Driving quality through plan design, programs and communications.
- Large employers are increasingly offering coverage of fertility treatments and fertility preservation services, as well as expanding the population
- More employers are partnering with specialty vendors to meet increased demand for comprehensive coverage for fertility treatments.
- Advances in pre-implantation genetic testing for aneuploidies (PGT-A) have improved the overall efficacy of achieving pregnancy through assisted reproductive technologies.
Definitions of Infertility
- Primary infertility is the inability to become pregnant or carry a pregnancy to a live birth after 12 months of timed intercourse or physician-supervised donor insemination.i Women aged 35 years and older are considered infertile after 6 months of trying to conceive. Secondary infertility applies to couples who have been able to have a child or children in the past but are now unable to conceive.ii
- Health plans generally adhere to these clinical definitions of infertility when determining eligibility for fertility treatment coverage. These definitions are predicated on achieving pregnancy through either heterosexual intercourse or therapeutic donor insemination, thereby including single parents by choice or LGBTQ couples. Self-insured employers can choose to alter the criteria for coverage, including entirely removing any time requirements.
This benefit manager guide discusses the range of fertility treatments and how to design plans to support evidence-based approaches to fertility treatment. The guide provides recommendations to employers looking to implement changes in their fertility coverage and align current or future benefit offerings with evidence.
Fertility Treatments: Background and Impact on Employers
The Centers for Disease Control and Prevention (CDC) estimates that 6% of married women and 9% of men struggle with some form of infertility.iii As a result, 12% of women aged 15 to 44 have experienced difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status.1 Clinical advances in fertility treatments have increased their efficacy and highlight the need for an innovative benefits package that gets them to the most efficient and cost-effective options available.
Employers have an important stake in helping employees and dependents who pursue fertility treatments find high-quality providers and utilize the most effective treatments. Coverage for evidence-based fertility treatments can improve maternal and child health quality outcomes and reduce employee and dependent medical costs.
Some companies that do not have a fertility benefit program in place cite cost as a barrier to implementation. They also may view fertility benefits beyond diagnosis and treatment of an underlying medical condition causing infertility as non-essential (i.e. not medically necessary). However, implementing an evidence-based fertility benefit or navigator program can prove to be cost effective for large employers. Offering little or no benefit for fertility treatments may save some money for the company up front, but employees fully paying out of pocket may be more likely to seek less expensive treatments that increase the likelihood of multiple gestations, which on average result in poorer maternal and child health outcomes and much higher medical costs.
Multiple gestations (i.e. twins or triplets) are associated with a host of serious health problems for both mothers and their babies. Mothers are at increased risk for preeclampsia (pregnancy-induced high blood pressure) and more often deliver before the pregnancy reaches full term. Preterm delivery often results in babies who are frail or have underdeveloped lungs. These problems are costly: in 2013, the total all-cause health care costs for delivery of a singleton was $21,458, compared to $104,831 for twins and $407,199 for higher-order multiples.iv For these reasons, many employers are exploring programs and benefits that promote evidence-based fertility treatments, which strive to achieve a single, healthy gestation.
Summary of Recommendations:
- Reassess eligibility determinations for fertility treatments to reflect the diverse needs of your workforce
- Steer members toward high-quality providers who follow evidence-based protocols and deliver superior clinical outcomes.
- Re-examine limits to fertility treatment benefits to ensure they do not inadvertently drive employees to get the “biggest bang for their buck” and forgo use of latest technologies and best practices like single embryo transfers.
- Ensure there are adequate connections between fertility benefits, maternity programs and other supplemental services and supports for new parents.
- Educate employees about available fertility benefits and programs.
Reasons Employers Should Consider Offering Fertility Benefits
- Meeting the demands of the changing workforce
For some companies, offering fertility benefits as part of the benefits package can help attract top talent. A growing number of large employers have chosen to implement or expand their fertility benefits in recent years both as a sign of goodwill towards their employees, as well as a strategy to combat attrition rates among women as they progress in their careers.v According to a survey of patients who received full coverage of their treatment cycles, many respondents reported feeling a greater sense of loyalty and commitment to their employers as a result.vi
ome employers are providing benefits to employees to proactively help them conceive in the future. The market for egg freezing is projected to grow twenty-five percent annually until at least 2020.vii Offering coverage for fertility preservation services afford employees flexibility in building their careers before starting a family.viii Vendors are also beginning to offer men the option of freezing their sperm for fertility preservation, signaling potential growth in demand for such services.
- Decreasing the rate of multiple births within their employee populations
Multiple gestations pose risks to the mother and her babies compared to a singleton delivery. The rise of multiple birth rates has often been associated with expanded use of fertility therapies, such as ovulation-inducing drugs and assisted reproductive therapies (ART), with an estimated 1.6% of 2013 births being the result of ART alone.ix Between 1980 and 2011, the rate of twin births rose 76 percent.x Triplet and higher-order multiple birthrates have declined in recent years, with the 2015 rate being the lowest in 21 years; changes in ART procedure that limit the number of embryos transferred have likely contributed to this decrease.
Many complications are associated with multiple births, which can result in an increased need for neonatal intensive care unit (NICU) treatment an added distress for the employee and his or her family. These complications include but are not limited to:
- Preeclampsia: This serious complication is twice as likely to happen with a twin gestation than with a singleton. In some cases, babies of mothers with preeclampsia are delivered early to ward off complications. xi
- Increased risk for a Cesarean section (C-section): Almost 90% of twin deliveries and virtually all higher-order multiple deliveries are done via C-section.xii This method of delivery raises the risk of mortality and complications for the mother and babies. The recovery for the mother is prolonged as well.
- Premature birth: 60% of twins, 90% of triplets and nearly all quadruplets are born prematurely.xiii
- Low birthweight: More than half of twins and virtually all higher-order multiples are born at a low birthweight, as it is generally related to preterm delivery.9
- Gestational diabetes: Women carrying multiples are at a greater risk of having high blood sugar, possibly resulting in larger babies, which can cause danger to the mother and babies during birth.9