When Tammy Sun was working at the tech company Evernote back in 2014, she was told by her fertility doctor that she had a low ovarian reserve. On her doctor’s advice she preserved some of her eggs. At age 35, Sun underwent oocyte cryopreservation, or egg freezing, yielding three to four eggs each cycle.
What she didn’t know is that she’d be covering the costs out-of-pocket.
“I naively assumed it would be part of my healthcare,” Sun says. Instead she paid around $35,000 for the three cycles. Sun was lucky to have the money in savings, but the experience prompted her to start Carrot Fertility, one of several US firms working with companies to help them add fertility benefits to their coverage. They’re not just a generous perk, proponents say, fertility services are a good way to attract and retain workers. They also boost gender diversity in hiring.
Fertility benefits as a workplace benefit gained traction in the US around 2014, when both Apple and Facebook said they would pay up to $20,000 to cover the cost of egg freezing for their staff. That same year, Bloomberg Businessweek, wondered: “Will Freezing Your Eggs Free Your Career?” (Short answer: It’s complicated.) Other tech companies including Google, Uber, and Yahoo followed suit.
Most mid-size and large US companies cover some form of treatment for workers dealing with infertility, according to a 2021 survey of 459 US employers conducted by the consulting firm Mercer. In 2020, 58% of companies with 500 employees or more covered evaluations by a reproductive endocrinologist or infertility specialist in their health plans, while 73% of so-called “jumbo employers” (with 20,000 or more employees) did. Drug therapies to treat infertility are also a common benefit, with over half of jumbo employers covering these.
More employers have also started to cover IVF in the past five years. Today, 42% of jumbo employers offer IVF coverage, a six percentage point increase from 2015, while 27% of employers with 500 or more workers offer this service, and 14% of smaller employers do.
Egg freezing benefits are on the rise, too: 19% of jumbo employers offered coverage in 2020, an increase of 13 percentage points from 2015.
Fertility benefits are more common among larger US employers, and those which offer higher wages. “Large employers tend to be trend-setters for adding benefits,” says Sam Purciello, a senior health management associate with Mercer. Smaller employers with smaller budgets may have a harder time covering pricier fertility treatments as part of their health plan, says Regan Gross, an adviser with the Society for Human Resource Management (SHRM).
But even when companies do cover fertility treatments, employees may still end up footing a good portion of the bill. For example, when Apple and Facebook first started offering egg freezing in their health plans, they paid for $20,000 worth of treatments, but patients can easily spend over $50,000 if they undergo multiple cycles.
In a tight labor market with nearly 11 million job openings as of December, fertility benefits can be a selling point for candidates choosing between jobs, says Purciello. A 2019 survey from Glamour and the fertility treatment company Modern Fertility found 59% of women would choose an employer that covered services like IVF over one that didn’t.
There’s also an argument that fertility options attract a more diverse workforce. When tech firms in Silicon Valley started adding egg freezing to their health plans five years ago, it was often framed as a way to retain female staff in an industry dominated by men. Purciello says employers’ focus has widened today to provide a “path to parenthood” regardless of workers’ gender or sexual orientation. Sun says surrogacy, used by some LGBTQ couples seeking to have children, is one of the fastest-growing claims filed by employers in Carrot’s network. Men may also make use of fertility benefits, particularly if their female partners are included in their health plans.
Seismic, a sales software company based in San Diego, decided to add fertility services to its healthcare plan to differentiate itself “in the marketplace as an employer of choice,” said the chief people officer, Linda Ho.
Ho said Seismic worked with an insurance broker to look at the costs associated with adding fertility services, assuming a certain share of employees would take advantage of the new benefits. After running the numbers, the firm decided to cover up to $30,000 worth of fertility treatments, including IVF and egg freezing, for employees on its health plans. Under the new plan, which Seismic adopted this year, the company pays for fertility treatments once a deductible or out-of-pocket maximum is met—typically between $500 and $1,800 for a single employee.
According to the Mercer survey, employers that don’t offer fertility benefits cite potential increased costs as the most common concern. But the vast majority (97%) of those that do offer benefits said they haven’t experienced a significant cost increase from adding fertility services, including IVF—typically one of the more expensive treatments.
Fertility insurance companies argue there’s a return on investment for companies to offer this insurance to their employees, says Lucy van de Wiel, a sociology researcher at Cambridge and the author of Freezing Fertility. “They say, ‘If you don’t cover this, then your employees will go and do IVF in the cheapest way possible, and then they will be off sick.’”
Van de Wiel suggests that some employers might see fertility benefits as a way to steer workers away from options that could lead to miscarriages, or high-risk twin pregnancies, for example, which could cost companies more in the long-term.
And while critics may see “implicit coercion” when employers with a vested financial interest in workers’ reproductive decisions offer fertility benefits, van de Wiel says there are also plenty of women who are happy to have fertility treatments covered anyway.
Whether you agree with it or not, employers in the US pay for healthcare, Sun says. And a suite of fertility benefits may be one way to “help people make healthy decisions that lead to healthy outcomes,” she says.