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SART found that: Society for Assisted Reproductive Technology, “Preliminary National Summary Report for 2022,” 2022, sartcorsonline.com/​rptCSR_PublicMultYear.aspx?reportingYear=2022.

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Shady Grove Fertility: Shady Grove Fertility, “Shared Risk 100% Refund Program,” accessed August 6, 2023, shadygrovefertility.com/​refund-programs-for-infertility-treatment/.

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Spring Fertility: When I emailed Spring Fertility to clarify their money-back policy, a company spokesperson explained that, for a patient who meets their refund program criteria, Spring refunds all money the patient paid to Spring, which constitutes all treatment costs. This doesn’t include medication costs, which the patient paid to the pharmacy, or anesthesia costs, which were paid to Spring’s anesthesiologists. Spring Fertility, “Live Your Life. Own Your Options,” accessed August 6, 2023, springfertility.com/​knowyouroptions/.

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twenty-one states: RESOLVE: The National Infertility Association, “Insurance Coverage by State,” last modified September 2023, resolve.org/​learn/​financial-resources-for-family-building/​insurance-coverage/​insurance-coverage-by-state/.

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to cover or offer: The distinction is important. A “mandate to cover” is when state law requires health insurance plans to include coverage for a specific benefit (in this case, fertility treatments). A “mandate to offer” requires health insurers to offer coverage, but the person or group buying the policy doesn’t necessarily have to elect coverage for that benefit.

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state-specific examples: RESOLVE, “Insurance Coverage by State.”

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Infertility, a disease: The World Health Organization (WHO), American Medical Association, and ASRM are part of the growing worldwide trend of recognizing infertility as a disease. These entities (and several others) view reproduction as a fundamental interest and human right and maintain that the access, treatment, and outcome disparities associated with infertility care and ART warrant correction. WHO, “Infertility,” April 3, 2023, who.int/​news-room/​fact-sheets/​detail/​infertility.

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defined by physicians: Centers for Disease Control and Prevention, “Infertility FAQs,” last modified April 26, 2023, cdc.gov/​reproductivehealth/​infertility/​index.htm [inactive].

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at least partial coverage: Sometimes, for example, initial diagnostic testing and screening procedures are covered, but the actual fertility treatment isn’t; many insurance plans that do pay for fertility testing say that once an infertility diagnosis has been established, they’ll no longer pay for fertility-related services. That’s absurd, but it comes back to the price tag: Covering diagnostic testing doesn’t cost them very much. Treatment, in the form of IVF or egg freezing, does.

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less limited reasons: Some private sector companies include surrogacy and adoption in their coverage, but most don’t. According to FertilityIQ, only one in five companies that offered fertility coverage also offered coverage for adoption or foster assistance—although average levels of coverage for the latter amounted to around $8,000 per employee versus the $36,000 level allocated for fertility.

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hot new perk: Avery Stone, “More and More Companies Are Covering the Cost of Egg Freezing. But Who Is It Really For?,” Vice, May 26, 2020, vice.com/​en/​article/​ep448j/​more-companies-are-covering-the-cost-of-egg-freezing-who-is-it-really-for-v27n2.

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19 percent: Mercer, “New Survey Finds Employers Adding Fertility Benefits to Promote DEI,” May 6, 2021, mercer.com/​en-us/​insights/​us-health-news/​new-survey-finds-employers-adding-fertility-benefits-to-promote-dei/.

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become a staple: Mercer, “New Survey Finds Employers Adding Fertility Benefits to Promote DEI.”

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Each member receives: Progyny, Member Guide: Understanding Your Progyny Benefit, 2020.

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in their mid-thirties: E. Chronopoulou, C. Raperport, A. Sfakianakis, G. Srivastava, and R. Homburg, “Elective Oocyte Cryopreservation for Age-Related Fertility Decline,” Journal of Assisted Reproduction and Genetics 38, no. 5 (2021): 1177–1186, doi.org/​10.1007/​s10815-021-02072-w.

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travel abroad for a better deal: Alyson Krueger, “Have Eggs, Will Travel. To Freeze Them,” New York Times, April 8, 2023, nytimes.com/​2023/​04/​08/​style/​egg-freezing-procedure-travel.html.

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alimony can finance: Marcia C. Inhorn, Motherhood on Ice: The Mating Gap and Why Women Freeze Their Eggs (New York: New York University Press, 2023), 74–75.

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“We pay too much”: Jia Tolentino, Trick Mirror: Reflections on Self-Delusion (New York: Random House, 2020), 87.

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twenty-one states: “Tracking Abortion Bans Across the Country,” New York Times, last modified December 8, 2023, nytimes.com/​interactive/​2022/​us/​abortion-laws-roe-v-wade.html.

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“The United States has”: Emily Witt, “The Future of Fertility,” New Yorker, April 17, 2023, newyorker.com/​magazine/​2023/​04/​24/​the-future-of-fertility.

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could mean impaired access: Gerard Letterie and Dov Fox, “Legal Personhood and Frozen Embryos: Implications for Fertility Patients and Providers in Post-Roe America,” Journal of Law and the Biosciences 10, no. 1 (2023), doi.org10.1093/​jlb/​lsad006.

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“personhood laws”: Wendy Davis, “The Next Big Battle in America’s Abortion Fight Will Be over Fetal Personhood,” NBC News, October 23, 2022, nbcnews.com/​think/​opinion/​americas-abortion-law-fight-will-fetal-personhood-rcna53477.

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raises all sorts of questions: Chabeli Carranza and Jennifer Gerson, “IVF May Be in Jeopardy in States Where Embryos Are Granted Personhood,” The Guardian, July 16, 2022, theguardian.com/​society/​2022/​jul/​16/​ivf-anti-abortion-states-embryos-personhood.

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could become illegal: Krys Mroczkowski, Colleen Ammerman, and Rembrand Koning, “How Abortion Bans Will Stifle Health Care Innovation,” Harvard Business Review, August 8, 2022, hbr.org/​2022/​08/​how-abortion-bans-will-stifle-health-care-innovation.

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public universities in Idaho: Rebecca Boone, “Idaho Universities Disallow Abortion, Contraception Referral,” Associated Press, September 27, 2022, apnews.com/​article/​abortion-health-legislature-idaho-birth-control-bd238c572da10d812ef5ba93f1860fc5.