Infertility treatment is not an easy path. Along with the physical discomfort, emotional ups and downs and often a lack of understanding by family and friends, most of those who choose to try to build their families through infertility treatment also face steep financial implications. Infertility treatment is rarely covered by insurance, except in the states of Illinois and Massachusetts, which have laws mandating coverage for infertility treatment. And even in those cases, not everyone is covered.

Exceptions to the Rules in States With Infertility Coverage
Melanie Dwyer* of Chicago is lucky to live in a state that mandates insurance coverage, but there are always exceptions to laws, and in Illinois, self-insured companies are exempted. Melanie's employer at the time she and her husband began treatment was self-insured, but she wasn't totally out of luck: they did offer some infertility coverage, with a $10,000 lifetime maximum benefit. To put this in perspective, one IVF cycle can easily cost $10,000 or more, and since IVF is rarely the first step in infertility treatment, most, if not all, of the benefit can be used up before getting to IVF. Melanie's story may yet have a happy ending -- she recently switched her insurance coverage to her husband's plan, which will cover multiple IVF attempts.

Recently, two teachers from St. Charles, Ill., made national news when they sued their school district, which, like Melanie Dwyers' former employer, is self-insured. The teachers' employer provides no coverage for infertility treatment. The women, Lisa Mack and Angela Moreau, sought coverage for infertility treatment, claiming that the school district's policy both violates the Americans with Disabilities Act and discriminates against women. The federal Equal Employment Opportunity Commission (EEOC) ruled that there was "reasonable cause to believe that the district has discriminated against a class of employees on the basis of disability by maintaining a health benefits plan that excludes coverage for (the women's) disability." The EEOC issued a letter allowing the women to sue the district in federal court.

This is not the first time the EEOC has ruled that infertility is a disability and thus, covered under the Americans with Disability Act; in October of 1998 they found that Franklin Covey had discriminated against employee Rochelle Saks by not covering her medically necessary infertility treatment in their self-insured policy. According to legal experts, most courts will continue to find infertility to be a disability. But these opinions are just that, and while the future may be promising for mandating treatment, what about the here and now?

What Happens in States Without Infertility Coverage
Charlotte and Bob Fairchild* are a good example of how lack of insurance coverage for infertility can affect the lives of an infertile couple. The Fairchilds live in a state (Georgia) that does not mandate insurance coverage for infertility. In four years, they spent about $60,000 on treatment. They have made numerous financial sacrifices in pursuit of a family. "We have not had vacations, except to visit relatives," says Charlotte. "We drive old cars. We use coupons, never eat out, never see movies, don't get the [news] paper. Bob takes his lunch to work, we cut up the credit cards and don't buy new clothes. I have home parties for Tupperware, jewelry or crystal to get presents for family." She adds that they also cashed in retirement stocks four times and maxed out credit cards twice to pay for treatment. Charlotte has been pregnant twice; both pregnancies ended in miscarriage.

Lori and Michael Page live in Leesburg, Va. The state of Virginia does not require insurance companies to cover infertility treatment, and the Pages have not been able to afford treatment for infertility. They had to pay out-of-pocket for surgery for Lori. "Our RE (Reproductive Endocrinologist) worded it as 'oviduct repair' and our insurance reimbursed us for 50 percent." Part of the Pages' diagnosis is "severe male factor" but they are unable to find out the cause, or whether it can be treated, because they can't afford to pay for the testing and doctors' visits. The Pages had to take out a loan to pay for Lori's tubal surgery. They are hoping to be able to secure credit to cover treatment from their RE. Without that credit, they will be unable to pursue infertility treatment.

Why Insurance Doesn't Cover Infertility Treatment
Why don't insurance policies cover infertility treatment? According to Deborah Wachenheim, government affairs director for RESOLVE, the national infertility advocacy and education organization, the major opponent of legislation mandating that health insurance include coverage for infertility is the insurance industry. The Catholic Church and some employers' groups also oppose legislation that requires that infertility treatment be included in insurance policies.

"Insurance companies and the employers' groups that oppose this coverage use figures that claim it's very expensive to provide this coverage," says Wachenheim, who cites two well-regarded studies that show that it is, in fact, very inexpensive for an insurance provider to add infertility coverage to a health plan; one study says that it would cost just a few dollars a year per insured person, and another says that it would cost about $20.00 a year per insured person. Wachenheim adds that insurance companies feel that any mandate for coverage is a "slippery slope" that leads to other mandated coverage. She also points out that the companies provide industry studies that contradict the studies by RESOLVE regarding the cost of covering infertility diagnosis and treatment.

Sally Adams*, of Dallas, Texas, and her husband have been in treatment for a little over a year and have spent $6,000 on inseminations, fertility drugs and monitoring. The Adams' infertility diagnosis includes both male and female factor. "Had insurance covered infertility treatments, we probably would have gone straight into IVF attempts rather than doing the insemination cycles, since due to our combined problems, IVF gives us the greatest chance at pregnancy," Sally says.

Advocate for Coverage From Your Employer
Sally has lobbied her employer to include infertility coverage. "They just lifted an exclusion for the treatment of disease and injury resulting from drug and alcohol abuse, but they still will not lift the exclusion for infertility treatments." Sally feels she's making headway, and hopes that either her employer will either agree to cover infertility or legislation mandating it will be passed.

Often an employer can make a difference in whether or not a company's health insurance benefits cover infertility diagnosis and treatment. RESOLVE's Deborah Wachenheim advises individuals to be sure to convey their desire to have infertility treatment as part of the health insurance plan. Companies have a great deal to say about what is part of their plan, especially when it is time to renew a contract with an insurance company.

*Names and locations have been changed to protect the privacy of individuals.