When you are considering IVF as an option for growing your family, there are many aspects to consider. The emotional, physical and medical facets of the decision are at the forefront, but the financial side of Assisted Reproductive Technologies (ART) is a serious consideration for many prospective parents. Insurance coverage may be incomplete or non-existent, and paying for these complex procedures out of pocket is a significant investment. Breaking down the price of a typical IVF cycle into its separate components and understanding the many factors which can affect the total cost will help you to understand what to expect.

What is included in an average IVF cycle fee?

Because IVF is not a single treatment but a series of procedures, many doctors, nurses, and technicians are involved at each stage of the process. Charging for every step separately could quickly become confusing, so most providers charge a single base fee per IVF cycle, which includes most of the major costs. Exactly what is included in this per-cycle fee can vary between clinics, but you can usually expect it to include such costs as:

• Lab tests. Not surprisingly, many tests are involved in any IVF cycle:
  • For women: blood tests to screen for conditions which may affect the outcome of a pregnancy, to check ovarian reserve, and to determine the levels of important hormones before and during cycle management. After embryo transfer, blood tests are used to check for pregnancy.
  • For men: semen analysis

• Ultrasounds. Ultrasounds are also used to monitor your ovaries during the lead up to ovulation to determine when your follicles and eggs are ready for the retrieval procedure. Ultrasound scans are a powerful way for your doctors to determine important fertility factors such as:
  • Uterus morphology (the shape and structure of your uterus)
  • Ovarian volume (the length, width, and depth of your ovaries)
  • Endometrial thickness and texture (the condition of the lining in your uterus)
  • Antral follicle count (the number of eggs your ovaries have in reserve)
    
    
• Egg retrieval. Egg retrieval is the most intensive procedure in an IVF cycle. After a carefully monitored cycle of fertility drugs, ovulation is triggered and you will go into the clinic to allow the doctor (guided by ultrasound) to surgically retrieve eggs for IVF.

• Sperm prep. Whether you are using a partner’s sperm or donor semen, a fertility lab will “wash” and treat the semen in a special centrifugal process to separate the strongest and healthiest sperm to use for fertilization.

• Embryo culturing. After the egg and sperm have been combined in the lab for fertilization, the resulting embryos are carefully cultured in a lab to give them a “head start," and to allow the highest-quality embryos to be identified before transfer.

• Embryo transfer. Once the embryos are about 5 to 6 days old, you will visit the clinic again so that the doctor can transfer them into your uterus, or the embryos can be frozen and transferred in a future cycle.

• Medication. The oral and injectable fertility drugs and hormones used in IVF are prescribed but not provided by fertility physicians, and the cost will largely depend on the pharmacy which fills the prescription.

• Anesthesia. Anesthesia for the egg retrieval procedure is typically administered by an outside provider who comes into the clinic just for the procedure, so the cost of anesthesia is billed separately by that provider.

• Embryo storage. If your IVF cycle produces more viable embryos than necessary for transfer, you have the option to store them through cryopreservation (freezing) for future transfers. The embryo storage service is usually administered by a separate facility, which will charge its own fees.

What other considerations may affect the cost of IVF?

Of course, there is no truly “typical” IVF cycle: each case is different, and the exact procedures necessary for an individual cycle can vary. Outside of the basic IVF protocol discussed above there are a number of procedures, technologies, and extra services which may be helpful in achieving pregnancy in certain cases, and a few other factors which can also change the overall cost of a cycle.

• Egg/sperm donation. If donor eggs or sperm are to be used in your IVF cycle, there will be additional costs. You are not paying for the eggs or sperm, but to reimburse the specific costs incurred by donation, therefore donor eggs are generally much more expensive to use than donor sperm. The cost may be slightly offset by the fact that you will not need to undergo the egg retrieval process yourself.

• Embryo donation. The cost of a transfer for a donated embryo may be less than a full IVF cycle, however, if the embryos cannot be transferred because of a failure of the thawing process, you will still need to pay all of the associated costs. 

• Surrogate. The use of a surrogate can greatly affect the total cost of your cycle. Generally you will be financially responsible for all medical and reasonable associated costs for your surrogate, up to and including living expenses in some cases.

• Assisted hatching. This procedure is sometimes used to assist implantation in patients with poor prognosis. In the earliest stages of development, an embryo is contained within a membrane known as the zona pellucida. In order to implant successfully in the uterine lining, the embryo must first break through this layer of proteins. In assisted hatching, an embryologist uses micromanipulation techniques under a microscope to create a tiny hole in the zona pellucida, which may encourage implantation. This highly specialized procedure is charged separately.

• Intracytoplasmic sperm injection (ICSI). When dealing with male-factor infertility such as low sperm count, quality, or motility, ICSI can help. In this procedure, a single sperm is injected directly into a mature egg to help fertilization. As this is a separate lab procedure, there are additional costs.

• Preimplantation genetic screening and diagnosis (PGS and PGD). Screening embryos for chromosomal abnormalities with PGS before transfer can offer prospective parents additional peace of mind: the process checks for aneuploidy, which means additional or missing chromosomes. These defects are a common cause of implantation failure and miscarriage. When patients are at risk for specific hereditary disorders, PGD is another layer of screening which can check for chromosomal translocations or single gene disorders. These additional screening tests have separate fees.

• Testicular sperm extraction (TESE). In cases of male-factor infertility where no sperm is present in the patient’s ejaculate, TESE is a minor procedure performed under local anaesthetic which allows sperm to be retrieved directly from the testicals. There is an additional fee for this procedure.

• Clinic success rate. For so many reasons, every cycle counts. When you are weighing the financial implications of IVF treatment, the number of cycles necessary to achieve a successful outcome is a crucial factor. The success rate of your chosen clinic, specifically their percentage of transfers resulting in a live birth, can have a huge effect on the overall cost of IVF for your family.

• Non-medical expenses. It is important to consider the additional cost of days off work to attend appointments and undergo procedures. If your chosen clinic is out of town, expenses such as travel and accommodation are also something to think about.

The emotional toll of infertility can be steep, and many couples find that the additional support and guidance of a professional counselor or therapist can be invaluable. A good counselor can help you process your experiences, gain clarity about difficult decisions, and cope with the ups and downs of your entire fertility journey.

What should I know before starting treatment? 

One of the most important things you can do to prepare yourself financially for IVF is to ask your clinic for a detailed list of procedures and corresponding costs. Transparency and honesty are an absolute must, and a responsible fertility clinic will not surprise you with hidden fees or unexpected procedures that have not been discussed in detail beforehand. You should feel comfortable asking direct questions such as:

• Are all tests, lab work and consultations included in the cost of treatment?
• Does the clinic provide financial counseling? Is there a fee?
• What insurance plans do you accept?
• What kind of financing plans are available? 

Discussions around money in the context of IVF can be difficult, and it is natural to feel nervous about taking on such a charged topic, but that should not stop you. When you are making big decisions about something as emotional and potentially life-changing as IVF, good information is indispensable. A strong understanding of what is involved on every level—including the financial—will allow you to enter the process with clear expectations and a sense of empowerment.