One of the most frequent questions I am asked by patients and prospective patients is about the cost of treatments. My practice is focused on lower-tech fertility treatments so I will address these costs here; I will not address costs associated with IVF or egg freezing. This article is not intended to be a quote for treatment but rather give a general idea of costs at First Steps Fertility and Women’s Health. Any costs listed are as of 2/12/20 and couId change at any time. I encourage everyone to check costs with the specific clinic they are interested in.
Unfortunately, there is no insurance mandate to cover fertility treatments in the state of Washington. There are currently 14 states that have laws that require insurance companies to cover infertility treatments: Arkansas, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island and West Virginia, and two states, California and Texas, have laws that require insurance companies to offer coverage for infertility treatment (National Council of State Legislatures, NCSL). For the majority of people who don’t have coverage for fertility treatment, the expense related to this care is significant and there is quite a bit of variation in costs from clinic to clinic.
Everyone who is seeking care for infertility will need a consultation with a fertility specialist such as a physician (MD or DO), nurse practitioner (ARNP), physician assistant (PA-C) or possibly naturopath (ND) in order to get started. The initial consult is usually quite comprehensive and covers a complete health history, OB/GYN and fertility history as well as a plan for testing. This visit usually lasts for about an hour and the cost is based on time. The average cost for the consultation at First Steps is about $200-$250. Follow up visits to discuss treatment plan, response to treatments, changes in treatment plan or new issues average $100-150, again depending on time spent and complexity of problems.
For all women seeking fertility treatment, preconception labs such as titers to check immunity to varicella and rubella as well as blood type are strongly recommended. Fortunately, most insurance companies will pay for this testing as it is not fertility specific. If uninsured, the lab I contract with offers a self-pay rate of under $100 for all three of these tests. Another important preconception consideration is recessive carrier testing; this testing is considerably more expensive but cost can usually be limited to around $300 for self-pay patients. Other blood tests that may be included in a fertility workup include thyroid stimulating hormone (TSH), prolactin (PRL), anti-mullerian hormone (AMH), follicle stimulating hormone (FSH), estradiol and progesterone. Often, these tests are covered by insurance if there are medical symptoms that justify their use such as irregular periods, PCOS or amenorrhea (not having a period). However, if self-pay, these tests at my reference lab range from $42-65 each. Other blood testing may be necessary based on your own specific circumstances (for example if you have recurrent pregnancy loss) and whether you have other health conditions that require monitoring.
Another important part of a fertility workup is assessment of the uterine cavity and fallopian tubes. While not necessary for everyone, a hysterosalpingogram (HSG), sono-hysterosalpingogram (sonoHSG), saline infusion sonogram (SIS) or hysteroscopy may be recommended. At my clinic, I use sonoHSG/SIS for uterine cavity and tubal assessment and the self-pay cost for this test is $350.
Finally, a fertility workup is not complete without evaluation of sperm. A complete semen analysis at First Steps is under $100.
Lower-tech fertility treatments often include oral ovulation induction medications such as clomiphene or letrozole. Fortunately, these medications are relatively inexpensive. Currently, using a GoodRx coupon, they can be purchased for $10-20 for a 5 day treatment course, depending on drug and dosage. As of today, the cost for a 10,000 unit hcg trigger with a GoodRx coupon at a local pharmacy is $108.
Many patients undergoing fertility treatment will use ovulation predictor kits to time intercourse or intrauterine insemination (IUI). Quality and cost of these kits is quite variable; currently, a box of 20 Clearblue Digital Ovulation Tests on Amazon is $35.98; this could last for 2-3 cycles depending on individual circumstances. Other patients will need or want monitoring of follicle development with ultrasound. Monitoring ultrasounds at First Steps are about $105 each as a self-pay patient. Many patients need only one of these scans per cycle, however more may be necessary depending on underlying fertility problems and response to medications.
For patients doing intrauterine insemination (IUI) with partner sperm, the costs associated including processing/washing of the sperm and the actual insemination procedure (putting the sperm in the uterus). The combined cost for sperm prep and IUI procedure at First Steps is just under $370. For patients using donor sperm, a vial of donor sperm prepared for IUI is around $700 at Seattle Sperm Bank (each insemination try requires a new vial) and ships to the clinic for free. Different sperm banks have different prices so patients should check with each bank for both the cost of the sperm and for shipping (in some cases the shipping is a significant expense). In this case, you don’t pay for a sperm wash at the clinic (this has already been done by the sperm bank if purchasing sperm for IUI) but you pay for thawing the sperm and a semen analysis after thaw to confirm the number of sperm available for insemination; this cost is about $105 at my clinic.
Hopefully this sheds some light on costs of lower-tech fertility treatment at First Steps. Again, every clinic has different pricing so generalizing from one clinic to the next doesn’t really work. Also, these treatments are not appropriate for everyone so a consultation with a fertility specialist is required to determine the right path forward for each individual or couple. My hope is that everyone finds a clinic that is a good fit for their needs based on many factors, not just cost. Please feel free to reach out to me at firstname.lastname@example.org any questions.