The Dollars and $ense of Family Building

This post is part of an initiative by Write Mind Open Heart and Baby Smiling in Back Seat. The financial part of my story will no doubt be very different from those of most other participants, as I live in France and therefore enjoy the benefits of the French government healthcare system, which is very generous when it comes to ART.

There are two parts to this post – first an overview of my personal family-building process (with some special attention to finances) and second a Q&A part (questions provided by BabySmiling and Lori Lavender Luz).

Background story:
We started our TTC journey when living in the US. When I finally dragged myself to the OB to find out why I wasn't getting pregnant, we were 1.5 years along. Apart from several tests (for both me and hubby) and a first Clomid cycle, we didn't consult with an RE an didn't embark on any ART treatments. This had nothing to do with finances, but with emotions. All tests had come back normal, so I was still in complete denial that something was wrong. I still listened to people who said I should just relax. No-one had really sat me down and uttered the words “unexplained infertility”. Besides, we were planning on making our second transatlantic move and I didn't feel like starting all kinds of treatments a few months before moving.

The new country (with its own culture, language, job search rules) took quite some time and energy to get adjusted to. By the time I felt like finding an OB we had been there for six months. By the time I'd built a little network and got a referral to a great RE (the OB sucked and wasted too much of my time), our first French year had passed... By the time I finally convinced myself that yes, despite all the normal test results, if I wanted to have a baby I should really get some medical assistance, we were definitely “tourist off” and finishing our second year of French live.

We talked with our RE about the options. IUI or IVF. He suggested starting with IUI, being a lot less invasive than IVF and that sounded great to us (still struggling emotionally with doing all of this, absolutely not ready for IVF yet). The government health care system would reimburse a total of six IUIs and four IVFs in our attempt to have a baby.

We did the first three IUIs in a row. All BFNs. Then we had a break, took a nice vacation, and on the plane back home I just didn't want to deal with it all anymore and was in no place emotionally to start IVF. So we opted for another three IUIs... Well, what a waste of time (and taxpayers' money, but I couldn't - and still can't - care less). Again, three IUIs in a row, again three BFNs.

Finally, after five years of TTC and three years in France, we started IVF#1. And lo and behold, I got a BFP and am now the proud mommy of a gorgeous toddler. I did a post at the time about the total cost of an IVF cycle in France. If interested, you can find it here (I think some rates have gone up a bit and I might have forgotten some costs of the hospitalization for ER (which were all covered), so I'll try redo one for IVF#2 soon).

We would love to bring a second child into our family, so we started IVF#2 last February, which unfortunately resulted in a BFN. We had one embryo frozen and should be going for FET#1 as soon as AF arrives again.

Q&A:

1. Consider your now or future children as adults, and consider the fact that you had to spend money to either conceive them or make them part of your family. What effect do you think the latter will have on the former one day? What, do you think, your grown children might feel about the funds it took to create your family?

   I hope that we can explain to them – and that they will understand - the difficulty we had in conceiving them, that we paid a higher price (financially and emotionally) for them than couples who had no difficulty conceiving and that they made (and still make) us so incredibly happy. Plus that they will go through life aware of and sensitive to the fact that being able to have children is a real gift, not readily available to everyone.

2. How did/would you handle it if your child asks you, "Mom, how much did I cost?" How would you answer at age 7? At age 18?

   I would be extremely surprised if my child would ask that at age 7, mainly because ART treatments are very well covered within the French government health care system, so the financial aspect would not really be a topic of conversation that he/she could have picked up somewhere and then ask me about it. At age 18 it would be a possibility, as by then I think my child would know exactly what it took us to bring him into the world and therefore I would be completely open and frank about the financial aspect as well (in our case, the question could also be “mom, how much taxpayers' money was spent on me?”).

3. When calculating the costs of your family building, what do you include? The direct costs are easy (such as RE fees for a cycle or homestudy fees), but what about fees that didn't directly lead to your child's existence in your life, such as cycles that didn't work, adoption outreach avenues that didn't work, failed adoptions, avenues that were explored (and that cost something) but not pursued, etc.?

   My initial reaction would be to just calculate the costs of the cycle(s) that resulted in the pregnancy and subsequent birth of my child(ren). But when I would look at it as a whole (after deciding that our family-building journey has finished, whether by our own free will or due to health or insurance constraints), I think I would add everything up, all the testing, the six failed IUIs, the first successful IVF, the second failed IVF, and any future ART cycles we would have had...

4. To what extent have finances determined the family-building decisions you have made? How have you able to balance financial considerations against other factors such as medical, ethical, emotional...?

   When we were still living in the US, I never really thought about what the financial impact would be if we would have continued with treatments after the initial Clomid Challenge Test. Had I been emotionally more ready, it would of course have been something to make us pause. The bills for the few tests did make me realize once more that health care was so much more expensive in the US than what we were used to in the Netherlands, but part of it was covered by our PPO and we had no problem paying the remaining sum. I often thought that I wasted so much time with this 'not being ready', but I guess financially it has been a good thing that we waited until we were in France.

5. Has institutional and governmental support for certain family-building paths impacted your choices? For example, ART being covered by insurance, tax deductions for adoption expenses, etc.

   When we decided to move from the US to France, it had absolutely nothing to do with the financial aspects of ART, but you'd almost think it did! We are extremely grateful for living in a country where ART treatments are so well covered by the government healthcare system. For that (and for the 30 vacation days a year, and being closer to our relatives, and a number of other reasons), we happily gave up at least half of our salaries... The details of the French deal: everyone who legally lives in France is covered under its government health care system. ART treatments are covered for 100% (but there is a cap per treatment or consult and many clinics have set their prices higher than what the government health care plan covers – for that there are additional insurances that you can either get as an individual or through your employer – we have the latter). An IVF cycle counts as one if there has been ER. Any FET is for insurance purposes part of the previous IVF cycle and has to be done before you can try for another fresh cycle. Also, if you have conceived through IVF, and you want/need to use it again to try for baby #2, the clock will be reset and you can again try four times. We do always pay great attention when our employers are about to change plans on the additional insurance and will vote against it if the proposed plan includes less coverage for ART treatments.

6. Have you considered having ART treatments abroad, either due to lower cost or due to certain methods being unavailable or illegal in your own country? In your decision-making, how did you balance the financial savings against issues like the unknowns of the country, perhaps not speaking the language, and medical practices that may differ from those of your home country? If you did travel abroad for treatments, what was your experience? Would you do it again?

   My answer is a bit the other way around, as we were already in a foreign country. When we were starting the ART treatments here in France, I briefly thought about how it might be easier to be back in the Netherlands for this, especially because of language nuances on such emotionally charged procedures. But insurance-wise it would have been hell, and medically I prefer to be in France too to be honest (as Holland often has long waiting lists before you can even do your first IVF, ER without anesthesia, only pee sticks and no beta tests to find out if it worked, etc.).

Visit Write Mind Open Heart for more perspectives on the Dollars and $ense of Family Building and to add your own link to the blog hop by May 1st, should you want to contribute your thoughts.