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The evaluation and treatment of fertility can be expensive, and is often not covered by insurance. A treatment cycle (the therapy for infertility is usually synchronized with ovulation, with each cycle representing an opportunity for a new “round” of treatment) can cost in excess of $5,000 for fertility medication, and as much as $10,000 for an assisted reproductive technology (ART), such as in vitro fertilization (IVF). If multiple cycles are attempted, the costs can add up quickly.

For many couples, the costs of fertility treatment are not covered by their health insurance, or their insurance covers only a very small portion of the expenses. As part of your initial evaluation for infertility, it is important that you meet with the financial counselor in your fertility doctor's office. This individual may help you better understand what coverage is, or is not, available for you, and may also help you to establish a payment program as well as help you identify alternative sources of credit or other financing options.

Thirteen states currently have some sort of infertility legislation on their books-Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New York, Ohio, Rhode Island, Texas, and West Virginia. These laws, or regulations range from mandates like those in Massachusetts that requires any insurance plan to pay for, or cover comprehensive infertility diagnosis and treatment, including assisted reproductive technologies (ART), to Texas, which only requires that insurance providers offer coverage of some fertility treatments should employers wish to purchase it. A summary of the current laws affecting infertility can be found on the website of the American Society for Reproductive Medicine at http://www.asrm.org/Patients/insur.html.

Generally, a health insurance plan is subject to state regulations only if your employer buys health insurance for you. If your employer has a self-funded benefits program (it administers its own health plan and does not buy insurance for employees from an insurance company ), your health coverage is regulated by a federal law (know as ERISA), which does not require coverage for infertility treatment. Other types of health insurance plans, such as those you buy as an individual or those purchased by churches, school districts, or other municipal agencies, may also be exempt from your state's insurance regulations. If you have a health plan and are not sure of your coverage, the best way to determine whether or not your plan is subject to state regulation is to ask your benefits manager at work and/or the financial counselor who works with your fertility doctor.

Resolve-The National Infertility Association ( www.resolve.org) advocates for insurance coverage for infertility diagnosis and treatment, and provides information on the subject including a review of federal and state regulations and pending legislation, and how individuals can become involved in the effort to impact their states. This information and related resources can be found on the Resolve website at http://www.resolve.org/site/PageServer?pagename=lrn_ic_home.

Last modified on: 3 January 2008