“What’s a 'carrier'?” was my first thought when our fertility doctor laid out our option (yes, singular). “A gestational carrier is like a surrogate, but using your genetic embryos.”
“Surrogacy? That’s for people with a ton of money, or with an incredible body they can’t afford to lose” was my second thought. Far from possessing either prerequisite, this was not going to be easy.
Going through fertility treatments and in vitro fertilization is one thing; paying someone a substantial amount of money to carry your baby in a legal and cost-contained way is quite another. Although it certainly wasn’t Plan A, our fertility story ended with two successful surrogate pregnancies, three healthy babies, and still just one mortgage.
“How much does that cost?” is a question everyone wants to ask (and a few ill-mannered strangers actually have). With an “average” cost of $110,000, tackling a surrogate pregnancy (or two) requires more than just saving pennies. In case you find yourself in the same position, here are some money-saving tips and real-life numbers from your “average” middle class family.
At the beginning of it all are the fertility treatments, which you can expect to be very expensive – averaging $10,000 - $25,000 plus medication per round of IVF. In our case, due to my young age, good health, etc, we weren’t anticipating having to do multiple rounds. When the results came back very poor, our doctor was sympathetic when I asked for a significant discount on the next round. We had had a very friendly but professional relationship by this point, and I had referred several patients to her by then, so I was comfortable in having the conversation. By making the appeal, I cut my IVF cycle cost (excluding medication and genetic testing) from roughly $12,000 down to about $9,000. Not bad for a five minute conversation.
Some employer-paid health plans include fertility coverage, so compare thoroughly when selecting your benefits if you have the opportunity. Had we known our first policy, with a $10,000 fertility benefit, excluded surrogacy, we would have planned differently. The second time we had a Blue Cross plan, which paid up to $10,000 without restrictions (still subject to a deductible, etc.).
With fertility treatment comes expensive medication and there’s not a deal to be had this side of the Atlantic. Don’t even bother looking. But across the Atlantic is Israel, where the Israeli government regulates the price of prescription medications to keep them affordable. While not exactly free-market capitalism, I couldn’t pass up an opportunity where a mere $25 gets you shipping of those same meds to your house - same manufacturer, same potency - for half the price (in our case, $2500 instead of $5500). Just make sure you adjust your IVF cycle to account for shipping time.
There has recently been a major pharmaceutical recall in the United States in which Ferring Pharmaceuticals recalled many lots of their fertility medication, Bravelle, and fully reimbursed their customers – many of whom spent several thousand dollars on the drug. Thus, best to keep abreast of industry news by setting a Google Alert.
Fertility practices often receive sample medication from the drug manufacturer, so don’t hesitate to ask if they have any samples for you. Medication planning isn’t an exact science and doses often change during the IVF course, meaning you could end up buying more than you expected at the last minute (at top dollar), so every little free sample helps.
Surrogate Agency Fees
If you are investigating surrogacy, you no doubt have seen a tremendous range in agency fees - anywhere from $10,000 to $50,000. Ours was a straightforward case: we needed a gestational carrier (using our own embryos) and we live in California, which is the most lenient state when it comes to third-party reproduction. Simply stated: we didn’t need the extensive resources of a top-dollar agency. Instead, we used a smaller agency because they were local, had local surrogates, and the lowest fee I could find ($12,000), which I was able to negotiate even further, saving $11,000 total for the two surrogate pregnancies.
This was one area where I knew we couldn’t skimp. Attorney’s fees pale in comparison to other surrogacy costs, and I certainly didn’t want to be responsible for some legal misstep that jeopardized the parentage of our baby. Our agency recommended an attorney that, after some vetting, we ended up hiring. She drafted the contract between the surrogate and us, communicated with the surrogate’s attorney (which is billed to the intended parents) and did the birth order legwork with the county court to establish parentage. Money well spent in my opinion.
When looking through surrogate profiles, the compensation was obviously very important, as well as geographic location, employment and experience. While our area has many available candidates, we gravitated toward a first-timer, with the rationale that the compensation was significantly less (about $20,000), she would be anxious to get started (read: open to negotiation), and being our first time also, it was like we were in this together. Surrogates are very thoroughly screened and must have prior uncomplicated pregnancy history of their own, thus all candidates are already “experienced.” I didn’t think it worth the additional cost to go with someone who was a seasoned surrogate pro.
Similarly, most intending parents fixate on the surrogates age, and while women in the early 40’s can carry a pregnancy perfectly well, our eventual surrogate had been passed-over repeatedly. As a result, she worked with us at a more reasonable price, and provided she was given a clean bill of health, we were motivated to go this direction.
Does the surrogate have a job? Everyone wants to hire a responsible adult, but the way I saw it, there’s always a possibility that she would need to go on bed rest at some point. That means it’s up to the intended parents to pay for lost wages, child care, housecleaning, etc. which can add up to thousands of extra dollars. I reasoned that if our carrier didn’t have a job, we wouldn’t have to worry about these extra costs, and she could treat the pregnancy as her full-time “job,” which she did to the fullest extent.
Which brings us to surrogate compensation. Initially, the numbers listed in the profiles seemed daunting, but we learned many first-timers are encouraged to select the “basic” compensation amounts for their profile, and then the agency negotiates from there. In our case, the final numbers were significantly less than what was originally advertised. The agency director was helpful in guiding us toward a number she thought would work with our surrogate and advising us on ways to bring down additional surrogate-related fees.
Most insurance policies have a surrogacy exclusion, so chances are you’re going to need to purchase a policy for your surrogate. The agency is tasked with finding and applying for such policies on behalf of the surrogate, and you pay the premiums, copays, etc.
We had a different policy for each of our surrogacies – the first was purchased, and in place, before embryo transfer, as stipulated in our contract. The second time around, however, there were different factors to consider. We planned the embryo transfer for our second surrogacy for August, six months after our previous February delivery. The marketplace rules prevent you from buying a policy outside of the enrollment period so we were faced with:
- Continuing to pay on the original policy from February to August, which would have amounted to several thousand dollars in needless premiums
- Wait until January to do the embryo transfer with a new policy, which would have forced us to wait another six months, which was a deal-breaker
- See if the surrogate would agree to us paying for her medical bills in cash from August until the new year, when we would get a new policy.
For most pregnancies, the first six months’ medical bills include a monthly office visit ($75-$200) and an ultrasound ($200-$300), which totaled far less than the monthly premiums we would have had to pay had we resorted to option #1. We opted to pay in cash for the first 24 weeks and then had a PPO policy for her starting January 1 for the remainder of the pregnancy. All in all, figuring out the real medical expenses and thinking through the awkward timing saved us about $4,000 in insurance costs.
If You Work For Yourself, Convert Into A Corporation
Whenever I find myself in a situation that requires significant monetary output, my first question is “How can I make this tax deductible?”. I mean if you’re going to spend the money, you might as well try to get credit for it somewhere. Not everyone has this opportunity, but I am self-employed, and when I ran the scenario by my CPA, he had some valuable advice (as a California company). If I set up my company as a C-Corporation, I could elect to pay for any and all benefits for my employees. So I made myself an employee of the corporation (a simple payroll process) and then ran all surrogacy related expenses through the business, deductible as employee benefit expenses. It certainly doesn’t directly recoup my expenses, but translates to a sizeable deduction nonetheless - in our case, about $138,000.*
Make An ROI Case To Your Employer
If you find yourself considering surrogacy, you’re in a unique situation that calls for creative strategy. In our case, I had previously had two consecutive 25-week preemies that spent eight total months in the hospital. Our employer-based insurance plan paid more than a million dollars between the two NICU stays. What employer wouldn’t rather pay for a surrogate pregnancy rather than another NICU stay? We tried (but ultimately failed) to make the case to our employer that if they paid for surrogacy, they would bypass the risk of having to cover us for another NICU bill should I try and carry myself.
There’s many support groups out there, charities with surrogacy grant opportunities, and some interesting stories of friends and relatives carrying babies for their loved ones. So where there’s a will, there’s got to be a way.
*Consult your tax professional for tax advice. The author of this article is not authorized or licensed to provide tax advice.