Fertility drugs and treatments are expensive, but employers have increasingly begun to cover their cost.
By Vanessa Grigoriadis
A little over a year ago, Haley Burns, 29, was trying to get pregnant and was also becoming restless in her job. An information technology specialist for Sharp HealthCare in San Diego, she began searching for another position (while trying to get pregnant), and checking out the benefits of Sharp’s competitors (while also trying to get pregnant).
The last time she had been on the job market, Ms. Burns said, “I wanted the ability to work remotely, and of course I wanted the biggest paycheck I could get.” Now she had a different priority: fertility coverage.
Ms. Burns had prepared well for a baby, even moving to a master-planned community in San Marcos, Calif. “We moved to this neighborhood specifically for the great schools and the extra bedrooms to put the kids in,” she said. “It’s completely suburbia.”
But as time ticked by without a bundle of occasionally shrieking joy tucked into one of those extra bedrooms, she felt discouraged. She cut out caffeine, took long walks with her rescue dog, Blu, and focused on reducing her stress, which was hard to do because the main reason she was stressed was that she couldn’t get pregnant.
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The way this story, euphemistically called a “fertility journey,” usually goes is that Ms. Burns would dig into her savings in pursuit of her goal. Conceiving the unnatural way has never been more widespread, with around one in 65 babies in America born after fertility treatments. Michelle Obama recently revealed that neither Sasha nor Malia came into this life after just a romantic date with Barack.
But in 2019, perhaps surprisingly given the general attenuation of benefits like vacations and pensions to the American worker, more employees at the country’s largest and most prominent companies are finding that their companies’ health care plans include fertility coverage.
The slow but rising trend can be credited to a combination of fading taboos around difficulty conceiving; a competitive job market with employers eager to adopt recruiting and retention tools; and the reframing of infertility as an issue less about ambitious women who have waited too long than one of corporate diversity and inclusion. The rising power in the workplace of women in their 30s, many of whom take responsibility for building a family, cannot be discounted.
Employer insurance covering some fertility treatment has been around for a while. But in the past, companies have resisted including coverage for in vitro fertilization, the gold-standard treatment and one of the most expensive. Prices begin at $12,000 for merely one try at a “live birth,” in the unnervingly pragmatic parlance of doctors.
Mercer, a benefits consulting firm, analyzed big employers (that’s 20,000 workers and up) and found that 44 percent offered some sort of I.V.F. benefit in 2018, compared with 37 percent in 2017.
Smaller companies showed less of an increase, and benefits for egg freezing — the treatment that helps women put their eggs on ice, regardless if they have sperm available right now — are far lower. Some states, like Massachusetts, require insurers to offer I.V.F. coverage.
The federal government hasn’t taken up this mantle, and given its current chaotic state, you would have to be on a lot more medication than the procedure requires to seriously consider that to be a possibility. Perhaps it will happen in the coming decades, with the United States birthrate falling to a record low last year.
These days, I.V.F. coverage is “escaping” the sectors that have traditionally offered it, meaning tech, banking and media, said Jake Anderson, a former partner at Sequoia Capital and a founder of Fertility IQ, a website that assesses doctors, procedures and clinics. General Mills, Chobani, the Cooper Companies and Designer Shoe Warehouse have either introduced coverage or greatly increased dollar amounts for 2019. Procter & Gamble Company offered only $5,000 in fertility benefits until this year, when it increased the benefit to $40,000.
In some cases these shifts happened after women lobbied the C-suite for increased coverage, though other women struggling with infertility are uncomfortable telling employers about impending pregnancies, fearing they may be penalized for the leave they will require.
It’s hard to believe corporate communications departments aren’t burning up the airwaves with this information, but very few news releases about robust fertility coverage have been issued. Some companies listed on a survey of patients conducted by Fertility IQ did not respond to requests to confirm benefit information, though those other big names were happy to discuss plans.
“You’d imagine in a #MeToo world where people are falling all over themselves to present themselves as family friendly, female friendly, that they would shout from the rooftops that they were offering this benefit,” Mr. Anderson said. “I can’t think of a more generous benefit than to help somebody build a family when they can’t do it, and at these dollar amounts.”
Mr. Anderson also noted that some companies are not publicizing the benefit well enough internally, to their own employees.
Some corporate silence may exist to discourage what some employees have started doing: fertility shopping. Though these benefits could help employers recruit the best candidates in a tight job market, the price tag could be high if lots of employees actually, you know, use the benefits. After all, while I.V.F. prices start at $12,000 a cycle, many patients pay closer to $20,000. And with “live births” often requiring two or more cycles to conceive, the bill can be $40,000 and up.
Kristi King, 38, the director of marketing sciences at Penn Schoen Berland, a marketing research and consulting firm in Denver, had $10,000 in fertility benefits through the company — generous, to be sure, but not enough to cover the five I.V.F. cycles she has undergone.
Ms. King estimated that she and her husband have paid about $50,000 out of pocket for treatment. She said she sold a condo, refinanced her home and is always on the lookout for what she calls “sky money,” like a rebate. “It’s been stop and save, stop and save,” she said. “We’ve had to spend a year between treatments trying to get the finances to keep going.”
So far as she knew, the only way to get more money for her quest was to work as a part-time barista at Starbucks. It was something she had read about online, where the topic is discussed in clicky articles like “I Took a Job at Starbucks to Get Infertility Benefits” and infertility forums like “Matt and Doree’s Eggcellent Adventure,” a Facebook group founded by Doree Shafrir, a podcaster and writer, and her partner, Matt Mira.
For years, Starbucks was among the most prominent of large companies when it came to fertility coverage. It offered benefits to even low-level contract employees, so any given person making Frappuccinos may receive $15,000 in I.V.F. benefits — plus medication — kicking in after three months of employment. (Howard Schultz for president?)
Ms. King was talking on her cellphone while at Lowe’s shopping for racks for her garage to store her Christmas ornaments. She described switching doctors, traveling out of the country for treatment, and the way optimism turned to frustration and pain. Her voice began to tremble.
“This should be covered like any other medical condition, to your maximum benefit amount, just like if I get cancer,” she said. For her, “the financial piece made the emotional piece exponentially harder. There’s so much on the line, in addition to your heart being on the line.”
No matter how much money is put toward treatment, there are no guarantees. “I.V.F. can be fantastic and miraculous, but it can also become a frenzy,” said Tamara Jenkins, the director of “Private Life,” a 2018 film that stars Paul Giamatti and Kathryn Hahn as a couple in the creative class who lose grip of rational thought and blow through their savings in the mad pursuit of a child.
Ms. Jenkins, a former patient herself, said that experience with fertility treatments was wide-ranging among her crew, including a member of the prop team, who brought a heap of her old paperwork and infertility gear for shoots.
“There’s something dangling in front of you and you keep pursuing it, and it can make people insane,” Ms. Jenkins said. “People’s expectations have to be real.”
Employers also don’t match expectations equally. At some companies, both heterosexual and same-sex couples, as well as singles, can access benefits. But at others, coverage isn’t triggered until an employee has had unprotected sex of the baby-making kind for six or 12 months.
Emma, 38, a social worker who asked that her last name be withheld for privacy, said she took out a personal loan of tens of thousands of dollars to pay for her treatment. She was unable to get access to her fertility coverage through her employer even though she had a diagnosis of diminished ovarian reserve (otherwise known as “not enough good eggs”).
“I am queer and do not currently have sex with men,” she wrote in a Facebook message, but nevertheless her employer’s insurance required her to “try ‘naturally’ for 12 months before they would cover anything.”
Employers could be helpful with this problem, if they choose to be. Morgan Stanley has rolled out an extended family plan for 2019 to cover treatments without any diagnosis requirements, making trying for a baby easier for employees who are single or in same-sex relationships; the company covers assisted reproductive technology to a lifetime maximum of $30,000.
Progyny, a fertility benefits manager, is also streamlining fertility treatment and removing hurdles like the “trying naturally” commandments. Its clients, including Unilever, MassMutual, Viacom and Cerner, also pay for genetic screening of embryos, with a typical cost of about $5,000, which helps identify genetic diseases and the embryos that are most likely to lead to a miscarriage.
“Most women without coverage or with traditional carrier coverage are shopping for cost on every procedure and adding up how many dollars they have left, so they make compromises on treatment,” said David Schlanger, the chief executive of Progyny.
The typical compromise? Placing more than one embryo into a womb in hopes that one or more of those eggs will create the much-dreamed-of “live birth.” And when I.V.F. works too well, costs can be extraordinary for the delivery of twins and up, who can also require a great deal of care in and out of the hospital. For employers, offsetting these costs is appealing, and provides Progyny with a business angle.
“We’ve had employers say, ‘We had eight sets of twins last year, and triplets, from I.V.F. that cost us $9 million in medical. Can you help us?’” Mr. Schlanger said. Employees of Progyny clients who undergo I.V.F. are bearing one child per pregnancy at a higher rate than the national average.
In general, having one child at a time is preferable from a health perspective, though some people who want two or more children, total — and who have been on a lengthy and taxing “fertility journey” — may prefer twins in hopes of exiting the clinic forever.
Hillary Filstrup, 32, a claims adjuster for property damage in Dallas, has been trying to get pregnant for four years. She said she didn’t have coverage through her employer, and she and her husband were considering cashing out a stock portfolio before her husband’s company added I.V.F. coverage and contracted with Progyny.
Ms. Filstrup began I.V.F. in early January and plans to transfer one embryo. She has been diagnosed with polycystic ovarian syndrome, endometriosis and a blocked left tube. At Christmas, her husband, a video-game enthusiast whom she describes as the “least romantic person in the world,” gave her a silver Tiffany necklace with a pendant shaped like a lima bean, to represent their future bean.
“For him to do something romantic meant more to me than anything in the world,” she said. In her vows, she said she’d “always be player No. 2,” and when she gets a positive pregnancy test she will give him a onesie with the phrase “player No. 3 has entered the game.”
Employer-led I.V.F. coverage also forces us to grapple with some thorny issues, such as the unfairness of the possibility that only the infertile affluent or employed can have their own children (minus the residents of Massachusetts or other states with mandates).
And it’s also a way to sidestep a national conversation about the merits of universal infertility coverage, which would include bigger questions, like whether bringing more children into an overpopulated, globally warming world is morally defensible. Or if people who would eventually conceive on their own are pushed into treatment by some of the nation’s greedy fertility clinics. Or if the childless population must help other people bear children, even if children bring people health and happiness, and thus are perhaps justifiable medical expenses, like psychotherapy or some knee surgeries.
For now, the debate will center on practical, simpler questions, like: How many rounds of I.V.F. should be covered? When is infertility no longer considered treatable? Should employers cover the price of creating and transferring an embryo into a surrogate’s womb? Should a woman using her own eggs become ineligible in the final childbearing years, say, at 43?
And what do doctors think of this? Some, like Dr. James Grifo, the program director of the New York University Langone Fertility Center, say of the increase in coverage, “in general, it’s a good thing — people have coverage, and they can get the care they deserve.” He added, “but insurance companies dictate what kind of care you can provide, and what you can do. They dictate protocols for clinical practice, and patients aren’t protocols.”
If infertility rates continue to rise in America, employers may be spending more on employees’ health care plans, but be partly compensated by their loyalty and beavering work ethic. For Ms. Burns, the experience of looking around for another position in her field and learning that Sharp HealthCare’s premium insurance included three rounds of I.V.F. coverage, and other businesses didn’t, kept her in her current job. In fact, figuring out that some companies didn’t cover I.V.F. made her “mind blown,” as she put it.
“It’s changed my appreciation for a company that makes the choice to offer this, because there’s not really any gain for them, and maybe there will be younger women who come up under me who will benefit,” she said. “It made me take a step back and realize the type of people I work for.”
Valeriya Safronova contributed reporting.