Is IVF actually right for you?

Interested in having a baby outside of the bedroom? In vitro fertilization is just one of many options on the reproductive technology table. This episode, Life Kit reporter Andee Tagle shares how to choose the right conception method for you -- from planning out your timeline to the financial and legal questions you should ask. Follow us on Instagram: @nprlifekit https://www.instagram.com/nprlifekit/?hl=en Sign up for our newsletter here. https://www.npr.org/newsletter/life-kit Have an episode idea or feedback you want to share? Email us at [email protected] mailto:[email protected] Support public media with NPR+ and enjoy perks for over 25 podcasts like this one. This show’s perks include sponsor-free listening and convenient playlists of popular help topics like personal finance, getting healthy, and more. Learn more at plus.npr.org http://plus.npr.org/. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

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• 0:01Speaker 00

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• 0:25Speaker 02

  You know, people think about IVF as this sure thing, and it's not a sure thing. And that kind of topples people over when they're like, well, I was banking on IVF.

• 0:34Marielle Segarra?

  Yeah. People talk about it as a type of insurance policy, but it's really not a guarantee.

• 0:41Speaker 02

  Yeah. And it's not even necessarily the best choice for everyone trying to start a family. Just listen to reproductive endocrinologist Dr. Lucky Secon. She's who we featured in our first story on how to get pregnant.

• 0:54Speaker 07

  There's a whole swath of women in my generation that feel blindsided and that feel they didn't have all of the correct information. And maybe with the advent of egg freezing and all this chatter and headlines about IVF, they actually had an overconfidence in how much science can overcome. And I see that every day.

• 1:14Marielle Segarra?

  Well, we are going to set the record straight today. You're listening to Life Kit. By the way, I'm Marielle Segarra, and I am talking to Life Kit reporter Andy Tagle about the things to know when you're considering getting pregnant with the help of reproductive technology like IVF.

• 1:29Speaker 02

  That's right. And it's not just IVF, by the way. The umbrella term here is ART. That stands for assisted reproductive technology. I'm going to apologize upfront because that is not the last of the acronyms coming your way. What we're going to do today is give you a lay of the land. So we'll break down some of the different options available, the general price of those options, timelines, some legal considerations, and how to deal with your feelings as you go through it all. That's coming up after the break.

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• 3:14Speaker 02

  No matter your specific situation, I'd bet if you're listening to this episode, your list of potential worries is a long one. And on the top, a great big, where do I start? Or, when do I start?

• 3:30Speaker 10

  Don't start with the paperwork. There'll be plenty of paperwork. Start with the family that you want to build in mind.

• 3:38Speaker 02

  This is Janine Oliaga, a family formation attorney and reproductive rights advocate. And she brings us takeaway one. To find the right fertility path for you, start by defining the picture of your ideal future family. And then, plan your runway. As in, what's your ideal family size? When you close your eyes and look at that future family portrait on the wall, how many little ones do you see? Is it important to you that the children staring back at you actually look like you? Or your partner, if you have one? Do you

• 4:16Speaker 09

  feel strongly about experiencing pregnancy? I always recommend to start this process one or two years before you're actually ready to get pregnant.

• 4:24Speaker 02

  Maria Goodman is a licensed midwife and co-author of the book, Baby Making for Everybody. Family building and fertility for LGBTQ+ and solo parents.

• 4:34Speaker 09

  And I focus a lot on empowering queer folks and solo parents throughout their family-building journeys.

• 4:40Speaker 02

  Maria's top recommendation to all the people they work with, if the luxury is available, is to give yourself as much time as possible. Let's go through the motions of building that ideal family to better understand why that timeline is so important. Making a baby, we know, requires three ingredients: egg cell, sperm cell, and a uterus. So if you don't have all those things ready to go, the next step in building that family portrait will be figuring out how you want to go about sourcing whatever components you're missing. For example, if you have two uteruses in your relationship, or your partner has motility issues, you'll have to decide where your sperm is coming from.

• 5:25Speaker 09

  It can take a long time to understand your choices between a known or directed donor, someone in your community that you want to enter into a legal and relational contract to become the sperm donor, or go through the bank.

• 5:43Speaker 02

  Let's quickly note for the record, the process of choosing a gamete donor, meaning someone who donates their egg or sperm cells, could probably have an episode all its own. Because Maria says a lot of people can get really stuck in this part of the process. But since we're only dreaming for now, here's a way to start narrowing down your options.

• 6:08Speaker 09

  Choose your five most compelling, rank them, one through five, and then let your top three guide you.

• 6:16Speaker 02

  Once you have those sorted, you have to actually go and find that donor. If you go through a sperm or egg bank, the process can be quick, once you've made a decision. Like, three to five business days type quick. Going the fresh route can take much longer, anywhere from a few weeks to half a year, depending on who or what you're looking for. Plus, getting all the necessary testing done and contracts written up. And if you need a gestational surrogate, you can plan to tack on anywhere from a few more months to a few years to find the right match. And when you've made it through all of that,

• 6:59Speaker 02

  it's time to prepare physically. Let's note, this might be a more extensive process for some than simply tracking your cycle.

• 7:08Speaker 09

  So I work with a lot of trans men who decide that they want to carry a pregnancy. And we know from some small but well-done studies that it takes about three to four months for people going off of gender-affirming hormone therapy to return to ovulation and be able to conceive. And before doing that, we strongly recommend setting up major support systems, because it can be a big emotional undertaking.

• 7:37Speaker 02

  Now, we're only talking hypotheticals, but you can see how quickly the time can start to add up, right? And we haven't gotten to the procedures yet, which brings us to takeaway two. Which ART is right for Y-O-U?

• 7:58Speaker 10

  There's so many different paths to parenthood through all different means: gestational surrogacy, egg donation. So there is no one way to become a parent.

• 8:09Speaker 02

  Generally speaking, finding the right path will depend on a few different factors. Primarily, age, health, and budget. We'll start with age. Let's say you and your partner are both currently 38. And that future family portrait features two, maybe three, perfect, precocious little ones, all with matching PJs and one of their grandma's curly locks. Here's Dr. Lucky Secon again.

• 8:41Speaker 07

  The American Society for Reproductive Medicine says, if you're 38 and older, and you know you want to have two children, and you haven't started that journey yet, it's very reasonable to consider interventions like IVF to freeze embryos, given what we know about how fast the biological clock begins to tick.

• 9:00Speaker 02

  Oh, the biological clock. You might have heard that this clock starts ticking around age 35. Lucky says there's no on-off switch like that, but 35, for people with uteruses, is considered somewhat of a turning point. So if you were to map out on a chart the health of your egg cells through your lifespan, age 35 is when you start to see a downward slope. Because the proteins that keep the chromosomes in egg cells lined up correctly slowly begin to break down with age.

• 9:35Speaker 07

  But I want to say that nobody has perfect eggs. Even in our 20s, 20% to 25% of embryos will have missing or extra DNA. And that increases to about, maybe a third of them at 35.

• 9:50Speaker 02

  By 37 or 38, your odds are more like 50/50. And by age 40, the split is 70/30, meaning up to 70% of the time, an egg cell will have missing or extra DNA. So it's going to be harder to have a viable pregnancy naturally. Your number of eggs also decreases with time, and starts to decrease more rapidly around, you guessed it, age 35.

• 10:24Speaker 02

  And this can be true of sperm quality, too, by the way. So you want to take all of this into consideration before choosing a treatment option. If you're on the younger side, like mid to late twenties, and you know, you want to have a family, but maybe later down the line. Lucky says it might be worth exploring freezing eggs or embryos now, if you can, or sooner rather than later.

• 10:49Speaker 07

  It's kind of like giving yourself a head start should you ever need IVF because the egg count and quality decreasing can make it harder, even with the best of technology to overcome infertility.

• 11:02Speaker 02

  If you're on the young side or somewhere in between, say, early thirties, but you don't have a ton of disposable income, or you don't like the idea of lots of needles. There are less medicalized ways to go about the process. Maria is a practitioner of at-home intrauterine insemination, or IUI, which is a far less involved, less invasive method of trying to conceive than IVF. With IUI, a sperm sample is collected and then washed, so only high-quality sperm are left. That sperm is then inserted into the uterus using a catheter during ovulation.

• 11:45Speaker 02

  It's a more budget-friendly option and is more likely to be covered by insurance, but it also has a lower success rate than IVF at any age. One study, for example, clocked the pregnancy rate for patients under 30 as 52.3% for IVF, while IUI yielded 39.2%. So if you're older than 35 and you've been trying for more than six months, or if budget isn't a concern and you want to go straight for the best odds, maybe you do head straight to your nearest IVF doc. But you should know that there are trade-offs.

• 12:27Speaker 02

  In vitro fertilization involves surgical procedures, daily hormone injections, and monitoring over a period of four to six weeks per cycle, all of which come with separate price tags. And while it's an effective option for many people, not everyone will be a candidate for IVF. If you suffer from certain high-risk health conditions like severe heart or lung disease, for example, severe mental health disorders, or are past a certain age and unwilling to use donor gametes, you might not qualify for treatment. And with all of these options, it's important to note that many people don't get pregnant

• 13:12Speaker 02

  on the first go. So it's important to build in buffer time, not to mention an emotional and financial buffer for multiple tries. Maria says they often help their clients to come up with a loose plan based on their ideal.

• 13:30Speaker 09

  And that usually involves three to four tries with a certain method and then changing something, so changing either the method of conception, the donor sperm. It can be a winding journey and we don't know what options are going to make the most sense until we're there.

• 13:49Speaker 02

  After the break, let's talk that baby-making budget.

• 14:03Speaker 03

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• 14:58Speaker 02

  So maybe now we have an idea of what the path ahead could look like. The dream is hazy at the edges, but it's starting to take form. Now it's time for an ice-cold bucket of reality.

• 15:15Speaker 08

  So we typically say an average IVF baby costs $70,000, seven zero.

• 15:22Speaker 02

  This is Angela Rastagar, the co-founder and CEO of Sunfish, a fertility financing company.

• 15:31Speaker 02

  Before starting her business, she worked for another large fertility firm where she was tasked with helping clients understand the full cost of becoming parents.

• 15:40Speaker 08

  People would cry to me on the phone or, you know, sell their engagement ring or dip into their 401K. And it was just really breaking my heart to see people making these very difficult financial decisions. Takeaway three.

• 15:56Speaker 02

  Becoming a parent through ART can be a big investment. Understand the full financial picture before you sign on any dotted lines. The first bit, retrieving and freezing the eggs, assuming they're your own.

• 16:14Speaker 08

  That's typically between $8,000 to $15,000 or so, plus medication. You're going to need different medications just to retrieve them.

• 16:23Speaker 02

  If you're going to go through a full cycle, so you're going to fertilize those eggs

• 16:28Speaker 08

  and sperm, test the embryos, and then transfer them to a uterus. We typically see an IVF cycle cost about $25,000 plus medication, which is typically another $5,000 to $10,000. And each time you do another embryo transfer? That usually costs another $4,000 to $7,000 or so. So you have to pay for that each time. And it takes most people a few attempts to go through that whole process.

• 16:57Speaker 02

  And if you don't have all your own ingredients, don't forget you'll have a few more things to add to your shopping cart.

• 17:06Speaker 02

  Donor sperm. $1,500 to $2,000 each. Don't forget to multiply by four to six attempts on average for people with no known fertility issues.

• 17:18Speaker 08

  Donor egg. Anywhere from $6,000 to up to, I've seen, $50,000. And if you need a surrogate? Anywhere from $150,000 to $200,000. I know the numbers are scary to go into. Now, at this point, you might be wondering, where does insurance come in? Insurance benefits are growing. Some employers have benefits. We currently estimate about 42% of treatments are covered by some sort of insurance or benefit. So 42%, that means the other 58% are paying totally out of pocket.

• 17:57Speaker 02

  So that's, you know, not great. In some cases, insurers might require you to start with certain procedures before covering others. For example, you might only get paid out for IVF after trying IUI a certain number of times. So make sure to read the fine print on your policy and then talk to your doctor about what makes the most sense for you.

• 18:24Speaker 08

  For example, if you're older, if you're worried about timing, do you want to stop and try that for six months or just go straight to IVF? That would probably be a conversation your doctor would have with you. And when you go for that initial consultation, be sure to ask for a complete bottom-line picture of the costs. Including transfers, testing, any other costs that might be included, not just your first step of the egg retrieval and embryo creation.

• 18:50Speaker 02

  And while we're on the subject, another big cost saver is thoroughly vetting your clinic and making sure you have a trustworthy provider that will treat you and your embryos with the utmost care. Not all clinics are created equal. There's a ton of helpful information for every individual IVF program in the US via the CDC and the Society for Assisted Reproductive Technology at art.cdc.gov. Now, you'll want to be careful when looking at individual clinic numbers because they're not all meaningful and not necessarily one-to-one.

• 19:33Speaker 02

  But you can and should confirm that they're accredited and that they adhere to the guidelines set forth by the American Society for Reproductive Medicine. It's also not a bad idea to take a look at and even ask about your clinic's live birth rate. That information, at least, might be able to make you feel more secure before handing

• 19:56Speaker 08

  over your credit card. Because a typical American family doesn't have that much cash just sitting, ready to go, especially a young couple. It's a very sizable amount of debt that people are taking on to pursue this journey. Remember, you're allowed to get creative.

• 20:13Speaker 09

  I have a community member whose siblings started a family-building fund at their wedding to help cover the cost of donor sperm or fertility treatments and help them feel like they had support during that process.

• 20:29Speaker 02

  There are also a lot of different orgs out there that offer cost-saving measures. One great resource to get you started, an organization called RESOLVE, the National Infertility and Family Building Association. Whatever you decide to do about your finances, a small silver lining here is the opportunity to have those hard but necessary conversations early on. Which brings us to takeaway four. Set expectations early, often, and in writing.

• 21:07Speaker 02

  It's important to be aware upfront that the terms and conditions of your fertility journey can vary a lot depending on things like what you're planning to do, where you live, or both. One of Janine's big disclaimers for people just starting out.

• 21:24Speaker 10

  Before you commit to a path, make sure you know, will this result in the recognition of my legal parenthood? Don't spend money, time, effort, emotion to find out that a door is closed because the state that you plan to move forward in no longer has that or has never had that as an option for you.

• 21:42Speaker 02

  Currently, for instance, there's proposed legislation in several states around the idea of personhood. Very briefly, these personhood bills would establish legal rights for embryos by defining life as beginning at conception or fertilization. What that means is, in the future, depending on where you live, you might not be able to access embryos you've already frozen, or find access to an IVF center or fertility treatments at all. Some paperwork you definitely want to think about upfront. Contract language for any kind of donor or surrogate. The example Janine gave me here is a gay couple. If two

• 22:26Speaker 02

  men want to have a baby that is genetically related to one of them, they'll need to first find an egg donor and then a gestational surrogate. Contracts will be required for both the donation and the surrogacy process. And then, once baby is born, both partners can be the legal parents, but one person will neither share genetics nor gestate

• 22:49Speaker 10

  the pregnancy. The law needs to recognize the intended parents, not simply assume that the person giving birth is the intended parent. So there's just so much extra planning for anyone who's having a child through assisted reproductive technology, but specifically for LGBTQ individuals.

• 23:07Speaker 02

  One idea that was novel to me, but that Janine says is growing in popularity and relevance, adding a fertility clause to your prenup.

• 23:18Speaker 10

  I don't think there's a better time to discuss it. I mean, when you are getting married to someone, you're thinking about building a life with them. Why not talk about, hey, if we have to go through IVF, or if we are going through IVF, what do we want to happen to our embryos? There is so much litigation, specifically in New York, where I practice, over embryos in the context of a divorce. Who gets them and who's a legal parent of children born from those embryos?

• 23:47Speaker 02

  Before I let you go, let's check in. That was a whole lot of information at once. How are we feeling? If the answer is closer to overwhelmed, then over the moon excited, no one could blame you.

• 24:02Speaker 09

  I think it's really important to normalize grief as part of the family building journey.

• 24:09Speaker 02

  Maria has helped thousands of people through this process. And they say they don't think they've seen anyone go through it without some form of grief, be it the anxiety of not knowing what will happen, or the frustration of not being able to get pregnant within the confines of your own relationship. But even though your pregnancy journey might not look the same as your cousin's or that friend from high school on social media, Maria says the uniquely wonderful part about baby making in this way is how purposeful you can be as you build a life for your future family.

• 24:47Speaker 09

  I think it's a beautiful gift that we give our children of them knowing that they were so wanted.

• 24:58Speaker 02

  All right, let's recap. Takeaway one, to find the right fertility path, picture your future family and give yourself as much runway as you can. A few years in advance, if possible. Takeaway two, fertility treatments are not one size fits all. Consider your age, your health, your budget before moving forward. Takeaway three, are you willing to go into debt to become a daddy? Becoming a parent through ART can be a BIG investment. Make sure you understand the full cost before jumping in. Finally, takeaway four, IVF,

• 25:41Speaker 02

  IUI, finding donor gametes, they're all complicated processes that come with equally complicated decision making. Setting expectations upfront and in writing will save you heartache later down the line.

• 26:01Marielle Segarra?

  That was Life Kit reporter Andy Tagel. And that's our show. By the way, you're a fan of Life Kit, right? Well, don't keep us a secret. What do you think about telling a friend you like Life Kit? Send them an episode. Thanks for helping us spread the word about our show. This episode of Life Kit was produced by Margaret Serino. Our digital editor is Malika Gharib, and our visuals editor is CJ Ricolon. Megan Kane is our senior supervising editor, and Lauren Gonzalez is our executive producer. Our production team also includes Claire Marie Schneider, Lennon Sherburne, and Sylvie Douglas. Engineering support comes from Tiffany Vera Castro. Fact checking by Tyler Jones. I'm Marielle Sagata. Thanks for listening.

• 26:50Speaker 03

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