilized embryo is placed directly into the uterus).
Treatments are sought and offered to patients seeking assistance using their own gametes or those that require donor sperm or donor eggs provided by an egg donor (egg donation). Unlike most of Europe, egg donors in the U.S. might be non-anonymous depending on state law and donor’s contract. In other words, donors may decide – signing the contract to remain anonymous or opposite. However, it’s important to notice that patients may have access to extensive donor’s profile before matching. Sperm donors remain anonymous. Egg donor availability in the US is significantly better than in Europe, one of the reasons behind it is donor compensation range. In the US donors may get between 6,000$ to 18,000$ compensation for egg donation process – which makes it easier to attract potential donors. In comparison in Europe, the average compensation for egg donors ranges between 900-1,400$.
For those patients requiring treatments using less medication, so-called ‘Natural IVF’ is possible. This is where the egg collection procedure involves no injections or stimulation drugs – eggs are retrieved during the natural menstrual cycle.
Surrogacy in the US
The first legal surrogacy agreement was undertaken in the U.S. in 1976. The country is widely regarded as one of the ‘go-to’ places for individuals and couples who are seeking to create a family using a surrogacy process. There are now only three states in the country that do not recognize gestational, or commercial (paid for) surrogacy which are, Michigan, Louisiana and Nebraska. The latter state prohibits surrogacy but there is no specific law that prohibits it.
The state of New York was the latest state to loosen the law around paid surrogacy contracts. From February 15th, 2021 a strict legal framework operates which will protect surrogates including introducing a minimum compensation of $35,000, rigorous contract criteria designed to safeguard all parties and intended parents are required to pay the surrogate’s life and health insurance costs for one year after the birth of the baby.
The surrogacy process in the U.S. is supported by a network of experienced and proficient third-party agencies who facilitate the process on behalf of intended parents. Although their services do not come cheap, they provide an essential service from utilizing their contacts to identify potential donors, surrogates and treatment providers, managing the surrogacy process including practical, legal and financial support and ensuring that surrogates are compensated fairly.
Infertility treatments in the United States: where anything is possible
It is estimated that the fertility industry in the U.S. is worth $5.8 billion annually. This worth is a result of the relatively high cost of treatments (particularly in comparison to those charged in other countries in Central and Eastern Europe) but also in large part due to the flexibility of U.S. treatment providers.
The U.S. fertility industry offers a range of services and treatments often not available in other countries. As we have seen, nearly all states now legally offer gestational surrogacy where gender selection enables intended parents the opportunity not only to choose the sex of their baby but other physical characteristics such as eye colour. The ability to offer patients a bespoke baby based on their ‘requirements’ is a service only available in a handful of countries in the world and is certainly one of the reasons behind the country’s ability to attract an increasing number of international patients and intended parents.
IVF financing in the US
As we have seen less than a third of US states offer employees a mandate which covers the cost of IVF treatment which means that many US citizens have to fund treatment out of their pocket. According to a recent study by FertilityIQ, a digital platform that tracks fertility benefits, about 80% of Americans, who access treatment, receive little or no IVF coverage.
For those people where insurance cover is not an option the average cost of IVF in the US which is around $50,000 is a figure which is out of reach for many. A small but increasing number of American companies are beginning to offer fertility benefits as part of wider employee packages and similar schemes are run by dedicated third-party agencies which offer health plans (which include fertility treatments) direct to employees and employers.
A list of finance programs offered to individuals and couples has been put together by RESOLVE, the National Infertility Association in the U.S.
Some individual treatment providers offer an array of IVF refund packages. Roughly half of the country’s fertility clinics offer a bundle of treatments (two plus cycles) payable in a single discounted payment. A proportion of which may be refunded if treatment(s) are successful before the completion of the program. These programmes, however, vary in cost and success rates depend on the clinic running the programme. Finally, individual clinics place eligibility criteria on accessing refund programmes so your participation may be restricted by your age, fertility history or current medical health.
If patients cannot access insurance cover, employer benefits, third party loans or clinic refund schemes the only option left for many is to take out costly personal loans, make payments against credit cards or consider similar high-cost credit facilities.
Choosing a clinic in the United States
For those reliant on insurance or loan cover your choice of clinic or location may be out of your hands but for those who are paying independently or for those international patients travelling to the U.S. it is wise to follow a series of pointers when choosing a treatment provider.
- Do your research, take a good look at the provider’s website, read patients’ reviews, ask for opinions if you belong to a patient/fertility forum.
- Spend time speaking to the clinic and obtain fixed costs for your desired treatment.
- If you are looking at success rates, don’t take anything at face value. If possible, find out the success rate for your age, the treatment you want and any condition you experience.
- Based on your wants check what facilities and services are offered by the provider i.e., do they offer counselling services; what level of a complementary therapy is offered; do they provide an after-care service
Important questions to ask: What medical and scientific facilities are offered? How long has the provider been working in the field? Does the clinic offer finance packages? Are storage costs included in any quote? If you are travelling from abroad what support does the clinic provide in terms of finding accommodation and helping with travel plans.
Finally, take your time. There is an increasing number of independent resources available that provide guidance and advice – don’t be pressurized into any rash decisions – fertility treatment can be a huge investment in time, money and human capital so be prepared to do your research.
IVF in the United States – wrap-up
IVF laws in the United States and insurance coverage vary state by state which means that domestic patients can be restricted to accessing certain treatments due to legal or financial constraints. If money isn’t a consideration American fertility patients have access to unparalleled numbers of treatment providers offering bespoke care packages.
The international patient also has access to a number of treatments and processes which are not available in the majority of countries. A number of States offer gestational surrogacy and there is a comprehensive network of agencies that have been set up to provide a full management service. Intended parents can also opt for gender selection and be very specific in their requirements of prospective donors.
IVF success rates in the United States are amongst the very best in the world but they come at a price. For domestic patients, a variety of financing options exist but without access to insurance mandates fertility treatments, and in particular, IVF treatments are beyond the reach of the average U.S. citizen.
What is the average cost of IVF in the US?
Trying to establish an ‘average’ price for IVF treatment in the U.S. is very difficult as most fertility centres do not publish treatment costs but concentrate more on sharing information on insurance mandates. According to the American Society of Reproductive Medicine (ASRM) the average price of an IVF cycle in the U.S. is $12,400 (not including medication), however, other commentators have suggested this figure is nearer to $50,000 once you factor in all medication and necessary ‘add-ons’.
Is IVF covered by insurance in the USA?
Insurance mandates covering IVF treatment remains patchy with only a third of states offering it. Those states which do not offer IVF treatment within their insurance mandates may offer less expensive fertility treatments.
Which IVF clinic has the highest success rate?
Based on the Centers for Disease Control (CDC) latest figures in 2018, there were just over 300,000 ART cycles performed at 456 clinics across the U.S. which resulted in over 81,000 live births. According to the CDC’s figures:
- Western Fertility Institute in Los Angeles had the best success rates for patients under 35 (live birth rate per transfer 73.7 %);
- CCRM Minneapolis is the best IVF clinic for patients aged between 35 – 37 (live birth rate per transfer 77.8 %);
- the Advanced Fertility Center of Chicago had the highest success rates in patients aged between 38 – 40 (live birth rate per transfer 74.2 %);
- Conceptions Reproductive Associates of Colorado is the best US clinic for patients aged between 41 – 42 (live birth rate per transfer 86.4 %) and finally,
- Santa Monica Fertility demonstrated the highest success rates for patients undergoing frozen egg donor treatment (live birth rate per transfer 77.5 %).
Full results from the CDC 2018 statistics can be found here