How Infertility Impacts Employees
The Financial Impact
Infertility is often the first medical crisis an individual or couple faces together and it can take a significant emotional, physical and financial toll. Despite the booming technological advancements in fertility and family building within the last half-century, there are still unmovable barriers to treatment—the biggest of which is cost. One of the most common types of fertility treatments is in-vitro fertilization or IVF. It is a complex treatment process that involves hormone injections, multiple physician visits and repeated blood tests and monitoring. Most people who decide to take this route have to undergo 2+ cycles of IVF over a course of months. As a result, it’s common to spend upwards of $50,000 out of pocket on treatment. To put this in perspective, in 2019, the median household income in the US was $68,703. The vast majority of people who went through IVF treatment in 2018 paid for most or all of their treatment out-of-pocket, with little help from their insurance carriers, according to surveyed IVF patients treated in the trailing twelve months.
And it’s not just fertility treatment that bears a significant price. Many individuals and couples will use adoption or surrogacy to build their families. According to Child Welfare information Gateway, independent or agency-based adoptions can cost anywhere from $15,000 to $45,000. These fees typically cover a birth mother’s medical expenses, legal representation for adoptive and birth parents, court fees, social workers and more. And the surrogacy process can be even more expensive, ranging from $100,000 – $150,000 to cover costs such as agency fees, matching services, psychological screening, legal services, medical expenses for the intended parents as well as the surrogate (including fertility services for the creation of the embryo), surrogate compensation and surrogacy services.
The Emotional Impact
While some companies try to address the financial aspect of fertility treatment, few if any are prepared to address the emotional strain of infertility. In addition to the stress, there is real risk for depression and anxiety. A 2017 study reported that within the group of individuals trying to conceive, 50% suffered from depression during their journey. As a couple goes through more cycles to achieve a pregnancy, their chances of dropping out of treatment increase significantly. It’s not surprising that 55% of individuals suffering from infertility believe it is more stressful than unemployment and 61% believe it is more stressful than divorce.
Despite growing awareness, there is still a stigma around infertility and individuals are often left on their own to find a support system. Traditional medical carriers rarely, if ever, have the dedicated, expert resources to provide personalized fertility education and direction to support people who are utilizing their coverage for treatment and have questions, require information, or are simply looking for emotional support during what may be one of the most difficult experiences in their lives.
How Infertility Impacts Employees and Employers
When companies offer insurance coverage, it is typically a one-time, fixed financial benefit (e.g. $15,000 lifetime maximum per member for fertility treatment). When that dollar benefit is applied in a typical insurance carrier’s plan, which can often have complex medical protocols and pre-certification requirements, the financial benefit is often exhausted before a successful pregnancy is achieved. Due to the high cost of treatment, many employees experience financial pressure and run out of coverage mid-treatment. As a result, the employee may be incentivized to make poor clinical decisions such as transferring multiple embryos in order to achieve pregnancy with fewer rounds of IVF. This treatment course often results in costly and dangerous multiple births. They may opt for less expensive, less effective fertility treatments first, such as artificial insemination (IUI), which carries a risk of multiple births and may exhaust the benefit before trying a more effective treatment plan such as IVF. Or they may choose to forgo tests and technologies that can improve the likelihood of a healthy singleton pregnancy.
This impacts the downstream costs that members and employers absorb related to high-risk prenatal care, pregnancy complications, pre-term delivery and NICU stays related to multiple (twins or triplets) births. The medical costs of multiple births compared to a single child are exponential in nature: $35,000 for a single child compared to $150,000 for twins and over $560,000 for triplets, with medical expenses for multiple births often exceeding $1 million. In addition to the medical costs, multiple births also contribute to decreased productivity and increased disability claims. Parents with multiples are also at a 4.4x greater risk of being away from work longer because of longer hospital stays, additional medical care and treatment for chronic conditions. The lost productivity related to preterm births represents $5.7 billion in costs.
The economic burden of depression and anxiety and the effect on employee productivity has been well documented. In fact, a recent WHO-led study estimates that depression and anxiety disorders cost the global economy $1 trillion each year in lost productivity. A study from Lyra Health showed that 48% of survey respondents self-reported that mental health has impacted their capacity to work over the past year. Whether someone is receiving treatment or supporting a partner, they will endure some level of impact on their mental health. Due to the highly emotional nature of infertility and the associated treatments, it’s natural that certain areas of work performance may be impacted. This can translate into reduced productivity, increased absenteeism, and diminished engagement.