The average cost of just one IVF cycle starts at $12,000. That doesn’t include medications and tests (which can run several thousand dollars each), time off work, or the multiple rounds most patients endure: Only 30% of patients succeed the first time. The cost of a successful IVF tends to be closer to $61,000. For those in need of surrogacy, the price jumps to $90,000–up to $150,000. With little state and insurance aid, most patients pay out-of-pocket.
How do we expect millennials to afford that? (After all, they’re still burdened by school debt.)
“Fertility is often an unexpected expense,” explains Claire Tomkins, cofounder and CEO of Future Family, a startup specializing in personalized monthly payment subscription services for fertility care. “A very high percentage of people don’t seek treatment due to the financial aspect. It’s the number one reason people in the U.S. do not go forward with treatment. It’s also, not surprisingly, the largest stress point.”
Tomkins understands the struggle firsthand. The former marketing executive, 40, was inspired to launch Future Family after having spent over $100,000 on six rounds of IVF to conceive her first child five years ago. Like many Americans, the sticker shock felt unbearably high.
Infertility is often an unforeseen diagnosis that coincides with other major life events–like say buying a house–for which couples are not financially prepared to tackle. And so, a growing percentage are turning to a reliable support system: the bank of mom and dad. It makes sense: Baby boomers, regarded as the richest American generation, possess 54% of all U.S. household wealth. In comparison, millennials hold a mere 4%.
Future Family launched in 2016 and now works with 250 clinics. Since then, it’s seen over 50% of its clientele who seek financial support from their family. Specifically, the company experienced increased demand from patients who sought to include parents as co-signers.
So starting Wednesday, the company now permits a family member (or in-law) to take out a plan on behalf of their son or daughter. Dubbed the “Grandbaby Plan,” it’s the first customized fertility loan for IVF and egg freezing. Previously, the financial responsibility lay solely on the couple.
“We had lots of customers who were saying to us, ‘Well, my mom or dad wants to help me,” says Tomkins. “That was very much the origin of this.”
Future Family offers flexible subscription service plans that cover testing, medical expertise, a “nurse concierge” to handle medical appointments, and IVF or egg-freezing treatments. Plans start as low as $300 month. It also provides fertility testing via a lab at 40% less cost than those done at a traditional private clinic.
The company is centered around the philosophy that financial wellness is just as much a part of fertility care as any other treatment involved. Tomkins emphasizes Future Family’s mission to deliver “stress-free fertility care” by combining medical coaching with accessible financial products. That means (relatively) low-cost payments along with a concierge that guides you–and, well, now potential grandparents–through the entire, often complicated process.
“There is a whole layer of support that a lot of people have not experienced before when it comes to healthcare,” says Tomkins. “So the difference between say handing your child some cash or taking out a Future Family plan is an investment in actually making this a supported journey that actually feels good.”
There’s also the fact that many boomers don’t necessarily have the means to cut a $20,000 check up front. The Grandbaby Plan makes the cost more manageable for those who can’t necessarily raid retirement funds. Many, meanwhile, are no stranger to helping out adult children. A 2018 survey found that 53% of Americans between the ages of 21 and 37 received some form of financial aid from a parent. Of those, 37% received support monthly while 59% got help more than a couple of times a year.
Hasidah is a Jewish advocacy and non-profit organization that provides emotional and financial resources for those experiencing infertility. Founder and CEO Rabbi Idit Solomon works with numerous clients who partially depend on family assistance in addition to other revenue sources. On the more extreme end, she’s witnessed one parent completely deplete their retirement fund.
More often that not, Solomon encounters Baby Boomers overwhelmingly willing to help their kids. “If their child says ‘we’re really struggling with this,’ for many parents who have the means, there’s little conversation,” she says, “it’s turn to the checkbook.”
An unaddressed health care crisis
For the first time in U.S. history, the majority of new moms in the U.S. are over 30, thereby making medical intervention a more pressing reality. The CDC’s National Survey of Family Growth found that over 7 million women (that’s 12% of American women of reproductive age) have sought fertility treatment services. And yet, there’s a judgmental bias against those–particularly women–who wait to pursue having children.
Any infertility issue issue doesn’t improve with age, but at the same time, our economics incentivize delaying motherhood. For women who reproduce before age 35, their pay never recovers relative to that of their husbands.
“It’s a Catch 22 because you have you have to be financially stable [to have kids],” says Solomon. “The other reality is you’re still not addressing the other half of people who have infertility due to medical conditions … It’s unfair to judge people about their choices of how and when they’re going to have a child when there’s a variety of reasons as to why people experience infertility.”
Infertility care is one of the largest out-of-pocket health expenses that millennials face. It has more or less been treated as an elective, instead of what if often is: a reproductive disease. Betsy Campbell, chief engagement officer of Resolve, a fertility patient advocacy organization, is one of many leaders attempting to solve the accessibility issue.
“We don’t have these conversations about how cost prohibitive hip replacement surgery–because it’s covered by insurance,” says Campbell. Granted, IVF remains relatively new in terms of standards of care, but at this point, she argues, it can no longer be deemed an elective. (IVF accounts for a little under two percent of births in the U.S., but in certain European countries, it hovers over 10 percent.)
“Our insurance policies need to keep up with the changes in technology.”
Future Family is just one of a dozen female-led fertility startups that emerged in the last few years. It’s an issue that’s also seen more awareness among men, who have established their own reproductive care and sperm health companies. (One-third of all infertility cases are caused by male reproductive issues, and 30% of cases are a mix of both male and female infertility, according to recent research.)
But only a small minority seek assisted reproductive technology, undoubtedly because of the astronomically high costs. Campbell notes that IVF essentially becomes a luxury for those who can afford it–or the few who live in the states or work for companies with comprehensive coverage.
“We see people who have to raid their 401Ks,” says Campbell. “We know people who’ve had to move in with their parents or borrow from relatives. Many start GoFundMe pages … I have heard people joke that they’ve already spent a college fund for the kid– just to have the kid.”
A 2015 Resolve survey found that women aged 25 to 34 years accrued an average of $30,000 of debt after undergoing fertility treatment. Roughly 39% participants used credit cards to pay for their procedures, while 12.6% took out loans and four percent use their home as equity. While there are no hard statistics, anecdotally, Resolve has heard from patients nationwide who sought family assistance.
“Parents want to become grandparents,” says Campbell, “so it’s a struggle. This does impacts them. It’s a disease that really impacts the entire family.”
Much has been reported on Baby Boomers impatiently waiting for their adult kids to give them a toddler before they’re too old to play with them. In fact, some have taken up babysitting just so they get up close and personal with a baby: Childcare.com saw a sixfold increase in women aged 50 and up offering their services, with two-thirds reporting they had no grandchildren of their own. The Facebook group “Surrogate Grandparents USA,” boasts 4,5000 members looking to fill the empty hole that should belong to progeny.
Heck, ethicists now debate as whether it’s moral to “deprive” children of grandparental love by waiting too long to procreate.
Looping in one’s more financially secure parents undoubtedly offers yet another avenue for couples to pursue their dreams of having a family. But what are the emotional costs of putting the dream grandchild on eager grandparents’ credit card?
“They’ll do anything”
Author and relationship expert Andrea Syrtash was just 14 years old when she was diagnosed with infertility. She points this out to dispel the common notion that it’s a medical condition that only affects women who waited until their late 30s or 40s. One in 8 American couples experience issues with infertility.
Over the course of eight years, Syrtash underwent 18 fertility treatments and spent over $70,000 in order to finally have her daughter through a gestational carrier. She and her husband, a New York City teacher, dipped into all their savings throughout the process.
Although the New York Board of Education insurance coverage plan covers up to three IVF cycles, it wasn’t enough. At a certain point, the couple was forced to accept the cost of one round of IVF from Syrtash’s parents.
“My parents offered because they had seen we have been going through endless cycles and many, many years of treatment–and we were feeling cash strapped,” reflects Syrtash. “They said, ‘this is the most important thing we could support–whatever we can do to help.'”
In 2017, Syrtash founded Pregnantish, an online lifestyle publication dedicated to helping people navigate fertility treatments. Reader feedback attests to the high percentage of women struggling to afford care. In fact, Pregnantish recently launched a patient survey on why people leave treatment. One of the top reasons? Lack of funds.
“Infertility affects you on so many levels–emotionally, physically, and certainly financially. The mix of that can be so incredibly difficult for people,” explains Syrtash. “It’s hard enough that you have a failed cycle but then you may be billed $15,000-$20,000 for that failed cycle. It’s adding insult to injury.”
Syrtash applauds new programs such as the Future Family payment plan, noting that family members often ask how they can help couples. Now, there’s a way they can. However, mixing family and money often leads to a host of complexities.
Ann Meyers, 35, of Auburn, New York was diagnosed with a diminished ovarian reserve two years ago. She was therefore not a candidate for IVF. Instead, she’d need donor eggs. “It triples the costs,” she tells Fast Company.
Meyers works at a non-profit, while her husband is employed by a building management company. They simply didn’t have $30,000 on hand to pay for the embryo transfer and storage, as well as necessary procedures like intracytoplasmic sperm injection. When her in-laws suggested they could help, it was welcomed relief, but not without its own mixed emotions.
“I felt very uncomfortable,” admits Meyers. “I don’t like asking people for help or money … but [my husband] said, ‘my parents want grandchildren so badly. They’ll do anything.”
Infertility was a personal, painful issue that she was now forced to open up to greater family members. Not to mention, involving parents so very clearly invested in the outcome undoubtedly creates a heightened sense of pressure.
“I knew that if they were paying for it, I would have to keep them in the loop at every step–and every step isn’t necessarily a happy, positive step,” she explains. “It’s kind of being forced to share before you’re ready … but you feel like you have to because they’re so generously giving you this money.”
While Meyers concedes the financial gift has been “life-changing” and she’s incredibly grateful, many times she wishes she and her husband alone faced this journey. “It’s hard to feel like you have an obligation,” says Meyers. “They’ve given you so much money. If you don’t end up with a baby on the other side–that guilt is weighing heavily on me.”
Syrtash notes that all healthy relationships center on communicating expectations. When it comes to involving parents, she stresses the importance of explaining that an investment, i.e., treatment cost, does not guarantee a baby.
“Going in, there shouldn’t be strings attached that ‘I’ve just bought you a baby,'” says Syrtash. “But of course anytime money is involved, it can affect the dynamic of the relationship.”
In addition, some boomers might overestimate their savings. With adults living longer and standard of living expenses rising, they might deplete savings which could become necessary down the line. Not to mention, what if they themselves suffer a medical condition? Retirement is their backup too.
Tomkins is aware of the trickiness that accompanies involving parents–or better yet, in-laws–in financially securing their bloodline. “It’s one of those fraught topics,” she says.
Future Family has no plans to solicit or target boomers; there will be no “ensure a grandchild” Christmas gift campaign. Instead, the program will be communicated to current and future customers, offering them one more solution during the financial process. It will soon grow to include siblings, relatives, even friends. At any point, all members are welcome to speak with a specialist who can field any questions or concerns.
“It’s a deep part of our philosophy–that if tech is going to make medicine better, it’s going to make it more personal,” says Tomkins. “It just turns out that involving your family is one of those really good ways to move forward.”
Still, Tomkins concedes she might open the floodgates for awkward Thanksgiving discussions. Once the boomers get word, they might just demand their part in the fertility journey. “I feel a little guilty that we might be unleashing a lot of pushy mother-in-laws,” she laughs, “but we’re taking our chances here.”