Is IVF actually right for you?

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0:17Andee Tagle: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. Yeah. People talk about it as a type of insurance policy. But it's really not a guarantee. Yeah. And it's not even necessarily the best choice for everyone trying to start a family. Just listen to reproductive endocrinologist Dr. Lucky Sikon. She's who we featured in our first story on how to get pregnant. 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.

0:54and 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. Well, we are going to set the record straight today. You're listening to LifeKit. By the way, I'm Mariel Segarra, and I am talking to LifeKit reporter Andy Tegel about the things to know when you're considering getting pregnant with the help of reproductive technology like IVF.

1:21Andee Tagle: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 up front 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. This message comes from Whole Foods Market. September's always busy. Whole Foods Market can help.

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3:46Andee Tagle: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? Don't start with the paperwork. There'll be plenty of paperwork. Start with the family that you want to build in mind. 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?

4:39Andee Tagle: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 feel strongly about experiencing pregnancy? I always recommend to start this process one or two years before you're actually ready to get pregnant. Maria Goodman is a licensed midwife and co-author of the book Baby Making for Everybody, Family Building and Fertility for LGBTQ Plus and Solo Parents. And I focus a lot on empowering queer folks and solo parents throughout their family building journeys. 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.

5:22Andee Tagle: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. 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.

6:14Let'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.

6:28Andee Tagle: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. Choose your five most compelling, rank them one through five, and then let your top three guide you. 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.

7:13Andee Tagle: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, it's time to prepare physically. Let's note, this might be a more extensive process for some than simply tracking your cycle. 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.

7:59And before doing that, we strongly recommend setting up major support systems because it can be a big emotional undertaking. 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 A-R-T is right for Y-O-U. 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.

8:40Andee Tagle: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 Sikon again. 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.

9:31Andee Tagle: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. 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.

10:22By 37 or 38, your odds are more like 50-50.

10:28Andee Tagle: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. 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 20s, 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.

11:21It'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.

11:33Andee Tagle:If you're on the young side or somewhere in between, say early 30s, 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. 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.

12:28Andee Tagle: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. 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.

13:20Andee Tagle: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 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. And that usually involves three to four tries with a certain method and then changing something.

14:08So 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. After the break, let's talk that baby making budget.

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15:19Andee Tagle:Okay, 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. So we typically say an average IVF baby costs$70 ,000. Seven-zero. This is Angela Rastegar, the co-founder and CEO of Sunfish, a fertility financing company. 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. People would cry to me on the phone or, you know, sell their engagement ring or dip into their 401k.

16:09And it was just really breaking my heart to see people making these very difficult financial decisions. Takeaway three.

16:18Andee Tagle: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. That's typically between$8 ,000 to$15 ,000 or so plus medication. You're going to need different medications just to retrieve them. If you're going to go through a full cycle, so you're going to fertilize those eggs 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?

17:07That 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.

17:19Andee Tagle: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. 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. 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.

18:14So 42%, that means the other 58 % are paying totally out of pocket.

18:19Andee Tagle: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. 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.

19:03Including transfers, testing, any other costs that might be included, not just your first step of the egg retrieval and embryo creation.

19:11Andee Tagle: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 U.S. 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, 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.

20:05Andee Tagle: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 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. I have a community member whose sibling 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.

20:50Andee Tagle: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.

21:28Andee Tagle:It's important to be aware up front 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. 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. Currently, for instance, there's proposed legislation in several states around the idea of personhood.

22:11Andee Tagle: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 up front. Contract language for any kind of donor or surrogate. The example Janine gave me here is a gay couple. If two 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.

22:57Andee Tagle: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 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. One idea that was novel to me, but that Janine says is growing in popularity and relevance, adding a fertility clause to your prenup.

23:39I 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? Before I let you go, let's check in.