November 05, 2024
Employers have an important stake in helping employees and dependents who pursue fertility treatments find high-quality providers and in ensuring access to the most effective options. In response, more employers are collaborating with specialized vendors to expand coverage for evidence-based fertility treatments and help those going through treatment with navigation, rather than solely focusing on cost considerations. By doing so, employers can improve maternal and child health outcomes while reducing medical expenses for employees and dependents. This section explores various strategies and resources available to employers, empowering them to enhance employee decision-making throughout the fertility treatment process.
Evidence-based Approach to Fertility Care
Employers are realizing that offering access to evidence-based fertility care can ensure that employees receive the most effective and safe treatments currently available. By adopting an evidence-based approach, patients can minimize their risks and enhance their chances of a successful pregnancy. To ensure that employees have access to top-tier fertility specialists and facilities, increasing the likelihood of successful outcomes, employers often establish partnerships with centers of excellence (COEs) that have a proven track record of delivering high-quality care and adhering to evidence-based practices. According to Business Group on Health’s 2025 Employer Health Care Strategy Survey, 52% of large employers respondents will offer fertility/family-forming COEs in 2025, with an additional 14% considering doing so for 2026/2027.
To learn more about the common metrics used for assessment across each COE category, check out the Business Group’s article, How Do You Know if a COE Is Truly Excellent?
For employers who cover fertility benefits, a reimbursement dollar cap model may not equate to better outcomes, as there is no alignment of values in terms of quality of care and cost. For employers who have a reimbursement dollar cap model in place, however, an unintended consequence is that employees may try to get "the biggest bang for their buck" by selecting the lowest-cost provider or clinic that transfers multiple embryos, potentially leading to multiple births and time spent in a neonatal intensive care unit. Such clinics may also forgo tests or procedures like elective single-embryo transfer (eSET), which help drive success and healthy pregnancies. eSET is when a single embryo is transferred from a pool of multiple, viable embryos and is the only recommended way to avoid the risk of multiple gestations after in vitro fertilization.64 Following eSET protocols directly influences the rate of multiple births. It should be noted that when requirements to only use eSET practices are in place, the rate of multiple births decreases while the rate of pregnancy tends to remain the same.45
In a U.S. study of infertile women undergoing a combined 15,418 IVF/embryo transfer cycles, patients with infertility benefits electively chose to transfer one embryo/cycle significantly more often than patients with no coverage, thereby reducing costs due to multiple births.46 In fact, 27% of employers who offer fertility benefits require their health plans’ in-network reproductive specialists to adopt a eSET policy.13 Various countries have taken different approaches when it comes to embryo transfer. For instance, Argentina has moved toward eSET, while countries such as Brazil and Mexico continue to practice multiple embryo transfer.47
Navigating the Journey
The journey toward parenthood can be emotional and stressful. As part of a comprehensive offering, employers may want to consider support programs that help guide employees through their conception and family-forming journey. Health plans are increasingly offering their own fertility programs that coordinate with maternity support programs when the employee becomes pregnant.
Employers also may consider the use of navigational services through their health plan or a third-party vendor. Such services can not only guide employees to high-quality information and providers, but also ensure their enrollment in other applicable programs aimed at easing their transition into parenthood. In a U.S. study, patients were provided with comprehensive support, education and clinical-based treatment plans that prioritized clinical criteria over costs. The results, when compared to national benchmarks, revealed greater pregnancy success, healthier pregnancies and healthier babies.48 If fertility is not the right path to parenthood or doesn’t work, employees can be guided to other programs that may be offered, such as adoption or surrogacy.
According to a survey conducted by the Royal College of Obstetricians & Gynecologists, 62% of women in the U.K. expressed feeling overwhelmed by the abundance of advice they received.49 Notably, the U.K. and Armenia are the sole European countries with state-organized fertility education programs aimed at assisting individuals in navigating fertility care and challenges.50 In fact, partnering with a global vendor to assist employees in navigating family-forming options can provide valuable education on the range of family-forming options available and dispel common misconceptions.
Managing Fertility Drugs
Pharmacy costs often form a significant portion of the overall expenses incurred in fertility treatments. Therefore, delays in care and access can quickly drive additional costs and derail treatment. One of the ways employers can ensure that their fertility benefits are effective is to have timely, barrier-free access to fertility medications available for employees. Having all medications administered by one pharmacy benefit manager (PBM) may ease administration and efficiency in managing specialty medications for employers, but patient needs and preferences should be taken into consideration as employers evaluate their fertility benefit design. Considerations can include:
The ability to dispense medications in accordance with timing of a specific treatment cycle
The level of patient support needed to ensure adherence to complex at-home drug administration
The impact of prior authorization on provider prescribing patterns and the potential for delivery delays that could impact treatment)
This section was informed by members of Business Group on Health’s Pharmacy Benefit Committee.
Outcomes Do Matter
Similar to how physicians rely on patient data to evaluate treatment responses and guide future treatment options, the availability of high-quality data on patients today presents a unique opportunity for employers to measure outcomes to determine if the benefits in place are effective. Employers can utilize a range of metrics to help them understand the effectiveness of their fertility and family-forming benefits and determine whether employees are successfully pursuing their family-forming aspirations. These metrics are shown on Table 160:
Table 1: Metrics for Assessing the Effectiveness of Fertility and Family-forming Benefits
Access | Quality/Success | Cost | Experience |
---|---|---|---|
Where can employees access care and how can different support modalities be used depending on patient location and needs. |
Rates for eSET, pregnancy, miscarriage and live birth provide insights into the program's effectiveness in helping employees achieve their family formation goals. |
Bundled case rates and total costs for patients provide an understanding of both plan expenses and employees' out-of-pocket costs. |
Patient experience on how the fertility benefits solution impacts employees' emotional well-being and overall treatment journey. |
The Centers for Disease Control and Prevention (CDC) publishes an annual report that includes success rates and other data for fertility clinics participating in the ART Surveillance System. This data provides patients with the average chances of success per ART cycle or ART transfer. However, it is important to note that reporting to the CDC is voluntary, and not all clinics contribute to the system. Globally, International Committee for Monitoring Assisted Reproductive Technologies (ICMART) has a report that includes data from 79 countries.51
Opportunity to Prioritize Quality and Affordability
The demand for fertility treatments has grown considerably in recent years, reflecting a changing workforce and treatment landscape. Employers may run the risk of employees using affordability as the main criteria for provider and treatment selection instead of quality or overall health outcomes if the levels of coverage are not reviewed in the context of the latest evidence and clinical advancements. Employers can design their benefit to help employees find high-quality providers and the most effective treatment through a comprehensive fertility benefit while controlling their long-term cost trend associated with overall family planning and health care services.
Employer Recommendations
- 1 | Promote superior clinical outcomes: Guide members toward high-quality providers who adhere to evidence-based protocols, including eSET, and consistently deliver exceptional clinical outcomes.
- 2 | Examine existing benefits: Reassess fertility treatment benefit limits to ensure that not only is the initial fertility consult included, but subsequent visits and treatments are also included as defined by the plan limits.
- 3 | Assess gaps in coverage: To promote equity among all employees, it is important to understand the services provided by public health systems in countries outside the U.S. This will help ensure sufficient coverage within the employer's health care plan.
- 4 | Prioritize quality and accessibility: Evaluate programs with proven quality, clinical and patient satisfaction outcomes.
- 5 | Streamline access to fertility treatment: Remove unnecessary requirements for accessing fertility treatment, especially when implementing enhanced benefits such as COEs or fertility vendors, to ensure that employees can easily avail themselves of the necessary care.
- 6 | Measure outcomes: Utilize available high-quality data to measure the effectiveness of your fertility programs.
- 7 | Enhance member navigation: Create strong links among various programs to offer comprehensive support for parents throughout the family-forming journey. Facilitate smooth transitions from prenatal care and pregnancy visits to postpartum and maternity programs. Collaborate with a vendor partner for global fertility programs to assist employees in navigating local fertility options.
- 8 | Drive global consistency: Partner with a vendor that can support you globally and allow for a globally consistent strategy. Focus on countries where access is easier to obtain while continuing to monitor how to meet employees’ needs in more restrictive markets.
- 9 | Stay informed about coverage landscape: Stay vigilant in monitoring regulatory requirements and mandates for fertility treatments and family-forming benefits globally to ensure ongoing compliance.
For more insights into how employers can drive global consistency, review the Business Group guide on Creating a Globally Consistent Benefits Strategy
This Guide is for Business Group on Health members only. It should not be reproduced, distributed or quoted without permission from Business Group on Health
- 1 | World Health Organization. Infertility Prevalence Estimates, 1990–2021. April 3, 2023. https://www.who.int/publications/i/item/978920068315. Accessed August 22, 2023.
- 2 | Patterson A. Fertility benefits rapidly rising as employers look to attract and support talent. International Foundation of Employee Benefit Plans. March 10, 2023. https://blog.ifebp.org/fertility-benefits-rapidly-rising-as-employers-look-to-attract-and-support-talent. Accessed August 22, 2023.
- 3 | Maven Clinic. The state of fertility & family benefits in 2023. January 1, 2023. https://www.mavenclinic.com/interactive-experience/the-state-of-fertility-and-family-benefits-report. Accessed August 22, 2023.
- 4 | Ozkan M, Baysal B. Emotional distress of infertile women in Turkey. Clinical and Experimental Obstetrics & Gynecology. 2006;33(1) : 44-46.
- 5 | Tavousi,S A, et al. Psychological assessment in infertility: A systematic review and meta-analysis. Frontiers in Psychology. 2022l 13 : 961722.
- 6 | Carrot Fertility. Fertility at work. April 18, 2023. https://content.get-carrot.com/rs/418-PQJ-171/images/Carrot - Fertility at Work.pdf. Accessed August 22, 2023.
- 7 | Cousineau TM., Domar AD.. Psychological impact of infertility Best practice & research. Clinical Obstetrics & Gynaecology. 2007; 21(2) : 293-308.
- 8 | Santona A et al. Parenthood desire in Italian homosexual couples. Journal of Family Issues. 2002; 43(4): 974-992.
- 9 | Lindheim SR., et al. Societal pressures and procreative preferences for gay fathers successfully pursuing parenthood through IVF and gestational carriers. Reproductive Biomedicine & Society Online. 2019; 9: 1-10.
- 10 | MerkisonJ, et al. Racial and ethnic disparities in assisted reproductive technology, a systematic review. 2023;Fertility and Sterility.
- 11 | Business Group on Health. Quick Survey Findings: Family Benefits. October 7, 2021. https://www.businessgrouphealth.org/resources/quick-survey-findings-family-benefits. Accessed August 22, 2023.
- 12 | Boulet, Sheree L., et al. "US state-level infertility insurance mandates and health plan expenditures on infertility treatments." Maternal and child health journal 23 (2019): 623-632.
- 13 | American Society for Reproductive Medicine. Disparities In Access To Effective Treatment For Infertility In The United States: An Ethics Committee Opinion. 2021. https://www.asrm.org/practice-guidance/ethics-opinions/disparities-in-access-to-effective-treatment-for-infertility-in-the-united-states-an-ethics-committee-opinion-2021/. Accessed August 22, 2023.
- 14 | LindheimSR., et al. "Societal pressures and procreative preferences for gay fathers successfully pursuing parenthood through IVF and gestational carriers." Reproductive Biomedicine & Society Online 9 (2019): 1-10.
- 15 | Daneshmand S, et al. Expanding same-sex couples’ access to assisted reproduction. Fertility and Sterility. 2016; 106 (3): e111.
- 16 | France 24. French parliament votes to extend IVF rights to lesbians and single women. June 29, 2021. https://www.france24.com/en/france/20210629-french-parliament-set-to-extend-ivf-rights-to-lesbians-and-single-women. Accessed August 22, 2023.
- 17 | Weigel G, Ranji U, Long M, Salganicoff A. Coverage and use of fertility services in the U.S. KFF. September 15, 2020. https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/. Accessed August 22, 2023.
- 18 | HR News. Gen Z workers are flipping the script on inclusive workplace benefits. April 26, 2023. https://hrnews.co.uk/gen-z-workers-are-flipping-the-script-on-inclusive-workplace-benefits/. Accessed August 22, 2023.
- 19 | WTW. Employers prioritize family-friendly benefits. June 3, 2023. https://www.wtwco.com/en-us/insights/2020/05/employers-prioritize-family-friendly-benefits. Accessed August 22, 2023.
- 20 | Jaslow R. Cost of having baby: $21K for single birth, $105k for twins. CBS News. November 11, 2014. https://www.cbsnews.com/news/cost-of-having-baby-21k-for-single-birth-105k-for-twins/. Accessed August 22, 2023.
- 21 | Chambers G M, et al. Hospital costs of multiple-birth and singleton-birth children during the first 5 years of life and the role of assisted reproductive technology. JAMA Pediatrics. 2014; 168(11) : 1045-1053.
- 22 | Centers for Disease Control and Prevention. Assistive reproductive technology surveillance—United States, 2018. Morbidity and mortality Weekly Report (MMWR). February 18, 2022. https://www.cdc.gov/mmwr/volumes/71/ss/ss7104a1.htm. Accessed August 22, 2023.
- 23 | Human Fertilisation & Embryology Authority. Multiple births in fertility treatment 2019. February 2, 2022. https://www.hfea.gov.uk/about-us/publications/research-and-data/multiple-births-in-fertility-treatment-2019/. Accessed August 22, 2023.
- 24 | Resolve: The National Infertility Association. Fertility Insurance Coverage Myths and Facts. June 1, 2023. https://resolve.org/learn/financial-resources-for-family-building/insurance-coverage/fertility-insurance-coverage-myths-and-facts/. Accessed August 22, 2023.
- 25 | Business Group on Health. Quick Survey Findings: Global Consistency Strategy. November 17, 2021. https://www.businessgrouphealth.org/resources/quick-survey-findings-global-consistency-strategy. Accessed August 22, 2023.
- 26 | World Health Organization. Infertility. April 3, 2023. https://www.who.int/news-room/fact-sheets/detail/infertility. Accessed August 22, 2023.
- 27 | Cleveland Clinic. Infertility. April 19, 2023. https://my.clevelandclinic.org/health/diseases/16083-infertility. Accessed August 22, 2023.
- 28 | Centers for Disease Control and Prevention. Infertility FAQs. April 26, 2023. https://www.cdc.gov/reproductivehealth/infertility/index.htm. Accessed August 22, 2023.
- 29 | American Society for Reproductive Medicine. Frequently Asked Questions About Infertility. https://www.reproductivefacts.org/browse-resources/frequently-asked-questions/faq-about-infertility/. Accessed August 22, 2023.
- 30 | Resolve: The National Infertility Association. Intrauterine Insemination (IUI). June 1, 2023. https://resolve.org/learn/what-are-my-options/intrauterine-insemination/. Accessed August 22, 2023.
- 31 | Fertility IQ. IUI or Artificial Insemination. June 2, 2023. https://www.fertilityiq.com/iui-or-artificial-insemination/how-well-iui-works-by-patient-type. Accessed August 22, 2023.
- 32 | Centers for Disease Control and Prevention. What is Assisted Reproductive Technology? October 8, 2019. https://www.cdc.gov/art/whatis.html. Accessed August 22, 2023.
- 33 | Penn Medicine. Fertility Blog: IVF by the Numbers . March 14, 2018. https://www.pennmedicine.org/updates/blogs/fertility-blog/2018/march/ivf-by-the-numbers. Accessed August 22, 2023.
- 34 | Fertility IQ. IUI or Artificial Insemination: The Cost of IUI. July 1, 2023. https://www.fertilityiq.com/iui-or-artificial-insemination/the-cost-of-iui#components-of-iui-cycle-cost. Accessed August 22, 2023.
- 35 | Fertility IQ. The Components of IUI Cycle Cost. June 2, 2023. https://www.fertilityiq.com/ivf-in-vitro-fertilization/costs-of-ivf#cost-components. Accessed August 22, 2023.
- 36 | Gumas E. Belgium Has Made IVF Affordable and Accessible. The U.S. Is Another Story. The Commonwealth Fund. June 30, 2023. https://www.linkedin.com/pulse/belgium-has-made-ivf-affordable-accessible-us-another/. Accessed July 15, 2023.
- 37 | Chambers, Georgina M., G. David Adamson, and Marinus JC Eijkemans. "Acceptable cost for the patient and society." Fertility and sterility 100.2 (2013): 319-327.
- 38 | Enriquez, J. Turner, A. Carrot Fertility. Spotlight on Fertility Care in latin America. August 18, 2022. https://www.get-carrot.com/blog/spotlight-on-fertility-care-in-latin-america. Accessed August 22, 2023.
- 39 | Zegers-Hochschild, Fernando, et al. "Assisted reproductive techniques in Latin America: the Latin American registry, 2017." JBRA assisted reproduction 24.3 (2020): 362.
- 40 | Mohr, Sebastian, and Lene Koch. "Transforming social contracts: The social and cultural history of IVF in Denmark." Reproductive Biomedicine & Society Online 2 (2016): 88-96.
- 41 | Fertility Clinics Abroad. IVF Age Limit: How Old Is Too Old?. November 30, 2020. https://www.fertilityclinicsabroad.com/ivf-clinics-abroad/ivf-age-limit-how-old-is-too-old/. Accessed August 22, 2023.
- 42 | Circles Surrogacy. How Much Does Surrogacy Cost?. June 3, 2023. https://www.circlesurrogacy.com/parents/how-it-works/surrogacy-cost. Accessed August 22, 2023.
- 43 | Piersanti V, et al. Surrogacy and “procreative tourism. What does the future hold from the ethical and legal perspectives?." 2021; Medicina. 57(1) : 47.
- 44 | The Associated Press. NBC News. Japan's Supreme Court upholds transgender sterilization requirement. January 25, 2019. https://www.nbcnews.com/feature/nbc-out/japan-s-supreme-court-upholds-transgender-sterilization-requirement-n962721. Accessed August 22, 2023.
- 45 | Tobias, Tamara, et al. "Promoting the use of elective single embryo transfer in clinical practice." Fertility Research and Practice 2 (2016): 1-9.
- 46 | Stillman RJ, Richter KS, Banks NK, Graham JR. Elective single embryo transfer: A 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice. Fertil Steril. 2009;92(6):1895-1906. doi:10.1016/j.fertnstert.2008.09.023. https://pubmed.ncbi.nlm.nih.gov/18976755/
- 47 | Zegers-Hochschild, Fernando, et al. "Assisted reproductive techniques in Latin America: the Latin American registry, 2017." JBRA assisted reproduction 24.3 (2020): 362.
- 48 | Niakan K. Gomberg J. Rijula E. Satterwhite H. Evaluation of Progyny’s Methodology Used in their Fertility Outcomes Study. July 21, 2022. https://progyny.com/wp-content/uploads/2022/07/Milliman-Report-Evaluation-of-Progynys-Methodology-Used-in-their-Fertility-Outcomes-Study.pdf. Accessed August 22, 2023.
- 49 | Royal College of Obstetricians & Gynecologists. Better for Women. December 2, 2019. https://www.rcog.org.uk/media/h3smwohw/better-for-women-full-report.pdf. Accessed August 22, 2023.
- 50 | European Parliamentary Forum for Sexual & Reproductive Rights. European Atlas of Fertility Treatment Policies reveals mixed picture across Europe. September 12, 2021. https://www.epfweb.org/node/886. Accessed August 22, 2023.
- 51 | Hicks C. Fertility and Family Building Interview. Maven. July 19, 2023.
- 52 | Lobo I et al. Birth defects: Causes and statistics. Nature. January 1, 2018. https://www.nature.com/scitable/topicpage/birth-defects-causes-and-statistics-863/#:~:text=Every%20year%2C%20an%20estimated%207.9,children%20are%20disabled%20for%20life. Accessed August 22, 2023.
- 53 | European Commission. Prenatal Screening and Diagnosis. June 4, 2023. https://eu-rd-platform.jrc.ec.europa.eu/eurocat/eurocat-data/prenatal-screening-and-diagnosis/guide_en. Accessed August 22, 2023.
- 54 | International Foundation of Employee Benefit Plans. Fertility Benefits on the Rise. July 25, 2022. https://blog.ifebp.org/fertility-benefits-on-the-rise/. Accessed August 22, 2023.
- 55 | Washington University Physicians. Fertility & Reproductive Medicine Center. Perimplantation genetic Testing- FAQ. June 5, 2023. https://fertility.wustl.edu/treatments-services/genetic-counseling/preimplantation-genetic-testing-faq/. Accessed August 22, 2023.
- 56 | European Society of Human Reproduction and Embryology. ESHRE Guideline female Fertility Preservation. June 7, 2020. https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Female-fertility-preservation. Accessed August 22, 2023.
- 57 | Maritan-Thomson D. All You Need to Know About Egg Freezing. MDPI. November 1, 2022. https://blog.mdpi.com/2022/11/01/all-you-need-to-know-about-egg-freezing/
- 58 | Patel, R. Family Building Interview. Cleo. June 27, 2023.
- 59 | Muza, S. Dona International. Meet DONA International Doulas Across the Globe during World Doula Week. March 28, 2019. https://www.dona.org/world-doula-week-2019/. Accessed August 22, 2023.
- 60 | Kindbody. Clinical Outcomes and Fertility Benefits: What Every Employer Should Know. https://kindbody.com/clinical-outcomes-and-fertility-benefits-what-every-employer-should-know. Accessed September 1, 2023.
More Topics
Resource-
Executive SummaryFertility and Family-forming Benefits: a Guide for Employers
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Part 1Driving Forces and Emerging Trends Amplifying the Importance of Fertility and Family-forming Benefits
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Part 2The Path to Family Formation: Understanding the Complexities and Challenges
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Part 3Navigation to Reach Better Quality and Affordability
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Part 4Evolving Technologies and Solutions in Fertility and Family Formation
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