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Financing Fertility

Is financing fertility a completely out-of-pocket expense?  Jennifer is finding herself facing fertility issues and needs your advice.  She emails:

I have searched your site to see if there are any past blogs on fertility issues. I find myself in a painful situation at the age of 38 and very much wanting a second child. Unfortunately I just had my third miscarriage (second in a row) and was very surprised to find that my insurance (which is very good insurance) does not cover any fertility issues...not the work up, the diagnosis or the treatment. I am hoping to tap the wisdom and experience of other Portland Mamas who may have experience with fertility treatments, who may have ideas about which insurance (if any) covers fertility, and how people financed the costs which seem as if they can get expensive so quickly. Thanks Mamas....

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Hello there - most insurance companies do not pay for fertility. I believe I heard ads on the radio for Oregon Reproductive Medicine and that they have financing.

I would also suggest go to this accupunturist: Dr. Xiu "Joe" @Ren He Tang Acupuncturist clinic http://www.insiderpages.com/b/3720198870

We tried conceiving for a long time (tried many thins including seeing fertility drs and some drugs) & I went to him and conceived in 2 months.

GOOD LUCK!

a good friend of mine also had success with and acupuncturist.

Recurrent miscarriage is actually a different medical diagnosis than infertility, and you might want to contact Dr. Philip Patton at OHSU (a recurrent miscarriage specialist). His office might also be able to help you navigate whether insurance will rightfully pay for the work up why you are miscarrying. Do not use the term infertility with your insurance because you are not infertile per se.

forgot to add:
I too had several losses before I found Dr. Patton & was able to carry my daughter to term. We also used acupuncture in the process of staying pregnant.

I highly recommend the book Coming to Term by Jon Cohen about recurrent miscarriage.
Best wishes

The State of Oregon is one of the few states in our country that does not require insurance companies to pay for at least a portion of infertility treatment. So, any local insurance companies will not cover it, but if you go with a national company that is headquartered in a state with requirements regarding infertility, then they will have to cover treatment even if you live in Oregon. Insurance companies are governed by the laws of the state where they are headquartered. So, it might be worth doing some research on your different options.

Oregon Reproductive Medicine can help you with different financing options as well. They have also helped friends of mine that suffered from multiple miscarriages...you might not be a candidate for IVF, but there might be a much less expensive and less invasive option that can help you, especially if you've had a successful pregnancy with your first child. Good luck!!

Oregon Reproductive Medicine now works with Health One who provides financing for infertility treatment. This practice also has a IVF refund plan that can help control costs. It isn't a financing program however.

Full insurance coverage for the treatment of infertility is unfortunately rare, though insurance at NIKE and INTEL often has good coverage.

My initial visits, blood tests and other tests/procedures were covered by my insurance because my doctor at Oregon Reproductive Medicine "coded" the tests/procedures in a way that was not considered infertility testing/treatments by the insurance company. They said if that did not work, I could get a 10% discount. Might also want to see if you can do pretax medical dollars for reimbursable expenses, which can help. For example, Clomid was not covered by my insurance, but I was able to get reimbursed for it.

Em wrote:
Insurance companies are governed by the laws of the state where they are headquartered.

This is not accurate. Insurance companies are governed by the laws of the state in which the policy was issued. Unless it's not truly an insurance policy (read: self-insured company providing health benefits to its employees) because then it's governed by federal law (ERISA - more holes than cheesecloth).

If a company issues an insurance policy for an Oregon corporation, the insurance policy IS governed by Oregon laws.

I can't answer your questions about insurance as I haven't had to cross that bridge yet, but I did read a wonderful book that is full of great information. It's "Avoiding Miscarriage: Everything You Need To Know To Feel More Confident In Pregnancy"
by Susan Rousselot

The title is not my favorite but it's a very informative book that I found very helpful.

I have Endometriosis and my Dr.s thankfully coded as much of my fertility treatments including two "diagnostic" surgeries under the Endo as they could. I had the second surgery knowing I had Endo but hoping I would conceive as I had after the first. It worked.

I called around to see if I could get a Fertility Dr. who also did regular Gyno care so as not to set off alarms with the insurance company. It sucks to have to manipulate the system this way but some things are worth it.

ACUPUNTURE!! A good friend tried for 2 years to get pregnant ( age 38)with 3 miscarriages. She tried Acupuncture and was able to get pregnant within 2 months and carry to full term.

ACUPUNTURE!! A good friend tried for 2 years to get pregnant ( age 38)with 3 miscarriages. She tried Acupuncture and was able to get pregnant within 2 months and carry to full term.

I believe Kaiser Permanente covers infertiliy treatment, though it may depend on your plan.

We didn't have coverage for ferility related issues w/ Kaiser, but we did have 50% coverage with our former Providence plan.

I did not use this when I went through fertility work ups, but a good friend accessed some kind of product in which she paid for the equivalent of 2 rounds of IVF and got to do it three times. If it worked out the first time, you lose a bit of money (but only have to do it once), if you do it twice you "break even", and the third time is essentially free.

But - I echo what others have said about miscarriage vs infertility per se. If you are conceiving but not keeping the pregnancy, fertility treatments won't necessarily help. You definitely want to talk to someone about the pregnancy and how to make it more likely for you to carry a pregnancy to term.

Good luck to you, I know how hard this can feel.

Hi, I facilitate a local Resolve Infertility Peer Support Group. There are about 15 states that mandate infertility coverage of some sort, but unfortunately Oregon is not one of them. Texas, West Virginia, Arkansas and others mandate, but not Oregon, it's crazy!
We had an active advocacy group a few years ago, but the political climate does not seem conducive to that kind of change right now. In Oregon, once a company has over 50 employees, infertility coverage becomes an option usually available to the owners to select for all employees, according to the insurance agent for my husband's office when I was coordinating benefits.
Other suggestions above like meeting with a miscarriage specialist, or going through low interest financing with ORM or OHSU are good ones. Acupuncture is the only known way to increase uterine blood flow, and it helps tremendously with IVF success rates, so if your insurance covers that, it is a helpful addition if you haven't already started.
I wanted to highly recommend a book and CD in case you are interested: Conquering Infertility by Dr. Alice Domar with the Harvard Mind/Body Institute is excellent, as is Belleruth Naparstek's Help for Infertility CD. Both helped me tremendously during my infertility journey and I regularly hear the same from our peer support group attendees.
On a hopeful note, a good friend of mind experienced secondary infertility in her late 30's and had 2 or 3 miscarriages and then a successful pregnancy and birth. I hope a full term pregnancy is just around the corner for you. A clomid challenge test with a Reproductive Endocrinologist would give you some good information about your ovarian function and viability. Sorry to not have better suggestions about the daunting and expensive aspect of affording treatments. Good luck and if you'd like to email me, please do so! Take care. Kirsten@surroundinc.com

Thank you everyone for your comments. I really appreciate all the suggestions and support. It is helpful. Urban Mamas have come through once again. So glad to have this amazing resource...

I was in a similar situation as you with two miscarriages back to back before I sought the fertility help of Dr. Matteri, of Oregon Reproductive Health (2222 NW Lovejoy). Not only did I have 2 miscarriages in 6 months, but it had taken me 3 years to even get pregnant in the first place.

Something that Dr. Matteri helped me realize was that miscarrying is not always a result of something wrong with the mother (older eggs, low progesterone, fibroid, etc.) While we would certainly be exploring those possible causes, we also did an extended analysis of my husband's sperm. They analyze & test 3 different things - sperm count, sperm mobility (a gravity test, ie how many "strong swimmers" make it to the top of the test tube), and motility (how the sperm look in form).

What we discovered is that he was low or below average on all 3 tests! Dr. Matteri recommended an IUI (Intrauterine Insemination) so that we could get the healthiest sperm possible up close to the egg at ovulation.

In addition, he recommended I do acupuncture so that my body would be in balance and ready for pregnancy. I worked with an acupuncturist for the 1 month prior to the IUI, with one treatment per week.

After one IUI, I was pregnant again and am on course to deliver this winter!!

In addition, I continue to do acupuncture into my 1st trimester 1x every week. My 2nd trimester will be 1x month and when I get closer to delivery I will go back to 1x week.

I am a few weeks out from entering my 2nd trimester but so far the pregnancy is going very well and I have had very little morning sickness. My first ultrasound showed a beating heart at 6 weeks, so the chance of miscarrying from here forward is less than 2%.

We have Providence Health Plan (Personal Option plan) and fertility assistance was covered at 50%. My total cost for the fetility work-up, sperm analysis, ovulation drugs (clomid), and IUI came to about $800 over a 2 month period. If I had needed to do additional IUI procedures, the cost per month would have been around $350.

All this said, don't assume that the reasons behind your miscarriage are only due to your fertility health. Be sure to have your husband's sperm analyzed for all 3 tests and also, take the clomid challenge to make sure you are ovulating regularly. There are tests you can do to rule out fibroids and endometricurosis that are not billed as infertility, but rather "women's health" codes. These diagnostic tests are not as expensive as you might think. Once you have the results back and if they are conclusive, then take the time to explore which kinds of fertility assistance you may need.

Also, I recommend the same books mentioned above. One of the things they will all tell you is to start treating your body as if you are pregnant - cut out caffeine, take a pre-natal vitamin, stop drinking, etc. If your body is healthy before you get pregnant, it will be in good shape to carry to term.

Good luck and take care!

I think I read this but didn't comment at the time. I was trying to get pregnant, after my first, had a miscarriage, and was having trouble again. My doctor was not really receptive when I said I thought there were bigger issues than just age (38) related fertility. I had a feeling it was, though. I'm now about 6 months pregnant and everything's going fine, but I think I got here because I worked on a combination of things.

I had a strong feeling that I had low progesterone, because of symptoms I read about. I also was fairly sure I was ovulating very late in my cycle; I was trying to track it but always seemed to miss it. Low progesterone has been linked to recurring miscarriages (but I didn't want to experiment and risk another!), ovulating late, low body temperature, and depression, among a few other things that I identified with. Anyway I started using natural progesterone cream because there was no harm in it, and had potential benefits(and I used it until 18 weeks pregnant). As far as ovulating late, that was also confirmed with early ultrasounds, which showed both the miscarriage and this conception at around day 30 of my cycle, when I was usually menstruating at day 31.

The other things I did on my own were going to a Traditional Chinese Medicine doctor for herbs and acupuncture. Dr. Wei Li, and she was great. I also hadn't realized how run down I still was from my previous pregnancy, and felt so much better after starting the herbs. Several people mention acupuncture here, but also know that it is proven to be very effective when used in conjunction with western fertility treatments so it's worth doing both. I also got the book "Fertility Wisdom" by Angelu Wu, and followed her program, a little loosely, but really liked her Qi Gong routines. I think it was important to stop all alcohol consumption, and eat lots of whole foods, and avoid/promote foods that I read about in Wu's book. I also went through my personal products and made sure I wasn't using anything with parabens or pthalates, or other suspect endocrine disrupters, even herbs that are known to bring on cramping. I went to a Tui Na practitioner a couple of times also.

I know people gasp at the cost of having a child with fertility treatments, but to me it's much more understandable to spend the money on that than a new car, and I'd have been willing to finance it if we continued to not have luck with other means.


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