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And they’re going up: Yeganeh Torbati, “With Egg Freezing Increasingly Common, Fertility Clinics Hike Storage Fees,” Washington Post, April 14, 2023, washingtonpost.com/business/2023/04/12/egg-freezing-storage-prices/.
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on average, 2.1 cycles: FertilityIQ, “Egg Freezing: The Costs of Egg Freezing,” accessed January 8, 2023, fertilityiq.com/egg-freezing/the-costs-of-egg-freezing.
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“Welcome to the fertility casino”: Ron Lieber, “A Baby or Your Money Back: All About Fertility Clinic Package Deals,” New York Times, April 14, 2017, nytimes.com/2017/04/14/your-money/baby-fertility-clinic-package-deals.html.
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“Meet Prelude Fertility”: Miguel Helft, “Meet Prelude Fertility, The $200 Million Startup That Wants to Stop the Biological Clock,” Forbes, October 17, 2016, forbes.com/sites/miguelhelft/2016/10/17/prelude-fertility-200-million-startup-stop-biological-clock/?sh=7c175af87260.
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“envisioned a new norm”: Anna Louie Sussman, “The Promise and Perils of the New Fertility Entrepreneurs,” New Yorker, May 19, 2021, newyorker.com/tech/annals-of-technology/the-promise-and-perils-of-the-new-fertility-entrepreneurs.
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Bundl also promises: Bundl, “Peace of Mind with Shared Risk IVF,” accessed August 27, 2022, bundlfertility.com/peace-of-mind-with-shared-risk-ivf/.
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“We are now targeting”: Ruth La Ferla, “These Companies Really, Really, Really Want to Freeze Your Eggs,” New York Times, August 29, 2018, nytimes.com/2018/08/29/style/egg-freezing-fertility-millennials.html.
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“The more friends”: OVA, “OVA Programs,” accessed November 18, 2022, ovaeggfreezing.com/programs/.
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“freeze and share”: Kristine Thomason, “New Programs Allow Women to Freeze Their Eggs for Free—As Long as They Donate Half of Them,” Women’s Health, womenshealthmag.com/health/a43621157/egg-freezing-donation-programs-national-infertility-awareness-week-2023/.
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package or “shared risk” programs: When patients do multiple IVF cycles, the costs climb fast. To offset this, roughly half of U.S. fertility clinics offer the chance to pay up front to buy a package of treatments at a discount, sometimes with a refund if the patient doesn’t “succeed,” i.e., go home with a baby. This is a gamble on the patient’s part. If you need to use these extra treatments, you purchased them at a discount. But if you have a baby or get pregnant before using all these cycles, you don’t get your money back.
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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.
