Fertility Uncovered is this year’s theme for National Infertility Awareness Week (NIAW, April 21-28). One of the primary goals for the week is to inform the public about issues related to infertility coverage and
“the significant lack of access to family building options…for millions of women and men struggling to build a family”.
This annual observance is the largest public awareness campaign that addresses the public health issue of infertility. Its primary sponsor is RESOLVE: The National Infertility Association.
RESOLVE offers many ways to get involved with advocacy at the national, state and even employer level all year long.
The infertility coverage problem
The focus on the state of healthcare coverage for infertility, a medical condition, is especially important as it affects so many people.
The magnitude of the problem is reflected in two facts:
- About 1 in every 10 women in the US aged 15-44 have difficulty becoming or staying pregnant (Centers for Disease Control and Prevention)
- About 1 in every 65 babies born in the US comes after infertility treatment (NYT, Jan.30, 2019)
Many people lack access to infertility treatment because their insurance coverage doesn’t include infertility care. Or, the benefit is inadequate.
In addition, there’s often no backup plan when people don’t have the financial means to pay out-of-pocket for family-building options, such as
- Infertility treatments,
- Third-party options (e.g., gestational carriers)
Finally, dealing with all the financial implications of access to treatment takes its toll. One woman described her experience: having to deal with “the financial piece made the emotional piece exponentially harder.”
Related Content from Author: Why Infertility Treatment Should be a Covered Benefit
Infertility awareness spikes but understanding still low
As with most things, there’s some good news and some bad news. Starting with the good, awareness of infertility as an issue is “at an all-time high.” More people of all backgrounds are speaking out and sharing their stories and challenges.
For example, Michelle Obama candidly discussed her miscarriages and using in vitro fertilization (IVF) in her book “Becoming.” Doing so sparked a public dialogue, especially among African-American women.
It’s a reminder that infertility affects everyone — no matter their economic status, race, occupation, sexuality or religion or even celebrity.
Unfortunately, while awareness of infertility as an issue is high, awareness of what factors influence fertility is low. Of most importance, many people – especially women – do not understand how much fertility declines with age. For women, this begins at age 35.
While men are capable of fathering children at later ages, the quality and quantity of sperm are often affected. You can learn more here.
The lack of understanding is global
In the US and other countries, women and men misunderstand what factors affect the ability to get pregnant and have a healthy baby. One consequence is that people wait too long to start a family by misjudging the impact of age.
This is considered such a serious problem in the UK, they launched a national education campaign on fertility aimed at young people.
Infertility Coverage Varies
Most people are aware that insurance coverage for infertility treatment continues to be lower than it should be. It’s also inconsistent and varies widely by state, industry and individual employer. Notably, some states have coverage mandates.
Even when an employer offers an infertility benefit, there may be restrictions on procedures covered. In addition, the financial value of the benefit is often too low to be useful.
Importantly, limited coverage can put IVF treatment out of reach. In fact, one survey suggests 30% of couples don’t seek or drop out of treatment due to cost.
-Infertility coverage is limited in different ways:
Dollar limits for care
For example, if an employer only covers up to $5,000, it may limit access to treatment. One IVF cycle costs approximately $12,000 and multiple cycles are usually required.
A benefit may be designed to cover only infertility medications but not IVF. Or, only one IVF cycle may be covered. Other necessary procedures such as genetic screening or egg freezing and storage may also be excluded from a benefit plan.
Activating the Coverage
An employee may be required to have unprotected sex of the baby-making kind for 6 or 12 months before their coverage is triggered. This may leave out same-sex couples or singles. Some employers, on the other hand, offer equal access to benefits for heterosexual and same-sex couples, as well as singles.
All these coverage limits for needed infertility care may result in significant out-of-pocket payment by employees, putting care out of reach.
Employer Infertility Coverage Trends Are Improving
Over the past few years, analysis and reporting have identified the tech, banking and media industries as ahead of the curve in offering meaningful infertility benefits. Part of their impetus has been to gain a competitive advantage by attracting and retaining the best employees.
Some tech companies even announced they’d cover egg freezing and storage thinking it might be an incentive for women to wait longer before having children. Other industries and employers, however, are just now catching on to the advantages of offering this family-friendly benefit.
Surveys repeatedly show that employees are more loyal, satisfied and productive when their benefits include infertility coverage. They are also likely to stay longer.
One survey of 10,000 verified IVF patients with complete employer IVF coverage in 2017 reported:
- 62% are more likely to remain in their job for a longer period
- 53% are more willing to overlook the shortcomings of their employer
- 22% are more likely to work harder
- 88% of women who had their IVF fully paid by their own employer decided to return back to that employer after maternity leave.
Attitudes about infertility coverage are changing
There’s also an interesting new reframe on infertility helping to drive positive change and expand coverage. According to the New York Times article, “IVF Coverage is the Benefit Everyone Wants”, the issue has (finally) become less about “ambitious women who waited too long” to have children. Now, it’s a matter of “corporate diversity and inclusion.”
The new attitude is improving coverage in some places:
- Among large employers (20,000 or more employees) 44% offered some sort of IVF coverage in 2018, up from 37% in 2017 (according to Mercer, a benefits consulting firm).
- Previously, Proctor and Gamble offered a benefit that covered up to $5,000 in costs. They increased it to $40,000 this year.
- Companies like Unilever, MassMutual, Viacom, and Cerner now pay for genetic screening of embryos, with a typical cost of about $5,000. This helps identify genetic diseases and the embryos that are most likely to result in a miscarriage.
The best infertility benefit promotes a better outcome for the mother, baby, and employer.
To have treatment covered, some now use a “centers of excellence” approach that also requires seeing a fertility specialist who transfers only one, instead of multiple, embryos. This is safer for all, with less risk of expensive complications at birth and afterward. Also, it usually has a faster return to work for moms.
Better outcomes enhance patient quality of life and positively impact the employer’s bottom line.
Options are available to help employers offer a better infertility benefit
What can be done to address access and employer coverage? ARC Fertility is dedicated to making infertility treatment accessible to those who want nothing more and nothing less than to get pregnant and deliver a healthy baby.
You may be fortunate enough to have employee benefits that include coverage for infertility services. However, as described, you may be surprised to learn that what is covered often has limits based on the type of service and the cost. According to one survey:
- Of the 57% who had insurance coverage, coverage was limited in some manner for diagnostic tests and/or infertility treatment.
- Among those with coverage, 47% reported that their insurance covered only half the cost of one full cycle of IVF.
- For those without IVF coverage, 61% paid an average out-of-pocket cost of $15,000-$30,000.
It’s no surprise then that many people need to explore different avenues to help afford their dream of building a family. Since 1997, ARC Fertility has provided options that make a difference, meeting the unique needs of over 70,000 patients.
ARC Fertility options include discounted bundled treatment packages (including refunds for unused cycles) with financing for affordable monthly payment plans. To learn more, click here.
The company also offers treatment packages that are designed to be used in combination with partial insurance coverage. For example, when a patient only has coverage for cycle monitoring.
Other organizations offer income-based programs that can help with the cost of fertility medications. Some offer grants and scholarships for those in need. A link to these resources can be found on the ARC Fertility website.
ARC Employer Program Offers Leading-Edge Cost-Effective Benefits
The low incremental cost of adding fertility coverage to existing health benefits surprises many employers. They may know how important fertility coverage is to employees but balk over perceived cost.
ARC Fertility offers an employer program suitable for employers of all sizes with flexible benefit options and value for employees. It’s provided through the largest national fertility network — 80-member clinics providing fertility services in more than 210 throughout the US.
-ARC Employer Program features include:
- Easy to implement; fits any size employer; can be added at any time
- An employer can choose zero, partial or full subsidy
- No Per Employee Per Month fees. Payment only when services are used
- Ability to know and control benefit cost
- Cost-effective treatment services dedicated to good outcomes with single embryo transfer and lower health care costs
- Recognized centers of excellence with individualized care based on national standards
- Employee education on healthy reproductive lifestyles
-Employee benefits offered include:
- Access to board-certified reproductive endocrinologists
- Concierge Fertility Specialists to guide and support employees through the entire process
- Consultations for comprehensive diagnosis, advice, and treatment
- Convenient telehealth services to minimize the out-of-office time
- If needed, financing options to eliminate the gap between employer coverage
In recognition of our work with employers, couples and individuals, ARC Fertility has been named a finalist in the Health Care Value Awards sponsored by the Validation Institute. The awards recognize outstanding services, products, and programs across thirty-four categories spanning the healthcare industry.
-ARC Fertility Outreach Aimed at Awareness/Education
Awareness of infertility as an issue is not enough. To help those interested in learning more about family building, ARC Fertility actively promotes education on a wide variety of infertility issues. These range from clinical care to emotional and social support resources.
Here are some helpful resources:
- ARC monthly blog on a wide variety of topics.
- The ARC Fertility Calculator which helps you assess your potential for getting pregnant based on individual factors.
- The ARC Affordability Estimator combines your probability of success with the right treatment package.
- ARC also sponsors Reproductive Facts, the most comprehensive infertility website aimed at consumers. Resources include user-friendly fact sheets in English and Spanish, explain how IVF works, provides a glossary of terms and much more.
For organizations and healthcare professionals dedicated to helping others build a family, nothing is more important than assuring access to quality care for the treatment of infertility.
That means providing educational information and tools for effective decision-making. It requires advocacy for meaningful employer insurance coverage. And, it calls for designing affordable treatment options so that finances don’t ever block the dream of having babies.
- Out of every 100 US couples, 12-13 have trouble getting pregnant
- More than 8 million babies have been born worldwide using IVF and other advanced techniques since the first successful birth in 1978
- However, for many, infertility coverage is inadequate. Often, it does not cover commonly performed procedures used to treat the medical condition of infertility
- Fertility benefits have well-documented returns including employee satisfaction, productivity, and retention/longevity
- The need to pay a large portion or the entire cost of infertility treatment out-of-pocket is out of reach for most people
- The cost of adding coverage to a health benefits package is incremental and lower than most employers realize
Fortunately, healthcare professionals, companies and patient groups constantly advocate for making family-building options accessible to all. Progress is being made, but there’s more work to do.
Related Content from the Author: How to Deal with Infertility and Depression
David Adamson, M.D.
G. David Adamson, BSc, MD, FRCSC, FACOG, FACS is a reproductive endocrinologist and surgeon, Clinical Professor ACF at Stanford University, and Associate Clinical Professor at University of California San Francisco.
His undergraduate, medical school, and obstetrics/gynecology residency training were at the University of Toronto, and his Reproductive Endocrinology and Infertility fellowship training at Stanford University. Currently, he is Director of Equal3 Fertility, APC, and CEO of ARC® Fertility.
Dr. Adamson has over 300 peer-reviewed and scientific/medical publications and has lectured extensively for more than 30 years nationally and globally on assisted reproductive technologies, endometriosis, reproductive surgery, infertility, and access to quality reproductive health care. Dr. Adamson led the committee that created The FIGO Fertility Toolbox and the organization that created the global Endometriosis Phenome and Biobanking Harmonization Project (EPHect). He created the Endometriosis Fertility Index, all digital tools used globally to improve health care for reproductive-age women.
He is Chair of the International Committee Monitoring ART (ICMART), which is a non-State actor (NSA/NGO) in official relations with the World Health Organization (WHO) and President of the World Endometriosis Research Foundation (WERF). Dr. Adamson is on the Board of the International Federation of Fertility Societies (IFFS) and FIGO Committee on Reproductive Medicine of which he is Past Chair. He is the Founder, Chairman, and Chief Executive Officer of Advanced Reproductive Care (ARC® Fertility), the largest United States network fertility company.
Dr. Adamson is Past President of the American Society for Reproductive Medicine (ASRM), Society for Assisted Reproductive Technology (SART), AAGL, and several other major gynecological societies. He has been recognized as one of the best 400 physicians for women in America. He has received many awards, including the Outstanding Achievement in Medicine award from the Santa Clara County Medical Society, a Certificate of Special Congressional Recognition for contributions to the community, Distinguished Surgeon award from the Society of Reproductive Surgeons, Honorary Life Membership from the Canadian Association of Internes and Residents, the Barbara Eck Founders Award from RESOLVE, numerous honorary memberships and professorships, and the ASRM Distinguished Service award for his outstanding achievements in advancing the practice of reproductive medicine.
Dr. Adamson enjoys spending time with his family, reading, hiking, traveling, and ice hockey.
In addition to being a contributing author for The Doctor Weighs In, Dr. Adamson also serves on the TDWI Editorial Board, where he medically reviews articles submitted for publication.