What is IVF?

A commonly used acronym, IVF refers to “in vitro fertilization.” IVF is a process by which mature eggs are taken from a person’s ovaries and fertilized with sperm in a lab to create one or more embryos. These embryos are then frozen until the prospective carrier receives medicine designed to prepare their uterine lining for the embryos to be thawed and implanted directly into the uterus, with the goal of producing a healthy fetus. Some couples use their own eggs, sperm, and uterus, while other couples have one or more of those donated to them (for a uterus, this is known as a surrogate, which is currently illegal in Arizona).

What if Couples Separate During IVF?

Already a complicated process, it can become even more tumultuous when couples separate while embryos are still frozen. To plan for this contingency, before couples begin IVF treatment, the providers have them fill out a form that includes the couple’s wishes for the embryo in the event of a divorce/separation. But this does little to solve the problem when spouses change their mind about the disposition of the embryos afterward, which is exemplified in the case of Terrell v. Torres [1]. In Terrell, the couple filled out the IVF provider’s form, marking the box that directed the provider to donate the frozen embryos if the couple could not agree to continue conception. The Supreme Court of Arizona found that this form constituted a contract, making embryo creation contingent on obtaining permission from both parties. Meaning, the frozen embryos would need to be destroyed if the parties were unable to agree upon the disposition of the embryos.

Just two years later, the Arizona legislature enacted ARS § 25-318.03, which attempts to save frozen embryos and permits giving the embryos to one of the spouses instead of destroying the embryos [2]. However, like in Terrell, the statute also disclaims either non-consenting party involved in creating such embryos from future parental or financial responsibilities if they become viable for use. Meaning, even if a spouse does not consent to becoming a parent via IVF, the frozen embryos may still be used to foster a child. However, the non-consenting spouse will not be held responsible for any parental or financial support to the child. This is arguably a positive development, because it protects the interest of the spouse who no longer wishes to raise children with the other spouse, while also protecting the other spouse’s right to make use of the extremely costly embryo.

Financial Costs of IVF

With the rising interest rates and current market inflation, more and more people are having comprehensive discussions about the high cost of living. What is missing from these conversations is how the economy has affected the actual cost of life – specifically, the costs of creating and maintaining life. Inflation has impacted more than just the price of necessities required for raising children. It has also caused the average price for a couple hoping to conceive through IVF to balloon to more than $20,000 for a single cycle of fertility treatment [3]. This cost has increased approximately $7,000 since just two years ago [4]. To make matters worse, couples can anticipate needing more than one cycle of IVF (even at the highest success rate, which is after six cycles, there is only a 65% chance of becoming pregnant) [5].

One doctor provided the following as a rough approximation for the breakdown of the different expenses involved throughout the IVF process [6]:

• $800 for monitoring
• $1,250 for egg retrieval
• $1,500 for fertilization
• $1,500 for embryo transfer
• $200-$2,000 for medicine
• $750 for genetic testing per embryo
• $1,250 to freeze the embryo during genetic testing
• $1,500 to thaw the embryo after genetic testing
• $500-$750 potentially in additional charges, depending on the number of eggs

The cost of this process can, sometimes, be prohibitive. One story, involving a couple out of Missouri, illustrates the difficult reality of undergoing the IVF process on a limited budget. As a same-sex couple, IVF was the only way for them to conceive biological children, and they were not interested in adopting children. They pled their case to insurance providers and medical professionals, arguing that they should not have to sacrifice their desire to give birth to biological children just because they are not able to proceed through normative means. After all, heterosexual couples have that right, so why shouldn’t they? These women should have had access to health benefits that would have made the process significantly easier. Instead, the mental turmoil and myriad obstacles threatened their will to continue the process. They ended up needing to take out a personal loan and asking their family members for financial support [7].  

Other Barriers to IVF

For couples using IVF, the excessive cost is not the only issue with the process. Other factors contributing to the high cost of IVF are the significant regulatory barriers related to obtaining insurance coverage for the process. This issue exists across the United States and primarily lies in the intricacies of insurance policies when considering reproductive processes. In some states, IVF must be covered by insurance and is subject to lifetime maximums [8], but about half of the states (including Arizona) allow insurance carriers to refuse to offer any type of infertility treatment coverage [9]. While it may seem that the American healthcare system is to blame for this disjointed approach to coverage, this issue is not unique to the United States. It is a global issue, causing people around the world to call for greater price transparency and reform [10].

Conclusion 

There are many factors to consider when couples look to expand their families via IVF. Between the potential for emotional turmoil, the prohibitive cost, and the lapses in insurance coverage, IVF is riddled with barriers. But IVF is the only option for some people. Abortion is the primary focus in the fight for reproductive freedom, but IVF is just as impactful and inaccessible to many couples. Thus, greater attention should be paid to the difficulties associated with IVF, because significant reform is needed.

[1] Terrell v. Torres, 248 Ariz. 47 (2020).

[2] A.R.S. § 25-318.03 (2022).

[3] GoodRx, “How Much Does IVF Cost?”

[4] IVFSpecialists, “How much Is One Round of IVF?”

[5] “RRC, “How Many IVF Cycles Should I Plan For?” 

[6] GoodHousekeeping, “What Does in Vitro Fertilization Cost? It Depends on a Lot of Factors.”

[7] USA Today, “‘Still a lot of hurdles’: For LGBTQ+ couples, the path to in vitro fertilization is harder.”

[8] Even for these “good” coverage states, the lifetime maximums are often lower than the current cost of a single IVF treatment.

[9] Resolve, “Insurance Coverage by State.” 

[10] UN News, “Better access to fertility care essential for global health: WHO.”

Isabel Ranney is an associate attorney at Woodnick Law and is licensed to practice in the state of Arizona. Prior to becoming an attorney, Isabel was a law clerk at Woodnick Law for nearly three years. 

Mallory Scott is a 3L at the Sandra Day O’Connor College of Law at Arizona State University, and a law clerk at Woodnick Law PLLC. While working as a clerk during the summer, she has the opportunity to work on real-world litigation, but also research topics of interest relating to the future practice of law. The practice values exploration into collateral topics that relate to families, especially their relevance to popular culture and media.