How health plans can design inclusive, equitable fertility benefits

The demand for fertility treatments is rising: it’s estimated that the use of ART (assisted reproductive technology) increases 5-10% each year. Yet, many employer-sponsored health plans don’t cover fertility treatments—a recent report found that only 29% of employers offer fertility benefits—forcing many members to pay thousands out of pocket to start their families.

For those plans that do offer fertility benefits, the coverage is often limited. Some only cover costly treatments like in vitro fertilization (IVF) and egg freezing, overlooking the needs of the LGBTQIA+ community and other historically marginalized groups. While IVF and egg freezing are undoubtedly important, it's essential to expand fertility coverage to be inclusive of all employees and support all pathways to parenthood. Fertility benefits are crucial to your plan’s health equity strategy—here’s why.

Fertility needs are as diverse as your members

Your members will need different types of support when building their families based on their unique and varied backgrounds and identities.

• Gender: Infertility currently impacts 12% (or 1 in 8) of couples in the US, which is expected to increase as individuals wait longer to start families. 20% of infertility is caused by male factor infertility, and 30 to 40% are caused by both partners.
• Race: Infertility is more likely to affect Black and Latine people, and they are less likely or take longer to seek fertility treatments. They're also more prone to worse outcomes than their white counterparts. 
• Sexual orientation and gender identity: LGBTQIA+ people may look to become parents through donor conception, adoption, or surrogacy. ‍
• Marital status: Single people are also affected—many individuals want to take control of their reproductive future without a partner through fertility preservation treatments.

No matter what path they take, the journey to conception can be long and arduous, with significant physical, emotional, and financial strain. It can also be an all-consuming, stigmatizing process for many individuals, which leads to increased rates of depression and anxiety. Health plans looking to solidify their commitment to health equity and supporting employers’ DEI goals need to offer comprehensive, inclusive fertility benefits.

Why fertility benefits may be leaving members behind

The burden of infertility affects individuals of every gender and demographic group. Although fertility treatments are becoming both more common and more successful, historically marginalized communities still face disparities in care and outcomes.

For example, LGBTQIA+ members may face more barriers to fertility care and experience discrimination based on their sexual orientation or gender identity. Because of this, they often pay out-of-pocket for extremely costly fertility treatments. Some even opt to forgo trying to conceive because of the costs—63% of same-sex couples said that while they want to start families, they can't because insurance wouldn't cover them.

Black and Hispanic members also experience discrimination and face steep obstacles to receiving fertility care. Black women are more likely to report infertility compared with white women, and Black and Hispanic women are less likely than white women to receive fertility care. These demographic groups are also less likely to have successful IVF cycles. Conversely, white women are the most likely group to receive treatment in general, suggesting race plays a significant role in the likelihood of treatment.

Components of inclusive, equitable fertility care

Committing to health equity means offering fertility care that meets the needs of a diverse member population, rather than only caring for those experiencing medical infertility. Health plans can better support members of historically marginalized communities by providing more robust coverage for:

IVF for all couples and individuals

LGBTQIA+ individuals face many structural barriers to family building. Many are denied financial support for IVF treatments due to coverage rules that are biased towards heterosexual couples, including requiring an infertility diagnosis or mandating that a couple use their own egg and sperm in the IVF process.

There are also racial disparities present in fertility treatments—studies suggest that BIPOC patients are often referred to fertility specialists later than white patients, suggesting their diagnoses are delayed. Delays in diagnosis and treatment occur for a variety of reasons, but one survey of Black women found their experiences with doctors had been influenced by race, gender, and/or class discrimination, and some reported that their medical professionals made assumptions about their ability to pay for services.

Offering members an option to access culturally-humble fertility care and IVF without limiting who receives the service can be critical. Since IVF is cost-prohibitive to most without coverage, this benefit can be life-changing.

Fertility preservation

Fertility preservation is a helpful resource for those who aren't ready to become parents yet—and a particularly important one for trans people. Even if an individual has medically or surgically transitioned, they may still be able to have children that are genetically related to them. An inclusive fertility preservation benefit should cover gamete preservation (eggs, oocytes, and sperm) and access to testing services so members can feel empowered to take control of their fertility without compromising their identity.