What to expect: Cost and coverage related to male infertility care

By | 2018-03-06T16:39:34+00:00 March 2nd, 2018|Categories: Featured, Treatment Options|Tags: , , , , |0 Comments

How much do male fertility treatments cost? Infertility care is often expensive and not covered by insurance. This article provides a quick description of the diagnostics tests and treatment options related to male fertility and an idea of what out-of-pocket costs are.

Getting Tested: figuring out why you are not able to get pregnant

Step one in treating infertility is discovering the underlying cause. Statistics vary depending on the source, but infertility can be caused by issues with the female partner, the male partner or issues with both partners. Sometimes a cause cannot be identified, and the case is diagnosed as idiopathic, or “unexplained infertility.”

As a starting point, the fertility evaluation is generally considered “medically necessary” if the couple has been trying unsuccessfully for at least 12 months when the female partner is under 35 and 6 month when older than 35. If you have had cancer, served in active combat or have other conditions that are known to impact fertility (such as undescended testicles, testicular torsion, varicocele, etc), the medical evaluation may be covered sooner, (if not before) you begin trying. If you have concerns, you can always schedule an appointment with your primary doctor to discuss them and get a roadmap to your options.

To diagnose infertility, both partners should be evaluated. A woman should be able to complete an initial evaluation with her Ob-Gyn or family practice doctor. The female evaluation includes a medical / reproductive history, investigation into how well she ovulates (which may include blood tests or ultrasounds), and various tests to examine her uterus, cervix and fallopian tubes. The male evaluation typically begins with a semen analysis. If the semen analysis reveals any abnormalities a full evaluation which includes a medical / reproductive history, a physical exam and a few blood tests by a urologist who specializes in male reproductive health is recommended.

Estimates for what male fertility testing will cost out-of-pocket

About 25% of health insurance plans offer some sort of fertility coverage, which usually include the initial diagnosis. If your plan does not cover a semen analysis, there are many lot of options for an initial test.

Home tests: Home tests cost between $25 – $60 per test. Some are sold in bundles which enable repeat testing. Home test kits are convenient and a good first step to get some feedback on your fertility early in the process.

Lab tests: The general market rate for a lab semen analysis in the United States is between $100 – $300 depending on where you live. A few fertility clinics offer a free (or low cost) semen analysis to attract get new patients in the door.

If the lab or home test come back as abnormal, it is a good idea to get a full evaluation by a urologist with specialty training in male reproduction. This workup generally includes a medical history, a physical exam and blood tests to check hormone levels. If you do not have fertility coverage, you may be able to get coverage for this workup by billing it as a men’s health check. Most insurance plans cover testosterone testing and physical exams.

The cost of treating male infertility

Treatment of male infertility varies according to underlying cause and outcomes of the female workup. Many doctors like to say that that fertility is a team sport and you can’t put a game plan together without understanding what’s going on with both partners. Here are some common treatments that are often recommended to help resolve male infertility:

Lifestyle changes (Free): Several lifestyle factors such as smoking, drinking, poor diet, lack of exercise, exposure to heat, high stress and many others can contribute to male infertility. Doctors will often counsel men on small improvements that can make a big difference for their sperm. To see if you have any major risk factors, take this quick health assessment.

Testicular cooling (Free – $70): Testicular cooling has been studied as a potential way to improve semen quality, particularly in men who are  regularly exposed to high heats. Testicles need to stay at least a few degrees cooler than the rest of your body for proper sperm production, so actively cooling your testicles for 20-30 minutes a day is an easy, low-cost option that could make a big impact.

Supplements ($20 – $100 / mo): Studies have shown that certain nutrients can improve semen quality, so many urologists will recommend supplements in addition to other treatment. Supplements vary quite a bit in price and quality so do your research. More expensive doesn’t always equal better.

Medications ($100 – $3,000): Medications often prescribed for male infertility include antibiotics to fight urological infections and Clomid or hormone injections to help boost sperm count and testosterone levels. (Note: if a doctor prescribes testosterone injections, please get a second opinion. This can often cause much more harm than good when it comes to sperm.)

Artificial insemination ($50 – $1,000): Inserting sperm closer to the egg can help pregnancy happen when sperm counts are lower. There are lots of options ranging from inexpensive home kits to a medicated and monitored Intrauterine Insemination (IUI) cycle that is performed at a fertility clinic.

Male fertility surgeries ($3,000 – $15,000): Surgeries can be done to treat varicoceles, reverse vasectomy, correct other plumbing issues or retrieve sperm from inside the testicle. Cost varies by type and complication of the procedure. Coverage varies by condition and state.

In Vitro Fertilization (IVF) ($10,000 – $20,000/ cycle): In-vitro fertilization is a commonly recommend treatment for severe male infertility. Cost can vary by type of cycle (medicated fresh or frozen or unmedicated), fertilization technique, additional testing and type of medications used. Coverage varies by state.

Planning ahead: how to afford fertility treatments

The high costs of fertility care can feel like kicking a man when he’s down. But here are a few tips that can help you put together a plan that helps you build your family without going broke:

1. Find out what your insurance will cover: You won’t know if you don’t ask. If you haven’t had to use your health benefits before, here’s a nice primer article to give you an overview of how health insurance works and how to figure out what is covered and what isn’t.

2. Start with low cost options and move up: Many male fertility issues can be resolved inexpensively. Getting tested early in the process gives you more time to try things like supplements or lifestyle changes before jumping to more expensive and invasive treatment options.

3. Get educated: Healthcare is a little like taking your car to the mechanic, getting educated on options and costs will help you make more informed decisions. Getting a second opinion, doing research online and connecting with organizations like Fertility within Reach or Resolve can help you feel more confident in your next steps.

4. Talk to a financial counselor: Most fertility clinics have a financial counselor on staff to help you navigate costs, figure out benefits, negotiate discounts, develop a payment plan or apply for financial assistance

Resources & References

Practice Committee of the American Society for Reproductive Medicine Diagnostic evaluation of the infertile female: a committee opinion American Society for Reproductive Medicine, Birmingham, Alabama 2015

Practice Committee of the American Society for Reproductive Medicine Diagnostic evaluation of the infertile male: a committee opinion American Society for Reproductive Medicine, Birmingham, Alabama 2015

Fertility within Reach, a national non-profit that increases access to fertility treatment and benefits by educating patients, policymakers and service providers with proprietary and evidence-based data through personalized consultations, workshops and legislative testimonies.

Resolve, a 501(c)3, national patient advocacy organization that provides free support groups in more than 200 communities; is the leading patient advocacy voice; and serves as the go-to organization for anyone challenged in their family building.

Sara SDx

Sara SDx

Editor of Don't Cook your Balls, Co-Founder of TrakFertility.com, Health Coach and Men's Health Advocate. Passionate about sperm, men's health and helping people build their families.

Leave A Comment