There are a lot of numbers involved when Miraya and Andy Gran tell their story of becoming parents.

Two infertility diagnoses, one surgery, four rounds of intrauterine insemination and two rounds of in-vitro fertilization, known as IVF. There are also the seven miscarriages they experienced over eight years. The biggest number is $102,000, the total price tag they had to pay before they conceived their daughter, Isla.

The total amount of their treatment that insurance covered: zero.

"We've had four different jobs amongst the two of us since then, and none of them covered infertility," said Miraya, who described the experience as isolating. "You feel like your society has left you behind."

The Grans are telling their story to any politician who will listen, part of a lobbying push by families for legislation to make Minnesota the 22nd state to require insurers to help cover the high cost of getting pregnant with infertility.

Roughly 1 in 8 couples struggles to conceive for a year or longer, and the number of people seeking treatment is growing. Five fertility clinics in Minnesota performed a record number of IVF cycles in 2021 and saw a 36% increase in five years.

"People are taking out second mortgages on their home, cashing in their 401(k)s, maxing out credit cards and throwing bake sales just to start a family," said Sen. Erin Maye Quade, DFL-Apple Valley, the bill's sponsor. "We want people who want to be parents to be able to become parents."

'Inclusive as possible'

Last spring, legislators guaranteed in law the right to infertility treatment as part of a proposal to codify all reproductive rights, but a separate bill to mandate insurance coverage wasn't included in a final health and human services budget package.

The proposal would have required all Minnesota health plans that offer maternity benefits to also provide "comprehensive coverage for the diagnosis of infertility, treatment for infertility, and standard fertility preservation services," including up to four rounds of IVF.

Fourteen of the 21 states that mandate coverage include IVF, which is the most effective treatment for many causes of infertility. It's also the most expensive. One round of IVF, where an egg is retrieved and fertilized in a lab before being transferred to the uterus, costs on average from $15,000 to $20,000.

Andy and Rachel Wilke realized they needed IVF after several unsuccessful rounds of intrauterine insemination. Also known as IUI, intrauterine insemination is less invasive but can still costs thousands of dollars each cycle.

Their insurance helped cover testing, but once Rachel was diagnosed with endometriosis, they had to cover the cost of treatment themselves. They took out a $25,000 personal loan to pay for their IVF procedure — and now have had two children through the process.

"We were the fortunate ones," said Wilke, who has testified at the Capitol alongside his wife. "Not every family is fortunate enough to take on that debt, which feels silly to say, but we had the means to do that."

The high cost prohibits some families from pursuing treatments. Others are priced out after several failed attempts to conceive with treatment, or they have to wait until they can save enough money to keep trying.

Serena Birkeland and her husband have spent roughly $50,000 on their infertility medical bills, which are not covered by their insurance. They're waiting to find out if their latest attempt to become pregnant through IVF was successful. If not, they are debating going further into debt or waiting until 2024 to try again.

"That's just not something anyone should have to consider," said Birkeland, who added that the treatment is not a guarantee for all couples.

"We have great benefits for employees if their family comes easily. It comes down to being as inclusive as possible," Birkeland said.

Finding a compromise

During the 2023 legislative session, questions arose about whether coverage should be expanded to include people on Medical Assistance, which would have cost the state $18 million over two years. That extra cost raised concerns in the House, where many other proposals were competing for a slice of Minnesota's $17.5 billion budget surplus.

"I'm a person who believes everyone should have access to the health care that they need," said Rep. Tina Liebling, DFL-Rochester, who chairs the House's health finance committee.

"If we say that only people in large group health plans are entitled to infertility treatment, we are creating haves and haves not in our system."

Maye Quade and Rep. Jeff Brand, DFL-St. Peter, the bill's sponsor in the House, said passing the legislation is a top priority next year. They're working on a compromise proposal that they hope will gain enough support.

"This is one of those opportunities to help people start a family and not take out a bank loan," Brand said. "We're talking about one of the basics of life, and the technology is there, but it's quite costly."

One of Brand's constituents is Bailey DeVetter. She was diagnosed with polycystic ovary syndrome, a hormonal disorder that's among the most common and treatable causes of female infertility. DeVetter was working for a church and her husband was in his final year of medical school when they went through four unsuccessful cycles of IUI. The procedures cost them $1,400 out-of-pocket each month, more than their rent.

By the time she realized IVF was the best route, DeVetter was emotionally spent and financially drained. The couple heard through a Facebook group about the CNY Fertility clinic in New York, which was less expensive than some Minnesota clinics.

"There's this ticking biological clock you're feeling all the time, so we're seeking what is our best solution here," DeVetter said. "How can we get the most bang for our buck, which is a really awful way to have to approach having children, but that's what it came down to."

She and her husband tried the clinic, flying thousands of miles total to Syracuse, N.Y., for her two appointments. It worked: The couple now have a 4-month-old daughter named Brett.

The Grans recently moved into a green house on a quiet street in Bloomington, where 2-year-old Isla plays with a baby doll on the home's wood floors. They made the move to accommodate a growing family, but their challenge now is being able to afford to have another child.

They took out a second mortgage on their previous home, maxed out credit cards, and their friends and family held a fundraiser at a brewery to help cover their $102,000 bill. Miraya said they have two viable embryos left from IVF, but a transfer will cost thousands of dollars more.

For now, she's turned her attention to being a mom and lobbying. She's testified at hearings, participated in calls, attended town halls and made her case directly to Gov. Tim Walz and Lt. Gov. Peggy Flanagan. She's hopeful they'll add mandated infertility coverage to their supplemental budget bill next year.

"I literally wake up sometimes at night thinking about if I hadn't gotten [Isla], and I think about the women out there who didn't get the opportunity," Miraya said. "I was so angry over everything I'd gone through. I just want to make it better for other people."