Employer Considerations in Managing Fertility and Infertility Benefits

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AJMC®: What trends have you observed in the types of benefits being offered for fertility and infertility treatments by employers?

RICHARD-DAVIS: Recent trends in fertility and infertility treatment benefits reflect a significant increase in both demand and awareness. Historically, infertility was stigmatized and rarely discussed. But today, more individuals are openly sharing their fertility journeys. This cultural shift has led to greater awareness and, consequently, a rise in demand for fertility services.

Additionally, women are waiting longer to have children, and age has a considerable impact on fertility success. This trend is driving greater use of assisted reproductive technologies [ARTs] such as in vitro fertilization [IVF]. As a result, the need for fertility services continues to grow.

From a coverage perspective, the landscape has evolved as well. Currently, 29 states mandate fertility treatment coverage, and more states are considering similar legislation. At the federal level, a bill supporting nationwide fertility mandates is under discussion, although it has not yet passed. Together, these developments are shaping a broader, more accessible framework for fertility care, increasing the demand for services and awareness within the specialty.

In summary, the combination of shifting cultural attitudes, delayed family planning, and changing legislation is driving a marked increase in the need for comprehensive fertility benefits.

AJMC: What are the primary factors driving companies to expand their fertility treatment coverage?

RICHARD-DAVIS: In terms of employers and looking at expansion of fertility coverage, there are a couple of drivers. A large percentage of our workforce are women—and young women as well as midlife women—so demographics is 1 thing that is driving that. Our company just recently added fertility coverage, and when I asked our HR [human resources] manager about the drivers, the factors that drove that decision was to attract a younger population in terms of employees and to be competitive in that market. We’re seeing that with the technology industry and with many of the corporations that are competing for the talent pool, offering fertility services is one of those things that is valued. When you ask individuals about whether they have fertility coverage or not and how that impacts their perspective of their employer, they will tell you that they feel much more supported when those services are provided. They are less apt to leave, so you have a higher retention rate. And while in treatment, there’s less fear, there’s less worry, and so they can focus more on their job. There’s increased productivity in the group of patients who do have fertility coverage. For the employer, those things make a major difference in their ability to recruit talent and retain talent.

AJMC: How do you see the relationship between a company’s benefits package, particularly concerning fertility benefits, and employee engagement, well-being, and retention?

RICHARD-DAVIS: The fertility journey is inherently stressful, and when family planning doesn’t go as expected, it can significantly impact an individual’s well-being and productivity. The emotional and financial burden of infertility can create considerable stress for employees, especially if they lack support. However, when companies offer fertility benefits, they provide much-needed financial and psychosocial support, reducing stress and helping employees navigate the process more effectively.

The good news is that adding fertility coverage is not a high-cost proposition for employers. In fact, the return on investment is often substantial. Employees who have access to fertility benefits are less likely to experience anxiety or disruptions in their treatment due to financial concerns, which helps them stay focused and engaged at work. This leads to a more satisfied and loyal workforce.

By addressing the emotional and financial challenges of infertility, companies foster a healthier, more productive work environment. The holistic support offered through fertility benefits not only helps employees during a difficult time but also enhances overall employee engagement, well-being, and retention.

AJMC: Is there increasing pressure on payers to include fertility benefits as part of their coverage, and how is this influencing the structure of benefits?

RICHARD-DAVIS: There is increasing pressure on payers to include fertility benefits in their coverage that is largely driven by employer demands. However, the structure of these benefits often includes constraints—such as requiring multiple cycles of intrauterine insemination before moving on to IVF. These step-therapy protocols can delay effective treatment and reduce success rates by forcing patients to undergo less effective and more time-consuming interventions before accessing more advanced care.

Instead of prescribing specific treatment sequences, payers would be better served by offering coverage with reasonable caps while allowing specialists and patients to make treatment decisions based upon individual needs. This approach aligns with best practices, for which decisions are made collaboratively between the physician and patient to ensure that the care provided is both timely and appropriate for achieving the best possible outcomes.

AJMC: How do companies measure the effectiveness of their fertility benefits in supporting employees?

RICHARD-DAVIS: While quantifying the return on investment for fertility benefits can be challenging, companies often assess effectiveness through employee engagement metrics such as reduced absenteeism, lower presenteeism, and increased job satisfaction. Employees who feel supported by fertility benefits tend to have greater loyalty to the company.

As more companies adopt fertility coverage, businesses competing for talent must recognize that employees increasingly prioritize these benefits. Companies that do not offer fertility coverage risk higher attrition rates particularly among women of reproductive age, who often represent a significant portion of the talent pool.

AJMC: How are employees adapting to using their fertility benefits, and what challenges are they facing when trying to navigate these new options?

RICHARD-DAVIS: For employees to utilize their fertility benefits, there are several things that are important. One is that they have a good understanding of what that coverage is. When you look at fertility coverage benefits, if you’ve seen 1 plan, you’ve seen 1 plan—it’s very complicated and complex. Utilizing resources can help the employee better understand their plan. There are resources like RESOLVE: The National Infertility Association, which is a support and advocacy group for infertility patients. The practice typically has financial counselors who help patients to navigate their plan. But for the patient or for the employee, it’s important to get as much as you can in writing from your insurance company so that you can see what’s covered and then have that conversation with your provider and the team that’s taking care of you.

AJMC: How do you think the complexity of benefits affects employees’ decisions regarding treatment options?

RICHARD-DAVIS: The complexity of the fertility benefits affects the employee’s ability to use it significantly, because there are so many different tiers to it—so many different levels. For example, there may be mandates to provide fertility coverage, but that coverage may only cover diagnostic services. It doesn’t cover any of the treatments, so when patients enter into the care arena, and you go through the diagnostic aspect, and the coverage stops, now they have to step back and make decisions about whether they can afford to go forth. That may delay their treatment. If you have coverage, it’s understanding how much coverage you have and what the best way is to optimally utilize that coverage. Some plans prescribe what you can do. For example, there are plans for single women that require that you’re married. If you’re a single woman considering going through fertility treatment, that’s something you need to know up front about your plan. If you are part of our LGBTQ+ community, there are some plans that require that you use your own egg and your own sperm. That’s not really an option for couples who are looking to reproduce in our LGBTQ+ community. So those nuances are really important to understand coverage, and they are why I would highly recommend that employees get their coverage in writing so that they can clearly see what’s outlined. If there’s ever any question about it, they can go back to their plan and ask for clarification.

AJMC: How do you see benefit plans evolving to better support LGBTQ+ individuals and women who may not want to marry? What strategies are being implemented to address these changes?

RICHARD-DAVIS: As societal attitudes evolve, there will be increasing pressure and advocacy for changes in benefit plans to better serve diverse populations including LGBTQ+ individuals and women who may not wish to marry. Organizations like RESOLVE and the American Society for Reproductive Medicine [ASRM] are actively working to drive these changes. Additionally, our government relations team monitors both benefit plans and relevant laws that could negatively impact patients and advocates for necessary reforms. Our profession remains committed to identifying and addressing legal and policy barriers that affect patient care while also pushing for policies that improve access and equity in reproductive health care.

AJMC: What additional resources or support do employees typically seek when dealing with fertility issues?

RICHARD-DAVIS: Employees often aren’t aware of the resources available to them, which makes it essential for practices and support organizations like RESOLVE to proactively educate patients. RESOLVE, for example, offers a toolkit with template letters and detailed information on state mandates and coverage options, which are invaluable for patients navigating fertility treatments. In addition, many practices and organizations including the ASRM provide educational materials that empower employees to make informed decisions. The more informed patients are, the better equipped they are to advocate for themselves and choose the best course of action for their fertility journey.

AJMC: How can companies advocate for better fertility benefit structure with payers?

RICHARD-DAVIS: Companies can advocate for better fertility benefit structures by pushing for plans with minimal restrictions and more flexibility. Coverage should allow for individualized treatment plans for which decisions are made collaboratively between the patient and their provider rather than being dictated by prescriptive guidelines. For instance, some plans exclude ART, which can lead patients with conditions like severe tubal disease to undergo unnecessary, costly surgeries that do not improve outcomes. By advocating for less restrictive coverage, employers empower specialists to make the best treatment decisions based on the patient’s unique needs, ultimately improving patient care and reducing unnecessary costs.

AJMC: How well do employees and employers understand the fertility benefits available, and what percentage of employees are using their fertility benefits?

RICHARD-DAVIS: Exact data on the percentage of employees using fertility benefits is not readily available, but it’s clear that employees with access to fertility coverage are more likely to use these services. In states with mandated fertility coverage, there is higher use of fertility and ART services, suggesting that when coverage is provided, employees are more likely to take advantage of it.

For employers, understanding and structuring fertility benefits can be complex. It’s essential for HR professionals to conduct thorough research and consult with experts to design coverage that best meets the needs of their employees. Organizations like RESOLVE are valuable resources in this regard. Employers should avoid making cursory decisions and instead make informed, thoughtful choices to ensure comprehensive support for their workforce.

Regarding the distinction between medical and pharmacy benefits, it’s crucial for employees to fully understand their coverage. Some plans separate fertility services from pharmacy benefits, while others bundle them together under a single cap. Fertility medications—especially those used in ARTs—can be expensive, making it critical for patients to know how their pharmacy benefits are structured. If these are separate, employees will likely use their pharmacy benefits to help offset the high costs of treatment drugs, as these can be significant, particularly for more advanced fertility procedures.

AJMC: What steps can employers take to ensure that fertility benefits are inclusive and accessible to all employees?

RICHARD-DAVIS: For employers, what I would encourage them to do is to think about inclusion. When I say that, it’s looking at the entire body of your employees, because we are a very diverse society whether race, gender orientation, sexual orientation, or single people building families is involved. Families are built in all sorts of ways now, and I would encourage employers to be very sensitive to that and to try to work with employees, understand what they need, and design benefit packages that are as inclusive as they possibly can be.

AJMC: What strategies have you found effective in raising awareness about available fertility benefits among employees?

RICHARD-DAVIS: Raising awareness about available fertility benefits can be effectively achieved through several strategies, starting with HR. When new employees join the company, HR should highlight fertility benefits as a key perk, especially for those of reproductive age. This ensures that employees are aware of the support available to them from the outset.

Additionally, companies can partner with organizations to host employee health fairs or offer educational webinars and seminars. These events provide valuable opportunities to educate employees about fertility benefits. Often, employees may not be aware of their need for these services until the conversation is initiated, at which point it becomes clear how many would benefit from the coverage.

Incorporating broader educational outreach and collaborating with local fertility professionals can further enhance awareness and support for employees. By opening these discussions, employers can ensure that employees are informed and able to access the resources that best support their needs.

AJMC: How can employers create a supportive environment for employees undergoing fertility treatment? What resources or benefits should be highlighted to help them?

RICHARD-DAVIS: Recognizing the emotional and physical stress of the fertility journey is crucial for both employers and employees. Many employees hesitate to share their fertility struggles, which can add unnecessary stress. Workplaces that are inclusive and sensitive to these challenges create an environment where employees feel supported and comfortable seeking help.

Additionally, it’s important for employers to ensure employees are aware of how to use benefits like the Family and Medical Leave Act. Many fertility treatments require time away from work, and employees may not always be aware that they are eligible for leave. By educating employees on these benefits, HR can help reduce stress and ensure that employees have the support they need during this difficult time.