What is the average clinical cost for an IVF cycle?

The average clinical cost for a basic IVF cycle is $15,000-30,000 and east coast centers generally charge a higher fee than west coast centers. Medications, if not included, are $3,000-$8,000. There are additional services and options available which can increase the cost of an IVF cycle substantially. For example, preimplantation genetic diagnosis and/or screening (PGD/PGS) of the embryos will increase costs an additional $5,000-$8,000 depending on the IVF center and the extent of testing performed. If there is a need for intra-cytoplasmic sperm injections (ICSI) the average cost is between $1,500-2,500. Genetic testing of Intended Parents may not be included and can range from $400 to $4000 or higher depending on testing required. Embryo freezing and storage may or may not be included in IVF fees and the average cost is $600-1,000, plus an annual fee for storage of cryopreserved embryos. Many IVF centers now offer a guarantee program for an additional $8,000-$10,000, but they have a very strict criterion for the program and not all patients will qualify. Contact your IVF center for a copy of their fee sheet.

What is the average surrogate compensation?

Compensation paid to a first-time surrogate is generally $24,000-$30,000 depending on the location of surrogate; west coast surrogates generally receive higher compensation than those in other parts of the U.S. Repeat surrogates will receive an additional base fee of $5,000-10,000 for each successful cycle and pregnancy. The overall cost for a first-time surrogate cycle and pregnancy (without an egg donor) is $75,000-$100,000, including surrogate compensation, insurance for maternity care, agency fee, attorney fees (including parental establishment) and basic IVF costs. If working with an agency, the agency should be able to provide an accurate estimate of anticipated costs for your specific situation.

What extra costs should I anticipate for a surrogate cycle and pregnancy?

There may be small unexpected expenses that will come up during the pregnancy; however, if the surrogate has medical complications, and is required by the IVF center or OB/GYN to be on bed rest, the increase in cost averages $250/week in addition to her base fee. In most cases, the need for bedrest is a result of bleeding or shortened cervix and is seen most often with twin pregnancies. The bedrest fee is used to cover childcare and housekeeping and will continue for as long as the surrogate is on bedrest.

Lost wages may also be due to the surrogate if she is employed. Unless a maximum amount was negotiated for lost wages the fee will be paid for the entire time she is on bedrest. If there is a healthy pregnancy and a normal birth lost wages may include up to 12 weeks of family leave: 4 weeks prior to due date and 4-8 weeks post birth depending on doctor’s recommendation and whether there was a vaginal vs. c-section birth.

In order to receive lost wages, however, the surrogate must be able to prove income based on paystubs and/or tax returns. She must apply for State Disability first and the Intended Parents then pay the difference between the disability amount allotted and the actual wage the surrogate would have earned. If the surrogate does not contribute to State Disability or there are no available benefits in the surrogate’s state, the Intended Parents may be responsible for the total amount due for lost wages. The lost wages maximum should be established during the match and finalized during the contract negotiations.

What should I anticipate for insurance costs for my surrogate?

Insurance benefits within the U.S. are not consistent from company to company or policy to policy and not all insurance policies will cover maternity care of a surrogate. It is important to understand insurance policies that cover surrogacy are for the care of the surrogate while carrying the child/children for Intended Parents. Intended Parents are expected to pay for premiums, co-pays, deductibles and uncovered medical costs unless otherwise negotiated in the contract. You should always review the benefits and exclusions sections of the surrogate’s policy before you finalize your legal contract in order to understand your potential financial liabilities.

Maternity care costs and coverage for the surrogate could be as low as a few thousand dollars if the surrogate has good insurance already in place; or $12,500-$15,000 if a new policy is purchased. It is customary for Intended Parents to pay the monthly premium cost for 12 months or longer if you are under contract with the surrogate. Intended parents also pay for co-pay/deductibles which average $7,500 per year. It is important to note the co-pay/deductible maximum is an ‘annual’ deductible not a deductible per ‘fiscal’ year.

Employer policies are generally a good option; however, you must be careful that it is not a ‘self-funded’ policy because the employer then has the right to make decisions about what will or will not be covered under the policy. Many employers will not pay for maternity care of surrogates as they view it as a second job. If your surrogate has a self-funded policy you may need to purchase additional insurance or you will have to cash pay for the surrogate’s maternity care.

Some insurance companies state they will cover the maternity costs for a surrogacy, but they may retain the right to place a lien on surrogate’s compensation. A lien on the surrogate’s compensation does not mean the surrogate pays for the medical expenses. Intended Parents are expected to pay the negotiated amount on behalf of the surrogate. The lien may be half the amount of the surrogate’s compensation, or in some cases it may be the entire compensation. It is best to understand the lien rights of the company and if possible negotiate with the insurance company before the finalization of the legal contract.

Other insurance companies may seek full reimbursement of actual medical costs and it is not tied to the surrogate’s compensation or any maximum co-pay/deductible – in other words there is no limit to what they can seek. The average cost for an uncomplicated singleton pregnancy may be $6,000-8,000 and an additional $5,000-10,000 if a c-section is required. The average cost for an uncomplicated twin pregnancy ranges between $15,000-20,000 and an additional $5000-10,000 per child if a c-section is required because it is considered two deliveries. If there are further complications the cost will increase so it is always best to set aside additional funds for medical costs.

New Life Agency offers Lloyd’s of London surrogate policy. The good thing is it does cover surrogacy (most expenses) and you will understand the maximum out of pocket potential; however, the downside is that it is the most expensive policy you can purchase and you may need to use their service providers or the cost may not be covered at all. New Life also offers a reasonably priced ‘backup policy’ that allows you to receive coverage under Lloyd’s should the surrogate’s insurance company change coverage or will not pay for maternity care.

ART Risk offers a negotiating program which is reasonably priced. They ask for a specific amount of money to be held in a medical expense account and they negotiate directly with the medical provider to get rates comparable to what an insurance company would negotiate. They will also review your surrogate’s policy on your behalf. The average fee for a review is $250.

What medical insurance is available for the newborn child or children?

IN THE OVERWHELMING MAJORITY OF CASES THE SURROGATE’S INSURANCE WILL NOT COVER THE COST OF THE NEWBORN’S CARE.

U.S. Intended Parents can apply for and receive immediate coverage of their child/children either through their own insurance policy or they can purchase a new policy for the child through the Affordable Care Act and the coverage will be effective from time of birth. In this case, Intended Parents will provide the hospital with the insurance information and they will pay the cost of the premium plus any co-pays and deductibles directly to the hospital.

International families are not as fortunate and the cost of care of the newborn child can increase the overall cost of a surrogacy significantly. The children of foreign nationals, although legally U.S. citizens upon birth, are not automatically covered by U.S. healthcare. Some states within the U.S. specify that children born from parents who are foreign nationals may not be insured upon birth and must have a wait period before the child can be covered. It is important to understand the laws in the state in which the surrogate will give birth in order to assess the financial risk. If an International family lives legally in the U.S. at the time of the birth or works for a U.S. company that offers newborn insurance, however, it is possible the child could receive immediate benefits. International families should check with their employer to see if there are any corporate ties to the U.S. that would allow them to purchase U.S. insurance for themselves, and therefore, eventually also for their child/children once born.

Some countries, such as Germany, offer their citizens the ability to have immediate coverage for their newborn even when born outside of Germany; however, parents generally need to pay out of pocket first and then seek reimbursement from their country. For most International families, however, there may be few options for care of the newborn other than “cash pay.” or one of the expensive newborn plans through Lloyd’s of London or ART Risk’s negotiation plans.

ART Risk is a company that will negotiate medical costs for the newborn. They do not provide an actual insurance policy; rather they have Intended Parents put a predetermined amount of funds in a ‘medical expense account’ and they negotiate directly with the service provider to get the lowest cost available. The current fee for the company is $3,000, plus $10,000 in the medical fund for a singleton and $4,000 to the company, plus $25,000 in the medical fund for twins.

New Life Agency also provides coverage for a newborn and also negotiates with the provider. Currently, the fees for the program are not listed on their site, but the cost last noted averaged $25,000-$50,000 for a singleton.

What is the potential financial cost difference between a singleton vs twins?

We all know twins are adorable and most people think they will be getting ‘two for the price of one” but that is not the reality in most cases. Surrogates may have more complications when carrying multiples and the children may have more complications as well - all of which results in increased costs to Intended Parents. A multiple pregnancy and birth is more costly for International Intended Parents due to the lack of insurance available for the newborn or the increased cost for the New Life or ART Risk programs.

Increased costs are not just restricted to the care of the child after birth. The surrogate will receive additional compensation of $5,000-10,000 for each additional child she carries. The surrogate may be on bedrest or have restricted activity at some point during the pregnancy resulting in additional bedrest fees and lost wages. The OB will charge an additional fee for managing a twin pregnancy as they consider it caring for two children, not just one pregnancy. In some instances the surrogate may require at home monitoring or hospitalization to keep the pregnancy going as long as possible, which means an increase in medical costs plus her own children will need additional care. In the majority of cases, the surrogate is required to have a c-section, which not only increases the fees paid to the surrogate ($2,500), but also increases the amount due for co-pays, deductibles and potential reimbursement of medical costs. Any increases in costs are the responsibility of the Intended Parents. It is the cost of care for the children, however, that can make the costs escalate quickly.

On average, the cost of the Neonatal Intensive Care Unit (NICU) averages $8,000-$10,000 per day per child. Premature babies may spend weeks or months in the hospital and the cost can quickly become overwhelming. If there is also the need for surgery for one or both babies that is also the financial responsibility of the parents. Domestic parents should be able to insure the child or children upon birth; however, this does not mean they won’t incur extra expenses with co-pays/deductibles and living expenses. International families may have no other option than to negotiate with the hospital and cash pay.

Remember, the increased cost for multiples is not just for the care of the children or insurance while in the NICU. Parents are required to stay with their children during their hospitalization and this could result in lost wages for one or both of the parents, plus the additional cost for local housing, meals, transportation, etc. Premature births may have lifelong consequences for the health and learning abilities of the children; therefore, the costs may not end with the discharge of the newborns from the hospital.

A singleton pregnancy is the healthiest for the surrogate and the child she carries. This is why most physicians now recommend single embryo transfers for the best outcome for all.