Chapter 1
Understanding fertility
Fertility 101:
Fertility health is complicated, and it’s a topic that most people aren't familiar with unless they’ve gone through a fertility journey themselves. But it’s an area that’s becoming more and more important for HR leaders to be knowledgable about. Why? To start, one in eight different-sex couples will be diagnosed with infertility. And that number doesn’t include same-sex couples and single-intending parents who need additional support to grow their families. For employees later in their careers, hormonal health becomes a different challenge as menopause and low testosterone symptoms start to interfere with daily life. When employers don’t address these concerns, 88% of employees would change jobs to access fertility benefits.
Learning more about fertility health and what each journey can involve is the first step toward creating a more supportive workplace for anyone pursuing parenthood or managing their hormonal health. We hope you find this guide to be a useful place to start.
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What is fertility?
For people with ovaries, fertility describes someone’s ability to get pregnant and carry a pregnancy to term.
For people with testes, fertility refers to semen health parameters like sperm shape, volume, and speed.
What is infertility?
An infertility diagnosis is made after 1 year of frequent, unprotected different-sex intercourse or 6 months if the partner with ovaries is 35 or older.
1 in 8 different-sex couples face infertility — more than diabetes
What causes infertility?
of infertility cases can be traced to the partner with ovaries
to the partner with testes
are due to a combination of factors or are considered unexplained
Some of the most common causes of infertility include:
- Natural decline in egg quantity and quality with age
- Abnormal sperm production or function
- Problems with the delivery of sperm
- Overexposure to certain environmental factors
- Damage related to cancer and its treatment
- Ovulation disorders
- Uterine or cervical abnormalities
- Fallopian tube damage or blockage
- Endometriosis
Chapter 2
Menopause and low testosterone
Menopause
Menopause is the time that marks the end of the menstrual cycle. It’s diagnosed after someone has gone 12 months without a menstrual period. Common symptoms include hot flashes, sleep disturbances, and mood changes.
Low testosterone
Male testosterone levels decline on average about 1% a year after age 30. 40% of males aged 45+ have low testosterone
How symptoms impact employees
Chapter 3
Fertility and family-forming options
Most different-sex couples start out by trying to get pregnant without intervention. For same-sex couples, the process starts with researching options for donor eggs or sperm, or for gestational carrier services or adoption.
For different-sex couples, same-sex female couples, and single-intending parents, treatment typically starts with IUI, because it’s less invasive, and then moves to IVF. Depending on coverage, some people choose to start with IVF — we’ll get more into that later.
Other fertility care options include fertility preservation. Some people pursue fertility preservation before getting treatment that can damage fertility, such as cancer treatment. Others choose fertility preservation if they’re not ready to grow their family but know they want to in the future.
Key terms to know:
Intrauterine insemination (IUI): During an intrauterine insemination (IUI) procedure, sperm is placed directly into the uterus using a small catheter to improve the chances of fertilization by increasing the number of healthy sperm that reach the fallopian tubes when the person is most fertile.
Fertility preservation includes egg, sperm, and embryo freezing, which is the process of using technology to preserve biological reproductive material at extremely low temperatures. There are many reasons people may choose to undergo egg and sperm freezing. Some may want to preserve their eggs and sperm before undergoing cancer treatments or hormone replacement therapy, while others pursue fertility preservation for personal reasons.
“In vitro” means outside of the body. IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in the uterus.
Commonly known as surrogacy, gestational carrier (GC) services involve having a person carry a pregnancy on behalf of the intended parent or parents.
Chapter 4
Limits of infertility coverage
Many fertility treatments are not considered “medically necessary” by insurance companies, so they are not typically covered by private insurance plans or Medicaid programs.
When coverage is available, certain types of fertility services (e.g., testing) are more likely to be covered than others (e.g., IVF). Accessing donor sperm and eggs, gestational carrier services, and adoption are not covered by insurance — and get very expensive.
Family-forming costs
fertility treatments have
little to no coverage
The medical definition of infertility
excludes most LGBTQ+ couples
and single-intending parents
Chapter 5
Types of fertility benefits
Flexible financial fertility benefit
A flexible financial fertility benefit gives companies the opportunity to create a customized plan designed specifically for their employees. Due to the flexible nature of the offering, this benefit typically covers any and all fertility-related treatments and services and has many built-in resources to help people navigate their pursuit of parenthood.
Pros
- Is inclusive of all employees regardless of age, sex, sexual orientation, gender identity, faith, or geography, including those outside the U.S
- Can cover everything from egg or sperm freezing, IUI, IVF, adoption, donor and gestational carrier services, and more
- Is usually compatible with existing health insurance, including high-deductible health plans (HDHPs)
- Is typically more cost-efficient compared to cycle- or insurance-based programs
- Usually provides access to an in-house care navigation team and a network of high-quality clinics
- Typically includes claims processing, taxes, and other administrative work
- Does not require an infertility diagnosis
Cons
- Can be a higher upfront financial investment compared to more lightweight perks and corporate gifts like apps, wearables, and at-home fertility tests
- May offer employers less control over which services benefit dollars are spent on
- May require more engagement from employees in learning about how to personalize treatments and services for their unique preferences and needs since protocols aren’t pre-determined by the employer
Traditionally female-focused clinical offerings
There are some fertility benefit's that only provide female-focused offerings, such as egg freezing and IVF, and frequently operate out of the benefits own local clinics — which are sometimes referred to as boutique clinics.
Pros
- Offer specialized knowledge, attention, and services for women
- May feel more female-friendly since they’re smaller and specifically catered toward millennial women
- Are usually inclusive of single and LGBTQ+ women
- Do not require an infertility diagnosis
Cons
- Are limited to people with ovaries
- Have limited results data on successful pregnancies available
- Are often geographically limited to a specific city
Standalone online fertility care support
Online fertility care support services provide individuals and couples with an online suite of tools to help with maneuvering fertility journeys. This usually includes virtual appointments with clinicians, a fertility specialist search function (often with location, accepted insurance plans, or rating information), and a library of frequently asked questions. These services may be specific to fertility care or may cover a wider variety of healthcare topics. While many other previously mentioned benefits include online fertility support as one piece of their offering, this section covers options that offer only online support.
Pros
- Offers easy access to information and support
- Is generally inclusive of all sexual orientations, gender identities, and marital statuses
Cons
- Varies widely in coverage
- Offers varying levels of expertise with different healthcare topics
- May not be transparent about provider recommendations (i.e., they may allow providers to pay for a higher spot on search results)
- Does not remove the high bar for employees where financial access to services is concerned
Chapter 6
Understanding the impact of fertility benefits
When employees have the right support for these complex, emotional journeys, it makes a significant difference in their personal and professional lives — and a big impact on how they feel about their employers. Here are just a few reasons to consider bringing inclusive fertility benefits to your workforce:
