Male & Femal Fertility Test Cost and Insurance Coverage

Last Updated on February 15, 2020

Fertility testing is recommended for couples after a couple remains unsuccessful at becoming pregnant for one year. Both the partners are required to undergo a thorough medical and physical assessment since 40% of cases involve male factor infertility while another 40% involve female factor infertility. Another 10% account for issues with both partners while the remaining 10% remain undetermined.

The male and femal fertility test cost varies based on the type of procedure involved and the extent of invasiveness.

Average Male Fertility Test Cost

Male factors account for about 40% of infertile couples. Typical problems include low sperm count, irregular sperm appearance, choked sperm ducts or poor sperm motility. The least average male fertility testing cost can range from $50 to $300 or more for a sperm count and motility test. The most average male infertility testing cost can cost up to $5,000 or more for tests such as the testicular biopsy.

Male Fertility Test Cost Breakdown

Semen/Sperm Analysis
Analyses the health and viability of a man’s sperm and helps determine if infertility issues relate to male infertility factor
Average Cost: $50

Urinalysis
To determine the possible presence of sperm in the urine which may indicate retrograde ejaculation
Average Cost: $15

FSH Blood Test
Helps find the reason for a low sperm count or if there are any issues with the testicles
Average Cost: $80

LH Blood Test
Carried out to determine testosterone levels and the state of sperm production
Average Cost: $80

Prolactin Blood Test
To determine erectile dysfunction or investigate testicular dysfunction
Average Cost: $80

Testicular Biopsy
This procedure is performed to pinpoint abnormalities that may contribute to infertility or to recover sperm for use in assisted reproductive techniques such as IVF
Average Cost: $3,000-5,000

Average Female Fertility Test Cost

Common tests for male infertility are fairly basic with very little need for invasive testing. Once, these basics have been examined with no issues determined, attention is given to more options for female infertility tests.

The first step in female fertility testing is a detailed appointment with a fertility physician. This covers all the factors that could contribute to infertility including medical history, lifestyle, use of birth control options, menstrual regularity/irregularity, pregnancy history, and the use of medications, if any.

Potential female infertility gets assessed as part of a comprehensive physical exam. The doctor will work with basics such as thyroid health, a pelvic exam, and take a pap smear. Once again, doctors will start will the least invasive methods to resolve any issues.

The least average female fertility testing cost can range from $50 to $200 or more for blood tests. Somewhat female fertility testing cost can cost $600 to $1,000 or more for tests such as the endometrial biopsy, transvaginal ultrasound or the HSG. The most female infertility testing cost can cost up to $7,000 or more for tests that require anesthesia, such as a hysteroscopy or laparoscopy.

Female Fertility Test Cost Breakdown

Ovulation Predictor Kits (OPKs) Or Fertility Monitors
Detects the luteinizing hormone (LH) in urine, which increases 24-48 hours before ovulation
· Standard OPKs are available as over-the-counter products and can cost $30 for 10 sticks
· Digital ovulation kits are priced at $40 for one digital reader and 20 test sticks
· Standard fertility monitor can cost around $230 for one fertility predictor and $65 for 30 test strips

Follicle Stimulating Hormone (FSH) Blood Test
Helps detect  issues with ovarian function or confirms the start of menopause
Average Cost: $80

Luteinizing Hormone (LH) Fertility Blood Test
Detects LH levels in blood
Average Cost: $80

Transvaginal Ultrasound
An internal pelvic ultrasound that looks for ovarian or uterine disease
Average Cost: $600

Hysterosalpingography (HSG)
Takes an x-ray of the fallopian tubes and uterus by injecting a dye via the cervix, enabling the radiologist to view if there’s any blockage or other issue.
Average Cost: $700

Endometrial Biopsy
This procedure requires scraping small tissue samples from the uterine lining just before menstruation. The purpose is to determine whether the uterine lining is thick enough to support a fertilized egg for implantation and growth.
Average Cost: $600

Hysteroscopy
The fertility expert inserts a hysteroscope into the uterus via the cervix to view any growths, abnormalities, or scarring in the area. The physician can take pictures for reference in the future.
Average Cost: $4,000

Laparoscopy
Performed under general anesthesia, this procedure uses a slim fiber-optic telescope inserted into the abdomen to view the fallopian tubes, uterus and ovaries. Any serious anomalies such as scar tissue, endometriosis or other adhesions are taken out using a laser.
Average Cost: $7,000

Insurance Coverage for Fertility Test Cost

Typically, fertility testing/diagnosis does get covered by many health insurance plans. However, this only implies that the plan will pay for services related to testing and not necessarily cover those relating to treatment. Many plans say that once a diagnosis has been established, they will no longer pay for fertility-related services.

That said, your insurance will give coverage depending on your plan which can range over the vast vista of nothing, to diagnostic testing, to the entire procedure. These services vary greatly and may even change from one employer to the next from the same insurance company.

There are 17 states which mandate infertility coverage requiring insurance companies to make the coverage available. But once again, the coverage isn’t uniform. Instead, if you are a resident of or work in any of these states, then find out the following about your insurance plan:

Is your plan self-insured or fully insured? Self-insured implies that the employer provides benefits using the organization’s funds. Fully insured means that the organization pays a premium to the insurance carrier. The premium is fixed annually and depends on the number of employees enrolled every month.

Does your plan depend on the number of employees enrolled? Some plans require a specific number of enrollments. For instance, some employers may only offer coverage if the number of employee enrollments exceeds 25  and others may do so if the enrollment number is greater than 50. Any fewer enrollments and the employer may not be required to provide coverage.

Was the plan written in the governed state? For the law to be honored the plan must have been written in the state with the law in place.

The majority of people use group insurance policies that are devised to lower premiums costs by evening out the expense risks among the group members. Those who do not, can get individual insurance but this is difficult and more expensive to handle.

Insurance Law for Fertility Test Cost

Living or working in the 17 states, keep the following considerations in mind:

  • You are responsible for co-payment even when you use private insurance.
  • Insurance coverage only becomes available after it’s been established that you have met the criteria for infertility. Typically this involves proving that you’ve been trying to conceive for one year to be eligible for coverage. If the woman is above 35, then that time span narrows down to six months.
  • Some states ask that the couple must have an unexplained history of infertility for at least 2 years while some even require that the couple experiences infertility for up to five years before they become eligible for coverage.
  • Patients with private coverage may need to pay anywhere between $100-$1,000 out-of-pocket expenses, depending on the type and number of tests as well as their insurance plan.

Arkansas

  • Requires 2 years minimum of unexplained infertility for both partners.
  • Or infertility associated with endometriosis, blocked fallopian tubes or irregular male infertility factors.
  • Covers IVF up to $15,000.
  • No coverage for test cost.

California

  • Here, group insurers provide coverage for infertility treatment, excluding IVF. (It is up to the employers’ discretion to make this procedure part of the package).
  • If so, they can cover expenses for diagnosis, testing, medication and surgery as well as for GIFT.

Connecticut

  • Interested parties must have a policy for 12 months before becoming qualified for coverage.
  • The given insurance covers 4 ovulation induction cycles, 3 IUI cycles, 2 IVF cycles, GIFT, ZIFT, low tubal ovum transfer and 2 embryo implantations for each cycle.
  • Nothing for test cost.

Delaware

  • Covers consultation plus diagnostic testing, along with IUI, fresh/frozen embryo transfers, 6 completed egg retrievals IVF, ICSI, medication, and more.

Hawaii

  • 5-year history of infertility makes candidates eligible for One IVF cycle to be fertilized with the spouse’s sperm.
  • Test cost is not covered.

Illinois

  • IVF, embryo transfer, artificial insemination, and GIFT, ZIFT with 6 egg retrievals are covered.
  • IVF, GIFT and ZIFT coverage only provided when other less expensive treatments don’t work.
  • No coverage for test cost.

Louisiana

  • Insurers can’t decline covering treatable medical conditions which lead to infertility.
  • Insurers also aren’t required to cover fertility drugs, and services such as IVF, tubal ligation reversal and more.
  • Test cost isn’t covered.

Maryland

  • Two-year history of infertility and treatment with less expensive options result in 3 IVFs per live birth up to a maximum lifetime expense of $100,000.
  • No coverage for test cost.

Massachusetts

  • Diagnosis plus treatment is covered including IVF, GIFT, artificial insemination,  sperm and egg banking and more.

Montana

  • Infertility services to be covered as a component of basic healthcare.

New Hampshire

  • Evaluations, lab assessments, medication and treatments linked with donor sperms, eggs and embryos are covered.

New Jersey

  • Diagnosis, diagnostic test cost, IVF, fresh and frozen embryo transfers, medication, surgery and more is covered for couples under the age of 46 trying to conceive with less expensive treatments.

New York

  • Diagnostic tests plus procedures with up to 3 IVF cycles are covered.

Ohio

  • Covers different diagnostic procedures with the exception of IVF, GIFT and ZIFT.

Rhode Island

  • Females  between the age bracket of 25 to 42 are covered for diagnosis plus infertility treatment with a cap of $100,000.
  • Fertility preservation is not included.

Texas

  • Five-year infertile couples get IVF coverage by group insurers but may or may not by individual employers. The woman’s eggs are to be fertilized by their spouse’s sperm.

West Virginia

  • Infertility services covered under basic healthcare.