In 2013, Katie Lelito was a graduate student and research assistant at the University of Michigan. She and her husband were ready to start a family, but months of trying brought no success.
Tests lead to an infertility diagnosis and one possible solution for conception: in vitro fertilization (IVF). Unfortunately, the expensive treatments–which run about $10,000 each and come with no guarantee–weren’t included in Lelito’s healthcare coverage, and she and her husband couldn’t afford it themselves. Their only alternative was to petition her employer for coverage. Lelito started with a letter-writing campaign using templates provided by Resolve, a national infertility association.
“I tailored the letter to my position, and argued that the university tries to get women to stay in the sciences,” she says. “That means we often put off our reproductive lives. They cover Viagra, abortion, sterilization and birth control, but they don’t cover fertility treatments. That doesn’t create a welcoming environment in science.”
According to a 2010 National Survey of Family Growth from the CDC, 1 in 8 couples struggle with infertility, but less than 30% of employers provide coverage for treatments. Lelito wasn’t going to let the statistics stop her. For more than a year, she continued to write letters, speak to university officials and state legislators, and make her personal story public. In October 2014, the University of Michigan decided to add infertility benefits to its 2015 healthcare open enrollment, providing up to $20,000 for IVF after a diagnosis.
Unfortunately, the announcement was too late for Lelito, who had taken a job as a neurobiologist at a North Carolina-based chemical company. And she was back to square one–her new employer didn’t offer infertility coverage.
“I had learned that it helpful to assume good intent–assume your employer doesn’t know that this benefit is important to employees,” says Lelito. She attended an HR event and asked if they’d be willing to cover IVF. The HR representative brought the suggestion up the chain of command, using a letter Lelito wrote. A month later, they added the benefit, offering $10,000 lifetime maximum of treatments.
“We’re seeing a new focus on benefits for parents, such as IVF reimbursement,” says Dorothy Miraglia King, executive vice president of Engage PEO, a human resources outsourcing firm. “While there is heightened awareness of fertility benefits due to announcements from Apple and Facebook about egg-freezing, (fertility) coverage is not common.”
According to the 2014 employee benefits report by the Society for Human Resource Management, 84% of organizations provide health insurance coverage for contraception, but only 29% provide infertility services. Currently, 15 states require employers to offer fertility coverage but benefits vary; King says most of the companies that offer benefits are headquartered in one those states.
Gina Bartasi, CEO and founder of the online fertility-information source FertilityAuthority, hasn’t seen much change in the number of companies offering fertility benefits since her organization was founded six years ago.
“The majority of patients are still responsible for paying for their treatments,” she says. “The states that mandate coverage are relatively generous in what they offer, but in light of the Affordable Care Act, benefits are being reduced instead of increased.”
Getting more companies to offer coverage might have a simple solution. In 2006, Resolve surveyed 900 employers and found those that offer coverage reported that the number one reason it had been added was because an employee asked for it.
“Infertility isn’t just a woman’s condition,” says Barb Collura, president and CEO of Resolve. “Male employees want to have families as well. The best way to get your employer to consider adding the benefit is to share your personal story. Discussing the financial and emotional impact will open eyes in companies.”
But this takes bravery, admits Lelito: “You’re basically saying. ‘I would like you to help me get pregnant so I can leave my job in nine months,’” she says. “The truth is that now I’m a loyal employee now because they did that for me.”
Lelito believes most companies are unaware of infertility and its intricacies: “We turn women into villains: they put off having children and then we blame them for infertility,” she says. “Infertility is a malfunction of the human reproduction system, but we still view it like it’s a cosmetic procedure–something for the wealthy who can afford it. We need to start talking about it and making it more acceptable.”
One reason companies decline coverage is because some argue that it’s too experimental; depending on the age of the woman, the success rate is 40% or less, according to the Society for Assisted Reproductive Technology.
“It’s still the standard of care for infertility,” says Lelito. “Until something else comes along, it’s all we have.”
From an employer standpoint, offering fertility treatment coverage is a recruiting and retention tool, Bartasi says. “We all know that women are waiting to get married and have children,” she says. “It’s a challenge because a female’s most productive professional years conflict with her most fertile years.”
Collura is hearing from insurers that finance and hi-tech companies are leading in adding this benefit, and she believes adding fertility benefits says to employees, “We care about you.” “More companies want to be attractive to women,” she says. “If one out of eight is going through this, then this benefit is going to be just as important as adoption.”
King says companies are trying to find the middle of the road and meet the needs of all of their employees. “You can’t be everything to everyone,” she says. “You have to provide resources and access to services, but the key is to focus on employee wellness. Businesses in today’s economy also have goals, objectives and financial considerations to take into account when deciding these policies.”
Bartasi is hopeful for the future. “Right now it’s still a relatively expensive proposition for employee and employer,” she says. “I anticipate that as there is more competition between providers, fertility prices will come down.”
FertilityAuthority is helping make that happen by building a mobile app on which patients can pre-purchase IVF treatments. The app will provide physician information, prices, patient reviews, and success rate.
“Transparency will help level the cost associated with IVF,” says Bartasi. “Once price comes down, more employers will be able to afford to offer it.”
Lelito and her husband used their new coverage, but the treatments didn’t result in a pregnancy. She’s advocating for other women by sharing what she learned on her blog, helping others make changes in their own companies.
“The real power is going to come from people like Katie who are willing to share their stories,” says Collura. “It happened with women and breast cancer and it happened with AIDS. What a difference they made. We need to urge people to think about it that way. If people don’t speak up, it’s never going to happen.”