How Much Does IVF Cost?

f you’re pricing IVF at fertility clinics in the United States, expect to be quoted roughly $12,000 to $14,000 for one cycle. This, however, doesn’t mean you’ll pay that figure and be done. There are parts of the IVF process—some required, some optional—that most clinics treat as add-ons to the base fee. Depending on your needs, a single IVF cycle can cost $30,000 or more. More often, the total bill will fall somewhere between $15,000 and $20,000.

Often, a clinic’s base fee for IVF will cover monitoring appointments, bloodwork, egg retrieval and follow-up care. If you’re quoted below $12,000, it might mean that the base fee covers less than what’s listed above. If you’re quoted above $14,000, the base fee might cover more. Always ask for a clear list of what the base fee includes and what will be charged as additional fees.

At most clinics, the quoted price doesn’t cover the price of the injectable hormones, which can cost from $3,000 to more than $6,000, usually paid directly to the pharmacy filling the prescription.

Additional clinic fees may include intracytoplasmic sperm injection (a specialized way to create embryos), genetic testing of embryos, a trial transfer (also called mock embryo transfer) and/or cryostorage fees for embryos you wish to preserve.

When you’re budgeting, consider that you may need to go through multiple embryo transfers or multiple full cycles of IVF. Ask your clinic about the price of additional embryo transfers if the first transfer doesn’t result in a successful pregnancy and birth, as well as the price of additional gonadotropin cycles if you need to create more embryos. Many patients go through several cycles of IVF before conceiving or moving on to other options, but some clinics offer discounted pricing on the second or third cycle. There is no way to know how IVF will go for you, but your clinic may be able to give you statistics based on your age and ovarian reserve, the sperm quality of your partner or donor and any other relevant medical factors.

If you’re using a sperm donor, egg donor, gestational carrier or surrogate, that may cost anywhere from an additional few hundred dollars for a sperm donation to tens of thousands of dollars for a carrier or surrogate.

Here’s a breakdown of the fees you may be charged as you move through the IVF process. Not everything listed below will be required of every patient. And while we’ve included the procedures you’re most likely to encounter during IVF, there may be other tests or procedures required, depending on your health history. Your fertility clinic will help create a plan that’s right for you.

The figures below are all estimates. Make sure to get pricing directly from your clinic before starting the IVF process or signing paperwork.Costs Before the Procedure (Non-Donor IVF)Base fee: $12,000 to $14,000 (typically includes monitoring appointments, egg retrieval, embryo creation and fresh embryo transfer)Fertility assessment: $250 to $500. This assessment usually involves an ultrasound of the ovaries, a blood test and a physical exam.Semen analysis: $200 to $250Injectable medications: $3,000 to $6,000Monitoring appointments: Typically included in the base fee

Costs of Embryo Creation and Fresh Embryo TransferEgg retrieval: Typically included in the base feeAnesthesia (during egg retrieval): Included in base fee to $725Donor sperm: $300 to $1,600Intracytoplasmic sperm injection (ICSI): Included in base fee to $2,000. The standard way to create an embryo is to place an egg in a dish with tens of thousands of sperm and wait for fertilization. However, if not enough sperm can be provided, if the sperm are having trouble attaching to the egg, if the egg has been frozen prior to the procedure and/or if you are planning to do genetic testing on the embryo, doctors may recommend ICSI. During ICSI, the embryologist will inject a single sperm into each egg using a small needle.Mock embryo transfer: $240 to $500. Doctors mimic what they will do during the embryo transfer—insert a catheter into the uterus—only without an embryo on the catheter. Since every body is different, this procedure helps the doctor determine what type of catheter to use and where to steer it when the time comes for the real transfer. It’s a low-risk procedure, though one recent randomized controlled trial of 200 patients suggests it’s not always necessary. Some clinics don’t charge for a mock transfer.Fresh embryo transfer: Typically included in the base fee

Costs of Frozen Embryo TransferEmbryo cryopreservation: $1,000 to $2,000. Freezing embryos takes several steps that may add to the cost of your IVF package. First, doctors must expose embryos to a cryoprotectant agent to prevent the formation of ice crystals. Then, the embryos undergo vitrification, a rapid-chill freezing process (comparable to flash freezing) that also lowers the risk of ice crystals forming.Embryo storage: $350 to $600 a year. Some clinics include up to one year of free storage in the base price of IVF.Genetic testing: $1,800 to $6,000. Embryos may be frozen to wait for results of PGT, short for preimplantation genetic testing. There are multiple types of tests, and you’ll likely pay separately for each. Prices vary depending on which test your doctor recommends and to which genetics lab your clinic outsources its testing.PGT-A, or preimplantation genetic testing-aneuploidy, screens for extra or missing chromosomes.PGT-M, or preimplantation genetic testing-monogenic, looks for specific gene mutations that the embryo is at risk of inheriting based on the egg and sperm providers’ genes.PGT-SR, or preimplantation genetic testing-structural rearrangements, tests for inversions, translocations, deletions and/or insertions within individual chromosomes.PGT-P, or preimplantation genetic testing-polygenic disorders, the newest test, screens for the risk of polygenic diseases such as cancer, heart disease and diabetes.Frozen embryo transfer (FET): Included in base fee to $6,400. The price of a frozen embryo transfer sometimes depends on timing, as well as on previous attempted transfers. At some clinics, if you don’t attempt a fresh transfer, the first frozen transfer is included in the base fee. At other clinics, FET is always an additional fee (often to cover the price of the embryo thaw and monitoring tests). Some clinics also charge more for FET if you wait longer than a year after embryo creation to do it.Medication for FET: $300 to $1,500. Your clinic may prescribe progesterone shots before a frozen embryo transfer to help increase the odds of successful implantation.

Mini IVF Cost vs. Full IVF Cost

Minimal stimulation cycle IVF, or mini IVF, is the term for an IVF cycle done with minimal medications. You may also hear it referred to as mild ovarian stimulation IVF, mild-dose IVF or low-dose IVF. Instead of injecting hormones, a mini IVF patient might take an oral medication, such as Clomid, or they might opt for injectable medication but take a lower dose than is usually prescribed for an IVF cycle.

Mini IVF is less expensive per cycle—often around $5,000 to $6,000 plus medications, which can range from $50 or less for Clomid to $1,000 to $2,000 for injectable hormones. However, in terms of total cost, it’s hard to predict whether mini IVF will save you money. The lower hormone dose will likely result in fewer eggs retrieved and thus fewer possible embryos. If a mini IVF patient needs to do several cycles of embryo creation, that can end up being more expensive and risky than doing conventional IVF.

However, a review of 31 randomized controlled trials published in Human Reproduction Update in November found good news for individuals or couples exploring low-dose IVF with injectable medication. Though fewer eggs were retrieved from the low-dose patients compared to the patients who underwent conventional IVF, the number of high-grade embryos created was similar, putting both sets of patients on more equal ground in terms of pregnancy outcomes, but reducing cost for the low-dose patients.

There are also reasons to explore mini IVF that have nothing to do with price, including its reduced risk of ovarian hyperstimulation.Costs of Using Donor Eggs

If you’re using donor eggs as part of your IVF cycle, the price will depend on what options a clinic offers.

Some fertility clinics have relationships with egg cryobanks and/or fresh egg donor agencies and either require or suggest that you work within their system. In that case, the clinic likely will present you with a base price that includes the cost of the eggs (typically in batches of six to eight) and some, but not all, medical expenses.

Frozen donor eggs base cycle fee: $14,000 to $20,000+

Fresh donor eggs base cycle fee: $27,000 to $47,000+

As with non-donor IVF, this fee is a starting point. Ask your clinic what is included in the price of an egg donor cycle and what additional charges to prepare for.

Other clinics allow you to work directly with a cryobank or agency to obtain frozen or fresh eggs. Depending on which bank or agency you choose, you might end up spending less than you would by going directly through a clinic, or you could end up spending more. It’s unlikely that the total price will be drastically reduced by separating the fees. You may save a few thousand dollars by finding a cryobank that sells eggs in smaller batches; however, starting the IVF process with a lower number of eggs could mean you’ll end up with fewer viable embryos.

If a clinic allows, you may be able to save money by having a friend or family member donate eggs (called a known donor or directed egg donor). Most clinics, per American Society for Reproductive Medicine guidelines, will require the known donor to undergo a medical screening and psychological evaluation, and many will require a consultation with a lawyer. Talk to your clinic about its requirements regarding known donors, and the associated costs.Costs of Using a Gestational Carrier or Surrogate

Using a gestational carrier typically comes with legal fees and medical expenses. There are also agency fees if you choose to use an agency, as well as the fee paid to the person carrying the child. In all, expect to pay anywhere from $60,000 to $150,000+.

The term “traditional surrogate” is used to describe a gestational carrier who also provides the eggs. The fees involved in traditional surrogacy are similar to that of gestational surrogacy, though the medical expenses may be significantly reduced if IUI is used to inseminate the eggs. However, most states don’t allow traditional surrogacy.

There is also compassionate surrogacy, an arrangement in which the gestational carrier or surrogate does not charge a fee for carrying the child. This could save around $30,000 to $50,000.

02

A major development in the fight against prescription drug costs

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CNN  — 

While much of the oxygen in the US political conversation is sucked up by former President Donald Trump’s forthcoming trials, there is other news to report.

What could in hindsight be a milestone moment occurred Tuesday in Washington when the government announced the first 10 prescription drugs for which Medicare will negotiate prices.

Driving down the cost of prescription drugs has been a priority of every recent president and using Medicare’s considerable power to achieve savings has more specifically been the goal of Democrats.

This new power will take time to implement and must still survive multiple court challenges by pharmaceutical companies.

But it is a development that could ultimately affect every American who enrolls in Medicare’s prescription drug benefit.

According to CNN’s Tami Luhby, the first 10 drugs subject to these negotiations are: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica and Stelara, as well as Fiasp and certain other insulins made by Novo Nordisk, including NovoLog.

The medications treat heart disease, certain cancers, diabetes and autoimmune diseases, among other conditions.

These drugs cost Medicare enrollees big money – $3.4 billion in out-of-pocket costs last year. The enrollees who didn’t receive additional financial assistance shelled out as much as $6,500 on average, according to Luhby’s report. But she also notes that these drugs “accounted for $50.5 billion, or about 20%, in total Part D gross covered prescription drug costs” over the past year.

I talked to Luhby by email to learn more about how this new negotiating power came about, how it has eluded multiple recent presidents and what we know about how it will actually drive down prices and affect the financial position of Medicare.

Our conversation, conducted by email, is below:

WOLF: Presidents have been trying (and failing) to get this type of power for decades. How long has this been an issue and how did President Joe Biden finally get it?

LUHBY: Medicare only started covering drugs in 2006, thanks to Medicare Part D, which was created by Congress and signed into law by President George W. Bush in 2003. But the legislation specifically barred Medicare from being able to negotiate prices.

Democrats were trying to add a drug benefit – and allow Medicare to negotiate drug prices – as far back as former President Bill Clinton in 1993. More recently, House Democrats passed a more ambitious effort to allow the Health and Human Services secretary to negotiate drug prices in 2019, but it didn’t go anywhere.

For decades, the very powerful pharmaceutical industry – which donates lots of money to lawmakers and other politicians – was successful in blocking any attempts allowing Medicare to negotiate drug prices.

But the industry lost that battle last year when Democrats pushed through the Inflation Reduction Act, which gave Medicare the power to negotiate drugs for the first time ever. But it’s much more limited than the House bill.

WOLF: Will the list of drugs expand?

LUHBY: The criteria for selecting the drugs was laid out in the Inflation Reduction Act.

The initial set of drugs was chosen from the top 50 eligible Part D drugs that have the highest total expenditures in Medicare. Only medications that have been on the market for several years without competition are eligible.

After the initial round, the Health and Human Services secretary can negotiate another 15 drugs for 2027 and 15 more for 2028. The number rises to 20 drugs a year for 2029 and beyond.

In the first two years of negotiations, CMS will select only Part D drugs that are purchased at pharmacies. It will add Part B drugs, which are administered by doctors, to the mix for 2028.

WOLF: My impression is that Americans pay more for medical care and for prescription drugs than people in other countries. Is that true and will this new power fix the problem?

LUHBY: Yes, America generally pays more for medical care and prescription drugs than its peer countries – often much more. For instance, a one-month supply of the drug used in the diabetes medication Ozempic and its sister drug for weight loss Wegovy in the US costs quadruple the sales price in Germany and 4.5 times the price in the Netherlands, according to a recent study by KFF. Note: Those are the list prices, not necessarily what patients pay.

The price differentials stem largely from the greater involvement of other countries’ governments in their health care systems, which also includes setting prices. But there are tradeoffs – Americans, at least those who can afford it, may have better access to the latest treatments and medical technology.

WOLF: Since the government is the single largest health care spender, why shouldn’t the government have the ability to negotiate drug prices?

LUHBY: The Biden administration and experts argue that Medicare sets the reimbursement rates for many other services, such as hospital care. Now it is extending that power to drug prices.

But drugmakers and their supporters have filed eight lawsuits so far seeking to halt the program, saying it’s unconstitutional. The administration says there’s nothing in the Constitution banning Medicare from negotiating drug prices.

WOLF: What are drugmakers arguing in their lawsuits?

LUHBY: They each contend that the program is unconstitutional in various ways.

Among the arguments are that the program violates the Fifth Amendment’s “takings” clause because it allows Medicare to obtain manufacturers’ patented drugs, which are private property, without paying fair market value under the threat of serious penalties.

Plus, the negotiations process violates the First Amendment, the challengers say, because it coerces manufacturers into saying that they agree to the price that the government has dictated and that it’s fair.

Another argument is that the process violates the Eighth Amendment by levying an excessive fine if drugmakers refuse to negotiate and continue selling their products to the Medicare market.

WOLF: Can this new power change the financial outlook for Medicare?

LUHBY: The program is expected to save Medicare $98.5 billion over 10 years, according to the Congressional Budget Office.

The extent of the savings remains to be seen. The pharmaceutical industry argues that many of the medications on the list already have large rebates and discounts due to negotiations that currently occur in Part D insurance plans.

But some experts say Medicare’s new power will make a difference.

CMS Administrator Chiquita Brooks-LaSure told me that drug price negotiation is part of the strategy to make sure Medicare is sustainable.

WOLF: How much will it save the people buying these prescription drugs?

LUHBY: That’s harder to pin down. Brooks-LaSure pointed to other provisions of the Inflation Reduction Act that she said will have a big impact on patients’ spending. She highlighted the upcoming $2,000 cap on annual out-of-pocket costs in Medicare Part D, which takes effect in 2025.

03

Medicare to start negotiating prices for 10 drugs. Here are the medications.

Medicare, the health insurance program for people over 65 years old, said it will start negotiating prices on 10 drugs, part of its mandate under the Inflation Reduction Act to lower prescription prices for older Americans. 

The first drugs under price negotiations include diabetes medication Jardiance, insulin such as the NovoLog FlexPen and the heart medication Entresto, according to a statement by the U.S. Department of Health and Human Services. 

The negotiations mark the first time Medicare has been able to haggle over drug prices for its 65 million enrollees. They come at a time when 1 in 5 seniors say they are skipping doses because of the cost of their medications. While the negotiations are expected to lower drug costs for Medicare enrollees, the effort faces litigation from drugmakers and heavy criticism from Republican lawmakers. 

AARP, the advocacy group for older Americans, called the negotiations “monumental.”

“The No. 1 reason seniors skip or ration their prescriptions is because they can’t afford them. This must stop,” AARP executive vice president Nancy LeaMond said in a statement. “Allowing Medicare to negotiate prices for these first 10 drugs will finally bring much-needed access and relief to American families, particularly older adults.”Insurance companies changing coverage for weight loss drugs 00:47

“This is a ground-breaking change for Medicare enrollees,” Mariana Socal, an associate scientist at Johns Hopkins University, told CBS MoneyWatch. “For the very first time, they will actually know how much the drugs that they take actually cost.”

She added, “This is something that nobody really knows — it’s not only Medicare enrollees who don’t know, but any person in the United States doesn’t know how much their drugs really cost.”The 10 drugs under negotiation

Medicare’s first drug price negotiations will focus on insulin, blood thinners and more. The drugs are:EliquisJardianceXareltoJanuviaFarxigaEntrestoEnbrelImbruvicaStelaraFiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill

Why were these drugs picked?

The Biden administration said that it focused on drugs that were covered by Part D, Medicare’s primary coverage plan for prescription medications, which are among costliest drugs for the health insurance program. 

“These drugs represent a serious budget impact for the Medicare program,” Socal of Johns Hopkins said. “They are really the heavy heaters for the program.”

It also picked drugs without competition that have been on the market for at least 7 years, while excluding some types of medications, such as some orphan drugs, which are aimed at patients suffering from rare diseases, officials said on a Tuesday conference call. 

The list also includes several versions of Novo Nordisk’s Fiasp, a fast-acting insulin taken around meals, although the Inflation Reduction Act already caps Medicare patient out-of-pocket costs for insulin at $35 a month. An administration official said Tuesday that that upper limit will hold but there could be further changes in those costs. 

Overall, the 10 drugs treat diseases that are very common among its enrollees, such as blood clots, diabetes, heart disease and chronic kidney disease, officials said.How much could seniors save on medications?

According to the Biden administration, seniors spent $3.4 billion in out-of-pocket costs for these medications in 2022. In all, Medicare spent about $50.5 billion on these 10 medications, or 20% of its Part D prescription drug costs, between June 1, 2022 and May 31, 2023, the Biden adminsitration said.

The negotiations, as well as other pricing mechanisms authorized by the Inflation Reduction Act, could save taxpayers $160 billion by cutting Medicare’s spending on drugs, President Joe Biden said in a statement released Tuesday. 

“When implemented, prices on negotiated drugs will decrease for up to 9 million seniors,” Biden added.

Part D enrollees are expected to save about $400 a year on drug costs in 2025 due to several other IRA provisions, such as a $2,000 cap on out-of-pocket spending, officials said. However, that estimate doesn’t include the impact of negotiations on drug prices, they added.When would lower prices become effective? 

The agreed-upon negotiated prices would be published by Sept. 1, 2024. 

But the negotiated prices for these drugs wouldn’t go into effect until Jan. 1, 2026, the Biden administration said. Will Medicare negotiate prices on additional drugs? 

Yes, the Biden administration said it will select up to 15 more drugs covered under part D for 2027, and another 15 drugs for 2028, with the latter including drugs covered under both Part B and Part D. 

In subsequent years, 20 additional drugs will be picked for negotiations annually. 

Part B covers doctor’s visits and some outpatient drugs that must be administered in a medical office. Part D is the broader coverage for prescriptions.What is the status of the drug industry’s lawsuits?

The plan already faces eight lawsuits, including complaints filed by drugmakers Merck and Bristol-Myers Squibb, and a key lobbying group — the Pharmaceutical Research and Manufacturers of America, or PhRMA.

PhRMA said in a federal court complaint filed earlier this year that the act forces drugmakers to agree to a “government-dictated price” under the threat of a heavy tax and gives too much price-setting authority to the U.S. Department of Health and Human Services.

“[T]he biggest risk that would delay or prevent implementation of the Medicare drug price negotiation program, as currently proposed, remains litigation,” noted Heights Securities in a Tuesday research report. 

The Biden administration on Tuesday said that nothing in the Constitution prohibits Medicare from negotiating drug prices.

Even so, given the lawsuits, which have been filed across seven U.S. District Court districts, “it is very likely that the groups will receive conflicting rulings that will put the legal challenges on a fast track to the Supreme Court,” Heights Securities predicted.Does this have an impact on people outside of Medicare?

Long-term, the negotiations may also help younger Americans by bringing more transparency to drug pricing, Socal told CBS MoneyWatch.

“Initially, the movement will start with these 10 drugs,” she said. “Patients who are not part of Medicare will say, for example, ‘Wait a minute, I’m paying $200 out of pocket for this drug and Medicare announced that the Medicare price will be $100. How can this be possible?'”

With reporting by the Associated Press.

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