Infertility is a widespread concern for many people who want to create families.
According to the World Health Organization, 17.5% of heterosexual couples worldwide encounter fertility issues, which is defined as the inability to conceive within a year of trying. Among these couples, half the time infertility is linked to the male partner.
Despite the availability of options such as in vitro fertilization (IVF) that couples could turn to, financial challenges often create significant barriers in their journey to build a family. Starting with evaluations and ending in fertilization, treatments can cost tens of thousands of dollars.
In this Q&A, Juan Andino, MD, a urologist at UCLA Health specializing in the evaluation and management of men’s health, discusses key financial concerns of infertility care and shares options to consider when trying to navigate through those challenges.
Q: What is the significance of the financial burden associated with infertility care for affected individuals?
Dr. Andino: Out-of-pocket costs of care can deter patients from seeking care for many conditions in the United States. This is particularly true for fertility services. While laws have been passed in California that require insurers to offer fertility services, it is up to individual employers to determine if those services are offered and if they can vary insurance by insurance, plan by plan.
Q: How can families grappling with the financial strain of infertility treatment secure access to proper care?
Dr. Andino: States such as California do have laws dictating that group insurers (Medi-Cal excluded) offer fertility services, but it is up to employers to choose whether to include infertility coverage. So, the burden falls on patients to ask these questions to their insurance:
- What coverage is available for fertility treatment in this plan?
- Is prior authorization necessary for certain fertility treatments?
- Do I need to obtain a referral before I see a fertility doctor (reproductive endocrinologist for women, male fertility urologist for men)?
- Does this insurance policy include coverage for the diagnosis of infertility, such as lab work, office visits?
For people engaged in a job search and considering different options, they may want to inquire about this aspect of the employee health benefits package. In recent years, some industries, such as tech, have leveraged fertility coverage as a recruitment and retainment strategy. In a March 2022 Fortune poll, 45% of respondents said that fertility coverage was an important aspect of considering a new job.
Is there any additional insight or information you believe is crucial to include?
Dr. Andino: Our team at the UCLA Urology Men's Clinic is a resource for patients in L.A. and beyond who are struggling with fertility. Given that 50% of the time there can be a male component preventing or delaying a pregnancy, don't delay getting a checkup if concerned. Historically, society tended to blame women when there was an issue achieving a pregnancy and we now know this is simply not the case. Both partners should get evaluated simultaneously.
Earlier this year, the American Society of Reproductive Medicine (ASRM) expanded its definition of infertility:
- The inability to achieve a successful pregnancy based on a patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic testing, or any combination of those factors.
- The need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos to achieve a successful pregnancy either as an individual or with a partner.
This ensures that our LGBTQ+ patients are included in this more expansive fertility definition.
