September 07, 2023

Innovation in fertility treatment is evolving rapidly. By staying aware of advancements, employers can adapt their fertility and family-forming benefit offerings to include the latest technologies and solutions, providing employees with access to cutting-edge care and support while increasing their chances of achieving successful outcomes. Some of these advancements include, but are not limited to, at-home tools, applications in genetic testing and cryopreservation.

This section delves into the latest technologies and services that are shaping the field of reproductive health. Additionally, it explores benefits and strategies that employers can actively utilize to support employees throughout their journey of building a family.

Genetic Testing

Globally, 6% of babies are born with a genetic disorder. Prenatal genetic testing has the potential to help parents-to-be understand genetic risks.⁵² Unlike other countries, there are no regulations concerning the use of preimplantation genetic testing (PGT) in the U.S. For example, the regulatory system in the U.K. uses a committee to evaluate the severity of a condition and decide if testing is needed. Many other European countries allow limited testing during the first trimester.⁵³ In the U.S., roughly 16% of employers cover genetic testing as part of their benefit design, which is up from 12% in 2020.⁵⁴ Table 2 shows examples of three PGTs applicable to fertility treatments.

Table 2: PGTs Applicable to Fertility Treatments

	PGT-A: Aneuploidies	PGT-M: Monogenic Disorders	PGT-SR: Structural Rearrangements
Overview	Assessment of embryonic cells to determine whether they have the correct number of chromosomes, as embryos with the incorrect number of chromosomes tend not to implant, resulting in miscarriages or the birth of children with genetic disorders.	Looks for specific inherited conditions controlled by a single gene (e.g., Huntington’s disease or sickle cell disease).	Examines specific chromosomal abnormalities.
For Individuals	Used for individuals with history of inherited genetic disorders, known carriers of a chromosomal abnormality or experienced repeated miscarriages or recurrent failed IVF cycles.	Used only in specific conditions where the patient, their partner and/or donor are a carrier.

Fertility Preservation

Oocyte cryopreservation (egg freezing), embryo cryopreservation (freezing a fertilized egg) and cryobanking (sperm banking) are available and generally covered as medically necessary for those who may become infertile as a result of medical treatment for a disease such as cancer. Coverage for those looking to preserve their fertility for options in the future without the underlying medical condition is generally not offered under a health plan, though some employers are choosing to provide it as an additional benefit. Demand for customized and affordable cryopreservation services is spiking, with 56% of large employers offering the benefit to employees.¹¹ The optimal timing for a woman to freeze her eggs for a higher success rate is under 35 years, as after this age, the quality and number of eggs decline.⁵⁶ Increasingly, men are pursuing sperm freezing as well; vendors selling at-home sperm virility testing kits are rapidly entering the fertility preservation market. Employee needs differ considerably, so employers can weigh them separately when defining their coverage for these services. While the practice of egg freezing is increasing worldwide, certain countries still have restrictions, particularly in parts of the Asia Pacific like Australia.⁵⁷

The Role of Virtual and At-home Tools

Virtual care has become an integral part of the services offered by traditional brick-and-mortar providers. However, with most fertility clinics located in metropolitan areas, access to fertility specialists in certain geographical areas may be a challenge, even among those with the means to afford the treatment. Through virtual and at-home tools, employers can capitalize on the opportunity to improve access and reach patients that may not otherwise have convenient access to fertility care. According to the Business Group’s 2024 Large Employer Health Care Strategy Survey, 49% of large employers will offer virtual reproductive health services to employees in 2024, with an additional 13% considering doing so for 2025/2026. While virtual fertility solutions are gaining traction worldwide, the United States stands at the forefront of this progress.⁵⁸

Support Groups

For those struggling to form a family, it may be helpful to connect with others who are going through the same challenges. Employers can offer to organize a group for discussion or guide individuals to online directories where they can find virtual or in-person peer-led and professionally led support groups. Some large employers have employee resource groups (ERGs) specifically for employees who are parents and/or are expecting parents that can also serve as a source of relevant information and support.¹¹

Doula Support

Doulas are increasingly being considered and offered by employers as a way to address disparities in reproductive health outcomes during the fertility and family-forming process. They can serve as a liaison between the patients/families and medical professionals, providing emotional support and informational guidance throughout fertility treatments and the birthing process. In addition, doulas may enable families and individuals to better advocate for themselves throughout their health care journey.

DONA International certifies doulas in more than 50 countries. Doulas in each country bring forth their own unique remedies and traditions, offering support to families during pregnancy and in the postpartum period.⁵⁹

Employer Recommendations

• 1 | Optimize benefits: Reassess fertility treatment benefit limits to establish an equitable design that prioritizes the latest technologies and best practices.
• 2 | Educate employees about available resources: Actively communicate and educate employees about the range of reproductive health resources and support available to them.
• 3 | Provide skilled emotional support: Work with your mental health solution partners and employee assistance program (EAP) to provide access to emotional support during the fertility journey or counseling resources for individuals struggling with infertility.
• 4 | Provide access to doulas: Provide affordable access to certified fertility doulas to support patients during the entire fertility journey.
• 5 | Evaluate the best ways to provide access to fertility drugs based on your fertility benefit design: Assess the cost-effectiveness of fertility medications and their potential impact on employees' financial burden

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

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