Season 4, Episode 9: Financing Effing Fertility
Where Family Planning Meets Financial Planning
When a man loves a woman very, very much….lol. Baby-making / family-creating can be hella expensive and complicated.
Is egg freezing tax deductible? Can my partner’s FSA pay for my fertility shots? Is IVF a legit topic to bring up with a financial advisor?
Our guest Anna Bell Gall, Austin-based financial advisor, has the answers to all of these questions and more.
All the single ladies, LGBTQ pairs, cancer survivors, military couples, tech career powerhouses, fertility-challenged straight couples and a million others facing creative family-making, you know that the price tag can be one of the major planning and pain points. This episode is a place to start. Anna Bell is not only experienced and knowledgeable, she’s really nice and friendly and handles all our dumb questions with grace.
Here are some of the fertility info resources Anna Bell mentioned:
SART (Society for Assisted Reproductive Technology) data portal – Publicly available clinic success rates for egg freezing and IVF outcomes.
Baby Quest Foundation - Offers financial grants for fertility treatments.
The Cade Foundation - Provides grants for fertility assistance and adoption.
And here’s where you can find Anna Bell herself!
Ask us your dumb investing and finance questions, or just say hi! on our Ask Us page!
We have the social medias!! Here’s our Instagram and Facebook and LinkedIn.
This episode was edited by our co-producer Kelly West. Music by Bad Bad Hats and Devmo.
Transcripts for Season 4, Episode 9: Financing Effing Fertility
Caitlin [00:00:03] Welcome to Women on the Verge of a Financial Breakthrough, where we're figuring out finance one dumb question at a time. I'm Caitlin Meredith, a mediator and coach based in the Bay Area.
Sara [00:00:18] I'm Sara Glakas, investor, advisor, and founder of BlackBarn Financial, and the Austin Women's Investing Group, which you can find on Meetup.
Caitlin [00:00:26] Can you think of a woman who could use a little money motivation and send her this episode? And please, if you can, leave us a review. They help more women find the show and make us feel like a million dollars. Pretext.
Caitlin [00:00:42] Oh
Caitlin [00:00:48] Today on our show, we have Anna Bell Gall. Anna Bell is a financial advisor, investment advisor like Sara. But one of the ways that Annabella sticks out for me in all of the conversations I've had with financial advisors through the years is a specialty based on experience for financing fertility, which we've never talked about on Women on the Verge. So Sara, I'll let you do your version of the intro.
Sara [00:01:15] I just to add a little bit to that. I first met Anna Bell, I guess it's been five years ago, maybe almost to the day, because it was right at the beginning of COVID, right? Where we had a Zoom call because Annabell was coming into the industry as a career changer after a long and successful career in Washington, DC and various places in public policy. And so she and I had a conversation. She just reached out to basically like. Figure out what it's like to be a financial advisor. And she just really stuck out as a person who is always very informed, very frank, easy to talk to. So a couple of years ago, she was top on the list. In Austin, we've started a group of women financial advisors. We get together once a quarter just to talk about business and life. And Anna Bell is always a favorite participant in that group. And so when we. We're thinking about a topic like this, right? Anna Bell was the first person to come to mind. And Annabell is at Austin Wealth Management, which is a registered investment advisory firm and financial planning firm located here in Austin. So she and I get to see each other in person quite a bit.
Anna Bell [00:02:29] Thank you. And thank you very much for that generous introduction, Sara. That's very lovely. And I really credit you with a lot of the support and momentum as I kind of launch into this next chapter. So thank you for that.
Caitlin [00:02:44] I know I was thinking it must have been a pretty good conversation on your end to Anna Bell if you're like, yeah, I'm actually like she didn't scare me away. I'm going to keep pursuing this.
Anna Bell [00:02:55] Yeah, there definitely were some that tried and Sara was not in that group. She was in the encouraging and supportive and you got this group. So that was really nice and refreshing. And I've learned a lot from her and her expertise and she is a great champion and mentor for those of us in this space, so. So thanks back to you, Sara, and I appreciate the opportunity to be on today and talk about this issue because it is one that comes up often with not just my clients, but my friends, my colleagues, professional networks. It's something that I think is certainly top of mind for many women who are in, you know, really the age range from even late 20s, early 30s, you know all the way to mid 40s. So there's lots to unpack, so I'm looking forward to sharing what I know.
Sara [00:03:56] I mean and I think like when Anna Bell and I first talked, I mean I hope it was clear that we need more women in this industry and this is one of the reasons, right? Something that has huge financial impact that maybe a woman wouldn't either feel comfortable or feel like it was relevant or feel like she had to figure out on her own if she's in a relationship with a financial advisor then we need to figure how to be able to talk about it and how to plan for it as best we can.
Caitlin [00:04:25] Yes and not have it feel like something that's like too much on that like emotional or medical side and that it's a want not a need and so you might feel a little nervous about bringing it up because you're not exactly sure is this a legitimate financial goal that I would speak to with an investment advisor so I really take that point I'm not sure it would have even occurred to me. If I was in that situation like, oh, what I need is a financial advisor. I would think on the medical side what friends I needed to tell but not looping in a financial person to help me navigate that. And yet what I know about it is that it can be very, very expensive. Yeah, no, that's exactly right.
Anna Bell [00:05:06] And I would also say that there is sort of a broader audience of affected women, men, same-sex couples, LGBT couples, because infertility or fertility and reproductive assistance is a factor that comes into play for cancer patients, for people with chronic or hereditary diseases who may not be able to. You know, get pregnant the natural way or may need assistance for members of the military who are often deployed for long periods of time. So it's not just... I think women that are impacted this but there are the other discrete groups where reproductive health assistance and financing it can be really impactful, can be expensive, and is maybe something that they never thought about but suddenly does become a matter of urgency and so I think that's not often talked about as much. Even women nowadays who don't have partners or maybe even have partners but just aren't sure if they're necessarily the ones that they want to. Have kids with are still trying to be more proactive about this earlier on. Again, lots of affected groups that are impacted by this decision.
Caitlin [00:06:20] That's like a sociology course just in there about, we think of it as just like individual women struggling, but it's actually like entire industries. I know a lot of women in the tech sector, like any people working where like their career is taking the priority. And the implications of that are that a family life potentially will be postponed. Financial implications to that in addition to the medical one. So how do people start on this? What's the best way to talk about it in terms of someone at an earlier stage of life or later, or what's your entry way to talking about this with clients?
Anna Bell [00:07:03] Yeah, that's a great question. I serve clients not just in Austin, but all over the country and some internationally as well. I'd say for many of my clients who are female, single, or perhaps a primary earners in their household, they're very busy with their careers, they are climbing the ladders, they are often very senior level positions. And so I'd see that... For some of my younger clients becomes a question earlier on, just sort of what to do proactively and how should I plan to pay for this proactively that usually is egg freezing. So that is investigating which clinics offer that, what the timing is for that. How many cycles you want to do for egg freezing, how that sort of aligns with your work schedule and your travel schedule. So that tends to be earlier and hopefully it goes well and you can freeze and bank some eggs and just have that choice that option for down the road. So that is a different conversation than the conversation I have with my, again, tend to be older clients who find themselves in a situation where. They need to pursue IUI, IVF, the sort of assisted reproductive technologies because they either are having trouble getting pregnant or they have medical issues that preclude that from happening the natural that's quote-unquote the natural way. Both of those types of conversations I think are very personal, very sensitive. And in many cases, I think it's nice to be able to talk as a woman about it, because I've had my own experiences with it, went through very lengthy processes, very expensive processes. And so that's just a different dynamic with clients than if they are talking to. Their male advisor, because not a lot of male financial advisors know the nitty-gritty about timing of the egg cycles, the cost of the drugs, what your body goes through, what your mind goes through talking to your family members about it. So I try to support both the financial considerations as well as the emotional journey that affect a lot of my clients that go through this.
Caitlin [00:09:23] I appreciate that so much because I know for my friends that I've watched go through that process, like it is emotionally and physically draining, like both the like emotional roller coaster of did it work, did it not work, but also the effect of the hormones, the effect that the injections being automatic, and that to combine that with like financial decision-making, that's a lot. So to have someone who can guide you through that and perhaps like ahead of time too and knows like better how to predict what's coming down the pike, I can just see as such a huge support. It's not just money. It's also what your status is when you're making those decisions and having procedures done with unknown results.
Anna Bell [00:10:12] Yeah, and I think, yes, that's very, it's very true. And I think it's also easier to, for me anyway, as a woman to just ask the question during the early part of the financial planning process, when I first onboard new clients, or even after we've been working together for a year to just say like, hey, is reproductive assistance or planning for reproductive assistance such as egg freezing or IVF something that is a. That is interesting to you, would you be interested in learning more about the financial implications or data that I can share, you know, anecdotally. And so that's usually a good way to get the conversation started. If they don't initiate or if they don t break it up, I'm very comfortable, you know bringing that up and talking about it. But also where a client works or the type of role they have helps inform what their more immediate resources might be. So I kind of have good sense of. If you are at a large tech company, or even some of the larger consumer products company, financial services, big law. Many of those have in the past five to 10 years started to offer more wellness benefits and health benefits around fertility assistance. So egg freezing or IVF services. Or covering one to three rounds of IVF. So those are often kind of the low-hanging resources that we can go to right away and explore more about their particular program, what their financial benefits will be and look at that more closely. And then in terms of other sort of benefits that are a little more general but that you can utilize for this, flex savings accounts and health spending accounts are both pre-tax benefits. So. Somebody says, I'm really interested in this. And I say, Hey, looks like you know, you haven't taken advantage of your FSA account before let's plan next year for you to enroll at that at the maximum level. So you can, you know put away the maximum into that pre tax account and then spend it on your fertility assistance costs and then also get the you know, the pre tax health benefit. And so I have many clients who never use FSA accounts because they just don't know what they'll use it for their overall pretty healthy. Same thing with their HSA accounts. I know as financial advisors, we love HSA accounts for the triple tax benefits. And we also like for clients not to touch them. We prefer that they leave them alone. Like to treat them like a retirement account. Yeah, I make an exception for this, especially because it can be anywhere with the employee or employer contribution. It can be, anywhere up from $4,000 to $8,000 that you can put away for that and again provide that pre-tax benefit. And then there are a couple other employer health insurance programs do have fertility benefits. I don't think it's as common, but there are some just from, you know, employer provided health insurance that does offer that because they're, you whatever health insurance plan you're on does provide that. So sometimes it's worth it to dig a little bit deeper into that.
Sara [00:13:21] I mean, I wonder if for someone who's just starting to think about this or starting to plan for this, I think that most people come in with a perception of it's gonna be some pretty serious sticker shock. Like do you have some numbers? It can be a range or I'm sure you have a good idea of like what the different types of fertility treatments or fertility assistance procedures cost if you're paying out of it.
Anna Bell [00:13:48] Yeah, so the cheaper way to go initially is usually egg freezing, because that starts around $5,000 to $10,000, sometimes can go up as high as $20,000 depending on how many cycles you want to do, but also what the results are from the cycles. So I do have clients and anecdotal stories where folks thought like, hey, I'm going I'm really young, I'm 30, 32, 33. I'm gonna do an egg freezing cycle and get 30 eggs and that'll be great, that's all I need. But if then they do it and they only get six good ones. And so the question remains, do you wanna keep doing it? How many cycles you do it for? And then it's not just the medical, the pre-testing, the pre imaging that's done. It's also the drugs that come along with it. So there's lots of specialty. Drugs that go into the process, both for egg reasons, certainly more so for IVF, probably minimum costs for a full cycle of IVF depending on which clinic you're working with and what actually what geographic area you're in because they tend to be higher cost and more higher cost areas of living or for larger cities. But that I'd say, you know, like very minimal, probably 10 to 15,000, and then can go all the way up to 100,000 or 200,000 just depending on how many cycles you need to do. There are so many different iterative parts of an IVF cycle and a lot of things you can choose along the way to do like genetic testing, frozen embryo transfers and storage support that comes with that, specialty drugs, specialty treatments along the ways to help. Depending on what your issues are. So it can really get up there. And that's one of the things that I always say. The time value factor here is really in favor of that egg freezing. So that earlier investment, which is going to cost less, but can really Even though it's kind of a lot of the big chunk of change to put up front initially It can actually wind up saving you significant money Down the down the line if you do wind up needing to do IVF, but you've already baked, you know, you're younger
Sara [00:16:08] younger eggs. That is so interesting. I mean, I think on so many different levels, and I've never thought of it as like a financial investment as well that you might want to make sooner rather than later. I mean so I'm really curious. This is kind of going a tiny bit off topic, but do you think there is advice that we should be giving young women about thinking about freezing their eggs earlier than maybe I ever would have thought? Like, what are your views on that?
Anna Bell [00:16:38] Yeah, I think I will, I mean, I'm a big believer that preserving your fertility through egg freezing is always gonna be cheaper to do it sooner rather than 10 years down the line or five or eight years down line. Fertility only gets harder and more expensive as time goes on. It's the geriatric pregnancy thing. There's just so many health issues that emerge when women cross that kind of 35-year-old threshold and then get up into their 40s. And so I think that it is way cheaper to do it at age 30 versus age 40. So yeah, I'm a firm believer that if it's something you're considering, you should go ahead and really consider it seriously because almost always the benefits can be really huge if you are able to successfully freeze eggs. And now it's not, you know, it's not guaranteed. There are a lot of issues with, you and no, it's not a... Guaranteed outcome by any means, but it certainly puts you way ahead of the game if at age, you know, 39, 40, 41, you can tap into your 29 or 30 year old eggs as opposed to starting completely from scratch at that age. So yes, I think it's, I do think it is a conversation you should have more often. And I certainly think that for clients who are comfortable with this conversation, I do encourage them to have you know conversations with their parents or family members. If you have a parent who's like hey we're going to give you x amount of dollars when we pass away or you know that there's going to be an inheritance event happening. I tell many of my clients like you know have the discussion with them and say this is something I'm really interested in doing because I want to preserve my ability to you know, have kids. I don't want to feel rushed into the wrong marriage or the wrong partnership for the wrong reasons, but I want to make sure I can, you know, really put myself, you know in the best possible position for success later on for my fertility. Would you help me financially with this egg freezing program that I want to do? And I've had lots of positive outcomes from that from you know, parents who want to support their kids and their daughters and often sons who were like want to be grandparents in the future. So they think, you know handing over 10,000 or 20,000 when they were planning to give their kids money anyway, it's something they can help with sooner rather than later.
Caitlin [00:19:12] I'm so glad you asked her that, Sara. And as you were talking, Anna Bell, I was like, oh yeah, that was me. And I'm nervous to say anything because I know that the research, like my information is so out of date. But when I was 35, I was, like, you know what? I know I wanna have kids. I don't have a partner right now. I'm gonna look at freezing eggs. At that time, which was 15 years ago, The thinking was, I was like, okay, I could spend nine to $12,000 freezing some eggs right now. And I was 35, so they were already talking about the limited quality of my beautiful eggs. But the research at that point was, and I'm sure this has changed, there was very little actual research about success rates with thawed eggs at that time, 15 years ago. So. Felt like a huge financial gamble. Like if I only have $12,000 and I can come up with that, maybe I should just have the baby right now, you know, like try now, because if I spend this money to freeze eggs and there's very little research, i.e. Confidence that I could have success, and what I was told at the time was there was a much higher rate thawing embryos so that the the advice was if you really want to do this and money is an issue, which it was not only freeze your egg, like freezing embryos. So buy sperm, do that, spend three to $5,000 on sperm. Get the catalog out. Yeah, I got the catalog. I was, I knew all the catalogs, get that, choose the sperm, then have your egg retrieval, have them make it into an embryo in the lab and then have them freeze those embryos and then the decision was sort of like, okay, but if the reason I'm waiting is because I want to meet a partner that I want do this with, that's kind of awkward to then be like, oh, don't worry, I've got this. I have, you know, and I, I absolutely having all of these choices, I, amazing that we could choose that. And I know that has been the choice and I want it to be available for everyone. But in my, like, romantic. Had, it was like, Oh, this is kind of funny. Like I'm choosing not to have a kid right now, because I'd like to do it with a partner. And yet the best chance I have of doing this for the money that I can have now is to choose a pre choose a partner to have, you know, the to get the sperm from. And then, so anyway, I just, as you were talking, when we had you on the show, I was not thinking because I didn't end up needing, I didn't end up doing any of this. So I was like, oh, this doesn't apply to me. I was actually your client sitting there thinking like, how do I make this financial decision? I know that I want a baby more than anything, but like $12,000 would be a lot, what might be the difference between me being able to have a baby later or not if I don't have that money. I'll have this to say, what would you have advised me to do?
Anna Bell [00:22:30] Well, yeah, so first of all, yes, I do always caveat that, you know, egg freezing at 30 or 28 or any age is not a guarantee. And there is still, you know, a lack of data on the overall success of frozen eggs. And it's very true that you could probably count on half or even six or 70%. Let's say worst case scenario, not surviving the thaw. Let's say you only wind up with, you know, 30 or 20, 20 or 30%, you know good eggs left after surviving the thought. But I think data is really your frontier. So I always encourage my friends, my clients to look at the clinics that you're considering and their success rates with frozen eggs. And this all is reported data that's publicly available through SERS, S-E-R-S, and there's all kinds of reproductive clinic data information, but there are clinics that have really good track records and can point to that, and others that are less optimal. So that's something that I say, like really do your research, look at the clinic data from the past, you know, three to four years on success rates. For IVF for healthy embryos that survive that resulted in healthy pregnancies. I think that's a very valid question. But at the end of the day, egg freezing does remain the best technology right now that's available to preserve your fertility. And even if it's a small portion of the frozen eggs that survive, future IVF process that's done in the lab, your, again, 28-year-old, 30, 31, 32-year old eggs. Are going to have probably a higher likelihood of success becoming embryos and becoming healthy babies.
Sara [00:24:13] And having it be an option in a conversation that you're having, right? Because I think that Caitlin's experience is probably, if you'd had that information 15 years ago, do you think you would have gone ahead with the egg freezing at 35 or maybe even younger if it was part of the conversation that our generation could have had that really didn't?
Caitlin [00:24:32] I think I ended up feeling like, oh, it's already a little... I don't think this is true. This is not medical advice. Do not listen to it. But personally... We give no advice on this podcast, by the way. This is just like... Why are you listening? Is that... Oh, man. Like, I should have done this when I was 30. You know, with a limited amount of money that I was looking at then, freelance, journal, whatever I was, aid worker, freelance. Like the limited amount of money I should have done this when I was 30. If I'm really looking at this when I'm 35, I should actually be looking at having a baby right now. Like that that that had to do with my specific life stage and thinking. Like, how much money am I going to be able to get in five years? You know, a baby is even more expensive. So like, if I... The cost is pulling away from you? Yes, exactly. And so if this isn't a guarantee and I want a guarantee, there is no guarantee. But like, the medical messaging I was getting is you don't have any time to lose. Like, start now if this is really... Because there's such diminishing returns with each year. This is such a personal thing that I was sort of confronting. And if I had been in a partnership, I also want to say that I 100% would have done foster to adopt. Like the biology wasn't I don't believe biology determines family. And I would have been very creative. I wanted a baby. And the cheapest way to do that was for me to have it, you know, in that in that specific way. And I wanted the experience of pregnancy, et cetera. But I just wanna underline the fact that I am not associating like family with biology, but the real fact of like even foster to adopt, like all of those were going to be expensive propositions. So what what was the financial implication for where I was at the time?
Sara [00:26:34] I mean, I wonder, Caitlin, that kind of, Annabel, like a question for you, like as people are making these decisions, do you, and I think maybe focusing on like the affordability question, I mean and not necessarily that we have all the resources we need to do whatever it takes to have this process go the way we want, but more of this like we don't have unlimited resources. Are some of the creative ways of thinking about this that you've seen clients either think about or implement or that you researched or that that you heard about anecdotally? I mean, what are some ways where people have kind of overcome this affordability and also like this risk return trade-off that you all have talked about?
Anna Bell [00:27:19] Yeah, that's a great question. And there's, I think, good guidance, good suggestions, good recommendations on many of the fertility chat boards, message boards, Reddit. There's some really supportive communities where women can ask these questions and get guidance specifically on their own personal financial situation or with their own kind of type of professional role. Depending on your. On your clinic and where you're going. So some particular clinics offer packages. So those include multiple treatment cycles that are at a discount. So that's sort of like a kind of initial way to cut down on the cost a little bit. A big one that I always look at is equity compensation. If clients are in any role where they have RSUs or besting events, I've had- as part of your compensation package at your job, you receive shares in the company and they vest at a certain date, meaning they become yours. You own them at a certainly date. It's usually on a specific calendar or timeline. And in my philosophy, I treat them as essentially like a cash bonus that becomes available to you on the day that the units or stock shares vest to you. And I've had many clients who didn't even think about this option because to them, they were either like, really hanging on to that stock, say they're at a company that's doing really well, and they're just kind of watching the share price go up, and it never has occurred them to sell any of it, but it can represent sometimes. Tens of thousands, hundreds of thousands of dollars that you can unlock and direct towards something like this, which is, you know, very, I think, a much more impactful way to put the money to use for you and something that's valuable to you and that means a lot to you as opposed to just kind of leaning it in and your company's sort of stock little basket and then seeing what happens to it. There's also things like discount programs for lower income patients who go through this. There's nonprofits and organizations like Baby Quest Foundation and the Cade Foundation. They offer grants and support to individuals and couples to help cover fertility costs. So there are nonprofits and advocacy organizations that work on fertility and infertility issues for patients or individuals that have certain genetic or medical conditions. Many of those patient advocacy organizations or non-profit foundations associated with that condition will provide grants or support financially, but it does take you know, a lot of digging and research. And that's where I think that, again, fertility support communities and discussion boards can be really helpful, especially along, you know for certain types of medical conditions. There's also, when it comes to just the drug portion, because IVF especially requires... A lot of shots, a lot of drugs and shots. And certain pharmaceutical companies provide discounts or assistant programs for that. So that helps reduce your out-of-pocket expenses. And sometimes, again, if you've got good medical insurance, that can cover some of those higher cost drug prescriptions. And I won't go into too many details because the FDA is not fond of this, but there are resources besides U.S. Pharmacies that um you can explore um because many of the fertility drugs uh that us manufacturers make are often made by european manufacturers and sold elsewhere um but it's the same medication so there are avenues to explore on that front because their pharmaceutical costs for those drugs um are much lower outside of uh outside the us um and i'll leave it to your listeners to explore that and
Caitlin [00:31:19] Well, I'll go out. I'm not a financial or medical advisor, but I know people. I know several women that have gone to the Czech Republic, for instance, to have IVF because the costs were so staggeringly lower there. Now, of course, there's travel. There's taking time off of work. There's all sorts of, if you already have a family and a kiddo, what that looks like. And you don't have to specifically comment on the quality of medical. But I'm just like. I know that those were decisions made based on finances, that it was prohibitively expensive in the U.S. And they sought, in this case, a European country that provides those services. I guess this sort of like medical tourism for women looking for reproductive assistance.
Anna Bell [00:32:07] Yeah, that's, that is, yeah, also sort of that kind of a next, next step, next level option or alternative to doing it in the US. And I think that there's, as the technology evolves, and as there is more interest in this, there may be a price compression down the down the line, you know, things may drop in price, price, what did you call it price compression compression, Braids never hurt.
Caitlin [00:32:36] Never heard it, writing it down.
Anna Bell [00:32:39] Well, ideally, competition and more options means that prices drop, right? So people have more options to, you know, more competitive to choose from. And so theoretically, and I think it has been the case in some, especially for certain types of. Fertility drugs, you have seen prices come down in some areas and certainly in I think larger cities, larger metro areas for my clients that are in New York and LA and DC, Seattle, there are more clinics and more treatment providers. So when people have more options and they're not just, there's not just one local clinic or one local fertility specialist to go to, then that helps as well. Or if you have the ability to work remotely. Um you can go some go you know somewhere else for a couple months and um do either the you know egg freezing or IVF procedures. Some clinics offer what they call egg shearing or donation programs and it's kind of interesting what this is is that when you go through egg freezing as part of a way to offset your cost, you agree to donate a portion of your eggs to reduce or even eliminate the cost of your own egg freezing procedure. So you're essentially sharing your eggs. Say you're like a healthy, you know, 28, 29, 30 year old, and you really wanna do this, but you don't have a lot of money, but there's plenty of other older patients who would gladly like to take those donated eggs. And use them for their IVF procedures. So some clinics do offer that and you can get substantial savings off the cost of it. You have to be comfortable with the idea that you give up control of those eggs, right? So they are donated to another person or another couple and they are no longer your eggs. So that could be difficult for some folks, but that represents a great financial opportunity and also even an opportunity to help other couples who can't conceive on their own. Donated eggs are. You know, hugely beneficial and really can make, you know just a wonderful difference in the life of folks who would not be able to have a child otherwise.
Caitlin [00:35:01] We haven't talked about surrogacy, and I know that's kind of outside the scope of like medical assistance, but surely it's in the scope of financial implications. And I'm thinking about for couples or individuals who a pregnancy is not going to happen within the couple or the individual. And so surrogate is our option besides adoption. Are we talking like a whole other level here or that's so case specific that it's even hard to. Bring in the realm of a financial discussion with some ranges.
Anna Bell [00:35:34] Yeah, I have not run into it very much in my own practice and my own conversations. So it is much more, it's not as common, certainly, but it is more expensive because there are so many more costs associated with surrogacy because it's just the kind of the biology and the biomechanics that you're supporting and paying for. It is the health and wellbeing of an entire league. Grown adult who is carrying, you know, your child. And so there are, you know, there are medical costs for them. There are legal costs. So, you know, anywhere from, you know, five to 10 to 15,000 just for all of the the contracts and the agreements that are put in place around that. And again, there are agencies, circusy agencies that really specialize in this and do a great job putting the right folks together for circusy matches. And they handle, you know, they kind of have the whole range of services to handle that. But yeah, Circusy can easily, you know, run anywhere from, you Yep. 50,000 to 100,000 and maybe even more when it all is said and done, just kind of depending on where the surrogate lives, where you live, how many attempts it takes for a successful full-term pregnancy and a healthy baby. Because with surrogacy also comes things, I mean, they have miscarriages, just like everybody else, they have pregnancies that aren't viable. So...
Caitlin [00:37:12] It also made me think about reciprocal IVF, which I know many lesbian couples choose to do where one does an egg retrieval, and that is used for the embryo that then is transferred into the uterus of the second partner who then carries the pregnancy to term and then you're talking about two people's medical care, drugs, all of that. So I imagine that that can be quite expensive as well. Yeah, that's exactly right.
Anna Bell [00:37:41] I wanted to add just another thing too, this was obviously a lot more appealing when interest rates were lower, but home equity loans and HELOCs are another potential source for this. I definitely want if my clients have to supplement or need money from other sources and they own a home or a condo, especially if they've held it for a long time, rather than putting something on a credit card that is going to, you know. Start charging them a 22% interest rate at some point, I even now with rates as they are, I'd rather look at, you know, a something like a home equity loan or a personal line of credit from like it's like a credit union is something you know not like one of the big things that like a Credit Union rates are going to be a little bit lower to even consider it, you know something that's like six to seven percent. Interest rate, again, just one of those things that I don't think folks think if people think about home equity loans is like, I'm going to remodel my kitchen. But it's also a valid, perfectly valid source of money, liquidity to do something like something like
Caitlin [00:38:49] So in the beginning, we talked about FSA and HSA, and I just wanted to ask you to, I think people that have them know the difference, but I always forget. So let me tell you, the FSA, according to me, is the flex savings account that you get through your employer where you can put a portion of your income monthly into it. And use that, it comes with like a debit card that you can use for like over-the-counter drugs, doctor's appointments, dentist, glasses, whatever. It doesn't roll over each year. Am I getting that right?
Anna Bell [00:39:28] Correct. Yeah, that is the one that people normally think of as that use it or lose it tag. And I like to refer to because I wish I wish they come up with completely different names because it would really lessen the confusion. Because you'll also hear the term health care spending account or health care savings account. And they're often two different things. But that I also for FSAs, I like to say flex spending account because you really do need to.
Caitlin [00:39:52] You have to spend it. Exactly. Okay. It's not savings. I was surprised that you mentioned the FSA because I'm so nervous. I'm always telling people like, don't give them your money because they won't give it back to you. So unless you're someone who can really predict how much your medical costs going to be for that year, or you underestimate so that you know you won't save, put more into it than you can spend during the year. But it sounds like for you. Helping people plan ahead, like, okay, you're going to have an egg retrieval next year, so you know that's going to cost $8,000, whatever. Let's max that out because you'll spend it within that year. So it's not like a long-term plan. It's for short-term, upcoming expenses related to this. Am I getting that piece right?
Anna Bell [00:40:46] Right, and it's also even just the initial workup, the lab work, the imaging, the ultrasounds, and there's something called an HSG test, what they use to like check out your plum and make sure everything's clear. Those that all cost money too, that can is medical cost out of pocket. The meter starts running pretty quickly with these. Uh, with these things. And so, um, I, I'm the opposite. I, because of many of my clients are high earning W2 income earners. So I'm looking for every potential pre-tax deductions. So I am a huge pusher of the, put the maximum in every year. Cause I can, there's so many eligible expenses now. It's like sunscreen, multivitamins. It needs to be more, more constrained. Um, and like 10 or 15 years ago, and you did see a lot of people losing money, but if you leave.
Caitlin [00:41:32] Your job in the middle of the year, they don't give you that money. So anyway, don't listen to me for financial advice. I appreciate that there's like a lot more things. So you can buy like four years worth of tampons before the year is over, whatever, like, there's ways to use it. But I was just I wanted to just specify that that's not like a long term thing, like so the next three years are going to be looking at reproductive assistance. So put all this money in now, you'll be able to use It for the full three years, like Whatever you put in is for much. For medical expenses you will incur that year, not whereas the health savings account, which not everyone is eligible for. You have to have like, I do a high deductible plan that qualifies for it. So essentially they don't pay for anything. And, but your benefit is you get to have this savings account where it's not use it or lose it. It rolls over every year. And it's pre-tax income, which is a way of saying you put your income into it before you pay taxes and they don't make you pay tax on it. And you can use that for all of these same medical expenses.
Anna Bell [00:42:46] Right. Yeah. And the flex spending account, same thing, also pre-tax, the HSAs, you often get an employer match. Employers want to incentivize HSA because they're cheaper than PPO's, HMO's, more traditional health care insurance plans. So you do sometimes you're like, can I get, you know, 500 bucks or a thousand bucks from my employer that can kind of go into that pot? And that, yeah, both of those are pre-tax benefits and usually at kind of a higher. Um, a higher maximum, uh, cap annual contribution cap for, um, the HSA accounts and sorry, there was one other thing before I forget that is also a little unconventional, but I always look at for clients. Um, Roth IRAs, you can always take out your original contributions to your Roth IRA's without penalty. For many of my clients who are younger, they may have been being, you know, really good savers and. You know, read Sara's blogs and know to like, try to stash as much away into their Roth IRAs. And that's great because that can be those contributions, which again, you can take out without penalty can be a way to fund this as well. It's a balance because you don't want to deplete your Roth IRA completely. And you don t want to sell yourself back for retirement, right? But if it's, you know 10,000 or 15,000, and they have a healthy balance in the count. I would much rather than do that, then say like take a loan out against their 401k, which is a question I get frequently about this because that comes with interests, that comes other penalties. I would prefer we look at that Roth IRA first, especially if you have other investment accounts that you are aggressively saving into like a really healthy like employer match at your work. If I know you're saving aggressively. I'm doing a good job at other retirement accounts. I'm comfortable with a modest amount coming out of that Roth IRA because, again, there's no penalties associated with those original contribution withdrawals.
Caitlin [00:44:52] Well, and that could also be a place for like personal choice. Like I would have said, I don't care. I'll worry about Caitlin of 2040 later. I want a baby now. Like I'm going to use all the resources I have right now, even though it doesn't make financial sense. Like this is it. And that would be my choice. But knowing the implications would be really important in making that decision, too. You just said that Roth like blew my mind, but it made me think, have this other question, which is I think for all of these, except perhaps surrogacy, the costs would all be considered medical and therefore valid with an HSA to be spent with HSA or FSA. I'm wondering if there are costs that are associated with certain reproductive assisted technologies or procedures or... Systems, whatever, where you, you're going to be using just money, money. There's no tax benefit, there's no whatever, it's not medical, that it's legal. I think that came up for the surrogacy one. But is there any sort of thoughts that even if you have like the most robust HSA, there's still other money that you're gonna have to spend that HSA wouldn't be qualified? Do you see what I'm asking?
Anna Bell [00:46:17] Yeah, I mean, yes, that's, I'd say if you kind of work the numbers, there's probably I'd say probably only about maybe half of a full egg freezing cycle and the associated costs and expenses with that you could get from like a flexible encounter HSA, maybe. Third or fourth of that balance could go towards like a full IVF cycle because those get much more expensive. The majority of it is probably going to just be out of pocket. You're going to be cash flowing. And so that's when I talked about various resources to draw from your bonuses, your commissions, your RSUs, your family, potentially an early head start on your or a gift from family members. Home equity loan, but those kind of are all places where cash free and clear without any kind of tax complexity can be used for this.
Caitlin [00:47:12] Did you have any other questions?
Sara [00:47:14] I learned more than I ever could have hoped to learn on this call, listening to you all share your experiences and talking, and it's really opening my eyes and my mind to the possibilities for especially young women coming through my office or through the Austin Women's Investing Group or through our networks to kind of what the possibilities are and what the conversations should be.
Anna Bell [00:47:38] I would put it in the same general category as the wage gap, right? And like inequality when it comes to wages. And then the choice to have children at what point you do that in your career. And then, the reproductive assistance choices. Like, I kind of put that all in the Same category. They're all pretty general, but are unique to women and things that the more you normalize it and the more, the earlier you talk about it. And the more comfortable women are talking about it, the better it is for everybody.
Caitlin [00:48:10] Can I ask you another question, Anna Bell? This all relies on a woman's, the individual woman's financial resources or job or health insurance or HSA account. Can male or female partners of the individual who wants reproductive assistance contribute to medical costs for family building? Yeah
Anna Bell [00:48:36] And I should say that when I'm speaking with my clients that are couples, it's all kind of considered to be in the same pot. So we're talking about all of these costs as shared expenses for the most part. So if you are, let's say, a heterosexual male and you have a female partner, especially if you're married, you can, they're dependent, or sorry, they are. Flex spending account can also be utilized for the services. So you can kind of go between, you can cross over each other's accounts for expenses. So between the two of you, you can get, you know, it's like a little over 3,500 a year now. So it's 7,000, you now between the 2 of you. If you both max out the account at work and you put everything towards this. And there are costs for men as part of this. There is fertility testing that all men who are going through IVF usually need to go through. There's a battery of tests and blood work. So it's not just the women who incur expenses. So that's a good, a really good point, Caitlin.
Caitlin [00:49:48] Anna Bell, thank you so much for sharing this. I feel like this specialty doesn't get a lot of, as I said, the medical side. I know about the clinics, but not the financial planning side of it, and weighing your options and what information you could even get to do that. So I so appreciate that. Thank you so, Annabell. This is so great. You're very welcome.
Sara [00:50:16] Do you have a question about investing or finance? Send it to us in an email or voice memo on our website, womenontheverge.com.
Caitlin [00:50:24] We want our listeners to know that economic abuse can be subtle, but it's a serious form of control. Watch out for partners who limit your access to money, sabotage your job, or rack up debt in your name. If this sounds familiar, you're not alone and there's help available. Please learn more at TheHotline.org or call 800-799-7000.
Sara [00:50:49] Our podcast is edited by our co-producer Kelly West with music by Bad Bad Hats and Devmo.
Caitlin [00:50:55] I know, the first thing you notice is that I'm covered in gold
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