The International Council on Infertility Information Dissemination, Inc

New York Becomes Tenth State to Require Coverage of IVF and Sixth State to Require Coverage for Fertility Preservation for Certain Patients

A map of New York State emphasizing the New Mandate insurance companies to cover IVF treatment

Apr 01, 2019 
By: ASRM 
Origin: ASRM Bulletin Vol.22 No.1 

ASRM Bulletin Volume 22 Number 1

April 1, 2019 
 

New York lawmakers passed a budget measure late yesterday which updates the state’s existing infertility statute to include a requirement for health plans operating in the large group market (employers with 100 or more full-time staff) to provide coverage for three cycles of in-vitro fertilization. The budget measure also includes a provision requiring that patients at risk for iatrogenic infertility
be covered for fertility preservation services. 

Passage of the budget measure with these provisions caps a multi-year effort
on the part of ASRM and coalition partners including RESOLVE, the Alliance for Fertility Preservation, EMD Serono and Ferring Pharmaceuticals to pass the Fair Access to Fertility Treatment Act.  Inclusion of major pieces of FAFTA in the budget measure is a major victory for patients in New York and brings the state in line with current medical standards of care.

Provisions to lift the existing ban on surrogacy in the state were not included in the budget measure despite the hard work of other coalition partners. ASRM will continue to seek passage of The Child Parent Security Act via the regular legislative process. 

ASRM issued the following press release.

Washington, DC - The American Society for Reproductive Medicine (ASRM) applauds the news that New York has passed a long overdue update to the state’s infertility statute as part of its budget bill today.

“We are ecstatic that the leaders in New York have voted to require insurance companies who
participate in the large group market in the state to provide infertility coverage, including IVF and fertility preservation. This measure will allow many New Yorkers to get the health care treatment they need
in order to build their families. New York’s reproductive medical professionals wish to express our gratitude to Governor Cuomo and his staff for their leadership and to the champions in the legislature, Assemblywoman Aravella Simotas and Sen. Diane Savino, who have made access to this care a priority for New York families,” stated Peter Schlegel MD, President of the American Society for Reproductive Medicine.

Dr. Schlegel
went on to add, “We
are not done in New York yet, however. Having passed this vital measure to improve access to IVF treatments, we call on the leaders of the legislature to follow the Governor’s lead and reform New York’s antiquated laws pertaining to surrogacy, another vital therapeutic option for patients.”


 

The ASRM Bulletin
is published by ASRM's Office of Public Affairs to inform Society members of important recent developments.
Republication or any other use of the contents of the Bulletin without permission is prohibited. To request permission to quote or excerpt material from the Bulletin, contact Sean Tipton at stipton@asrm.org.   

 

Contact

Sean Tipton 
Ph: 202-863-2494 
E: stipton@asrm.org

Eleanor Nicoll 
Ph: 202-863-2349 or 240-274-2209 (mobile) 
E: enicoll@asrm.org

Support of IVF is Selfish: IVF is Murder

Scan of a hate note to INCIID on the Evils of IVF and referring to INCIID as murderers
Pregnant woman and ultrasound
IVF Babies

April 12, 2018, An open letter to the Anonymous person in Oklahoma City

Yesterday I received an anonymous hand-written letter postmarked from Oklahoma City, OK. The note was full of hateful rhetoric from someone describing all who are affiliated with INCIID working for INCIID, volunteering with or otherwise supporting the INCIID mission, 1.) selfish for not choosing to adopt, 2.) evil for supporting the right of men and women to pursue IVF because IVF is evil, and unnatural, and 3.) supporters and encouragers of murder.  (See note below)

Scan of a hate note to INCIID on the Evils of IVF and referring to INCIID as murderers

Normally, I answer letters personally. However, since this person wrote the letter anonymously with no return address, I will answer it publicly and treat the sentiments and note as a “teachable moment”.

Periodically, INCIID runs across people who, for whatever reason, make the decision to see hateful rhetoric as their righteous duty as the “morality police”. They point out (anonymously) how others should think or act without feeling or empathy or even facts and circumstances many face as they make personal decisions about building a family.

For the record INCIID, is about providing attributable, comprehensive and cutting-edge information (not treatment) about high and low-tech treatments for multiple pregnancy loss, or infertility, adoption and even living childfree if that is one’s choice.

INCIID is a charity helping individuals and couples explore their family-building options without prejudice and without suppression. INCIID supports the dissemination of current information on diagnosis, treatment and prevention of pregnancy loss. Expanding or creating a family is an individual, and very personal decision. 

 “Don’t be Selfish – Just Adopt”

Personally, I found this idea laughable in a sad sort of way. Anyone who knows me personally knows we did adopt a child with special needs, a child that has trouble returning affection, a child with multiple neurophysiological disabilities and who cannot speak – A child we had to fight for,  just to bring her home so she wouldn’t die from starvation, neglect and abuse. An adult child, now, who we continue to provide with unconditional love, support and necessary therapies.  

When someone tells a couple who is having trouble conceiving to “just adopt”  or calls them selfish, they show their ignorance about adoption and the process of building a family. Adoption is not for everyone. There are many in the world who are not suited to adopt. The decision to adopt, to get treatment or live without children is individual, and highly personal.

Adoption is a huge responsibility and lifelong commitment no matter what.  As an adoptive parent myself, who has spent many years researching adoption and writing about it, I feel I am qualified to say – it is not for everyone, it’s a personal decision that should NEVER be made in haste and never without careful consideration.

What is really selfish is to adopt a child when the intended parents are not equipped to handle the circumstances that come (for example) with children adopted internationally who have many special needs, or from the foster care system where children have multiple issues including neglect and abuse.

Pregnant woman and ultrasound"IVF is Unnatural"

The dictionary definition of natural is to be in agreement with the character or makeup of, or circumstances surrounding, someone or something”. So, to that I would add that when a couple or individual decides it’s time to add to their family – depending on their make-up or individual circumstances, IVF would be quite natural. If someone has blocked tubes, IVF is a natural course to pursue.

If someone has cancer and needs high tech intervention to conceive IVF would be a very natural course to take. If there is a genetic link to some of the terrible diseases that hurt, and lead to the suffering and death of a child, IVF would be a natural course of action to take. Individuals who would become parents think carefully about how to avoid inflicting pain on their children. That again is unconditional love.

Pre-implantation genetic testing to prevent conception of a hereditary genetic disease can save parents and children from needless suffering because it can detect single gene defects/disorders. PGD can detect fatal and painful diseases Tay-Sachs and Niemann-Pick Diseases – both fatal and preventable with genetic testing.

How arrogant, short-sighted and devoid of caring might someone have to be to even consider making a decision for others who are dealing with such life and death decisions.

How arrogant must a person be to call those who chose IVF “murderers? How egotistical, self-important and condescending must the moral police be to accuse cancer survivors and those helping them build a family “murderers”.

To spew this hateful rhetoric is just devoid of love, caring and empathy.

In closing, to my friend in Oklahoma City, I would just say on one thing we agree, “LOVE IS RIGHT AND GOOD, CHOOSE LOVE.”

IVF Babies

INCIID could have taken a path to sell our mailing list, run on advertisements but instead we felt that there was a need to provide information freely and without strings attached. INCIID’s love of others, those going through infertility, those experiencing the trauma of losing a child were the reasons INCIID was founded. The INCIID message to all those experiencing the heartbreak of infertility is that they are not alone.

Love is sharing information and providing it to others freely without judging their decisions.

Love is patient and kind. Those who love unconditionally don’t call others murderers. Love doesn’t boast and become the morality police or try to shame others who may not share their views. Love doesn’t dishonor others who believe differently. Love is not self-serving. Instead, Love is patient, and kind. Love protects and trusts and provides hope. People may fail but love, unconditional love, never fails. 

Surrogacy & 3RD Party Reproduction Webinar

Meet Marla Neufeld, Esq. Marla will answer your questions on April 5, 2018, at noon (12-1PM)  The topic is Third-Party Reproduction including donor egg, donor sperm and surrogacy.

 

Donor and Surrogacy Advice 03/21/18 from Nancy Hemenway on Vimeo.

 

Donor and Surrogacy Advice 03/21/18 from Nancy Hemenway on Vimeo.

 

Show Me the Money-Expenses Relating to ART by Jeffrey Kasky and Marla Neufeld

Show Me the Money—Expenses Relating to ART

by Jeffrey Kasky and Marla Neufeld

It’s hard for anyone in the depths of assisted reproductive technology (ART) procedures to believe that having a child can actually be free for some people! A wide range of techniques are offered for ART pro- cedures and with that comes a range of fees for the medical procedures involved. Examples of variables that impact the cost depend on if an egg or sperm donor is required, if the cycle is a fresh IVF cycle or frozen IVF cycle, the medication protocol, and if there are any medical complications that arise during the process. The location where the ART procedures take place impacts fees as they vary depending on the city, state, or country. Studies show that in areas with fewer infertility clinics, the costs are actually higher for treatment; an area with a higher cost of living does not necessarily equate to higher ART costs.

Costs of Common ART Procedures

It is difficult to find an average for fees of ART procedures as many fertility clinics charge different amounts; most clinics do not publish the treatment rates or payment terms on their website. Patients should have a consultation with the clinic’s financial staff to formulate a budget and payment plan for the medical expenses.

The American Bar Association (ABA) Guide to Assisted Reproduction

Questions to Ask Fertility Clinics Relating to Costs

It is challenging to know what questions to ask a fertility clinic when you are new to the infertility world and don’t know the intricacies of ART finances. It is recommended that patients considering ART do their due diligence in the begin- ning and have a meeting with the fertility clinic’s financial department to have a detailed conversation about the costs involved, payment plans and financial assistance options. Some questions to guide you in talking to the financial depart- ment include:

1.  Does the clinic have a detailed list of procedures and corresponding costs? This list should include the common ART procedures like IVF and IUI, medical procedures associated with standard screening of new pa- tients, and should also include additional procedures that may be neces- sary such as ICSI, PGD, storage fees for frozen embryos, etc.

2.  Are medications, tests, lab work, ultrasounds, and consultations in- cluded in the cost of treatment?

3.  If necessary, what are the costs, including screening costs, involved when using an egg donor, sperm donor, or surrogate?

4.  What are the typical costs associated with medications?

5.  Does the fertility clinic provide financial counseling and psychological counseling? If so, are there fees for these services?

6.  Does my medical insurance cover any of the medications, testing, moni- toring, or procedures and does the fertility clinic verify coverage or is that the patient’s responsibility?

7.  When is payment due? Is payment required upfront? Is a payment plan available?

8.  Does the fertility clinic offer a reduced rate if you purchase an IVF package?

Surrogacy Costs

The expenses in surrogacy are multifaceted. Not only do you have to consider the costs associated with the ART medical procedures described above but you also have to factor in other expenses such as the “compensation” and/or “payments” to a surrogate, among other expenses.When doing your research on budgets, keep in mind that every state has different standards for costs associated with the process. For example, some states prohibit “compensation” to the surrogate. In these states, the concept of “altruistic surrogacy,” wherein the surrogate does not get paid a fee for her services, benefits the intended parents in that they can only pay the surrogate’s out-of-pocket expenses and medical expenses. However, surrogates looking to be compensated for their efforts will look outside such states, which can thus be a detriment for families in the prohibitive state trying to find a good surrogate match. It’s a “Catch-22.”

TIP: Part of ART is mastering the “art” of formulating a budget for each procedure taking place.

Financial Implications of ART

Compensation and Payments to the Surrogate

The notion of “compensation” and “payment” versus “reimbursement” to a surrogate is somewhat controversial. The language used may carry importance insofar as whether the financial portion of the arrangement could or should be considered “income” to the surrogate for taxation purposes.

A surrogacy contract sets out the financial responsibility, however it may be framed, and creates a payment plan that the intended parents will pay their surrogate. When working with a surrogacy agency, the agency establishes the payments made to the surrogate and there is little to no negotiation between the intended parents and surrogate as to what she will be receiving financially. When self-matching occurs and no agency is involved, the parties, either directly or through the lawyers, negotiate the payment terms to a surrogate. When using a surrogate, with an agency or self-matched, the amounts paid to a surrogate will be different depending on where the surrogacy is taking place.

A surrogacy budget can be broken down into three categories: (i) payments the surrogate should receive, (ii) payments the surrogate may receive depending on whether certain events occur, and (iii) payments to third parties involved in the process.

Payments the Surrogate Should Receive

As seen in most surrogacy contracts, from the moment a surrogate is selected until a determined time after the child is born, intended parents can be “on the hook” for payments to a surrogate for weeks or months post birth (depending on the contract). Below are the common payments made to a surrogate:

Surrogate’s compensation—Again, care must be paid to use of terms such as “compensation,”“payment,”“fee,” and the like. With that said, this is her “base fee” that typically begins once she is confirmed to be pregnant and continues to receive financial support every four (4) weeks thereafter until the child is born. Many surrogacy contracts require the surrogate to reach a certain week of pregnancy in order for her to receive her en- tire agreed amount (for example, thirty weeks, gestation for multiples, thirty-two weeks, gestation for a single child), and if she delivers prior to that determined week, then her compensation would be paid up to that point. A surrogate who has already successfully completed at least one surrogacy will typically be able to receive a higher amount of support than a first-timer.

Life insurance and disability insurance policy for the surrogate—The intended parents are usually required to take out a term life insurance policy and sometimes a disability insurance policy for the surrogate naming someone in the surrogate’s family as the beneficiary in case something happens to her during the pregnancy.

Medication start—The surrogate receives a payment at the start of her injectable hormone medications or other type of medication (not including birth control) to prepare her uterus for the embryo transfer.

Mock cycle—Surrogate may receive a payment should the fertility clinic perform a mock embryo cycle, which is essentially a dry run of preparing the surrogate’s body for the real embryo transfer.

Embryo transfer—The surrogate receives a payment on the day of the embryo transfer.

Monthly allowance—To cover the surrogate’s daily expenses for the pregnancy such as prenatal vitamins, local gas expenses, and groceries, the intended parents may choose to pay the surrogate a monthly allowance instead of the surrogate having to itemize and account for the incidental expense

Maternity clothes—The intended parents pay the surrogate an allowance for maternity clothes. The maternity clothing allowance should be higher if the surrogate is carrying twins.

Surrogate’s travel—Some surrogates live close to a fertility clinic and hospital, but some may live in different cities, states, or countries than the intended parents. In such cases, the intended parents are required to pay for the surrogate’s (and sometimes the surrogate’s partner or spouse) out-of-pocket travel expenses for all procedures involved including the initial screening, monitoring, embryo transfer, doctor appointments, and delivery of the child. The travel expenses may include gas, car rental, taxi, hotels, airfare, trains, and a per diem amount if the travel requires an overnight stay.

Typical Payments the Surrogate May Receive

Loss of reproductive organs—Pregnancy is risky; surrogates are compensated should something happen to any of her reproductive organs during the course of the pregnancy. There is a monetary value associated with the loss of the surrogate’s fallopian tubes, ovaries, or uterus.

Embryo transfer cancellation fee—Some surrogates receive a flat fee if the medications begin but the embryo transfer is cancelled whereby such cancellation is not a result of the surrogate’s intentional actions.

Selective reduction or elective termination—Should a selective reduction or elective termination of the pregnancy occur that is permissible under the contract (i.e., the surrogate did not do these procedures against the wishes of the intended parents), the surrogate receives a fee for having to undergo such procedures.

Invasive procedures—An invasive procedure resulting in a payment to the surrogate will include any procedure relating to the pregnancy requiring administration of IV fluids or an overnight stay at the hospital, with the exception of the birth of any child, such as amniocentesis. Invasive procedures should not include any standard procedures relating to the fertility treatments.

Ectopic pregnancy—Should an ectopic pregnancy occur, the surrogate is compensated.

Miscarriage—Should a miscarriage occur, the surrogate is compensated.

Cesarean section—Should the surrogate require a C-section, the surrogate is compensated.

Multiples—If the surrogate is carrying twins or multiples, she receives additional payments for each fetus.

Bed rest—If the surrogate is placed on physician-ordered bed rest (cannot be self-initiated), the surrogate receives her verifiable lost wages for the days she misses work. Some contracts pay surrogates her net lost wages while others pay gross lost wages. If a surrogate has a short-term disabil- ity (STD) policy, the intended parents will only be responsible for the lost wages that are not covered by the STD policy. The contract should establish how long the intended parents need to pay the surrogate’s lost wages once the child is born. Additionally, some contracts require the intended parents to pay limited lost wages to the surrogate’s partner or spouse for the days they accompany her to certain medical appointments or the delivery of the child.

Childcare and housekeeping—The intended parents may be responsible to pay for the surrogate’s reasonable childcare and housekeeping ex- penses during the pregnancy (this may be covered by the monthly allow- ance), delivery, postdelivery recovery, and if the surrogate is placed on physician-ordered bed rest.

Breast milk pumping—Should the surrogate agree to pump breast milk postbirth, the intended parents should pay either a weekly or monthly fee to the surrogate along with any expenses associated with pumping, such as equipment, milk bags, and shipping. It is important to discuss the parties’ rights and responsibilities insofar as the delivery of the breast milk is concerned. If the milk does not arrive at the par- ents’ home in usable condition, does the surrogate have to forego her payment for that period’s pumping? We believe that the responsibility should be on the parents to ensure (pun) that the milk arrives in useable condition.

Spoiling your surrogate—In an expression of gratitude towards a surro- gate, many intended parents voluntarily spoil their surrogate with tokens of their appreciation such as buying them food, prenatal massages, and gifts for the surrogate and her family. Before you undertake any course of action that is not contemplated in the contract, however, you should check with your attorney to make sure that what you’re planning to do is legal in your jurisdiction!

Payments to Third Parties Involved in the Surrogacy Process

Fertility doctors—The intended parents are required to pay any expenses associated with the fertility clinic for the surrogate and intended parents, which includes the screening of the surrogate, including FDA screening consultations, medications, the embryo transfer, monitoring, blood work, and ultrasounds.

Obstetrician—The intended parents are required to pay any expenses as- sociated with the obstetrician for the surrogate and whatever is not cov- ered by the health insurance of the surrogate.

Hospital—The intended parents are required to pay any expenses associ- ated with the hospital for labor and delivery, including the hospital stay for the surrogate and any complications relating to the surrogate and whatever is not covered by the health insurance of the surrogate. The surrogacy contract should provide how long the intended parents are re- sponsible to pay for the medical expenses of the surrogate once the child is born. Note that the hospital bills associated with the resulting child are charged to the insurance of the intended parents, not the surrogate’s insurance.

Medical insurance review—If the intended parents have the medical insur- ance of the surrogate reviewed by a professional to determine if any ex- clusion for surrogacy applies, they are responsible for any fees associated with this service.

ART lawyers—The intended parents are responsible to pay their attorney to draft the surrogacy contract and handle the court proceedings neces- sary to finalize their parental rights of the child. The intended parents also pay for a separate attorney to represent the surrogate. Other legal costs associated with this process may include court filing fees and certified copies.

Trusts and estates lawyers—It is recommended that the intended parents get their estate plan in order to prepare for the child and are responsible to pay for an attorney to draft any necessary wills, trusts, or other estate documents.

Immigration lawyer—When going abroad to use a surrogate or if the intended parents are from another country, an immigration lawyer is in- volved to ensure the proper citizenship of the child at the expense of the intended parents.

Escrow company—The intended parents pay for the escrow services to administer the payments to the surrogate throughout the surrogacy process.

Background information of surrogate—Usually these expenses are built into the agency costs, but intended parents may need to pay for a crimi- nal background check, home study, or other investigative research on a surrogate.

Surrogacy agency—If the intended parents require a surrogacy agency, they are required to pay the agency fee.

Egg donor agency—If the intended parents require an egg donor agency, they are required to pay the agency fee.

Sperm bank—If the intended parents require a sperm donor, they are re- quired to pay the sperm bank fee or fee to the sperm donor directly.

Psychologist—The intended parents pay for the psychological screening that is required when using a surrogate.

Nutritionist—If the surrogate requires the assistance of a nutritionist, it is at the expenses of the intended parents.

Acupuncturist—If the surrogate requires the assistance of an acupunctur- ist, it is at the expense of the intended parents.

Embryo storage facility—If the intended parents have frozen viable em- bryos, should they want to continue freezing the embryos for a length of time, they are required to pay storage facility fees.

Courier fee—If the intended parents want to have a pro- fessional transport the frozen embryos from one fertility clinic to another the fertility clinic (i.e., if the donor is in another location from where the embryo transfer occurs), they are required to pay for the proper trans- portation of the frozen genetic material.

CAUTION

Do you see a theme here? EVERYTHING is at the expense or at least the responsibility of the intended parent(s). The surrogate is responsible for NOTHING. Yes, hopeful parents, it’s expensive, and the entire burden of such expense is put on you.

Egg Donation Costs

The term donor is really a misnomer as egg “donors” are not generally donating their genetic material without being compensated. Leading ART organizations and ART professionals agree that donors of genetic material should be paid for their time, effort and inconvenience, and that the compensation received is not based according to the planned use of the eggs, the number or quality of eggs retrieved, the number or outcome of prior donation cycles, or the donor’s ethnic or other personal characteristics. The costs associated with egg donation can be separated into two main categories: (i) payments to the egg donor, and (ii) payments to third parties involved in the egg-donation process.

Payments to the Egg Donor

Egg Donor Fee—The egg donor receives compensation for providing her eggs. Such fee is commonly paid in two installments. One payment is required upon the start of injectable medications for the egg donor and the second is required upon the retrieval of the eggs (regardless if any eggs are retrieved and/or the quality of the eggs, unless it was the intentional fault of the egg donor). While compensation to egg donors varies, the American Society for Reproductive Medicine (ASRM) provides guidelines on compensation to donors in that total payments to donors in excess of $5,000 require justification and sums above $10,000 are not appropriate. In addition to limiting compensation, the nonbinding guidelines forbid paying additional money to egg donors for specific traits such as academic history, physical characterizes, or prior success as a donor.

Complications Insurance Plan for the Egg Donor—Intended parents may be required to purchase a complications policy for the egg donor to cover any major complications that may arise during the medical procedures for the egg donor.

Travel for the Egg Donor—The intended parents will pay for out of pocket travel expenses for the egg donor (and sometimes her partner or spouse) to attend any fertility doctor appointments such as the screening, monitoring, and egg retrieval. The intended parents may be required to pay any verifiable lost wages for the donor if she misses work because of the procedures.

Payments to Third Parties Involved in the Egg Donation

Fertility Doctors—The intended parents are required to pay any expenses associated with the fertility clinic for the egg donor, which includes the screening of the donor, including FDA and genetic screening, consulta- tions, medications, monitoring, blood work and ultrasounds, and the egg retrieval.

ART Lawyers—If the fertility clinic or egg donation program does not provide the proper legal documentation, the intended parents pay for their attorney to draft the egg donor contract. The intended parents also pay for a separate attorney to represent the egg donor.

Background Information of Egg Donor—Usually these expenses are built into the egg agency costs, but intended parents may need to pay for inves- tigative research on an egg donor.

Egg Donor Agency—If the intended parents require an egg donor agency, they are required to pay the agency fee. Many fertility clinics provide a database of fresh and sometimes frozen eggs; there are also frozen egg banks available to intended parents. Some egg donor clinics and providers offer shared egg donor cycles where multiple intended parents share in the eggs retrieved from one donor; this may reduce the expense of the eggs for the intended parents.

Psychologist—The intended parents pay for psychological screening that is required when using an egg donor.

Frozen Egg Storage Facility—If the intended parents have frozen eggs, should they want to continue freezing the eggs for a length of time, they are required to pay storage facility fees.

Courier Fee—If the intended parents want to have a professional trans- port the frozen egg from one fertility clinic to another the fertility clinic (i.e., if the donor is in another location from where the embryo transfer occurs), they pay for the proper transportation of the frozen genetic material

Sperm Donation Costs

Sperm donation may be the least expensive piece of the ART pie when compared to egg donation or using a surrogate. Sperm can be obtained from a known donor or through the use of a frozen sperm bank where the donors are usually anony- mous. The costs associated with sperm donation can be separated into two main categories: (i) payments to the sperm donor, and (ii) payments to third parties involved in the sperm donation process.

Payments to the Sperm Donor

Sperm Donor Fee—When a man donates his sperm to a sperm bank, he receives a fee typically per donated specimen, depending on various fac- tors such as the quality of the sperm provided. This fee is typically not paid to the donor directly by the intended parents as they pay a separate fee to the sperm bank to purchase the sperm. If intended parents are ob- taining sperm from a known donor, they may negotiate their own fee for the sperm directly with the donor.

Payments to Third Parties Involved in the Sperm Donation Process

Fertility Doctors—If the intended parents are not getting sperm from a sperm bank or require the assistance of a fertility clinic to screen a sperm donor, the intended parents are required to pay any expenses associated with the fertility clinic for the sperm donor, which includes screening the sperm donor, including the Food and Drug Administration and genetic screening, medications (if any), and consultations.

ART Lawyers—Typically a sperm bank provides the documentation for the sperm donor to sign off on and to relinquish any paternal rights to the donated sperm. However, as seen when using a known sperm donor (like family or a friend), it is imperative that the parties use an ART lawyer to draft the appropriate sperm donation contract. The intended parents also pay for a separate attorney to represent the sperm donor.

Background Information of Sperm Donor—Usually these expenses are built into the sperm bank’s costs, but intended parents may need to pay for investigative research on a sperm donor. Some sperm banks charge extra for an additional child or for adult photographs of the donor, other images or videos of the donor, and handwriting analyses of the donors.

Sperm Bank—If the intended parents require a sperm bank, they are required to pay the clinic’s fee to purchase the sperm. The cost for the sperm depends on factors such as whether the sperm is washed or not, if it is from an anonymous source, and if specifics regarding the background of the donor—such as whether he has a graduate degree, etc.—are requested.

Psychologist—The intended parents are strongly recommended to partici- pate in psychological counseling, at their expense, when considering the use of donated sperm.

Frozen Sperm Storage Facility—If the intended parents have frozen sperm and want to continue freezing the sperm for a length of time, they can ex- pect to pay storage facility fees.

Courier Fee—If the intended parents want to have a professional trans- port the frozen sperm to the fertility clinic or home, they are responsible for paying for the proper transportation of the frozen genetic material.

Estimated Expenses for Surrogacy and Egg Donation

As you see, there are variables that come into play when trying to determine the costs of ART procedures. This only gets more complicated as you add on addi- tional services such as surrogacy and egg donation.

Men Having Babies, Inc. (MHB) is a nonprofit organization that provides invaluable services such as educational and practical information to assist gay prospective parents achieve biological parent- ing, provide consumer feedback on reviews of fertility clinics, and promote the af- fordability of surrogacy-related services for gay men through financial assistance and the encouragement of transparency and customer feedback.

In order to help all people going through surrogacy and egg donation, MHB developed a Surrogacy Budgeting System. The goal was to decipher and harmonize the divergent cost structures involved in the entire surrogacy and egg donation procedure and develop a generic budget, as of 2015, with expected cost ranges per line item involved in the proces

The charts formulated by MHB pools data gathered from fourteen fertility clinics and sixteen surrogacy and egg donation agencies across the country. MHB continues to update these tables and asks that clinics and agencies provide current pricing sheets at least once a year.

While MHB does not publicize each provider’s cost sheet, the broad spectrum of data is used to create a generic budget. The comprehensive listing of all cost components in standardized categories is the first of its kind and provides pro- spective parents a definitive checklist of all possible costs. While many providers do not offer clear or full estimates to all possible cost components, MHB filled the omissions with data from independent experts and from their experience with the couples that have gone through the organization’s assistance program.

The budget is presented in two tables: one has all the nonmedical costs as- sociated with the surrogate: agency and legal costs, compensation, and expenses. The other table has the egg donation and IVF costs: donor matching, legal fees, compensation, and expenses; and medical screening of all parties, IVF treatment, lab fees, medications, monitoring, and other related costs.

Each table includes three columns: minimum estimated expenses, maximum estimated expenses, and the likely cost for each line item on the budget. Note that providers vary considerably in how they define, organize, and price various services. For instance, while most surrogacy agencies quote an “agency/retainer fee,” they vary in how inclusive that fee is. For some, it would include all the re- cruiting, screening, legal, and support functions associated with surrogacy. Others will quote separate fees for some of the items, even if they are not optional or provided by third parties.

In the table, Men Having Babies has listed all of the potential components of each general function or service and provided the minimum and maximum costs Men Having Babies has seen associated with these components when they are quoted separately. However in the “Likely cost” column Men Having Babies has only listed the costs associated with the components that are likely to be item- ized, and assumed all the other components should be included in the general agency fee.

The tables include estimated totals per stage or general grouping, such as medical screening or IVF treatment, which are shaded in gray. Each page is also totaled, and these numbers are highlighted in yellow. When considering these numbers, please keep in mind the following notes:

The totals of each category represent averages of the respective totals across the various providers, but are not always the arithmetic sum of all the itemized components (since not all of these items are necessary or quoted separately).

To arrive at cost estimates of the entire surrogacy and egg donation, you will need to add up the total of both tables. Currently that would amount to a minimum of $83,000, a likely cost of $122,000, and a typical $191,000 for the high end of the spectrum.

These totals include only a basic journey—namely they do not include costs associated with having twins, optional medical procedures (such as preimplantation genetic screening), or when more than one IVF cycle is needed (which is the case in about 30 percent of the times). The tables can allow you to calculated likely costs for these scenarios and others, and factor them in based on your circumstances and level of risk aversion.

While these tables were created by compiling the most up-to-date data from clinics and agencies around the United States, they are only offered as a budgeting aid. Anyone embarking upon a surrogacy and egg donation journey needs to formulate their own budget based on the specific services required and the actual providers being utilized.

In order to better understand the MHB tables, some abbreviations are used as follows:

 GC—gestational surrogate

 IP—intended parent

ED—egg donor (or sometimes: egg donation)

ACA—Affordable Care Act health insurance policy

LL—Lloyd’s of London health insurance policy

MMPI—Minnesota Multiphasic Personality Inventory test

 

Update From INCIID the Heart - The first and only national IVF scholarship program.

Miracles and Memories -  Looking back to the first baby born into the INCIID IVF Scholarship: This article is part of the October 2006 INCIID Insights Newsletter

From INCIID the Heart Update

October 31, 2005, INCIID celebrates the one year anniversary birthday of the first Heart baby's entry into the world.

Shewanda and Carl Harris were one of the first couples to apply for a scholarship. Shewanda had one miscarriage and two ectopic pregnancies. According to Dr Mory Nouriani, “Shewanda’s case was an exceptionally difficult one. Her prior surgeries left her with one remaining ovary which had been scarred down, and we were only able to obtain 6 eggs from that remaining ovary.  Despite the up-hill battle, we were elated that her cycle was successful.” Shewanda’s only hope to conceive was through In Vitro Fertilization (IVF).  At an average cost of over $10,000 per attempt, IVF was financially out of reach for the Harrises. View a video clip go here.

INCIID continues to take applications for its unique IVF scholarship program.  The program is intended to help those who would otherwise be unable to afford treatment when IVF is the recommended in the next step of their infertility journey.

By the end of this year, we expect to have a dozen children here who would not have had a chance to be born. We are so pleased, Organon Inc. is once again providing stimulation medications for those chosen.  We have more than 25 clinics donating between 1 - 12 free cycles of IVF. We call the doctors of these very special clinics: "Doctors with Heart!" 

Applications are accepted year round. The free standing selection committee meets three to four  times a year to discuss and review the applications. The process from receipt of application to assignment to a clinic (if selected)  takes anywhere from six to twelve months.  All applicants must be prepared to pay for any additional costs not covered by the program as outlined in the FAQ.   

 

For  more information and to download an application.

 

 

INCIID Insights is sponsored by Sher Institutes for Reproductive Medicine.

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IVF Scholarships from INCIID

"From INCIID the Heart" IVF Scholarship

2019 Scholarships will be reviewed on a rolling basis as they are received each month.

The InterNational Council for Infertility Information Dissemination (INCIID -- pronounced “inside”) has the first and only national program designed to help individuals and couples -- From INCIID the Heart -- It provides an  In Vitro Fertilization (IVF) Scholarship to those in need through donations of funds and treatment from professional members, and consumers.    

 "Infertility care is sometimes portrayed as ‘wealthy couples creating designer babies. But nothing could be further from the truth".  The From INCIID the Heart is an important step in helping to eliminate the barrier preventing many couples from having children.

There are at least 6-7 million infertile couples in the U.S., and of those, approximately two million are unable to conceive without IVF treatment.  The majority have no insurance coverage for IVF and its associated medications, which can range in cost between $18,000 and $25,000 per couple. And  EMD Serono supports the program with donations of ovarian stimulation medications.
 
INCIID continues to gain support for the scholarship from a number of respected IVF clinics in the U.S. to donate their expertise and state-of-the-art facilities for patients who do not have the financial resources. Thes generous reproductive centers support the INCIID mission to help patients build families where they may not have the opportunity without help. The program will cover most of the basic expenses incurred during an IVF cycle.

Couples with financial and medical need may be eligible for participation in the program. The criteria are simple: No insurance covering IVF, Financial Need and Medical Infertility (as defined by the American Society for Reproductive Medicine - ASRM).  Final committee selections and decisions take cost-of-living in different regions of the country into account, applicants who may have student loan debt and a variety of other situations. Each application is processed based on an individual needs assessment.   INCIID required applicants provide copies of their most recent tax returns (2 years) and pay stubs (2 consecutive and most recent pay cycles), and supply a letter from their doctor recommending IVF as medically necessary. Selected recipients partner with INCIID in agreement to fundraise a small amount. 
Our goal is to give those without insurance coverage for IVF an opportunity to fulfill their dream of becoming parents.

For more information and to apply: READ the FAQ (Frequently Asked Questions) FIRST. Once you read the FAQ, download the application located at the end of the FAQ.

* All recipient/finalist cycles are subject to a final medical review and determination on whether the donated treatment is appropriate for the recipient. INCIID  may make changes in policies, procedures, offerings, and requirements at any time. The fundraising agreement in no way guarantees a cycle of IVF.

The application process is on-going. If you want to be considered for the program, please read the FAQ first and then send us your application. Applications are reviewed throughout the year. Before you apply: Please get the latest version of Adobe Reader.

INCIID is grateful to EMD Serono. for their support of this program.

Tips on Progesterone Use for IVF

IVF cycle

IVF cycleMaking Progesterone in Oil shots less painful.

Welcome. The goal of this educational module is to provide information and tips for making progesterone in oil injections easier and less painful. This tutorial is for informational purposes only. It is not intended to replace treatment plans provided by your physician.  You should always consult your doctor with questions about your treatment.

After viewing the presentation participants will become familiar with the kinds of progesterone medications offered as well as the most preferred forms of progesterone for patients during the last phase of an in vitro fertilization or IVF cycle.

After viewing the module, you should be able to describe the purpose and function of Progesterone in Oil injections. You will also be able to name  the three most common types of progesterone in oil used by most IVF practitioners and why particular kinds of progesterone are preferred over others – including which type is NOT recommended for pregnant women. Lastly, the tutorial will provide you with tips to make administration of the progesterone in oil injection less painful.

A Proposed Tennessee Bill in State Houses Proposes Any Child Produced by Artificial Insemination to be Illegitimate

Different Kinds of Families

 

Different Kinds of FamiliesWhat are these TN House and Senate bills really about? Let’s take a look more closely at artificial insemination (AI or IUI). AI is a relatively "low-tech" ART (Assisted Reproductive Technology) that deposits washed sperm directly into the uterus, bypassing cervical mucus and depositing the sperm in closer proximity to the fallopian tubes, where fertilization occurs. Used to bypass hostile cervical mucus and to overcome sperm count and motility problems. See Dr. Sherbahn's article on IUI for more information.

INCIID believes in people to make personal and private decisions – to create all kinds of families, families with different kinds of needs, different cultures different children, special needs and disabilities. Building a family is a very personal decision and that privacy is a right guaranteed in the United States Constitution. Don’t let any official tell you differently. That’s a right about to be tested in Tennessee.

Tennessee’s current code 68-3-306 provides that children born through artificial insemination are legitimate children when husband and wife consent. "A child born to a married woman as a result of artificial insemination, with consent of the married woman's husband, is deemed to be the legitimate child of the husband and wife." (TCA 68-3-306)

Tennessee’s Terri Lynn Weaver (R-Lancaster) of the House (HB 1406) and Joey Hensley (R-Hohenwald) of the Senate (SB 1153) propose bills seeking to label and classify all children born through (IUI) artificial insemination as illegitimate children. ART techniques include, donor eggs, donor sperm, surrogacy, and any procedure involving in vitro fertilization (IVF). Senator Hensley’s version would repeal TCA 68-3-306 declaring children born through AI/IUI “illegitimate”. There is no reason not to expect this to cover all ART procedures as well using any donor process (donor eggs, donor sperm).

Saddling children with the label “illegitimate” is not only cruel, traumatizing and not in their best interests but could also affect services they are entitled to receive. Children are not yoyo’s or ping pong balls to be bounced about by would-be reproductive sheriffs or the courts. Children are the future. They should be cherished, loved and provided opportunities whether they have a mom and dad, two moms, two dads or a single parent. Children should NOT be used to discriminate.

I think those of you in Tennessee should ask what kind of nefarious agenda is afoot and do Weaver and Hensley represent the kind of world you want for your children?  What’s next “children that were adopted” or “immigrant children adopted internationally”. Could this be more about marriage equality and stripping rights of parents if they happen to be the same sex? These bills are a very bad news for citizens and residents of Tennessee. Call your representative and tell them vote NO on SB 1153 and HB 1406 Send Weaver and Hensley a note and let them hear what you think of their bills.

“The emphasis must be on the right to privacy and reproductive control.”
Supreme Court Justice Ruth Bader Ginsburg

I someone you know needs help getting a voter ID or is having trouble getting the right credentials, contact VoteRiders

 

Terri Lynn Weaver (R-Lancaster)

301 6th Avenue North
Suite 105 War Memorial
Nashville TN 37243
Phone: (615) 741-2192

Joey Hensley (R-Hohenwald)

District Address
855 Summertown Highway
Hohenwald, TN 38462

E-Mail Address
sen.joey.hensley@capitol.tn.gov

Nashville Address
301 6th Avenue North
Suite 309 War Memorial Bldg.
Nashville, TN 37243
Phone (615) 741-3100

 

Sara's Story: "Why don't you just adopt?"

Mother, father and newborn baby

When I heard couples discussing their attempts at pregnancy and IVF, I said, with contempt in my voice,, “Why don’t you just adopt.”  Yes, I was one of “those people”.

I was adopted, and it worked out fine for my parents and me. I believed that people choosing IVF were self-centered and arrogant about the necessity to pass on their genes to offspring. I admit I took the attempts to create a family through treatment personally—as if people who choose IVF were somehow disparaging or devaluing my non-biological relationship to my parents and sister.

Fast forward to the time when I stopped birth control and my husband and I attempted pregnancy. Clearly I was not ovulating. Our insurance mandated we try for 12 months before I referral to a fertility specialist. We visited different reproductive endocrinologists, attended informational sessions at adoption agencies and researched. In the end, money made the decision for us.

Our state mandates fertility coverage. Attempting pregnancy through medical treatment with insurance co-pays was easier to afford than adoption agency fees.  

After a year of trying, fruitless medicated cycles and IUIs, we began IVF. Now, we were “those people” taking what I used to call “extraordinary measures” to start our family. Our first cycle resulted in an early miscarriage and a diagnoses of poor egg quality. My diagnosis also included Polycystic Ovarian Syndrome (PCOS) and hypothyroidism.  Our reproductive endocrinologist (RE) told us dramatic weight loss might improve my egg quality. Our RE believed that future IVFs would also result in retrieval of poor quality eggs. Those poor quality eggs result in non-viable embryos or end in miscarriages. We said,  Thank you and goodbye”. The result, we started our adoption journey.

Adoption today is nothing like it was 37 years ago when my parents adopted me. Mine was a closed adoption through Catholic Charities. It did not take that long, cost was much lower, and, whether they were ready or not, parents were handed a baby with no “instruction booklet.”. Closed adoptions cause damage to many members of the adoption triad. Today’s open adoptions, through ethical agencies, are much healthier better for all members of the adoption triad. At the same time adoptions consume time, money, emotionally draining and stressful.  

We spent more than two and a half years and thousands of dollars pursuing adoption. We laid our lives and marriage bare in the home study process. We poured our souls into our profile book. We were asked to consider cases of expecting mothers and babies in truly heart-wrenching situations. We me with expecting mothers who smoked, drank and abused drugs while pregnant. We watched as month after month, other waiting parents were chosen instead of us. The rejections we felt while we waited and hoped was personal and painful. Our agency explained we needed to be ready because adoption matches came up suddenly. When we were in the top 2 or 3 waiting parent finalists, we experienced a rush of energy and enthusiasm that “this time” would be our time. I bought a stroller or hang curtains in the nursery. I cut tags off of the carefully chosen gender-neutral going home outfit. Twenty months passed, exceeding our agency’s average wait time (by six months) for a baby. I was an emotional wreck and no baby. “Just Adopt” had me in therapy struggling to hang on. Even with the plethora of hormones, fertility treatments were not as emotionally draining.

I was an emotional wreck with a finished nursery and no baby. “Just adopt” had me in therapy and struggling to hang on in a way that fertility treatments, even with all the crazy hormones, never had.

For the sake of our emotional well-being, we asked our adoption agency to place our profile on hold. We simply did not want any more rejection. During our adoption wait, I pursued weight loss that our RE recommended to enhance egg quality. We went back to the RE who was encouraging, but said that the only way to know if my weight loss changed my egg quality was to try IVF again. I want to make it very clear that weight loss is not the answer for everyone. However, in my case it was. Our post-weight loss IVF brought us a beautiful baby boy.

After our son’s birth, we closed our case with the adoption agency. Our social worker, who was wonderful and supportive throughout the years we worked with her, agreed that our adoption journey had been particularly brutal. If the universe was trying to teach me a lesson for my previous self-righteous ignorance, it was karma overkill. I learned early n our journey not to judge the paths that others take. Our decision to pursue treatments, adoption, and then more treatments was how we, fumblingly, found our way in the dark. When dealing with infertility, all of the available options are filled with loss and pain. The choice as to which loss is endurable, which pain is most bearable, is highly personal. 

 

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