Barbara Collura is president and CEO of nonprofit RESOLVE: The National Infertility Association.
In the U.S., 1 in 8 couples have trouble conceiving or carrying a pregnancy to term. And the number of those struggling to achieve parenthood is much higher when single parents by choice and same-sex couples are considered. This makes infertility even more common than diabetes (1 in 10) or asthma (1 in 13) — but still, many employers don't offer any type of insurance benefits for medically necessary treatments.
With family building becoming more of a priority for many in the wake of this past year, people are prioritizing fertility treatments whether their company offers coverage for it or not. Some may even ditch an employer for one that offers support and coverage in this area.
It's time for employers to truly recognize the prevalence of infertility, how this disease does not have a one-size-fits-all approach and why it's critical to offer support to their workforces.
Fertility and Infertility — know the facts
A woman's prime reproductive years — her 20s — are also often during prime career growth years, which can create quite a conundrum. People who want to start a family after they've already set themselves up for career success will often have a much harder time doing so.
The average age of first-time mothers in America is now 26.3 years, according to the Centers for Disease Control and Prevention. That number is even higher when you look at big cities and coastal areas. In New York and San Francisco, for example, the age of first-time mothers is around 31 and 32, respectively. Those who want to have the best chance of success with pregnancy in their late 30s may want to freeze their eggs while they're in their 20s or early 30s so as to not interrupt their projected career path. However, they have to pay out of pocket if they don't have an employer-provided fertility benefit that includes fertility preservation coverage, and that can cost up to $20,000 before you even factor in yearly storage costs.
But infertility and difficulty achieving pregnancy is not exclusively a female problem. Approximately 30% of infertility problems are due to male-factor issues, so it's important to consider that men are also significantly impacted by these issues when talking about the prevalence of infertility.
A smart business move
When it comes to the business decision to implement an inclusive and robust family-building benefit, there's one red flag that is always raised: How much will it cost the company?
Well, here's some really good news: According to a 2021 employer survey from Mercer on fertility benefits in the workplace, 97% of companies surveyed did not experience a significant increase in medical plan costs when they began covering fertility treatments such as IVF.
In fact, there are a number of areas where employers save money after they put a fertility benefit in place. When employees pay for IVF treatment out of pocket because they don't have insurance coverage, they are often more focused on the short-term cost savings for themselves, meaning the employee will pursue less expensive but less effective treatments that have a higher likelihood of a multiple birth. An employee might also be inclined to transfer multiple embryos in an IVF cycle to increase their chance of success if they can only afford one IVF cycle. This practice will often result in twins or triplets, which can cause a high-risk pregnancy that can lead to poorer outcomes for both mothers and babies, including extensive and expensive hospital and neonatal intensive care unit stays. Subsequently, the employer is the one that bears the cost.
It's estimated that U.S. businesses spend $5.7 billion just to cover these healthcare costs associated with babies born with complications, according to a study by Reproductive Medicine Associates of New Jersey. Employers spend 12 times as much on healthcare costs for premature or low-weight babies as they do for babies without complications, according to research from March of Dimes.
But when employers offer a benefit specific to family building, these costs drastically decrease. A study titled "Does insurance coverage decrease the risk for multiple births associated with assisted reproductive technology?” compared states with insurance coverage mandates for IVF against states that didn't have a mandate; it found that patients were able to make decisions about their care based on outcomes — not immediate costs. Because of this, more people chose to do the safer option of single-embryo transfer. As a result, there were far fewer multiple births, and much healthier babies.
Additionally, many employees feel a heightened sense of loyalty to their employer after receiving coverage for family building. A Willis Towers Watson report found that 72% of employers in a survey cited "competitive pressure to attract and retain talent" as their reason for focusing on fertility and family-planning benefits. In working to retain top talent, this is an incredibly important thing to keep top of mind.
Offer an inclusive fertility benefit
Fertility treatment can come with extreme emotional and physical strain. With this in mind, employers should put people first and recognize the toll that this process has on employees. The best way to do this is to offer an inclusive and comprehensive benefit that can be used by everyone.
Often, single parents by choice and LGBTQ+ couples don't fit the narrow description for an infertility diagnosis (12 months of intercourse without a successful pregnancy), that many insurers have in place and that limits access to fertility care. When looking at payers and vendors for family-building benefits, ensure that the coverage is inclusive and not limited by outdated, heteronormative definitions. Look for benefits that are meant to include everyone — not arbitrarily exclude people.
Employers should also ensure that whatever vendor they choose for fertility benefits has a robust network that includes clinics and doctors in lower-income or more rural regions, so that employees who don't live in major metropolitan areas can also access high-quality care.
Understand that not everyone's family-building journey will be through pregnancy. Many people choose to build their family through adoption, fostering or surrogacy. Good family-building benefits will include programs for all family-building options.
When choosing a fertility benefit, employers also should look for a mental health component. That might be access to a therapist or mental health professional, educational content on how to deal with the stress caused by fertility treatment or an app that helps guide individuals through the ups and downs associated with the family-building journey.
It's high time for employers to realize how much of their employee population struggles with building a family and that employers can play a pivotal, life-changing role. The positive outcomes for employer and employee that stem from adding a robust family-building benefit should convince even the most skeptical to do the right thing.