Why should employers offer IVF coverage?

In my advocacy for IVF coverage, I’ve received three types of pushbacks: 1) financial (i.e., this is going to cost us too much money), 2) sentiment that IVF is elective, not healthcare, 3) skeptical of IVF’s success.

Over the years, I’ve gathered talking points from several resources, including Resolve’s Coverage at Work Toolkit and the “League of Extraordinary Uteri” (a website compiled for advocates of IVF coverage at University of Michigan who were successful in getting the system to add $15,000 in lifetime coverage), to counter this pushback.

The bottom line is: employers who want to show a good faith commitment to diversity, equity and inclusion and who want to retain and recruit top talent should offer infertility coverage, including IVF. In fact, they should offer a full range of family building options that a truly diverse employee pool would benefit from. But, for the purposes of keeping things streamlined here, I focused on IVF coverage.

If you are advocating with your employer, you will want to know whether they are fully insured, self-insured or whether it’s a government/military plan. Resolve, a U.S.-wide infertility association, has great definitions here. If you work for a large company, it’s likely they are self-insured. The upside of the latter is that the employer has the power to change their plans at their discretion. The downside is that they don’t have to adhere to state mandates to cover IVF.

If you would like to advocate with your state, you will want to see what infertility coverage already exists, if any, which you can do here. You will will also want to see if any legislation has already been introduced. You can do that by searching the Congressional database here or Resolve’s database here. Or, you can even do a Google search (for example, “Senate Bill + infertility + your state). You can also watch this video on advocating for IVF coverage in your state.

It’s important to note that across the U.S. employers have a new or renewed focus on diversity, equity and inclusion. Hold them accountable to ensuring their focus is not hollow and superficial. Lack of IVF coverage is 100% a healthcare inequity. And if employers are seeking to recruit and retain more women, BIPOC and LGBTQ employees, adding IVF coverage should be at the top of their list. 

Here are some talking points that you can revise and refine specifically for your employer (note: when I use “you” or “the employer,” you should insert your employer’s name):

Infertility coverage is an equity and racial justice issue.

The Centers for Disease Control and Prevention estimates that 1 in 8 couples experience infertility in the U.S. and yet an infertility diagnosis is not the largest barrier to becoming a parent: it’s cost. An average IVF cycle in the United States is $15,000. A recent survey found that women of reproductive age accrued $30,000 of debt on average after undergoing treatment. As such, only 1 in 4 people get the treatment needed to overcome infertility.

When the University of Michigan began offering its employees IVF coverage, it saw a more equitable distribution of people using the benefit, with IVF use increasing more than nine times among women in the university’s lowest-salary bracket.

Additionally, women of color disproportionately experience infertility. With adjustment for education, income, and self-reported pelvic inflammatory disease, married Black women had almost twice the odds of infertility as married white women.

Employers who offer IVF coverage benefit in recruiting and retaining talent.

Because a substantial proportion of infertility cases may be attributed to a combination of female and male factors or exclusively male factors, recruitment and retention of both male and female employees stand to be affected by fertility benefits.

88% of employees are willing to change their jobs for fertility coverage. Most fertility patients who receive IVF coverage through their employer report feeling a greater sense of loyalty and commitment to their employer as a result.

In the Great Resignation, competition is fierce for talent. One way employers are attempting to stand out is by offering infertility coverage. Last year, the number of employers offering “family-building benefits”—including fertility treatments, adoption and foster support—grew by 8%, according to the 2021 FertilityIQ Workplace Index, a fertility education company.

For employers in the medical field seeking to recruit and retain talent, there are heightened reasons to add IVF coverage. In the largest published study of U.S. female physicians, one in four of the roughly 300 respondents reported a diagnosis of infertility. This means that female physicians experience infertility at twice the rate of the typical population.

Not covering IVF is exclusionary.

There are several reasons intended parents may need IVF and it’s not always because they can’t naturally conceive a pregnancy:

• A majority of LGBTQ intended parents are looking to foster care, adoption, and assisted reproductive technology to grow their families.
• People with cancer who hope to have a genetic child may choose to freeze their eggs or embryos with IVF to preserve their fertility before undergoing treatment. Treatments like chemotherapy and radiation destroy sperm and eggs, causing infertility.
• Those who carry single-gene disorders like muscular atrophy, chromosome rearrangements or other genetic disorders, may pursue IVF to select genetically typical embryos to transfer.

Models already exist for employers seeking to add IVF coverage with zero to minimal costs.

From the top private companies in the world, like Starbucks, Netflix, Google, Intel Corporation, Meta and Nike, to state governments and university systems, IVF coverage is a healthcare need and demand that is increasingly being met.

Just last year, the City of Portland added coverage for its workers and Oregon state employees have IVF coverage through the Public Employees’ Benefit Board (PEBB) starting this year. The PEBB board approved a $35,000 annual maximum for assisted reproductive technologies (ARTs) with no member cost share related, so members will have normal cost-share for basic treatment of infertility, including diagnostic testing to determine underlying cause. Fertility benefits coverage was also extended to out-of-network providers.

A 2021 national survey by Mercer found that 97% of employer respondents said that providing infertility coverage did not result in a significant increase in medical plan costs.

Comprehensive reviews from Connecticut, Maryland, Massachusetts, and Rhode Island, which have mandated infertility benefits since the 1980s, show that the cost of infertility coverage is less than 1% of the total premium cost. This translates to about a dollar or less per member per month. Moreover, long-term health care costs are estimated to decrease because coverage equates to healthier outcomes.

Offering IVF coverage can save the employer money and mitigate liability by enabling intended parents to make less risky decisions.

When intended parents are forced to cover the costs of treatment themselves, they make riskier decisions to save money and increase the probability of conception at the same time. Intended parents will often participate in “Reproductive Tourism” and travel to countries like India or Thailand for cheaper infertility treatments with more lax regulations than in the United States. In these situations, intended parents opt to transfer high numbers of embryos. This results in high-risk pregnancies, post-pregnancy complications and low birth-weight multiples—a cost burden that the employer bears. Additionally, any infections or complications from sub-par medical treatment to the patient would be covered upon returning to work.

Employers spend 12 times as much on healthcare costs for premature or low-weight babies as they do for babies without complications. In fact, it is estimated U.S. businesses spend $6 billion just to cover these healthcare costs – many of which were tied to the delivery of multiples as a result of IVF conducted outside the U.S.

Not covering IVF incentivizes employees to exhaust coverage for other therapies prior to IVF. Insurance premiums already cover hidden costs of infertility treatments when patients undergo a procedure that is covered rather than one that is statistically likely to result in pregnancy. The cost of these procedures is estimated to fully cover the cost of more effective treatments such as ovarian stimulation, intrauterine insemination, and IVF.

Infertility is a disease; its potential cures should be covered just as cures of other diseases are.

In 1998, the U.S. Supreme Court stated that reproduction is a “major life activity,” and “conditions that interfere with reproduction should be regarded as disabilities,” as per the Americans with Disabilities Act of 1991. The World Health Organization and American Medical Association both define infertility as a disease.

Success rates of IVF increase with early intervention.

On average, it takes three cycles of IVF to yield a live birth. This decreases to two cycles for women under 35 years old. It should be noted, in comparison, that for heterosexual couples attempting a pregnancy without assisted reproductive technologies, the average success rate is 20%.

With IVF coverage, intended parents can access the healthcare they need sooner, which yields better outcomes.

In closing:

• Adding IVF coverage will likely reduce costs and ensure more successful outcomes for people diagnosed with infertility.
• Adding IVF coverage and family building benefits shows a dedicated commitment to diversity, equity and inclusion.
• Infertility is an important health issue with known treatments that should be covered by the employer.
• IVF coverage would also be a strategic business decision. It affirms the employer’s commitment to racial and socioeconomic justice, and to attracting and retaining talented employees.

We hope that the employer will consider offering full infertility coverage and supporting employees’ family building efforts.