The reality: Fertility treatment costs range from a few hundred dollars (monitored Clomid cycles) to $50,000+ (IVF with donor eggs). Most couples spend $15,000-30,000 before achieving pregnancy. Insurance coverage varies dramatically—21 states mandate some fertility coverage, but details matter enormously.
Treatment costs at a glance
Before diving into details, here's a high-level overview of what different treatments cost. Remember: most couples try multiple treatments, and costs add up.
| Treatment | Cost Per Cycle | Typical # Needed |
|---|---|---|
| Timed intercourse (monitored) | $200 - $1,000 | 2-4 cycles |
| Clomid/Letrozole + monitoring | $500 - $1,500 | 3-6 cycles |
| Injectable medications + TI | $2,000 - $5,000 | 2-4 cycles |
| IUI (intrauterine insemination) | $500 - $2,500 | 3-6 cycles |
| IUI with injectables | $3,000 - $6,000 | 2-4 cycles |
| IVF (in vitro fertilization) | $15,000 - $25,000 | 1-3 cycles |
| IVF with donor eggs | $25,000 - $50,000 | 1-2 cycles |
Detailed cost breakdowns by treatment
IUI (Intrauterine Insemination)
IUI places washed sperm directly into the uterus around ovulation. Often the first treatment tried for unexplained infertility, mild male factor, or single women using donor sperm.
What You're Paying For
IVF (In Vitro Fertilization)
IVF retrieves eggs, fertilizes them in a lab, and transfers embryos to the uterus. The most effective fertility treatment, especially for tubal issues, severe male factor, or after failed IUI cycles.
What You're Paying For
IVF with Donor Eggs
Uses eggs from a donor, fertilized with partner's sperm, and transferred to recipient. Offers significantly higher success rates for women over 40 or with diminished ovarian reserve.
What You're Paying For
Additional costs to consider
Beyond the treatment itself, budget for these often-overlooked expenses:
- Initial diagnostic testing: $1,500-3,500 before treatment even starts
- Reproductive immunology testing (if recurrent loss): $2,000-5,000
- Travel and time off work: Monitoring appointments happen frequently
- Acupuncture/supplementation: Some add $200-500/month
- Mental health support: Therapy during treatment: $150-300/session
Insurance: What's actually covered?
Fertility insurance coverage in the US is a patchwork—some people have excellent coverage, others have none. Understanding your specific policy is crucial.
đź“‹ States with Fertility Insurance Mandates
These 21 states require some form of fertility coverage, but details vary significantly:
⚠️ Mandate doesn't mean full coverage
Even in mandate states, coverage varies wildly. Some cover IVF; others only cover diagnosis. Some have lifetime maximums; others cover unlimited cycles. Religious employers and small businesses may be exempt. Always call your insurance directly.
Questions to ask your insurance company
Before starting treatment, get answers to these specific questions in writing:
- Does my plan cover infertility diagnosis AND treatment?
- What treatments are covered? (IUI? IVF? Medications?)
- What is my lifetime maximum benefit?
- Do I need to meet specific criteria first (age, duration trying, diagnosis)?
- Does coverage require prior authorization?
- Are there in-network fertility clinics? What's my out-of-network benefit?
- Does the plan cover PGT-A genetic testing?
- What about donor eggs/sperm or surrogacy?
- Does my deductible/out-of-pocket max apply?
Even without mandate coverage
Even if your state doesn't mandate fertility coverage, your employer may offer it voluntarily. Many large companies now provide fertility benefits. Ask HR specifically about:
- Fertility benefits through your main health plan
- Supplemental fertility benefits (like Progyny, Carrot, or Maven)
- Flexible Spending Accounts (FSA) that cover fertility treatments
- Health Savings Accounts (HSA) if you have a high-deductible plan
Ways to reduce fertility treatment costs
đź’Š Medication savings
Fertility medications can cost $3,000-7,000 per IVF cycle. Ask about: manufacturer discount programs, mail-order pharmacies (often 20-30% less), overseas pharmacies (some clinics facilitate legal imports), and medication donation programs for leftover meds from completed cycles.
🏥 Multi-cycle packages
Many clinics offer discounted packages for committing to multiple IVF cycles upfront. Some offer "shared risk" programs that refund a portion if you don't achieve pregnancy. Calculate carefully—these make sense for some situations but not others.
🌍 Fertility treatment abroad
Medical tourism for IVF can save 50-70%. Popular destinations include Czech Republic, Spain, Greece, and Mexico. Research clinics thoroughly—look for ESHRE certification in Europe. Factor in travel costs and the complexity of care across borders.
🏢 Employer advocacy
If your employer doesn't offer fertility benefits, advocate for them. Many companies have added coverage after employee requests. RESOLVE (the National Infertility Association) has employer advocacy toolkits.
Financial assistance resources
Fertility Grants
Organizations like Baby Quest Foundation, The Cade Foundation, and Gift of Parenthood offer grants of $2,000-16,000 for fertility treatments. Competitive but worth applying.
Financing Programs
Companies like Prosper Healthcare Lending, CapexMD, and Future Family offer fertility-specific loans. Compare rates carefully—they can range from 5% to 25%+ APR.
Clinical Trials
Participating in fertility research studies can significantly reduce costs. Check clinicaltrials.gov and ask your clinic about available studies.
Military Benefits
Active duty military now have access to IVF coverage through TRICARE for service-connected conditions. Veterans may have access through VA fertility programs.
Realistic budgeting: What couples actually spend
Here's what typical fertility journeys actually cost, based on common scenarios:
Scenario 1: Successful with Clomid + IUI
Total: $3,000 - $8,000
Initial testing ($1,500-3,000) + 3-4 IUI cycles ($500-1,500 each). This is the "best case" for couples with mild issues who respond to basic treatments.
Scenario 2: IVF after failed IUI
Total: $25,000 - $50,000
Initial testing ($1,500-3,000) + 3 IUI cycles ($3,000-6,000) + 1-2 IVF cycles ($15,000-25,000 each). Common path for unexplained infertility or moderate issues.
Scenario 3: Multiple IVF with PGT-A
Total: $60,000 - $100,000+
For those who need several retrievals to bank embryos, genetic testing, and multiple transfers. Often the path for diminished ovarian reserve or recurrent loss.
Scenario 4: Donor eggs required
Total: $50,000 - $80,000+
After potentially attempting own-egg IVF, moving to donor eggs adds significant cost but often success after one cycle.
The uncomfortable truth: The median income for families pursuing fertility treatment is $100,000+. This is a deeply unfair system that prices many people out. Financial stress compounds the emotional difficulty of infertility. There's no shame in what you can or can't afford.
Making the financial decision
Some questions to consider as you plan:
- What's your total budget? Decide before starting—it's harder to stop once you're invested
- What can you comfortably afford without compromising other important goals?
- What financing options make sense for your situation?
- At what point would you consider other paths (donor gametes, adoption, childfree living)?
- How does your partner (if applicable) feel about financial limits?
There's no right answer. Some couples feel strongly about pursuing every possible option regardless of cost. Others set firm limits. Both approaches are valid.
Frequently asked questions
Yes, sometimes. Blocked fallopian tubes, for example, make IVF medically necessary for pregnancy—there's no other option. Some insurance policies cover IVF for specific diagnoses even without general fertility coverage. Ask your clinic to help with documentation and appeals if initially denied.
Yes! Both FSA and HSA funds can be used for fertility testing, treatments, and medications. This effectively gives you a 25-35% discount (your tax rate) on out-of-pocket costs. If you know you'll pursue treatment, max out your FSA contribution for the year.
Potentially. Medical expenses exceeding 7.5% of your adjusted gross income can be itemized as tax deductions. For many couples with significant fertility expenses, this threshold is met. Consult a tax professional for your specific situation.
Mini IVF (minimal stimulation IVF) uses lower medication doses, retrieving fewer eggs. It costs $5,000-8,000 per cycle—less than conventional IVF but with lower success rates per cycle. It may be appropriate for specific situations (poor responders, older patients), but isn't simply "cheaper IVF" for everyone.
Some people do. Large tech, finance, and media companies often offer generous fertility benefits. However, consider waiting periods (often 6-12 months before benefits kick in), other aspects of the job, and whether the coverage is actually better when you factor in deductibles and restrictions.
These programs charge more upfront (often $25,000-35,000) but refund 50-100% if you don't achieve pregnancy after multiple cycles. They work like insurance—good deal if treatment fails, expensive if it works quickly. Calculate the break-even point and assess your own risk factors before deciding.