Over the past eight years, one Los Angeles-based prenatal health coordinator has helped thousands of women during their pregnancies. Yet working in the field didn’t help much when it came to her own pregnancy, which proved to be a costly challenge.
Anna, who asked to be identified by a pseudonym to protect her privacy, is one of thousands of women each year who opt to travel to clinics in other states (and sometimes other countries) in search of affordable in vitro fertilization, or IVF, procedures. She and her husband found that it was cheaper to travel across the country, from Los Angeles to Albany, New York, to receive treatment, than move forward with clinics closer to home. Yet they still spent about $20,000 in total to get pregnant, she tells CNBC Make It.
Each year, millions of American families struggle with infertility. For every 100 couples, 12 to 13 report they’ve experienced trouble getting pregnant, according to the Centers for Disease Control and Prevention. And about 7.3 million women of childbearing age in the U.S. have used fertility treatments to get pregnant.
IVF is one of the most popular routes. It’s a multistep procedure where a medical team removes eggs from a woman’s ovaries, and then fertilizes the eggs with sperm in a laboratory. The fertilized embryo is given a few days to grow and then implanted into a woman’s uterus. In total, the process generally takes four to six weeks.
The going rate for IVF
Last year, the average patient paid more than $22,000 for a single IVF cycle, according to FertilityIQ, a database that provides information about costs and treatments. Many times, that price does not include the necessary fertility drugs and testing, which can add up to an additional $3,000 per cycle. Not to mention the expenses associated with pregnancy and a hospital delivery.
Anna, however, didn’t qualify for the basic IVF, which isn’t uncommon. Women using an egg or sperm donor or those seeking genetic testing or specialized treatments such as intracytoplasmic sperm injection should expect to pay more.
In her case, Anna sought out preimplantation genetic diagnosis, or PGD. This is a specialized procedure where doctors test the fertilized embryos for chromosomal or genetic abnormalities before they are implanted. Anna has a genetic nerve disease and, after undergoing multiple surgeries and treatments throughout her life, she didn’t want to pass that onto her children.
But that extra testing increases the cost of treatment. At CNY Fertility, the clinic Anna and her husband opted to use, a basic round of IVF costs $3,900. The facility estimates that PGD costs roughly an additional $300 to $600 per embryo including biopsy and third-party lab fees. In Anna’s case, she and her husband chose to pay for testing on 17 viable embryos collected.
In the U.S., about 34% of IVF procedures performed in 2017 resulted in live birth among women ages 35 to 37, according to the Society for Assisted Reproductive Technology. But that success rate drops as women age — those ages 41 to 42 only have a 10% chance.
To help increase families’ chances of a successful IVF treatment, many clinics offer “guarantee” programs and pricing packages. The programs differ slightly clinic to clinic, but these tend to be money-back guarantees for if the IVF does not result in a successful pregnancy and birth. Patients pay more for the guarantee than they otherwise would if they were successful after just one IVF cycle.
“I’m pretty risk averse,” Anna says, adding she would have definitely paid more in advance because she was expecting to undergo several IVF cycles. But only certain patients qualify, and Anna wasn’t eligible because she chose to do PGD IVF.
Fertility treatments in the US are an insurance minefield
The reason IVF is so expensive isn’t that it’s a cutting-edge technology — in fact, the first successful procedure took place in 1978 — it’s that for many women, the cost of the treatment isn’t covered by insurance. About 71% of the women who went through IVF last year had no fertility treatment coverage, according to FertilityIQ.
Only 16 states — Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia — require insurance companies to have some sort of coverage for families seeking infertility treatments, according to the National Conference of State Legislators. Fourteen of those states require insurance companies to actually cover infertility treatment, but California and Texas have limitations. California specifically excludes IVF from the mandate. Meanwhile, Texas law requires insurance companies to let employers know the coverage is available, but insurers are not required to provide the coverage and employers are not required to include it in their health plans.
“The only reason we’re talking about the cost of IVF is because it’s not covered by insurance,” says Betsy Campbell, chief engagement officer at Resolve, the national infertility association. “Infertility is a disease and should be covered by insurance just like other diseases,” she adds.
Anna’s insurance did have a policy for PGD, so initially, she thought the procedure would be covered. But after seeing a reproductive endocrinologist, her claim was rejected. The insurance company only covered diagnosis, not treatment. So while her pretesting, such as the saline sonogram and hormonal testing, was covered, the IVF and PGD procedures were not.
So she “scoured for months and months” to find the most affordable out-of-pocket option. Initially, she looked into travelling to the Caribbean for care because the clinics there offered cheaper basic IVF, but the “logistics of traveling further to go abroad were too overwhelming,” Anna says.
In the end, she settled on CNY Fertility because it was the cheapest after a countrywide comparison, even with the additional travel costs.
Families finding creative ways to keep costs down
Typically, IVF patients have many expenses beyond the procedure itself that can add significantly to the overall cost, including medications, blood tests and ultrasound monitoring.
To keep her expenses as low as possible, Anna ordered the priciest medications from Israel and purchased others through discounts she found using GoodRx. Plus she paid for her IVF using a newly acquired credit card to snag a promotional points offer. Those points paid for the flights to and from New York, as well as accommodations and a rental car.
During the egg retrieval phase, Anna rented an Airbnb and a car, staying for about 10 days. Her job provides “pretty good benefits,” she says, so she was able to just take vacation time, but her husband was only able to join her for the last few days of the trip.
Once both Anna and her husband donated the eggs and sperm, the doctors went to work. Of the roughly 40 eggs retrieved from Anna, 17 were successfully fertilized. Those embryos were then biopsied and tested, but just one turned out to be chromosomally normal. That surprised and disappointed Anna, who was hoping for a few embryos in case the transfer was not successful. “I was pretty prepared for failure, but I went back [to the clinic for the transfer],” she says.
Anna flew back to Albany by herself for the frozen embryo transfer process, staying at a hotel near the clinic for three days. From there, Anna opted to do monitoring with an OBGYN in LA.
Thankfully, Anna’s IVF process proved successful. “I was really, really lucky, because if it didn’t work, I would have had to pay that approximately $20,000 all over again,” Anna says. Today, she is the mother of a happy, healthy 18-month-old son.
“It could have gone a totally different way,” she says. More than half of patients have to undergo a second IVF cycle, FertilityIQ reports, and almost a third must seek three or more.
Anna and her husband could only afford to try one cycle without going into debt. And they had already waited years to start a family. “We waited until we were in a financial position that we could afford it,” Anna says.
While Anna was able to rely on savings to pay for her fertility treatments, many women are not so fortunate. Over half of women, 52%, who were planning to undergo IVF this year say they will pay for treatment with a credit card, according to a poll of 776 women from Student Loan Hero. And many go into debt.
More employers helping couples shoulder the costs
For those living in states that do not mandate coverage, employers are typically the best resource for financial help. And the ranks of companies offering fertility options is growing. In the past year, major companies such as Cisco, and MassMutual have added fertility benefits. Starbucks and Chobani even offer coverage to hourly employees. Many tech companies, such as Apple, Facebook and Microsoft have even gone beyond basic benefits, offering egg harvesting or freezing services to employees as well.
This year, 66% of employers plan to offer fertility benefits, according to a Maternity, Family and Fertility Survey from Willis Towers Watson. If your employer does not currently offer this benefit, Resolve has a Coverage at Work program, which is designed to empower employees to ask their employers for fertility coverage.
“You need to be an advocate for yourself when it comes to you and your family,” Campbell says. “This journey affects people physically, mentally, spiritually, financially and socially.”
Fertility treatments are definitely a “high-pressure” situation, Anna says, one that should be easier for families to navigate. “It shouldn’t be as hard for other women as it was for me,” she says. “Even though it worked out for me, it was a great challenge — definitely a life challenge.”
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Christina Corso | Twenty20
Top moments and highlights from October’s Democratic debate
Sen. Elizabeth Warren has reached the top of the Democratic pack, and now she has the scars to prove it.
The Massachusetts senator weathered attacks throughout the fourth Democratic debate, which was held Tuesday night in Ohio. It was the first such event since Warren started beating former Vice President Joe Biden in several national polls.
Democrats also focused on the economy and the ongoing impeachment inquiry against President Donald Trump in a wide-ranging debate that, with 12 contenders on stage, was the most crowded in presidential history.
Here are Tuesday’s top moments.
Elizabeth Warren takes fire on taxes
Democratic presidential hopefuls Massachusetts Senator Elizabeth Warren (L) and Mayor of South Bend, Indiana Pete Buttigieg participate during the fourth Democratic primary debate of the 2020 presidential campaign season co-hosted by The New York Times and CNN at Otterbein University in Westerville, Ohio on October 15, 2019.
Saul Loeb | AFP | Getty Images
With no opening to statements to trudge through, the Democrats on stage wasted little time going after their main target, President Donald Trump. Their second target: Warren, whom they tore into after she repeatedly dodged questions about middle-class tax hikes under her health care plan.
Warren, whose campaign has rocketed to front-runner status in recent weeks, supports the “Medicare for All” plan pushed by Vermont Sen. Bernie Sanders, a democratic socialist. She promises that the plan would raise taxes on the wealthiest Americans and lower costs for middle-class families. But she refused to provide a straight answer on whether middle-class taxes would go up.
“At least Bernie’s being honest here,” Minnesota Sen. Amy Klobuchar said of Sanders, who acknowledges a tax hike under the plan, which would also abolish private insurance.
“I don’t understand why you believe the only way to deliver coverage for everybody is to obliterate private plans,” South Bend, Indiana, Mayor Pete Buttigieg told Warren.
Joe Biden addresses allegations against his son Hunter
Democratic presidential hopeful former US Vice President Joe Biden speaks during the fourth Democratic primary debate of the 2020 presidential campaign season co-hosted by The New York Times and CNN at Otterbein University in Westerville, Ohio on October 15, 2019.
Saul Loeb | AFP | Getty Images
Biden addressed President Donald Trump’s allegations of nepotism and corruption related to his son Hunter’s work in Ukraine and China. The allegations have threatened to distract from Biden’s candidacy.
“My son did nothing wrong. I did nothing wrong. I carried out the policy of the United States government in rooting out corruption in Ukraine,” Biden said when pressed by the debate moderators. And Biden also went after Trump and his personal lawyer, Rudy Giuliani, who has been pursuing the claims against the Delaware Democrat and his family.
“The president and his thugs are flat lying. He doesn’t want me to be the candidate. If I’m the candidate, he knows I will beat him like a drum,” Biden said.
Hunter Biden has come under attack by Trump and his conservative allies over his work overseas while his father was serving in government. Hunter Biden held a lucrative role on the board of a Ukrainian energy company, Burisma Holdings, while Biden was the point person for U.S. policy in Ukraine, and recently said he would leave the board of a Chinese private equity firm.
In an interview published this week with ABC News, Hunter Biden defended himself and said he “did nothing wrong at all,” though he conceded “poor judgment” for taking roles that complicated his father’s presidential bid. And he chastised Trump and his supporters for spreading conspiracy theories related to his work.
“I gave a hook to some very unethical people to act in illegal ways to try to do some harm to my father. That’s where I made the mistake,” he said.
At the debate, Biden repeatedly said that his son’s statement speaks for itself.
“My son made a judgment. I’m proud of what he had to say,” Biden said.
Buttigieg, O’Rourke battle over gun control
(From L) Democratic presidential hopefuls, Mayor of South Bend, Indiana Pete Buttigieg (L), entrepreneur Andrew Yang (C), former Representative for Texas Beto O’Rourke, participate of the fourth Democratic primary debate of the 2020 presidential campaign season co-hosted by The New York Times and CNN at Otterbein University in Westerville, Ohio on October 15, 2019.
Saul Loeb | AFP | Getty Images
In a heated faceoff, Buttigieg told former Rep. Beto O’Rourke that the problem with gun violence “is the policy,” while accusing O’Rourke of being unable to specifically answer how he’d get every AK-47 and AR-15 off the streets.
O’Rourke, in turn, said he believes that Americans will follow the law, no matter the provision. “We don’t go door to door to do anything in this country to enforce the law,” he said. “The expectation is that Americans will follow the law. I believe in this country. I believe in my fellow Americans. I believe they will do the right thing.”
Buttigieg hit back and called attention to O’Rourke’s lack of details.
“Well, congressman, you just made it clear that you don’t know how this is actually going to take weapons of the streets. If you can develop the plan further, I think we can have a debate about it. But we can’t wait. People are dying in the streets right now,” he said. “We have to just get something done.”
O’Rourke said policymakers should follow the suggestions of the students who led the March for Our Lives movement and the leaders behind anti-gun group Moms Demand Action. But Buttigieg pushed back, saying that he hopes every Democrat on that stage recognizes that the common problem is the National Rifle Association “and their enablers in Congress,” rather than the varying ideas on how to handle gun violence from the Democrats on stage.
Bernie Sanders addresses his health
Democratic presidential hopefuls Vermont Senator Bernie Sanders (C) and former US Vice President Joe Biden, flanked by California Senator Kamala Harris (L), smile during the fourth Democratic primary debate of the 2020 presidential campaign season co-hosted by The New York Times and CNN at Otterbein University in Westerville, Ohio on October 15, 2019.
Saul Loeb | AFP | Getty Images
Less than three weeks before the debate, Sanders suffered what turned out to be a heart attack.
The 78-year-old senator — the most senior candidate in the race — abruptly canceled his upcoming stops on the trail and underwent a procedure for an artery blockage, his campaign said. But a spokesperson promised that Sanders would appear at mid-October debate.
When the subject came up, Sanders was quick to assure the audience that his health was not an issue. “I’m healthy, I’m feeling great,” Sanders said to a round of applause.
“We are going to be mounting a vigorous campaign all over this country,” he continued. “That is how, I think, I can reassure the American people. But let me take this moment, if I might, to thank so many people from all over this country, including many of my colleagues up here, for their love, for their prayers, for their well-wishes. And I just want to thank you from the bottom of my heart, and I’m so happy to be back here with you this evening.”
This Saturday in Queens, freshman Rep. Alexandria Ocasio-Cortez, a fellow democratic socialist, will endorse Sanders’ bid for the presidency.
Trump’s Twitter account takes center stage
Sen. Kamala Harris (D-CA) and Sen. Elizabeth Warren (D-MA) appear on television screens in the Media Center as they go back and forth during the Democratic Presidential Debate at Otterbein University on October 15, 2019 in Westerville, Ohio.
Chip Somodevilla | Getty Images
The president’s Twitter account often sets the day’s political agenda. On Tuesday, it formed the basis of a head-to-head between Warren and California Sen. Kamala Harris, who called on her colleague to urge Twitter to take down the president’s account.
“I just wanted to say that I was surprised to hear that you did not agree with me that on this subject of what should be the rules around corporate responsibility for these Big Tech companies, when I called on Twitter to suspend Donald Trump’s account, that you did not agree,” Harris said. “I would urge you to join me.”
But Warren did not seem interested in discussing the matter.
“Look, I don’t just want to push Donald Trump off Twitter. I want to push him out of the White House. That’s our job,” Warren said.
“So join me. Join me in saying that his Twitter account should be shut down,” Harris responded.
To that, Warren responded: “No.”
“No?” Harris asked.
Warren then pivoted to “why it is that we have had laws on the books for antitrust for over a century and yet for decades now we’ve all called out how the big drug companies are calling the shots in Washington.”
Zilingo says it will help train women entrepreneurs in Indonesia
The logo of Zilingo is displayed on a window at the company’s office in Singapore.
Ore Huiying | Bloomberg | Getty Images
Southeast Asian fashion start-up Zilingo on Wednesday said it is launching a program in Indonesia, where it will provide microloans, vocational training and resources for women to run their own garment manufacturing businesses.
Those micro-businesses would receive and fulfill small-scale apparel orders from fashion brands on Zilingo’s network. For its part, Zilingo will make money by taking a cut from every transaction.
Zilingo was founded in 2015 as an online marketplace where independent fashion and lifestyle retailers can sell directly to customers. Those retailers get access to suppliers from places like Bangladesh to procure their products, and Zilingo helps them with cross-border shipping, inventory management and customer service. Zilingo charges retailers commissions between 10% to 20%.
The program, called SheWorkz, is aimed at providing women with the resources and flexibility to return to the workforce, according to Zilingo CEO and co-founder Ankiti Bose.
“One of the biggest problems that we have, it’s not only a social challenge but an economic challenge in Asia, is just how many women are not in the workforce,” Bose told CNBC.
“And, there are several reasons for it — some are economic, but many are social. They’ve gotten married, they’ve had kids, they’ve fallen off the workforce.”
Women made up about 38.9% of Indonesia’s total labor force in 2018, while their participation rate was 52% compared to 82% for men, according to World Bank data.
Various studies have said having more women in the workforce can boost countries in their economic ambitions and help companies drive better profits.
The program is supported by Indonesia’s ministry of economic affairs and state-owned lenders Bank Mandiri and Bank Negara Indonesia. For the pilot project, Bose said Zilingo will start with about 300 women who used to work for the start-up’s manufacturing partners, but who eventually left the workforce. New participants will be sought out after that.
“What we’re doing is going and extending them an option to work from their homes with all the facilities provided by us,” Bose said. The goal is to increase the program’s capacity to about 5,000 women in Indonesia over the next 12 to 18 months, she added.
If the program is successful in Indonesia, then Zilingo intends to bring it to other countries like India, which has one of the lowest female labor force participation rates in the world.
Zilingo, which launched in the United States this month, has raised more than $308 million in funds and is backed by well-known names such as Sequoia Capital and Singapore state investor Temasek Holdings.
Alibaba Group thwarts 300 million hack attempts per day
Alibaba’s company logo at its office in Hong Kong on February 22, 2012.
Aaron Tam/Stringer | Getty Images
Ma said he was “proud” that despite the tirade of subterfuge, Alipay — the group’s payments arm which reports close to 1 billion users and processes $50 billion worth of transactions per day — has yet to lose “one cent” to hackers.
“For Alibaba Group, we have over 300 million hacking attempts per day. Every day. But we deal (with) it. We don’t have even one problem,” Ma said at the Forbes Global CEO Conference in Singapore on Tuesday.
By way of contrast, embattled Chinese technology giant Huawei is subject to around 1 million daily cyberattacks, according to its security chief. Until now, other technology companies have been less forthcoming in revealing their cyber attack vulnerabilities.
Alibaba faced a sweeping cyber attack attempt in February, which threatened to compromise the accounts of 20 million users on its Taobao e-commerce site. The company said it detected the attack “in the first instance.”
Ma cited the company’s advanced tech capabilities, which he dubbed “AI: Alibaba Intelligence,” for its continued success rate, noting that machines are superior to humans in using logic to thwart malicious online behavior.
“We teach the machine all the ways people (are) cheating,” said Ma. “The machine remembers over millions of ways of cheating, so when we start the cheating, (the) machine already knows you are cheating. In this way we are protecting all the technology.”
Jack Ma (right), co-founder and former executive chair of Alibaba Group, speaks next to Steve Forbes (left), chairman and editor-in-chief of Forbes media, during the Forbes Global CEO Conference in Singapore on October 15, 2019.
Roslan Rahman | AFP | Getty Images
To achieve that degree of accuracy, however, Ma noted the company must collect vast swathes of customer data. He argued that doing so allowed Alibaba to develop safeguards to detect bad human actors.
“Give my data to a machine,” said Ma. “I trust a machine more than (I) trust people.”
“I give my data to people, I worry about that. People say ‘ah, this is Jack Ma, I want to know about him.’ Machine(s) don’t care if you’re Jack Ma or Jack Lee. Machine cares whether you do good things or bad things.”
Ma retired from Alibaba last month, 20 years after the company’s founding. At the conference in Singapore, he was honored with the Malcolm S Forbes Lifetime Achievement Award for his “outstanding” contributions to entrepreneurship.
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