In the Centers for Disease Control’s National Survey of Family Growth, 11 percent of women and 9 percent of men reported struggling to conceive. This same survey found that just 38 percent of currently childless women with suspected fertility problems sought out or received any fertility care. Within this group of women, most only received fertility testing and advice—but not treatment. When it comes to IVF treatment in the United States, it is estimated that only one in four couples in need of this assisted reproductive technology receive it. Why are so many people unable to get the treatments they need? If you’re having difficulty getting infertility treatment, is there anything you can do to improve your access? And, if fertility treatment is not an option for you, what can you do to optimize your odds of pregnancy success?
You’re Not Alone: Common Barriers to Fertility Treatment Access
If you’re having difficulty getting the treatment you need, you’re far from alone. You may face one obstacle or several. Here are some possible barriers to fertility care: Lacking Fertility Benefits in Health Insurance: This is dependent on where you live and who you work for. In Canada and Europe, fertility coverage is mandated by law in many areas. This isn’t true in the United States. Only 11 states have laws requiring fertility insurance coverage. Of those 11, just six require comprehensive coverage. Lacking Health Insurance: People who have health insurance—even without infertility coverage—can at least get basic reproductive care. Sometimes, this can be enough to treat simple fertility problems. For example, your OB/GYN could prescribe Clomid if your ovulation is irregular. You may need to pay full price for the pills, but your doctor appointment and very basic fertility testing would most likely be covered. However, if you are lacking any health insurance, your ability to get fertility care is limited. This is also true if you have only a catastrophic health insurance plan. Lack of Funds (With or Without Insurance): Even if you have great health insurance, the cost can still stand between you and the treatments you need. Your co-pay may be too high for your budget. Parts of your treatment may not be covered at all. If you need surrogacy or an egg donor to have a child, this is especially true. Location: There may not be enough reproductive endocrinologists in your state or country. In the United States, if you live on the East or West Coast, you are much more likely to have a fertility clinic in reasonable driving distance than if you live in the Midwest. There are 16 states in the USA with five or fewer SART (Society of Assisted Reproductive Technologies) accredited fertility doctors. There tends to be more fertility care available in states that require fertility health insurance coverage. You can check how your state rates at RESOLVE’s Fertility Scorecard page. Difficulty Receiving Good Care Due to Care Provider Bias: In an ideal world, a doctor’s care should not be impeded by personal bias. But doctors are human, and personal beliefs sometimes get in the way of providing medical care. Reasons doctors have refused patient care, or provided inaccurate information (telling the patient they can’t receive care when they could), include:
Doctor or hospital’s religious objections to IVFSocioeconomic status (or perceived socioeconomic status) of the patientOverweight patient (not for valid medical reasons, but due to personal bias)Marital status (some fertility health insurance coverage requires that the patient be married)Sexual orientationGender identityEthnicity or raceAge
This roadblock may occur at the primary care physician or OB/GYN level, or it can occur further up the chain with a fertility specialist. Those who meet bias at the first level of care may be less likely to ever seek help from a fertility clinic. (They may not even know they could if they wanted to, depending on what information the first doctor shared.) Difficulty Seeking Care Due to Personal Bias and Fear: This obstacle occurs from within the fertility challenged person themselves. Many men and women know they are struggling to conceive, but put off seeking fertility help (or never seek help). Possible reasons a person may not reach out for fertility help include cultural stigma against infertility, distrust or fear of physicians, the assumption they can’t afford any treatments, religious ideology, or belief that more time or luck will be enough to overcome infertility.
Don’t Automatically Assume You Can’t Afford the Treatment You Need
Some couples never even talk to their doctors about their fertility concerns because they assume they won’t be able to afford treatment. This is unfortunate, given that most fertility treatment can be inexpensive. First, see your doctor. Get a basic fertility evaluation. (This is assuming you have health insurance, see below for what to do if you’re lacking good insurance.) Then, once your doctor does an evaluation, find out what treatments are recommended and their cost. A very small percentage of fertility patients require IVF.
Educate Yourself on Possible Financial Assistance Options
Yes, some fertility treatments can be expensive. If you need injectables, IUI, or any assisted reproductive technology, high costs can prevent you from getting the treatments you need. That said, there are options you may not have considered. A little extra financial help may push you from not-possible to yes-we-can. Some options to look into include:
Getting discounts on treatment or medications Borrowing options for fertility treatment Shared-risk and refund IVF programs Grants and scholarships Crowdfunding
Take Advantage of Free or Discounted Health Services
Let’s say you don’t have health insurance or your health insurance is extremely basic. You may be able to get affordable care from a free or discounted health clinic. You won’t find IVF treatment here. But basic reproductive care should be available, including very basic fertility testing. Some of these public or discounted health clinics may even prescribe fertility drugs like Clomid. To find a Federally Qualified Health Center (FQHC), you can use the search tool on the Health Resources and Service Administration (HRSA) website:
Find a Free or Discounted Health Center
Another option is to contact your local United Way office or a local Planned Parenthood clinic.
Treat Underlying Diseases as Best as Possible
When you think of fertility problems, you likely assume the issue originates in the reproductive system. But this isn’t always true. Sometimes, an underlying medical condition (that doesn’t only impact fertility) causes infertility. Infertility may simply be the first symptom you notice. For example, obesity is a common (preventable) cause of infertility. Untreated thyroid imbalances and diabetes can cause fertility problems. Undiagnosed celiac disease is suspected of causing infertility. This is another reason why you should see your doctor if you’re struggling to conceive, even if you don’t have fertility benefits on your health insurance. You may not need “fertility treatments” to get pregnant.
Ask Your Fertility Doctor to Reduce the Cost as Much as Possible
Let’s say you do need fertility treatment. Sometimes, if you explain to the fertility clinic your financial situation, they may be able to reduce the costs (somewhat). Some possible ways costs can be reduced include:
Less monitoring Using less expensive medication options Trying a natural or mini-IVF cycle
Of course, there are risks and benefits to using less monitoring or trying a mini-IVF cycle instead of a conventional one. These cost-cutting options are not always possible. Discuss your options with your doctor.
Optimize Overall Health as Much as Possible
A healthier lifestyle isn’t going to unblock your fallopian tubes, cure primary ovarian insufficiency, or reverse azoospermia (zero sperm count). However, couples facing “borderline” fertility problems may push the odds of pregnancy in their favor. Some things to consider: Eat a healthy diet. Research has found that diet does play a role in fertility. Healthy foods can sometimes be more expensive. Cooking healthy can also take time, which you may not have if you’re working long hours. To get more veggies in your diet, purchase produce in season, and remember that frozen vegetables are just as nutritious as fresh. Also, don’t be ashamed to take advantage of your local food bank (if you qualify). Some areas have produce programs to help low-income families get more fresh foods into their diet. To save time with cooking, look online and at the library for information on advanced meal preparation and “quick and easy” recipes. A slow-cooker can be a good investment. Healthy doesn’t have to mean fancy or complicated. Get enough sleep, during the right hours. Sleep is important to your overall health and fertility. Shift-workers may face an increased risk of pregnancy loss as well. When you’re trying to conceive, make sleep a priority. Break those bad health habits. Do you smoke? Are alcoholic beverages an every-day occurrence in your life? Unhealthy habits can harm your fertility. Make time for relaxation. Stress does not cause infertility, but infertility can be very stressful. Excessive stress isn’t good for your overall health. Mind-body therapies can help you cope better.
Educate Yourself on Infertility and Connect with Others
The more you know, the more you can help yourself. Educate yourself on infertility, your fertility treatment options, and what steps you can take to improve the odds of conception on your own (if that’s possible). Also, seek out social support for your fertility struggles. Connecting with others who are dealing with infertility can help you see that you are not “broken” and that there is nothing to be ashamed of. This shift in attitude may make it easier to seek help.
Be Your Own Advocate
We assume our doctor will always give us the best medical advice, free of personal bias. Sadly, this is not always the reality. Being aware of the potential for bias can help. You’re more likely to recognize it, and know that another care provider may offer different options. For example, infertile couples have been told by their doctors that they had “no options” to have a baby, when in fact IVF was an option, but the doctor had religious objections to the procedure. Women have been told they were “too fat” for fertility treatment when another doctor would have offered treatment. Others have been told they had no fertility treatment options because the doctor assumed they couldn’t afford the treatments they need. Have only one fertility clinic in your area? Some doctors will offer consultation via phone or video conferencing. You may not have to travel to find out if it’s worth getting help elsewhere. What if you suspect (or know) that the local fertility clinic is refusing to treat you because of your marital status, sexual orientation, or gender identity? The American Society of Reproductive Medicine (ASRM) and the American College of Obstetrics and Gynecologists (ACOG) encourage their members to treat every patient equally, regardless of marital status, sexual orientation, or gender identity. However, they cannot enforce this attitude onto their physicians. You may need to travel to another city or state with a clinic that will offer you treatment, regardless of your marital status, sexual orientation, or gender identity. This, unfortunately, adds financial burden. Another option is to consider consulting with a lawyer who specializes in family or reproductive law. The law is likely on your side, but not necessarily. Some states have laws that protect LGBT patients from medical discrimination, while others allow doctors to refuse treatment on “religious” or “moral” grounds. You may also want to contact Lambda Legal, a non-profit organization that advocates for the rights of the LGBT community. They offer a “Legal Help Desk” via their website, along with information to help you know and understand your rights.
Advocate for Others: Take Action to Improve Access to Care
Take your frustration and use it to help others. Your advocacy efforts may not make a difference in time for your family building, but it may make a difference to someone else in the future. Becoming a fertility advocate can be an empowering experience. If you’re interested in getting involved, contact RESOLVE: The National Infertility Association. They can provide information on how to make a difference at the local and national level. Infertility is a disease, and fertility treatment access should be a human right. With advocacy and awareness, hopefully, we will come to a time soon when those who need fertility treatment can get the care they need, regardless of where they live, how much money they make, or how they identify.
