Volume & Growth
According to the Centers for Disease Control and Prevention, infertility impacts approximately in 1 in 7 Americans. Every year since the 2008 economic downturn, the annual US volume of in-vitro fertilization (IVF) procedures (yellow bars) has increased and the year-over-year rate of growth (pink line) has accelerated in seven of the previous eight years, reaching an all-time high of 15% annual growth in the most recent year of national reporting.
Price & Growth
In 2018, we estimate the average fertility patient paid over $22,000 per “cycle,” with over 10,000 IVF patients reporting. This cost figure represents a 7% increase over 2017 and nearly a 15% increase since we began tracking the metric in 2015.
We estimate IVF cycle costs will hit $25,000 by 2025 abetted by greater use of genetic testing ($5,000), embryo storage costs ($500 - $1,000 per year), and broader adoption of financing options to pay for care (at 6 - 24% annual interest rates).
Cycles Per Patient & Affordability
Unfortunately, the vast majority of IVF cycles do not succeed and according to FertilityIQ data, more than half of patients must undergo a second cycle, and nearly a third of all patients undergo three or more treatments. As a result, it’s common for patients to spend upwards of $50,000 out of pocket on treatment, which roughly equates to the annual US household income of $51,000 (US Census data).
The vast majority of IVF patients treated in 2018 paid for most or all of their IVF treatment out-of-pocket, with little help from their insurance carriers, according to surveyed IVF patients treated in the trailing twelve months.
Historical Employee Perceptions of Fertility Benefits
The vast majority of fertility patients who receive IVF coverage through their employer report feeling a greater sense of loyalty and commitment to their employer as a result, which we uncovered in a survey of patients who received full coverage for their treatment cycles.
All the same, at companies that provide generous IVF coverage, employees give their employers poor marks when it comes to communicating about such programs and their details. We captured this in an earlier 2017 survey of over 1,000 verified IVF patients who had their treatment completely covered.
Summary of 2019 Findings
This year over 30,000 IVF patients were surveyed on their employers' — or their spouse’s employers' — 2019 fertility treatment policy. Patients reported over 400 US businesses and organizations had policies in place to cover the cost of IVF. What’s noteworthy about this year’s data is the degree to which:
Companies broadly implemented new or dramatically improved policies beyond what was covered in 2018. Approximately 23% of companies on this year’s list newly-implemented or substantially-enhanced their fertility benefit. For context, roughly 10% of companies listed in 2018’s report created or improved upon their offerings from 2017.
Fields like consumer product and retail, insurance, healthcare and industrial manufacturing drove nearly all of the above-mentioned gains in 2019. Fortune 100 companies like ExxonMobil (70,000 employees), Procter & Gamble (95,000 employees), AT&T (273,000 employees) and Liberty Mutual (50,000 employees) instituted new or enhanced benefits that resemble what’s been offered in the technology and consulting industries for years in terms of size, and accessibility.
Sectors like technology, consulting, and finance are shaping up to have a rather unremarkable 2019. Every bellwether in these fields already offers a benefit and with the exception of McKinsey & Company, most aren’t making any noteworthy improvements. Growth in the technology field largely comes from small, well-funded, still-private or recently-public businesses like Stripe, Lyft, Eventbrite and others.
Companies are beginning to remove “pre-authorization” requirements that historically prevented employees from accessing subsidized care quickly, or in the case of lesbian, gay or unpartnered employees, subsidized care at all. Noteworthy examples of companies mitigating, or altogether removing such pre-authorizations include Morgan Stanley (a rarity amongst investment banks), Sony Corporation, and S.C. Johnson.
A handful of consumer-facing companies that have weathered negative publicity in the face of the #metoo movement have newly-created, generous benefit packages, with Vice Media and Under Armour being the notable examples.
Starbucks is no longer the only large company (but still clearly the pioneer in) extending a fertility benefit to hourly, frontline workers. Businesses like Chobani now provide a $25,000 benefit to all employees, including the 75% of its workforce operating in the company’s factories.
2019 is shaping up to be a breakthrough year for companies in the consumer product and retail, healthcare, insurance, and industrial spaces. Historically, benefit packages in these categories were uncommon and reimbursed at far lower rates than those provided by technology companies, investment banks, and consulting practices.
This year alone companies like ExxonMobil, AT&T, Procter and Gamble, Liberty Mutual, Tyson Foods, Northwestern Mutual, General Mills, and Geico, to name a few, have newly-introduced or dramatically upgraded their fertility benefit. These companies, along with a host of others, are now extending benefits that cover multiple IVF cycles and with few pre-authorizations required.
The implications of this are meaningful as each of these organizations employ upwards of 50,000 - 250,000 employees (well larger than their technology, consulting, or banking peers) and with few restrictions on access to care, and generous coverage, this trend could dramatically alter the volume and mix of hopeful parents able to build their families through IVF.
In sectors like consulting, banking, and technology, where fertility benefit penetration is high and packages are already rich (for example, Bain & Company, Boston Consulting Group, Bank of America, and Tesla all offer IVF packages with no dollar limit), 2019 appears headed to be a rather quiet year. There simply is little room for meaningful growth in these fields and aside from a possible loosening of pre-authorization restrictions for investment bank employees, we may not see much new development in the years to come.
Contrast this to years past where companies like Facebook, Google, Intel, and others dramatically upped their fertility benefits in an effort to attract talent. Within the technology field today, the noteworthy growth comes from the small, quickly growing cadre of companies (like Lyft, Stripe, Square, Stitchfix, and others) that are private or only recently became publicly-traded businesses. Many of these are still unprofitable businesses and are theoretically vulnerable to reconsider their policies should the economic tides shift, as many expect.
While a handful of large, nationally-recognized law firms instituted fertility treatment packages (and for the first time are starting to more closely resemble their consulting and banking peers), little progress was made in the non-profit, government, and higher education realm. This comes as little to surprise given many fear an economic downturn is on the horizon and no new major legislation has been passed to force cities, states, or universities to extend benefits.
This year we ranked companies based on two characteristics of their fertility benefit plan: the dollar amount for IVF procedure coverage and the extent to which employees must meet pre-authorization standards to actually access the benefit. These two criteria are used to calculate each organization’s “Point Total,” with a few notes:
Every dollar of IVF coverage corresponds to a point in the “Point Total”
Many companies do not specify a dollar amount of coverage but instead will cover a specific number of IVF cycles. Each IVF cycle covered equates to $22,000 of coverage and thus 22,000 points
For companies that provide an “unlimited” dollar amount of coverage, they are awarded 170,000 points
Companies that have minimal, or no, pre-authorizations are awarded an additional 20,000 points
All information was provided by the 30,000+ members of the FertilityIQ community who’ve underwent IVF or by the companies themselves. Information on cost and treatment cycle numbers were provided by the 10,000+ FertilityIQ members who received IVF treatment in 2018.