Infertility doctor weighs in on fertility benefits

Between a global pandemic and record-breaking healthcare debt in the U.S., it should come as no surprise that more women in their 20s are delaying starting families. But what happens when those twentysomething women choose to have a child ten or fifteen years from now?

According to the CDC, 6.1 million women struggle to get or stay pregnant. Yet, only 15 states require private healthcare insurers to provide some sort of fertility treatment, while only New York’s Medicaid program offers coverage — no Medicaid program covers in vitro fertilization. Still, larger employers have upped their fertility offerings for employees. Between 2015 and 2020, companies with over 500 employees saw an overall 4% increase in drug therapy, IVF and egg-freezing benefits, according to Mercer’s National Survey of Employer-Sponsored Health Plans.

“Being infertile is a very serious health issue — it’s not a choice for many people,” says Dr. Jane Frederick, a reproductive endocrinologist, infertility specialist and medical director at HRC Fertility Clinic in Newport Beach, California. “It should be a covered benefit because that patient needs help trying to have a family.”

Read more: A personal investment: This small business owner spent $10k to freeze her eggs for her future

While issues of infertility are becoming more prominent in conversations surrounding healthcare and benefits in recent years, Dr. Frederick understands this topic as one that has always been urgent for hopeful parents. Employee Benefit News spoke with her to learn what infertility means for patients, and why employers and health insurers need to up their coverage, if they haven’t already.

What should hopeful parents know about fertility treatment before they decide to go down that path?
The timing to seek treatment is probably the most important thing to know. I recommend that if a woman is under the age of 35, that she try on her own for a year, and if she is not successful, seek out infertility testing. If a woman is between 35 and 40, I usually recommend six months of trying on her own before seeking treatment. And anybody who’s over the age of 40 should seek out a specialist right away. The age of the egg is what determines the success of treatments. The younger the patient is who gets to my office, the higher probability is that I’ll be successful.

For example, if it’s a case of unexplained infertility, which means that there are good eggs, good sperms and the tubes are open, then the chance of pregnancy over age 35 is about 60% with treatment. If the patient’s over the age of 40, that success rate will drop to 25%. A lot of younger women can consider egg freezing as a viable option to give them a backup chance of pregnancy for when they become 40.

Read more: 3 trends in fertility and family planning benefits for 2022

So what’s the first step toward better understanding your own fertility? 
You can get some testing done with your primary care doctor. A simple blood test can tell us where you’re at in that biological clock — the blood test examines the FSH hormone or AMH hormone, and they’re more accurate to test when you’re on a period. Basically, day three of the period tells me how many good-quality eggs are still remaining. That’s a good litmus test for those who are not ready to have a child yet who are also in their late thirties.

But while one out of eight couples have infertility issues, it’s not always about the female — about 40% of the time it’s a male issue. The sperm either may be too low in count or not moving enough.

If treatments are needed, how much do they typically cost?
It could be zero or as high as $10,000 depending on their insurance and what treatment they need. Thirty percent of my patients have insurance coverage for infertility, so it’s better than the 0% from 20 years ago. Still, we’re lobbying hard to get as many insurance companies to offer this to our patients since we think it is very important that they have insurance coverage. I also know that there are many companies like Google, Facebook and Apple that offer infertility treatments as part of their employment.

A lot of patients will get pregnant just by taking a medication called clomiphene, which helps you ovulate — it’s beneficial for patients who have irregular cycles, and taking a pill is pretty inexpensive. A lot of patients also need surgery, like something gynecological in nature that I can repair. That’s usually covered by insurance because it falls under gynecology. Only about 1% of all of my couples actually need a high-tech procedure like IVF. But the goal is to not have to spend $10,000 to have a baby, but to look at how we can assess the issues.

Read more: The pandemic has exacerbated the demand for fertility benefits

What are some of the biggest challenges your patients face?
The biggest challenge is that the treatment is not free. So many patients understand that their biological clock is ticking, but they don’t have all the resources to move forward in trying to get pregnant.

We also need to be more understanding for the infertility patient. Infertility is the preamble to pregnancy, and there’s a lot of emotional ups and downs when you’re trying to have a baby — it shouldn’t be a stigma. The patient should not have to go to work and feel like she cannot share her experience. Employers and co-workers should be supporting that patient in her attempts to conceive just like we would support her when she is pregnant for nine months. And if we can talk about it more and share what the struggles are for my patients, I think that also brings more awareness to who has coverage and who doesn’t.

We should try to make infertility part of a more universal health care coverage like some of the European countries do. Although, there are a few states that were successful in passing mandated coverage for their residents. For example, Chicago, Illinois, New York and Massachusetts are friendly states for fertility patients that have insurance coverage, no matter what — it’s not about where you work or who your employer is. In California, we’ve been trying hard to pass that mandate as well.

As of now, how should employers support employees who wish to start families? 
Some people are born without a uterus or with an abnormal uterus. Some people can’t ovulate — regardless, it’s not the patient’s fault she has these issues. Employers should offer full benefits to their employees — [fertility treatment] should not be viewed as elective. Trying to have a baby is very important to many couples and we should assist them. Sometimes you can’t postpone it waiting for your insurance to kick in. It’s the same as if the patient had any other health issue. Keeping that patient healthy, happy and allowing them to have a family should be part of the employer’s desire for every employee. Infertility is a health issue, and it should be treated that way.

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