Priced out of parenthood

Hidden costs can break some families before they even begin.

“We were trying to have a baby for a year,” Beth (not her real name) told me.

In that interminable time, she winced through three baby showers for former bridesmaids; one tearful call from her sister-in-law, who was now expecting her fourth; and countless Instagram pregnancy announcements from people she didn’t even like. Everyone could get pregnant but her, and everyone had opinions on what she should be doing.

When she decided it was time to consult a professional, the oversubscribed fertility clinic was booked two months out. Still, one day she got some testing and a reproductive endocrinologist walked her through her options. Keeping in mind her age (34), and her goals (two kids), it might be time to start thinking about IVF.

She prepared herself for this moment.

She had consulted her health insurance well before arriving at the clinic, and knew she would be covered for two cycles. But there was a catch: the front desk team explained that while her treatment was covered, the meds that facilitated it were not—and one can’t proceed without the other.

Beth was devastated. She waited to start trying until she had bought a house, which drained her savings. She turned down a promotion because the mental toll of trying precluded any more variables in her life. She thought she had done everything right, ordering her choices, doing her research, ensuring she was prepared to build her family. But the math of paying for medication out of pocket was brutal: she just didn’t have $5,000 lying around.

The cost conundrum

IVF is expensive. Most of us know this in the same way we know a root canal or an emergency room visit is expensive. But even for the planful and informed, understanding exactly how expensive can be a maddening exercise. Insurance coverage is inconsistently available and often piecemeal. Medications and certain tests often add a Russian doll of hidden fees.

The average cost of a single ‘cycle’ of IVF — beginning with the artificial stimulation of a patient’s ovaries to produce eggs and concluding with the transfer of an embryo to the birth parent’s uterus — is commonly over $25,000. But a single IVF cycle is rarely sufficient, and so, the actual cost to have a healthy baby is typically much higher, and much harder to predict.

Drugs make up 25-50% of total cost of IVF and to figure out the exact amount you have to walk through a labyrinth of middlemen. For any given cycle, you can expect to be on 7-8 drugs which as a whole are patented, brand-only, and narrowly controlled by a few distributors. Over the last decade fertility medications have skyrocketed by 84% in cost—outpacing the 37% rise in list prices across all prescription drugs.

Sometimes these medications are covered by insurance and sometimes they are not. Even when they are, you are routed to a pharmacy benefit manager which may charge several times more than the amount you would pay if you had no coverage at all. Some savvy fertility patients opt to pay out of pocket even when they have insurance, so they can save as much of their fertility benefit allowance as possible.

Then there is the optional testing, referred to in the industry as “add-ons.” Add-on tests can be exorbitant even if they have little to no evidence of benefit. The Human Fertilization and Embryology Authority of the UK publishes a whole list with bright red exclamation marks next to tests that are best avoided. And yet, many are pushed onto patients anyway.

The average person seeking help could easily spend $180,000. ChatGPT tells me this is roughly the cost of a Porsche 911 Turbo S.

For those who opt to screen embryos for genetic diseases, PGT testing can easily add another $5000 to the total bill. And there is good reason to believe most families are pushed to consider PGT testing regardless of whether it is likely to be helpful.

Then there is the fact that most people will not have a baby on the first try. On average, women go through three failed IUI cycles and two or three or four (or five or six) rounds of IVF before successfully conceiving. Only 33% of people undergoing IVF get pregnant during their first IVF cycle, and just 54-77% of women undergoing IVF get pregnant by the eighth cycle.

The average person seeking help could easily spend $180,000. ChatGPT tells me this is roughly the cost of a Porsche 911 Turbo S.

The whole iceberg

A staggering 70% of all women undergoing IVF incur debt. And still, the financial hits are, at best, the tip of the iceberg. To find the base, I consulted Reddit.

Take a quick peek at the 63,000 member-strong r/IVF and hidden cost horror stories abound. “Why is it that on top of an already expensive process there’s a $750 coordination fee each cycle AND $550 anesthesia fee that insurance won’t cover?” one person comments.

Another was told over and over that they had full insurance benefits, but are now $11,000 over their out of pocket maximum and still counting thanks to “cycle management fees, other self pay only procedures, required mock cycles, meds that aren't covered.” A third says that their clinic charged them $1500 just for the surgical suite they did their egg retrieval in.

It’s not just that treatment is expensive, it’s that the process of navigating the payment system adds extreme stress. And the scope of the emotional burden is not commonly understood—or attended to.

Fertility can be existential. It taps into our deepest needs, doubts, and desires. Talk to an REI and they will tell you much of their first appointment with any patient is spent just telling them none of this is your fault.

Researchers have found that receiving an infertility diagnosis as just as anguishing as receiving a cancer diagnosis. In total, 56.5% of women and 32.1% of men in fertility treatment report clinical range depression symptoms, with 75.9% of women and 60.6% of men scoring in the clinical range for anxiety.

78% of fertility patients say they have actively limited social interactions, such as weddings, baby showers, and family gatherings, due to emotional stress.

A recent study of 893 insured women who chose to end their IVF treatment found that the lead reason for this choice wasn’t cost (25.1% attributed the reason to out-of-pocket costs and 24.6% attributed it to lost insurance coverage). The leading reason people abandoned their treatment was the stress it imposed (40.2%).

This week, in recognition of National Infertility Awareness Week, Maven Clinic published a far-ranging study on these hidden costs of fertility care. 78% of fertility patients say they have actively limited social interactions, such as weddings, baby showers, and family gatherings, due to emotional stress. Nearly half had turned down promotions, and 77% had downplayed their symptoms at work.

Access and beyond

For every person in the United States who accesses IVF, there are at least eight more people who may need it. This unfulfilled demand has pushed IVF to front page news, the kind of thing presidential candidates talked about on a debate stage, the subject of executive orders and countless op-eds. Search results for the term alone have ballooned by 25% in recent months.

Right now the Trump administration is contemplating multiple methods to expand access and affordability. They may choose to provide coverage for the Federal workforce and military, to include preconception care as an “essential service,” to use waivers that encourage more states to mandate IVF coverage as California recently did.

There are also multiple policy proposals to bring down the prices, to ensure we are paying for good outcomes rather than additional cycles or questionable tests, to simplify the labyrinth and to root out the hidden fees.

I am hopeful for progress here but also keenly aware that families need help with all the costs they face. Even if every hidden fee vanished tomorrow and every insurance plan covered every cycle, the emotional toll would remain. Fertility care is a gauntlet, not just because of what it costs, but because of what it asks of people: to stay hopeful amid repeated heartbreak, to manage a full-time job while being a full-time patient, to absorb disappointment while fending off isolation.

The data are clear: stress is not a side effect, it’s a leading reason people walk away from treatment. And it’s not just about attrition—it’s about dignity. Every person trying to grow their family deserves to feel seen, heard, and supported. They deserve a system that meets them with compassion, not just co-pays.

What my team is reading, building, and working against:

• Far before anyone makes their way to a fertility clinic, trying to conceive is exactly that: a lot of trying. I was moved by the raw, unfiltered humanity of this Substack by

  Sarah Furniss
  . It beautifully captures the quiet grief, the invisible labor, and the emotional weight that so often goes unseen. Read it to better understand what so many endure in silence—and let it move you to show up with compassion.

• ACOG has released new recommendations about prenatal care, moving away from the rigid 12-14 in-person visit model towards a more flexible model that incorporates telehealth patient preferences, risk level, and social factors. Not only is this guidance a win for common sense, and for Maven’s care model, it was an effort led by our former Visiting Scientist, Dr. Alex Peahl!

• Pregnancy-related death rates in the United States rose almost 28 percent from 2018 to 2022, ballooning at the height of the pandemic in 2021 before subsiding somewhat in the years since. New research from my colleague Dr. Rose Molina in JAMA finds that of those deaths, almost one-third took place more than six weeks after childbirth. This is not only a time when most new parents decide the worst is behind them; it’s also a time when the healthcare system largely unplugs from the process. It also suggests what we already know: virtual care can be an essential stopgap and potentially even life-saving.

• Fresh off of our longevity piece from earlier this month, I loved the can-do simplicity of this perspective published in the NYT—crucially not about how to avoid aging, but how to age happily.

• The inimitable futurist

  David Sable
  published a terrific article envisioning what fertility care will look like in 25 years. He explores how emerging technologies—from AI to automation—could transform IVF from a bespoke, resource-intensive procedure into a streamlined, scalable solution. It is a must-read for anyone thinking about the next frontier in reproductive medicine.