After months of monitoring, daily stomach stabs from hormone-filled needles, egg counts creeping into my dreams, this is it. It’s a sunny Saturday morning, and my husband and I are watching our one viable embryo travel through a catheter to its new home in my uterus. If all goes well, it’ll settle in and get cozy for the next nine months. Maybe it’s the Valium, but watching the ultrasound screen feels like some sort of embryonic reality show—a high-production reality show with no guarantee of a rose at the end.
I work for a tech company, and thanks to a progressive work perk, I’m on round 1 of IVF here at the fertility clinic. As easy as it is to hate on tech companies, Silicon Valley deserves all the likes for leading the way on fertility benefits. Many tech companies have recognized that infertility should be treated as legitimately as mental health — not to mention the competitive edge these benefits give when it comes to recruiting top talent, job satisfaction, employee retention, and building a strong family-friendly culture.
“We know that infertility doesn’t discriminate, but the ability to pay definitely does.”
I never thought I’d need help on the family-building front, but here I am. After several miscarriages that resulted from trying to have a second child — an issue called “secondary infertility,” which affects millions of women every year — my womb-fire baby pangs were strong enough that I decided to take advantage and put science to the test.
As grateful as I am for this benefit, I also find it problematic. My friends who aren’t in tech have their own fertility struggles, but they don’t have the same access. And neither do 73% of Americans without fertility coverage. Although infertility is recognized as a disease by the American Medical Association and the World Health Organization, the majority of U.S. health-insurance plans don’t cover access to reproductive medicine. How does that stack up next to other countries?
“Almost all European Union countries provide some state funding for assisted reproductive technology,” said Betsy Campbell of RESOLVE: The National Infertility Association. “Australia has publicly funded IVF. Israel provides free IVF for up to two live births. The U.S. lags behind. Only 11 states require IVF coverage, and within those, there are still limitations.” Not a shocker for a country that doesn’t make basic family assistance, such as parental leave and childcare support, a priority.
“Three out of four people never obtain the treatment they need. Only those who can afford it or who live in a certain state or who work for a company that provides benefits can get access to care. It means certain populations, like low-income patients of color, are underrepresented in the patient population.”
On top of the brutal emotional and physical toll of infertility — the crush of disappointing pregnancy tests, the frustration of having no control, the hormonal turbulence with every false start — the cost barrier to access only twists the knife. Shelling out $20,000+ for a single round of IVF simply isn’t an option for many who are paying out of pocket, and that leaves a gaping hole with respect to who can pursue treatment. “We know that infertility doesn’t discriminate, but the ability to pay definitely does,” Campbell said. The prohibitive cost brings to the forefront a deeply uncomfortable question: Who gets to have a baby?
“Three out of four people never obtain the treatment they need,” Campbell told me. “Only those who can afford it or who live in a certain state or who work for a company that provides benefits can get access to care. It means certain populations, like low-income patients of color, are underrepresented in the patient population.” If you’re not on the right side of the income gap, you’re left to figure out financing and potentially take on debt, pursue riskier (but more economical) treatments that can result in multiple births, seek out cheaper (but potentially unregulated) procedures overseas, or simply give up on the dream of building a family. Knife-twisting in action.
This issue isn’t going away, especially as women in the workforce wait longer to have children. Thankfully, there are reasons to feel hopeful. Senator Cory Booker introduced the Access to Infertility Treatment and Care Act in Congress last year, which would guarantee coverage at a federal level. This topic also made its way to the 2020 election platform. Democratic presidential hopeful Kirsten Gillibrand recently proposed a Family Bill of Rights, which would “make it easier for everyone to start a family — regardless of your income, race, or gender.” Her proposal includes required insurance coverage of IVF. Gillibrand gets it: “Fertility treatments are expensive and often out of reach. These services should be accessible and affordable for any family that needs them.”
While access to such resources doesn’t guarantee a baby, it would even out the playing field with regard to who gets the chance, especially for those who are able to have children only through IVF—the LGBTIA population. Building a family for same-sex couples can be riddled with obstacles, especially since adoption discrimination can leave them with no other option. That ultimately makes IVF access an equal-rights issue. A friend who recently went through several rounds with her partner reminded me that fertility treatments are the only way they can get pregnant as lesbians. “We desperately need this benefit,” she told me, along with the 63% of LGBTQ millennials considering having children, who’ll need assisted reproductive technology when the time comes.
So while legislation crawls through Congress, what can you do in the meantime? There are scholarships and grants available, and Campbell also recommends personal advocacy at work. “Honestly, the best way is to just make the ask. Talk with your employer and HR. Often it takes just one person asking.” Provide proof that it’s not only the right thing to do, she said, but also that it makes financial sense. “There’s a misperception that cost will go up significantly for employers with coverage, but studies show the impact on premiums is less than 1%.” There’s minimal impact on the bottom line, she argues, and a positive impact on employee retention. “Employees who receive full IVF coverage stay in the job longer.” Tech companies are clearly onto something, and it’s time for the rest of the country to catch up.
Back on the big screen, our little cell cluster disappears into a black ultrasound abyss. And now comes the nail-biting, two-week wait. While we’re bracing for disappointment, there are hot flashes of hope. Binge-watching Fleabag and late-night embroidery help take the edge off. But no matter what happens at the end of this hormone rodeo, I’m grateful that I’ve had the chance to give it a go. IVF isn’t for the faint of heart, but I keep reminding myself that I’m one of the lucky ones. Not everyone gets this chance, but everyone should.
