Starting a family is an expensive proposition. The cost of childcare went up by 70% between 1985 and 2011, despite little growth in wages. Across the U.S., couples reportedly spend a quarter of their income on childcare, with single parents spending double that. But the costs associated with parenting begin well before you’ve welcomed a child into your family. In 2019, aspiring parents, whether heterosexual or same-sex, have many options if faced with fertility issues—provided they can afford them. Forget the costs of caring for a kid; for same-sex couples, single people, or those facing fertility issues, the expense of having a child in the first place can feel insurmountable.
One cycle of IVF can cost at least $12,000 before medications—or before additional cycles if the first doesn’t take, which is the case for countless couples. Adoption can cost upward of $40,000 whether would-be parents use a private agency or attorney to broker the process, and there’s a reason surrogacy—which can rack up bills well into the six figures—is often associated with celebrities.
Despite this, more people are turning to surrogates—in 2015, there were reportedly 2,087 babies born through surrogacy, up from 738 babies in 2004—but that’s still a fraction of the nearly 4 million babies born that year. Some women who are delaying motherhood have also turned to egg freezing, which can cost $10,000 or more depending on the number of cycles.
Many companies now recognize the value of offering fertility benefits, likely in an interest to remain competitive. Tech giants like Facebook cover a set number of IVF cycles, while others, like Tesla, offer unlimited coverage. Of companies with more than 20,000 employees, more than 40% reportedly now provide some kind of IVF benefit.
And yet more than 63% of IVF patients in 2017 had no coverage, according to the database FertilityIQ. We asked five people about what it cost them to build their options, whether they opted for IVF, surrogacy, egg freezing, or adoption. Some had partial insurance coverage; others had to work around what they could afford.
We paid about $20,000 out of pocket for IVF
“Once you decide you want to have a baby, it’s really hard to un-decide that,” says Sam Seleski, who turned to IVF after nearly two years of trying to conceive. Around that time, Seleski also switched employers, which meant she no longer had any fertility coverage through her company.
“We had thought about getting a house,” Seleski says. “But once we knew we were going to pay out of pocket, we decided to hold off.” Her husband’s yearly bonus went toward the IVF payment, and the couple saved up in advance of the treatment. “Luckily we didn’t have to go into debt to do it,” she adds.
Seleski and her husband were fortunate to get pregnant after just one cycle of IVF—albeit a very expensive one, at $17,000. But the costs don’t end there. Since the couple wants to have more kids, they’re currently paying $750 a year to house their embryos in a clinic; assuming the embryos thaw successfully, it’ll run them anywhere from $3,000 to $5,000 to transfer the embryos. “So it costs less the next time, once you go through the initial process,” Seleski says. “That is, if it works.” Since Seleski was on the younger side, the couple skipped genetic testing, which would have cost them more than $1,000 per embryo.
It’s little surprise, then, that Seleski—who gave birth to her son last year—plans to prioritize fertility benefits as she job hunts. “I’m hoping to go back to work in the fall,” she says, “and the benefits package is a big factor in whether or not I will interview with a company. I think it makes a big difference, especially when you think about how much employers are asking of their employees.”
IVF is also a big time commitment. “When they’re doing the implantation or before they harvest your eggs, you’re going [to the clinic] multiple days a week,” she says. As someone in a leadership role, Seleski had the flexibility of dictating her own schedule—but she still found herself having to sneak an injection when she had to work late to host an event.
And there’s always a chance that none of the time or money may yield results. Seleski started with 20 viable eggs, of which 13 were successfully fertilized. Two days later, she learned that just six were dividing. But Seleski didn’t know how many had reached “blast”—when the embryo has divided enough to be successfully implanted—until she went in for the embryo transfer. “I showed up and they were like, okay, we have one embryo,” she says. “Out of 20 eggs, 13 fertilized. And we had one that was ready to go.”
We paid more than $30,000 for IUI and IVF
Kelly and Jaclyn Pfeiffer’s first attempts at getting pregnant were through artificial insemination at home (Kelly is a nurse) and then at the doctor’s office. Neither approach worked, and after a series of tests, the couple discovered that Jaclyn had polycystic ovary syndrome and polyps. After medication and surgery, they still weren’t able to get pregnant. “We were told our best chance was IVF,” Kelly says. “So that’s when things got expensive.”
The first quote they got was $40,000. “We couldn’t afford that, so it kind of felt like that was the end of the road for us,” Kelly says. But they kept looking and came across CNY Fertility in New York, which quoted just $3,900 for a cycle. (They live in Florida and had to travel to and from the clinic, but it was still cheaper on the whole.) After a failed embryo transfer and multiple cycles of IVF, they finally got pregnant and gave birth to twins in May. “They’re nontraditional twins,” Kelly says. “The girl is biologically mine, and the boy is biologically my wife’s, but I carried both of them.”
They now owe in the range of $21,000 to two clinics, which doesn’t include other costs, including medication and donor sperm. In total, Kelly estimates that they’re out more than $30,000. “We looked at all options,” she says. “Most people don’t realize this, but adoption can be way more expensive than IVF.”
As a same-sex couple, Kelly and Jaclyn also encountered a number of hidden fees. Since they did reciprocal IVF—they used Jaclyn’s eggs for their son—they had to pay for two egg retrievals, which amounted to an additional fee of nearly $5,000. “In order to be genetically connected to the baby, a man doesn’t have to go through a sperm retrieval,” Kelly says. To store both their embryos, they had to pay twice as much as a heterosexual couple (with a single set of embryos) would.
The Pfeiffers’ finances are tight. “We both work in the school system,” Kelly says. “Our benefits do not cover anything fertility-related. And because we’re in the school system, we have very limited salaries. There’s not a lot of room for growth.” When they did inseminations, the couple would budget for one vial a month. And since their IVF clinic offers in-house financing, Kelly and Jaclyn are paying that off in monthly installments. At many companies, fertility benefits are still paltry—so much so that Kelly says some people pick up additional work to secure employee benefits that will subsidize their fertility treatments. “In infertility groups online, there are so many people that have prestigious jobs but work for Starbucks [part-time] to get infertility coverage,” she says.
The irony of not having fertility coverage as someone who works in healthcare—and with children—isn’t lost on Kelly. “Not only do I work as a nurse, but I spend my day with children because I work in a school,” she says. “And my wife teaches kindergarten, so she’s raising other people’s kids, but doesn’t have coverage to make her own.”
We spent about $3,000 to adopt through foster care
When Matthew Ramsey and his husband started talking about children, they ruled out options like IVF and surrogacy almost immediately. “For us, assisted reproductive technology was never really something we considered because we had heard about the costs associated with that, and that felt too high,” Ramsey says. “We also knew there were tons of children out there who needed safe and loving homes.”
Since traditional adoption is also steep, the couple chose to adopt through foster care and found an agency in Seattle that had worked with a number of LGBTQ families. Once they were licensed to be foster parents, it took about a year and a half to find their sons. “We were placed with them in May 2014—they were just 3 and 5 at the time and are biological brothers,” he says. “In October 2015, we adopted them.”
Of all the ways to start a family or contend with infertility, this might be the cheapest option. Ramsey and his husband had to pay their adoption agency, Amara, about $3,000, along with attorney fees that were reimbursed by the state. While fostering their sons, they also received a monthly stipend, though that didn’t cover all their childcare expenses. Parents who want to adopt through the foster system can even opt to work directly with the state and skip paying a go-between like Amara. “So if you’re going the foster-to-adopt route, it’s next to nothing,” Ramsey says.
But as with all fertility treatments, the emotional costs remain. About 60% of foster children eventually return to their birth parents or other family members. If you foster a child with the hope of adopting them, there’s always a chance they may return to their birth family. “There are very limited financial costs, but the trade-off is reunification with their birth parents,” he says. “So that’s the risk or potential cost. If you go into it hoping to become a forever family, and that’s taken away from you, that can be very, very hard emotionally.” That’s one of the reasons the couple worked with Amara—the agency assesses a “risk level” with each child.
More than half of adoptions in the U.S. happen through the foster system, according to the Adoption Network Law Center. But Ramsey notes that for some parents who want to adopt through foster care, the process can feel daunting. It took Ramsey and his husband about a year and a half to get licensed to be foster parents. “You have to take a lot of classes and do a home study and write a lot about your background,” he says. “It just takes time. It can be intimidating and overwhelming to go through that process.”
Some people may also fear taking in children who’ve experienced some kind of trauma. “People hear horror stories about children and what they might be getting themselves into,” he says. Plus, same-sex couples, in particular, risk being discriminated against when they try to foster or adopt. “There are 10 states right now that allow foster and adoption agencies to receive federal funding and discriminate against prospective LGBTQ parents based on their gender identity or sexual orientation,” he says. “So I think there are a number of people willing to foster and adopt, but they get turned away.”
Though the finances were manageable, Ramsey points out that employers offer little support to people who become parents through foster care. “Some employers are now giving time off for folks who adopt,” he says. “But if you’re going the foster-to-adopt route, when I needed time off was when I got placed with the boys, not when I adopted them. So that’s just something else I would love corporations to think about.”
We paid $180,000 to have a baby via surrogate
It’s not just certain states in the U.S. that make adoption difficult for some LGBTQ couples. In Israel, adopting a child as a gay couple is virtually impossible. “Even though Israel is very advanced with laws for gay couples, there’s still a problem with adoption,” says Natan Elkanovich, who lives in Israel.
Surrogacy, too, is walled off to same-sex couples in Israel, as well as in countries like India and Thailand, where it would be more affordable. That meant that Elkanovich and his partner, Rosario Nistico, opted to go with a surrogate based in Los Angeles. “The process in the U.S. is three times as expensive,” he says. “But we had no choice. We wanted a baby.”
So began the long, expensive process of surrogacy. “You can do almost everything online, but you have to come to the U.S. for the medical stuff—to give sperm, get checked, and do genetic testing—and if possible, to meet the surrogate,” Elkanovich says. The couple ended up making another trip for the gender reveal and then returned for their son’s birth, when they had to stay in the U.S. for more than six weeks to finish all the necessary paperwork. Between multiple trips to the U.S. and medical bills, the surrogacy process cost Elkanovich and Nistico a whopping $180,000 in total.
As an artist, Elkanovich admits surrogacy would have been a much greater financial burden if he hadn’t sold work that could help cover the costs. “Thank God I had a few good years and I sold a lot of paintings,” he says. And while the couple had a positive experience both with their surrogate and the organization they worked with—US Surrogacy—the process was by no means simple. “There were many, many nights we weren’t sleeping,” Elkanovich says. “We had to talk with a lawyer, surrogate, medical center, and surrogacy agency. And we could only do those things at nights, during working hours in the U.S. It was a stressful period.”
From beginning to end, starting a family through a surrogate took the couple about three years and about $60,000 more than they were originally quoted. Despite this, Elkanovich and Nistico have an embryo on ice for when they’re ready for a second child. “It was all worth it in the end,” Elkanovich says. “Our son brings us so much joy.” Having a second child will be a cheaper, but will likely cost the couple about $100,000. “We need God to open the gates again to sell more paintings,” says Elkanovich.
We spent more than $25,000 on IUI and IVF
Much like the Pfeiffers, Tatiana Quiroga and her wife faced a number of hurdles while trying to start a family, from tracking down a doctor who worked with LGBTQ patients to finding the right sperm donor—all while trying to mitigate costs. “One of our challenges was that my wife is white and I’m Latina, and we wanted to make a family that resembled us as parents as much as possible,” Quiroga says. “Looking for donors that resembled me was actually quite challenging.”
At the time, neither of them had any insurance coverage for fertility treatments, so they opted for artificial insemination instead of IVF. That meant only Quiroga’s wife could carry the child and use her eggs. “People think lesbians kind of go into it with the advantage or privilege of having two uteruses,” Quiroga says. “But I’m not able to carry, so that took me off the table.” It took a year for them to conceive—and nearly $15,000 out of pocket. Each try cost about $1,000, and then there were additional procedures, including acupuncture costs, and the cost of sperm and storage.
“From there, it was a very smooth pregnancy,” Quiroga says. “So we felt pretty lucky when it came to that.” But this was in 2011, before same-sex marriage was legalized by the Supreme Court, which meant that as the non-biological parent, Quiroga had to adopt her own child to be legally considered her parent. “Being the non-biological parent, I still had to adopt them. With our oldest child, I had to do a second parent adoption. We had to do home study, background tests, fingerprints—it was a private adoption.” That put them out an additional $10,000.
By the time Quiroga and her wife were ready for a second child, she had coverage for fertility treatments through her employer, with about 70% coverage for IVF. But there were caveats: The couple had to prove they had tried other options before they could be granted the coverage. “With any of the insurance coverage, they want you to do your own ‘trying’ for a year before you’re diagnosed with fertility issues,” she says. “As a lesbian couple, how the hell are you supposed to do that?” That meant they still had to undergo IUI (intrauterine insemination), and spend thousands of dollars out of pocket, before IVF was even an option. Quiroga still had to adopt her second child, even after same-sex marriage was legalized, but this time, as a stepparent.
But as taxing as the process can be—emotionally and financially—Quiroga remains positive. “I really am a true believer that if you’re trying to create your family, the perfect little soul will come to you some way or another,” she says. “You may have started off your journey with IUIs and found yourself now adopting. Be open minded and take peace in that if you want to become a parent, you will become a parent. It may not be in the way you originally pictured and planned, but whoever that child is will come into your life.”
My company paid for me to freeze my eggs
For some people, fertility costs start mounting long before they want to get pregnant. In San Francisco, where Aditi (not her real name) lives, more people are taking advantage of egg freezing. Aditi first started seriously thinking about freezing her eggs after attending an info session by a fertility startup a few years back. When her law firm started offering the procedure as a benefit, she jumped at the opportunity.
If sponsoring egg freezing is a competitive advantage for companies seeking talent, it can feel like insurance for ambitious women. (It’s also become something of a luxe benefit for women who are both privileged enough to work at a company that covers the treatment and privileged enough to afford it even otherwise.) But whether or not an employer covers the procedure, egg freezing is now yet another cost associated with starting a family, one that compounds the already high price tag of fertility treatments.
Aditi says it was an expense she could afford even without assistance from her employer. “I was really planning to do it either way,” she says. “Fortunately for me, it wouldn’t have been that much of a financial burden.” For her, freezing eggs was about keeping her options open. “I’m not someone who felt like I definitely want to have kids,” she says. “I had assumed that I would, but I haven’t felt some strong pull, and certainly not for biological kids. But I felt I should do this because I didn’t want to be 38 or 39 and wonder why I didn’t do this. And I don’t know how I’m going to feel in five years. I’m looking out for my future self.”
More than 20,000 women across the U.S. have had their eggs frozen, according to the New York Times, but most of them—about 85%—have not thawed them. That means there isn’t much data on how many of these eggs yield a viable embryo. And experts say thawing eggs is more complicated than thawing embryos. “As I was doing the shots, I would find myself, like, looking at these message boards,” Aditi says. “And I realized you really don’t know what is going to happen. You could get a good number but then they’re all trash, in some way. Or they’re fine, and maybe your partner’s sperm is also fine, but when they fertilize embryos, it just doesn’t happen.”
The women who work at companies that sponsor egg freezing may not bear the financial burden of the procedure. But Aditi does worry that women might be lulled into a false sense of security—and make decisions about their careers and parenthood accordingly. “I think it’s a great option for people,” she says. “But I think we could start to see some issues if people take it and say, ‘Now I’m 100% set.'”
Many of her friends who have frozen their eggs are a “certain kind of person,” she says. “I think for people like that, you really don’t want to feel that you have failed in some way,” she says. “In a different time, if you were a woman who’s over 30 and single, you might feel that way—that your clock is running out. Now people can kind of deal with that feeling by doing this. They can feel like, ‘I’m fine. I took care of this. I don’t have to feel like I’ve failed in some way.'”