Melanie Martin, a surgical nurse in San Diego, said she and her husband cut every corner they could think of to save up enough money to pay for conceiving a child through the technique known as in vitro fertilization.
Like most other insurance plans, theirs didn't cover the procedure, so they sold one of their cars and she took extra shifts at work. They put part of the cost on credit cards and bought the drugs through an online pharmacy with lower prices. Their first two cycles were unsuccessful, so they took a break to pay off more than $40,000 in debt they had accumulated from the treatment and began saving for a third cycle.
Martin became pregnant in May 2013, and the couple expect their child shortly.
She and her husband most likely would have tried again if the third cycle had not been successful, she said, but she advises others to think carefully about how much debt they can take on in their quest for a baby.
"Even though we went through all the treatment to get our family," she said, "at the end of the day, you're right back with the rest of the world and have to provide for that family."
Thirty-five years after the first "test tube" baby was born, in vitro fertilization is the most common assisted reproductive technology used to treat infertility. More than 61,000 babies were born as a result of IVF and related techniques performed in 2011, according to the Centers for Disease Control and Prevention.
Yet just a small proportion of women who suffer from infertility use the procedure. Its cost remains daunting, and despite the hopes of some, Obamacare will have little, if any, effect on the price tag.
IVF involves the removal of eggs, which are fertilized with sperm in a lab and then transferred back to the woman's uterus. The overall cost of a single cycle using a woman's own eggs often ranges from $14,000 to $16,000, said Dr. G. David Adamson, a past president of the American Society of Reproductive Medicine.
"Cost is a problem," Adamson acknowledged because most insurance policies don't cover it. That means most couples must pay out of pocket. A woman may require more than one cycle to become pregnant, so the bills can quickly mushroom.
Barbara Collura, president of Resolve, a consumer advocacy group, said concerns about financing treatment compound the stress couples are already experiencing when confronting infertility.
While you might save for several years to buy a house, waiting that long isn't always an option with IVF because fertility decreases with age. Forty percent of IVF cycles in women under 35 who use their own eggs result in live births, but that percentage drops to 12 percent for women ages 41 and 42.
Since long-term saving may be out, that leaves other options typically used for covering unplanned expenses, such as dipping into savings, cutting back on other spending or borrowing the money.
Most reproductive clinics now offer special financing packages, such as discounts for multiple IVF cycles paid for up front or options to have part of the fee refunded if you don't become pregnant. But making sense of the options can be confusing.
Univfy, a company that sells IVF prediction tests, has recently introduced a free online "IVF cost calculator" (http://tinyurl.com/m5g3nfo) that uses your probability of becoming pregnant to help you compare the costs of different financing options.
Adamson said that because so many variables affect an individual's prognosis, the tool is "not, by itself, sufficient to make that decision." He recommends that patients who use the tool print out their results and discuss them with their physicians.
Here are additional questions to consider:
How much money should I spend on IVF?
Often, Collura said, couples determine an amount they are willing or able to spend initially, and then pause treatment to reassess whether they should continue. They may choose to pursue adoption if they can't conceive, so they may not want to spend all of their funds on IVF. After their early 40s, few women can conceive using their own eggs, so they may have to consider using donor eggs, which significantly increases the cost.
Do some states require insurance coverage of infertility treatment?
Fifteen states (not including Florida) have laws requiring some level of infertility coverage, but details vary widely. (A list of the states and their respective laws is available at http://tinyurl.com/6luyzgm.)
What if my insurance doesn't cover IVF?
Particularly if you work for a large employer, Adamson said, it's worth checking with your human resources department to see whether an alternative health plan might offer better infertility coverage at a higher premium. Also, the website mentioned just above lists nonprofit groups that may offer financial assistance or grants.