By Leah Golbert, SWHR Communications Intern
Infertility is clinically defined as the inability to achieve pregnancy after one year of intercourse without birth control or when an individual has had two or more failed pregnancies. About one-third of infertility cases are caused by factors due to men, one-third are caused by factors due to women, and the last third is due to either a combination of causes or the cause is unknown. In the United States, about 11% of women experience fertility problems during their reproductive years. The most common cause of infertility in women, impacting 40% of patients, is the failure to ovulate – when an egg is not released from the ovary.
While there are a variety of conditions that can increase one’s chances of infertility, there are also a growing number of Americans having children later in life, based on trends since 2022. For many individuals, it is becoming increasingly common to prioritize higher education, leisure time, and career goals over starting a family in one’s mid- to late- 20s. Waiting to conceive might impact women’s future fertility. According to the American College of Obstetricians and Gynecologists, as you age, your fertility declines. Once a woman reaches her early 30s, fertility begins to decline. By the mid-30s this decline accelerates more rapidly. At age 45, a natural pregnancy is highly unlikely for many women. These age-related fertility gaps are most commonly connected to a diminished ovarian reserve, where egg quality and quantity decrease.
Yet, there are many other factors beyond age that may influence a woman’s fertility. Diseases such as polycystic ovary syndrome (PCOS), endometriosis, and several endocrine disorders can lead to infertility as a result of changing hormone levels and inflammation near reproductive organs. There are also lifestyle and environmental factors which can play a role in infertility, including weight, stress, substance and drug use, nutrition, exercise, radiation exposure, chemotherapy, and more.
Access to Care
Physician visits to understand your fertility status, diagnostic scans, medications, and treatment plans are costly. Despite the expensive nature of infertility procedures, they are rarely covered by health insurance plans and are often inaccessible for low-income individuals. Even more common fertility treatments, such as those involving assisted reproductive technology (ART), and in-vitro fertilization (IVF) often lack coverage and leave patients with massive out-of-pocket costs. A single round of IVF is estimated to cost between $15,000 to $30,000, and the average number of IVF rounds needed to become pregnant is 2.5 – meaning the average IVF cost to become pregnant can easily exceed $40,000. Each state insurance plan has different requirements for providing coverage relating to medically-induced infertility. The National Infertility Association found that only 12 states cover both IVF and fertility preservation. As of spring 2024, just two state Medicaid programs, New York and Illinois, provided any form of fertility treatment.
Beyond cost, there are additional barriers that may impact access to fertility care. Those living in rural areas are also less likely to have access to fertility care clinics and physicians. Research shows that Black and Hispanic women travel twice as far as white and Asian women for fertility care and treatment. Black women are much more likely to report that their race was a barrier to receiving fertility treatment compared with white, Asian, and Hispanic women. Education level and health literacy can also play a role in access. Higher education level is correlated with higher fertility awareness, leading to better access and outcomes for patients. Understanding – and closing – these fertility care gaps are crucial to make reproductive health care accessible for everyone, regardless of race, ethnicity, age, location, education, or income level.
In recent years, individuals have relied more heavily on their employer’s care plans when making infertility care decisions. According to a Fertility Survey Report by Mercer from 2020, 55% of employers offer some fertility coverage, and 45% offer no coverage at all; larger employers were more strongly represented in the group providing fertility coverage compared to smaller employers. Employer coverage for IVF specifically rose from 24% in 2015 to 37% in 2020. Fertility benefits from employers can include flexible work schedules, mental health counseling services, fertility preservation services, medical appointment accommodations, time off for treatments, and more. Employers may also provide fertility stipends (monetary deposits in addition to an employee’s regular wages) to cover the cost of treatments like IVF and egg retrieval surgery. Employers can also offer a health reimbursement arrangements (HRA), which is a reimbursement plan for fertility services that works alongside employer provided health insurance.
Addressing Stigma and Promoting Inclusivity
There is often stigma surrounding female infertility, including ideas that the inability to have children is shameful and that women are lacking if they are facing infertility. These detrimental thoughts and expectations from society can create stress, low self-esteem, anxiety, and depression for those dealing with infertility. Up to 60% of women that struggle with infertility have had challenges with their mental health. Additionally, infertility can also put a strain on many relationships. Between 33 to 77% of women living with infertility experience some form of marital violence. It is important that friends, family members, partners, physicians, employers and peers employ empathy when others come to us about their fertility challenges.
Another important aspect to improving fertility care experiences is that of inclusivity, which involves fertility benefits being open to all individuals within the infertility journey, including LGBTQ+ couples and single women. Such inclusivity will involve ensuring representation in research and treatment options. Normalizing fertility discussions both in and out of the doctor’s office will help reduce the stigma surrounding infertility.
It will take all corners of the health care system – and all members of society, from employers to general providers to family members and friends – to improve infertility care and experiences for individuals. No matter one’s race, ethnicity, gender, sexuality, location, job, education, or income level, everyone is deserving of access to high quality fertility care.
For more information regarding infertility, check out these SWHR resources:
- Blog: A Focus on Mental Health and Infertility in Women
- Women’s Resource Guide to Fertility Health Care
- Clinician Resource Guide to Fertility Health Care
To find greater fertility care support, check out these fertility wellness organizations: