When Riley first laid eyes on her newborn this month, she couldn’t believe the relief she felt at the sight of her baby — so small that she and her wife nicknamed her Peanut.
But later, as she rocked her baby in her Bothell home, a frustration tugged at her.
It took nearly $64,000, a GoFundMe, tears and nights stressing over medical bills to have their baby. It should not have been this hard for a same-sex couple or a couple dealing with infertility to become parents in Washington, she said.
“That added financial burden and stress — it seems unfair,” said Riley, who asked for her last name to be withheld as she shared sensitive medical and financial details. “It was a very long, isolating journey.”
There are thousands of Washington families like Riley’s who have experienced a similar toil trying to have a child using fertility treatments, such as intrauterine insemination and in vitro fertilization. Most insurance plans don't cover fertility care in Washington, leaving couples to pay tens of thousands of dollars out of pocket for a shot at becoming parents.
It's a growing problem as the need for fertility care rises nationwide. In the decade ending in 2022, the use of assisted reproductive technology more than doubled, according to the most recently available data from the Centers for Disease Control and Prevention.
More adults are delaying starting families amid economic pressures, especially in high-cost areas like Seattle, and more same-sex couples are seeking assisted reproduction methods to build their families. Nationwide, these methods were behind 1 out of 38 babies born in 2022.
In some other states, it would have been easier for Riley to have a family. Half of all U.S. states have laws requiring insurance companies to cover at least some level of fertility care.
Washington, however, has repeatedly declined to join those states, citing its own financial woes.
The state Legislature has failed to pass bills that would require insurers to cover fertility care in the last three sessions, partially because the state's multibillion-dollar budget shortfall makes paying for that care for its own employees challenging.
As a result, some Washington residents are scraping together every last cent, taking on debt, traveling to other countries for treatment, switching jobs for better insurance coverage or putting off other major life goals — like buying a house — just for the chance at having a baby.
It takes a toll on patients," said Lori Marshall, fertility specialist and co-founder of the Seattle clinic Pacific Northwest Fertility. "It takes a toll on everybody who is dealing with the patients. Our billers … have to deal with patients crying about the money every day."
In vitro fertilization, the most effective fertility treatment, involves doctors surgically retrieving eggs, fertilizing them with sperm in a lab and transferring the resulting embryos back into the uterus. IVF can cost upward of $30,000 per round — several of which are often required for a successful pregnancy. The process requires a team of specialized medical experts, expensive medications and a series of clinical and lab procedures.
By the time someone tries IVF, they’ve usually already tried other methods such as fertility drugs and intrauterine insemination that can also add up to thousands of dollars.
Marshall said around half of her patients pay out of pocket. Many of them remain stoic yet quietly suffer with the financial toll.
“It’s the ones who have 10 credit cards that they put on the table at the same time, and they’ve maxed them all out trying to pay for an IVF cycle,” she said. “They just want to have a baby so badly that they’ll do anything to have one. Those are the ones that break your heart."
Rising costs, rising infertility
Sara Chan and John Conley have always followed what they felt was society's blueprint for success.
They excelled in school. Both earned doctorates in psychology. Found well-paying jobs with good benefits in Seattle. Bought a house in Port Orchard. Waited to have a baby until they could afford one.
But achieving financial stability in the Puget Sound region took longer than expected. By the time they felt ready to support a child, they were in their late 30s and had trouble conceiving.
“It feels like we've done everything we've been told,” Chan said, “but at the cost of our own fertility.”
At ages 39 and 43, Chan and Conley have spent years ripping apart the financial cushion they built to spend tens of thousands of dollars out of pocket on fertility care.
Infertility is on the rise due to a number of environmental factors, but the main one is that economic pressures are working against biology. More people delay childbearing as generations are bogged down by student loan debt and high housing costs.
“No one can afford (a child) while they’re young because everything is so expensive, and then you need IVF, and it’s even more expensive,” Chan said.
The lag is showing up in the declining national birthrate, which has dropped 14% over the past decade.
Washington, despite being the 13th most populous state, has experienced an even faster decline in its birthrate, which has dropped by around 23% over the past decade, according to the state Department of Health.
Nationwide, the rate of people using assisted reproductive technology has grown, but not as fast in Washington.
The number of these procedures performed in Washington rose 27% between 2013 and 2022, compared with 56% nationwide, according to CDC data.
Many people in Washington simply can't afford to start procedures, such as IVF, after seeing how much it'll cost them out of pocket.
That's what happened to Alisa Toyama. The Issaquah resident desperately wanted to be a mother throughout her adulthood, though she did not feel she could comfortably support a child until her late 30s.
Toyama, now 39, and her husband tried to get pregnant for years before seeking help.
When she was quoted more than $30,000 for one round of IVF earlier this year, her heart sank. She didn’t have that kind of money. Despite working for a hospital, her insurance wouldn’t cover any of it. She’s still wrapping her head around how to come up with the money.
“I want to experience motherhood and to be pregnant,” she said. “For me to not have that experience — it would crush me.”
A miracle treatment — for some
Some employer insurance plans offer IVF and other fertility coverage, but those jobs are often high-paying corporate or tech roles. And, sometimes, that coverage doesn’t extend as far as some might think.
Most people — especially in states such as Washington that don’t mandate coverage — must pay out of pocket for those treatments, which require many expensive steps and specialists.
Some couples have found a workaround by traveling abroad for treatment.
After years spent trying for a second baby, Lydia and her partner were quoted around $40,000 for one round of IVF in Seattle. Lydia, 37, asked for her last name to be withheld as she shared sensitive medical information.
The couple would only be able to afford one round, she said. They looked into IVF loans, an industry that has boomed in recent decades, and felt uneasy taking on debt for a treatment with uncertain odds.
Everything about her care in the U.S. made Lydia feel like she was part of “a big moneymaking scheme.”
So, the couple researched options abroad and found much more affordable care. Lydia and her partner recently arrived home after spending six weeks in Spain, where doctors performed two rounds of IVF for around $16,000, she said.
“Even after travel, it was a much cheaper option,” she said. “We also thought that if we had to spend thousands of dollars, we might as well also get a trip to Europe out of it.”
Employers in Washington rarely cover fertility treatment because some consider it to be an optional procedure — and it happens to be wildly expensive.
That’s despite the World Health Organization’s classification of infertility as a disease, and despite the grave medical issues that can be interwoven with infertility.
For people like Seattle resident Amy Landram, fertility care doesn’t feel optional. The now 33-year-old was forced to sacrifice her fertility in exchange for lifesaving chemotherapy treatment at 28 when she was diagnosed with breast cancer.
Her insurance covered her wig when she lost her hair from complications, but didn’t pay for her to freeze her eggs — the process that would preserve her ability to have children someday. She froze them anyway.
Now married and still undergoing endocrine therapy, she and her husband put every extra penny into saving for out-of-pocket IVF treatments. That meant no honeymoon and putting off buying a house.
“On my toughest days, my eggs are what I really look to,” she said. “It’s a hope that my dreams of building a family are still possible. But the financial burden definitely puts a dark cloud over that dream.”
The cost of a mandate
Some Republican states have fought IVF over the perception that discarding unused embryos is equivalent to the destruction of human life. For the largely Democratic state of Washington, that doesn’t appear to be the main concern.
Democratic lawmakers in both the House and Senate have proposed bills in the last three legislative sessions that would require group health plans to cover the diagnosis and treatment of infertility. The latest bill proposed covering fertility preservation treatments, such as freezing eggs, and two completed oocyte retrievals with unlimited embryo transfers.
The law would ban any restrictions on coverage of fertility medications that are different from those imposed on other prescription medications.
It would also help people who currently have fertility care coverage by widening the pool of people who would pay into fertility care coverage and standardizing what treatments are covered.
That would help people like Chan and Conley, who purchased an $800-a-month insurance plan with a small group of people all seeking coverage, only to have claims denied or pennies paid on the dollar.
But lawmakers decided the benefits of such a mandate wouldn't outweigh the cost of higher insurance premiums.
In 2023, Washington's Health Care Authority and the Office of the Insurance Commissioner requested an analysis of estimated costs modeling a hypothetical mandate.
The actuarial firm Milliman estimated that adding fertility coverage in 2024 would have added roughly $127 million in new costs across all insurance plan types in the state, with the bulk of the cost falling on employer-sponsored insurance. The analysis showed the additional monthly cost per member ranging from around $1 for Medicaid to nearly $5 for individual insurance plans.
Lawmakers and insurance companies have debated just how much of an effect a mandate’s costs would have on Washington residents.
Insurer projections seem to run considerably higher. On the bill heard in 2025, a representative for Premera Blue Cross testified that the mandate would cost $7.68 per member per month.
"The primary driver of the higher cost is the increased likelihood of high-risk maternity and newborn care associated with fertility service," said Christine Brewer with Premera Blue Cross.
To some legislators, the insurance companies' estimates seemed overblown. To others, it was alarming. They raised concerns about piling additional costs on households already grappling with an affordability crisis.
Plus, if the state required companies to cover fertility care, it would need to come up with tens of millions every year to provide coverage for its own employees, such as teachers, state troopers and department staff. That's a large ask, considering the state’s multibillion-dollar deficit.
"The competition for those dollars is pretty high in this budget environment," said state Rep. Monica Stonier, D-Vancouver, who championed the three bills in the House.
Lawmakers in support of the mandate contemplated ways to bring costs down, such as exempting state employees from the mandate.
That's what California did. The state passed a mandate in 2024 despite a projected $38 billion deficit for that upcoming fiscal year. The mandate took effect this year but pushed out the state’s requirement to cover fertility treatment until 2027.
But Washington lawmakers thought taking a similar measure wouldn't be fair to state employees or private employers.
They could reduce the amount of coverage to fewer IVF cycles, but that would encourage families to use multiple embryos during that one covered round, increasing the risk of multiple births. They could get rid of coverage for fertility preservation, but that would leave out people like Landram, who must freeze their eggs while sick for a shot at having a baby later.
"It was like there was nowhere to go," Stonier said. "Either way, we were going backwards on something."
Without an easy way to move forward, hope feels lost for some who supported the bill. Even so, Stonier plans on putting forth another bill next session, she said. She hopes to work with insurance companies to bring down the estimated cost of the mandate.
"To me, it's an equity issue in the first place to say that the insurance companies in our state decide who gets to start or grow a family, she said.
What next?
The Legislature appears to be at a standstill on an insurance mandate. Other efforts on federal and private levels offer some hope, however limited.
The falling birthrate has the White House worried. The Trump administration has pushed a pronatalist agenda, encouraging more families to have children. On his 2024 campaign trail, President Donald Trump dubbed himself “the father of IVF” and pledged to mandate insurance companies cover IVF treatment or have the government make it free for all families. But he has not proposed such a mandate since taking office.
Trump has proposed encouraging — not requiring — companies to offer stand-alone fertility benefits alongside a worker's regular health insurance, similar to separate dental or vision coverage.
A group of Democratic U.S. senators, including Washington's Patty Murray, are reintroducing a legislative package called The Right to IVF Act. The package would lower the costs of IVF treatment, expand IVF coverage for military families and require all employer-sponsored insurance programs to cover IVF.
Twice before, the bills have been blocked by Senate Republicans, who argued the mandate was too broad and constituted legislative overreach. Democrats have committed to continuing to pursue expanded access to IVF nationwide.
On the private side, more employers appear to be offering fertility coverage to attract and retain talent. Major companies in the Seattle area, including Amazon, Microsoft, Starbucks and Boeing, offer some sort of fertility care coverage. Several families The Seattle Times spoke with said they considered leaving their job for a company that had coverage.
Pacific Northwest Fertility estimates that around a third of Washington residents struggling with infertility have fertility care coverage. However, Marshall, the Seattle clinic's co-founder, said the percentage of its patients with fertility coverage increased from around 5% in 2005 to 60% now amid the rise of Big Tech in the city.
“One could argue that those people in tech are the ones who can most afford fertility care, which is ironic,” she said.
But Riley and her wife work in healthcare, not tech.
They're grateful the economic strain is over, and they finally have their baby girl in their arms. Still, like many couples, they dream of having another baby someday. That will mean going through the same emotionally exhausting process while trying to come up with tens of thousands of dollars — all on top of managing the costs that come with having a child in the Seattle area.
It's a daunting thought that lurks in the back of Riley's mind, even as she revels in new parenthood.
“The amount of money it takes to get to this point is life-altering money,” she said. “We spend all this money and would do it a million times over to have our babies, but other people might not have this money. They miss out on having a family.”
© 2026 The Seattle Times. Visit www.seattletimes.com. Distributed by Tribune Content Agency, LLC.
