What should fertility benefits look like? Reproductive endocrinologists weigh in

Fertility benefits are steadily rising in importance among top employers, and for good reason. Long treated as niche, fertility care is becoming more mainstream, both due to the preponderance of need and to the significant barriers to access that exist in today’s healthcare system. In offering fertility benefits, employers are looking to mitigate the impacts of exorbitant costs, inaccessible care, and the combined physical and mental toll of the family-building journey.

However, awareness of the need for fertility support is rising in tandem with the number of approaches to meet it.  A number of vendors have emerged offering different approaches to supporting employees’ fertility needs: some offer narrowly-focuses support on reimbursement for fertility services, while others focus on holistic fertility needs including but not limited to access to providers, clinics, and coaching.

But there is more to fertility and family-building than ovulation and hormone tests and IVF cycles, and there are many steps that employees can take before turning to IVF or IUI. And for the 70% of LGBTQIA+ individuals looking to expand their families, fertility support based on a diagnosis of infertility leaves them out of the conversation entirely. The question remains: how should employers think about fertility care in the workplace, and what should they look for in the sea of fertility care vendors?

We sat down with Drs. Brian Levine and Wael Salem, board-certified reproductive endocrinologists with CCRM, a leading clinic network in the US and Canada, to better understand the features that define best-in-class fertility benefits, and how employers can deliver evidence-based care that meets the needs of their entire population.

“What I wish I could do is connect them with educational resources and other kinds of support that could help with the natural anxiety many people have about starting a family — that’s a huge need.”
- Dr. Brian Levine

The provider’s perspective on fertility benefits

As reproductive endocrinologists, Drs. Levine and Salem are responsible for working with individual patients to tailor treatment plans that make sense for their circumstances. However, they often find themselves meeting with patients far earlier in their respective journeys than clinical guidelines recommend. Drs. Levine and Salem say that most benefits over-emphasize medical treatments, and in some cases, even drive employees to pursue them before they are necessary. 

The two physicians believe this is primarily due to patients’ lacking access to what Dr. Salem refers to as “common sense optimization of fertility,” including proper timing of intercourse, avoidance of spermicidal lubricants, and even ED treatment. Additionally, they believe providing access to mental health support and proper preconception care can make a meaningful difference, but many health plans do not adequately cover these services. 

“I have many patients seeking treatment because they’re anxious about their ability to get pregnant in the future, but they actually don’t need to pursue something like IVF yet,” Dr. Levine says. “What I wish I could do is connect them with educational resources and other kinds of support that could help with the natural anxiety many people have about starting a family — that’s a huge need.”

Dr. Salem notes that this more expansive definition of fertility care is better supported by scientific evidence—it’s also far more patient (and employer) friendly due to positioning invasive, expensive treatments like IVF as reactive rather than proactive treatments. 

“There’s a lot of misinformation around what kind of treatment needs to be done, even among those with access to fertility support through work, ” says Dr. Salem. “The vast majority of infertility care is actually really simple and inexpensive. We should start by optimizing preconception care, adjusting lifestyle factors, or timing ovulation. But based on my experience in the clinic, I think a lot of people aren’t getting this kind of support.”

Dr. Levine notes that some of his patients feel compelled to pursue treatments like IVF or egg freezing by anxiety about their fertility. “I do think there is an aspect of fear at play. We want pregnancy to happen right away. But totally healthy people would only be expected to get pregnant 20% of the time in a given month. So you have this big gap between the individual’s experience and the way their healthcare has been set up to help them. You’re either getting IVF, or you’re on your own.”

Aligning incentives between patients, providers, and vendors

According to Dr. Salem, that so few of his patients seem to have access to proactive preconception and fertility care speaks to the misaligned incentives between patients, providers, and benefits vendors. “When your only options are to go to a clinic, it gives this warped idea of what fertility is about,” says Dr. Salem. “When you have more personal support that helps you make the right decisions for your wellbeing, that helps everybody—the patient, the provider in the clinic, and the employer or insurer ultimately responsible for cost of care.” 

For employers providing healthcare for their workforce, offering that kind of support requires a better understanding of all that goes into a healthy experience in the first place, Dr. Salem says. “Excellent fertility care starts with providing reliable, accessible information for the individual,” he says. “It should help to dispel misconceptions about how long getting pregnant should or shouldn’t take. It should also help contextualize tests that people might be taking on their own, and offer simple ways to improve the likelihood of getting pregnant, including adjustments to diet and exercise. And finally, if necessary, it should help people determine when they need to seek help through a fertility clinic.”

Dr. Salem says that solutions that focus on in-clinic treatment ultimately fail to meet the breadth of needs within an employee or member population. 

“A fertility benefit that is designed to provide financial coverage for treatment alone does not make sense to me,” he says. “It excludes the vast majority of infertility cases where people need support and guidance and are vulnerable to misinformation. It’s not enabling everything that healthcare can actually do to help people grow their families.”

“Right now, there is a dearth of evidence-based resources. Many solutions on the market are giving people too much care or not enough—usually too much on the medical side and less on the support and guidance side.”
- Dr. Brian Levine

Designing an inclusive, outcomes-based fertility program

To Dr. Levine, fertility is at a tipping point. Advancements in research and technology are making certain treatments more effective, and there is growing recognition from both employers and health plans that fertility is a core component of healthcare. What’s needed are solutions that are capable of delivering the right support at the right time for individuals and their families.

“Right now, there is a dearth of evidence-based resources,” says Dr. Levine. “Many solutions on the market are giving people too much care or not enough—usually too much on the medical side and less on the support and guidance side.”

 Dr. Salem agrees. An effective fertility benefit, he says, should be founded on a team-based approach that positions fertility doctors like himself as part of a broader ecosystem of support. “I would like to see fertility treated with the breadth and depth it deserves,” says Dr. Salem. “The care I provide as a physician is one component, but there are lots of other aspects. And the patient needs someone who is their guide through the whole experience.”

Still, Dr. Levine is optimistic about the future of fertility care, especially when he considers how far the space has come since he first started practicing. “It is absolutely incredible to see the extent to which employers and insurers have embraced fertility — as a provider, I am ecstatic,” says Dr. Levine. “But for patients, making IVF cost less is really the floor of what we can do. We can give so much more to people. We have to.”