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The conversation about fertility—whether you’re thinking about kids in the near future or not—is still plagued by anxiety-inducing messages that keep women up at night picturing a ticking biological clock. Women deserve better—no fear mongering, just facts. So Glamour took the pulse of what women do and don’t know about their reproductive health to bring you the Modern State of Fertility.
Gina, 37, a teacher from the Midwest, needed to pay for another round of fertility treatments. She conceived her first daughter through in vitro fertilization (IVF) in 2013 and wanted to continue growing her family, but with a diagnosis of poor egg quality, recurring cysts, and stage IV endometriosis, another round of IVF was her only option.
The cost, however, put it out of reach. A single round of IVF rings in at about $20,000 on average, once you tally up the procedure itself along with a long list of other out-of-pocket expenses: medication, consultations, genetic screening. Most families pay for IVF out of pocket, and many rack up serious medical debt in the process—one survey by an online lender of 200 women undergoing fertility treatments found 44 percent of women were left at least $10,000 in debt after fertility treatments—making insurance coverage of fertility treatments a rare but game-changing beacon of hope. As a teacher (and track and cross-country coach), Gina didn’t have fertility benefits, which can potentially cover anything from IVF to egg freezing to fertility testing, so she took a third job as a barista at Starbucks, where a part-time gig was enough to get the insurance coverage she needed. “I don’t drink coffee and I knew nothing about coffee, but at the end of the day, I was there for a specific reason: insurance coverage,” she says. During her time at Starbucks, Gina went through another successful round of IVF and gave birth to a healthy baby girl.
An estimated 10 percent of women in the United States deal with infertility. For those trying to conceive, companies that offer fertility benefits are becoming incredibly enticing. “Women of childbearing age are now looking at a company’s fertility coverage and what type of leave policy they have, and it’s impacting their choices on a job they would take,” says Tania Paredes, Ph.D., a licensed clinical social worker in Miami. In a recent survey conducted by Glamour and fertility testing company Modern Fertility, 59 percent of women said they would choose an employer that provided coverage for fertility treatments like IVF over one that didn’t; 55 percent also said they’d choose an employer who covered annual fertility testing over one that didn’t.
Because companies offering such benefits are still scarce, over 70 percent of women who undergo fertility treatments do so with zero coverage, according to data from FertilityIQ, an online resource for fertility patients. That means women dealing with infertility are forced to spread themselves even thinner to get treatment. Paredes has had patients who, like Gina, took a second job just to get fertility benefits, which means tacking on at least another 20 hours to an already packed schedule, “all the while trying to stay mentally healthy for fertility treatments,” she says.
It also means many women are cornered into jobs they hate just to keep their coverage. Angela, 33, from Springfield, Missouri, decided to stick it out in her role at a call center for a large bank after she was diagnosed with polycystic ovary syndrome (PCOS), a condition that can severely impact fertility, six years ago. “My career path has been heavily dictated by infertility coverage,” she says. “My husband and I have an agreement: He's free to pursue his career dreams and make better money, and I'll stick with the employer that offers good coverage.” She stayed in her job through one round of IVF, which was successful, but “it was pretty soul-crushing,” she says. “The hormones and balancing doctor’s appointments with that wasn’t helping.” After she got pregnant, she started looking for a new job.
Not all fertility treatments result in pregnancy. According to the European Society for Human Reproduction and Embryology, 77 percent of assisted reproductive cycles performed globally every year fail. Without coverage, women are left to cope with the bitter combination of not having a baby and still paying the tremendous costs of having tried for one. “IVF has helped a lot of people, but there is a silent majority of people who haven’t been helped by it and don’t talk about it,” says Miriam Zoll, a health and human rights advocate who is the author of Cracked Open: Liberty, Fertility, and the Pursuit of High-Tech Babies.
Kati, 32, from Columbia, Maryland, strategically maneuvered her career based on insurance coverage. “I was willing to downgrade what I was doing,” she says. “I was willing to do office work or work as an administrative assistant or do whatever I needed to do just to have that insurance.” She got lucky, though, eventually landing a dream job with dream fertility benefits: 100 percent coverage for IVF up to three attempts per live birth.
But after three IVF retrievals and six embryo transfers, she hasn’t had a successful pregnancy. “I’ve had seven miscarriages. We’re exploring surrogacy or thinking about living child-free—it’s heartbreaking at this point,” she says. “I didn’t think we’d be here, but at the same time, I feel grateful for our insurance coverage. If I didn’t have it, we couldn’t even consider surrogacy—all of my money would have gone to one IVF cycle and that would be it.”
Fertility insurance does have its restrictions: Insurers require a medical diagnosis of infertility, which is defined as an inability for a heterosexual couple to conceive within 12 months. That excludes same-sex couples and single women who want to pursue IVF with donor sperm.
But some Silicon Valley companies are setting a new standard for fertility coverage. Female-founded benefits company Carrot works with companies like Foursquare and Coinbase to provide fertility benefits regardless of an employee’s diagnosis or treatment needed. Companies choose how much coverage they want to provide each employee (which could range from $10,000 to $50,000 or more per person), giving them full access to fertility testing, IUI (intrauterine insemination), IVF, egg freezing, sperm freezing, donor eggs, donor sperm, gestational carriers (surrogates), and adoption—regardless of age, gender, or sexual orientation.
A woman’s family planning goals should be respected just as much as her career goals, says Tammy Sun, CEO and cofounder of Carrot. She suggests that if you’re already in a role you love but your company doesn’t offer fertility benefits, advocate for them: “Go to leadership at your company or to your HR or benefits team and say, ‘Hey, here is the problem that we see with the lack of fertility coverage at work—we see fertility as a fundamental part of health care.’” If you’re job hunting, Fertility IQ, Glassdoor, and Monster compile lists of companies that offer remarkable fertility benefits. And when you’re in the negotiation phase for a new job, ask whether fertility coverage is on the table. “We have many companies come to us and say that they have a candidate and she’s asking for fertility benefits but they have nothing, so they want to set something up right away,” Sun says. “Just by asking, you could get what you want.”
Fertility benefits should be considered as standard as any health insurance—treating infertility shouldn’t leave women broke or forced to derail their careers to find coverage, advocates say. “We are not choosing to be infertile, we’re not choosing to need this treatment,” Kati says. “The body is not working in the way it should be. That should be covered just like heart disease, diabetes, or any other illness.”
Minhae Shim Roth is an essayist, journalist, and academic. Follow her on Instagram @by_minhaeshimroth and on Twitter @minhaeshimroth.
