Coming into fertility treatment, you’ve got to have your other areas in life pretty set. Adding financial stress and surprises to an already hard journey brings more tension to each of you, and it can affect your relationship and the success of the treatments.
In some cases where only one partner is very excited about having kids, and the second isn’t, when things don’t go as expected in the fertility treatments and you start feeling the financial stress as well, it makes the less excited partner even more reluctant. I truly believe that you need to take care of yourselves and get your financial shit together before you go into this. I hear stories about people who took loans and had to sell their house and lost everything because of that - even if eventually you end up with a kid - how can you provide for him if you don’t have money? Unless you feel VERY secure financially, I would recommend reviewing the costs and understand what comes your way. For us, we live in the Bay Area, one of the most expensive places in the US, across a year that had testing, two IUI rounds, two IVF cycles, and a transfer in it, we landed somewhere around $30,000 to $35,000 total.
How can you provide for him if you don’t have money?
I was lucky enough to have employer fertility ART (assisted reproductive technology) coverage of up to $35K for some of the costs, and my wife had $20K from her employer called Carrot, but what caught us by surprise was the cash flow part, where it took months to get the money back, and that my wife’s coverage was over after the first IVF so we had to pay out of pocket. I wanted to believe that we would have a baby before the out-of-pocket part but in the IVF journey nothing goes as planned.
Before you get near IUI or IVF
There’s a full workup for both partners before treatment even starts. We paid for semen analysis ~$500. Before getting an HSG test, in most cases, you must complete an initial doctor consultation, which ranges from $250 to $600. HSG test, which is checking whether the fallopian tubes are open, usually costs $400-1,800. AMH, a blood test estimating egg supply, runs $80-200. A general hormone panel runs $300-600.
A chromosomal karyotype test cost us $604. A saline sonogram combined with a catheter procedure to check the uterine cavity came to $1,144 combined, after some discounts. An endometrial biopsy was billed at $399. None of it is optional. It’s how they rule things out before they pick a plan for you.
Separately, carrier screening (checking whether you or your partner carry genes for inherited conditions) is its own thing. One of ours cost $600, the other $200. That’s different from PGT-A, testing the embryos themselves, which is optional. We did it on our first cycle, skipped it on the second, and our doctor was fine with that either way. It’s worth knowing you actually get to make that call, it’s not automatic.
One more thing nobody warns you about: ultrasounds keep happening, over and over, through any cycle. Each transvaginal ultrasound cost us $375, on top of a separate visit fee. We had five of these in about two months. It’s not a one-time cost, it repeats every time they need to check on you.
If IUI comes first
Each round was billed around $1,350 for us. What we actually paid came to $786 per round, depending on where we were in our coverage for the year.
An IVF cycle
This is where the real money goes, and where I understood the least going in. Stimulation runs somewhere between 8 and 14 days, and nobody can tell you the exact length upfront, it depends on how your body responds, checked with ultrasounds and bloodwork the whole way through. Then there’s the retrieval procedure, then the lab work: fertilizing the eggs, growing the embryos, sometimes testing them, then freezing what’s left. All of that gets bundled into one bill, it’s not just “the retrieval,” it’s the whole process of turning eggs into embryos you can actually use later.
Our first cycle came to $16,844 collected by the clinic. Our second one, three months later, was billed at $35,604 and we ended up paying $7,419 of it. Same treatment, same clinic, very different bill, because what changed wasn’t the medicine, it was where we were in our coverage.
The transfer
Billed on its own, sometimes months after the retrieval. Thawing the embryo, prepping it, and the transfer itself came to $4,790 for us.
Medication
This isn’t one number either, it’s spread across weeks, and it’s the one place we actually learned how to save real money.
Because nobody knows exactly how many days of stimulation you’ll need until your body tells them, clinics default to prescribing you more shots than you’ll probably use, so you don’t run out mid-cycle. That sounds sensible until you realize it can mean buying 14 days of medication and only using 10. Those extra four days of shots can be worth thousands of dollars, and some of it can’t be used again since it expires before your next cycle. Even though we planned better for the second IVF and got fewer shots, we ended up with more than $2,000 unused Gonal-F.
We ended up with more than $2,000 unused Gonal-F.
What worked for us: we asked the clinic to help us plan the medication plan so we can order just the minimum for the stimulation shots, something like 7 days, and reorder in small batches of 2 days at a time as the monitoring showed how things were actually going. They can help manage that risk. You just have to ask, the default is to over-order.
The other thing that actually saved us money: call around, or check pharmacy websites directly, before filling anything. Prices for the same medication are not the same everywhere. Some suppliers work specifically with Carrot or have better cash prices. We were surprised that even though our regular insurance, Kaiser, didn’t cover fertility at all, the pharmacy we ordered from still gave us a “Kaiser” discount on the medication. Don’t just fill the prescription wherever the clinic points you.
How fertility benefits actually work
Whether any of this gets covered, and whether the money that comes back to you gets taxed, depends completely on what kind of benefit you have. It’s not one system, it’s several different ones that layer differently depending on your employer and your insurance. If the clinic and doctor you picked aren’t actually in network, none of this math matters, see How to Pick the Right Fertility Clinic for what to check before you commit.
Regular health insurance, if it covers fertility at all, usually works through a lifetime cap on ART procedures specifically, things like IVF and ICSI. In plans structured like the one I had, diagnostic testing and treating an underlying condition stay outside that cap. What actually eats into it is the ART procedure itself, plus ART-related medication and monitoring during that cycle.
Separate employer fertility benefits, like Carrot, work differently. They typically split into two buckets: one for core medical care, which is usually tax-free, and one for everything else, which usually isn’t. That “everything else” bucket can stretch further than people expect. According to Carrot’s own site, it can cover things like doula support or even adoption costs, not just leftover treatment expenses. Worth checking what your specific plan actually covers rather than assuming.
Here’s how the tax part works, in plain terms: if something counts as actual medical treatment, the reimbursement is tax-free. If it doesn’t clearly count as medical, it gets added to your paycheck and taxed like regular income, the same as a bonus would be. You can lose somewhere around 25-40% of it depending on your tax bracket. It’s not a special fertility tax, it’s just regular income tax applied to money that felt like it should’ve been a clean reimbursement.
It’s not a special fertility tax, it’s just regular income tax applied to money that felt like it should’ve been a clean reimbursement.
In our case, we actually had two separate sources at once. I had ART coverage through my own insurance, capped at $35K. My wife had a separate $20K Carrot benefit through her employer. That’s not typical, most people won’t have two benefits stacked like that, but if you do, the same logic applies to each one individually. Check which bucket a given expense falls into before you assume it’s covered, or assume it’s tax-free.
We were also surprised more than once by what actually got covered in situations we assumed wouldn’t be. Don’t skip submitting something because you’ve already decided it won’t count. Submit it and let them tell you no.
Submit it and let them tell you no.
The cash flow gap nobody warns you about
Even when something is fully covered, the money is slow. Ours took about a month for the clinic to generate the itemized receipt, a week for us to upload it, two weeks for approval, then another couple weeks before it hit our account. Two months, start to finish, for one reimbursement. That means you’re floating the full cost yourself the whole time, even on the stuff that’s coming back to you eventually.
What actually saved us money
We asked directly for a self-pay discount once our coverage ran out on a specific procedure, and got one. We had to ask, it wasn’t automatic. Looking at our own receipts, the discounts ranged from almost nothing to close to 30% off, depending on the charge.
- Ordering the stimulation shots in small batches instead of taking the full prescription upfront.
- Calling more than one pharmacy, or checking their websites directly, before filling anything, including your regular insurance’s pharmacy even if it doesn’t cover fertility at all.
- Submitting receipts the moment we got them instead of sitting on them, since the two-month lag only gets longer if you wait.
Here’s a table that summarizes all of it
| Stage | What it includes | Roughly when | Cost per instance |
|---|---|---|---|
| Initial workup, both partners | Consult, bloodwork, semen analysis, imaging | Month 1 | $600 – $2,500 |
| Extra testing if something comes up | Karyotype, saline sonogram, biopsy | Month 1-2 | $400 – $2,000 |
| Carrier screening | Genetic testing on you and your partner, not the embryos | Month 1-2 | $200 – $800 |
| IUI, per round | Monitoring plus the procedure | Month 2 onward | $1,000 – $3,000 |
| IVF, per cycle | Stimulation monitoring, the retrieval procedure, and fertilizing and growing the embryos | Whenever you enter | $7,000 – $25,000+ |
| PGT-A, genetic testing on the embryos themselves | Optional. Sometimes bundled into the cycle price above, sometimes billed separately | Same cycle as retrieval | $3,000 – $6,000+ if billed separately |
| Frozen embryo transfer | Thaw, prep, the transfer itself | Weeks to months after a viable retrieval | $4,000 – $5,000 |
| Storage, from year two on | Keeping embryos frozen | Every year after the first | Around $950/year |
If IUI doesn’t work, most people try again before moving to IVF. If a retrieval doesn’t produce a viable embryo, some people go through several rounds before ever getting to a transfer. Five isn’t unheard of. Multiply the per-cycle numbers above by however many rounds it actually takes for you. That’s the real math, not the total by itself.
Questions to ask before you start
- How much money have you set aside for each phase? Have you set up reserves in case there is a new unplanned spend?
- Does your insurance cover fertility treatment at all, and if so, what’s the lifetime cap? What counts against it, and what stays outside it?
- Does your employer offer a separate fertility benefit? What does the non-medical bucket actually cover, and which part of it is taxable?
- How long does a reimbursement actually take to hit your bank account, not just how long approval takes?
- Can you ask for a self-pay discount once your coverage runs out?
For IVF patients:
- Is PGT-A something you want, or something you’re being defaulted into?
- Can the IVF medication be ordered in small batches instead of all at once?
- Is storage covered by anything after the first year, or fully on you?
I would suggest doing a financial reassessment every month or two to make sure that you are on top of your personal and health expenses. Also, talking about financials and letting each other know that you trust each other with managing this process is important. It won’t be easy to stay on top of following the costs, making sure you are billed the right codes, submitting to insurance, making sure you got the reimbursement, plan your medication so you can save and prepare financially for future treatments. If you got this financial box checked, it will be a huge relief for you and your partner.