- Infertility is top of mind for many adults having children later or with a partner of the same sex.
- Startups like Carrot and Progyny provide fertility-treatment coverage to fill healthcare-plan gaps.
- This article is part of "Trends in Healthcare," a series about the innovations and industry leaders shaping patient care.
As Vernize Rios stood in her office's printing room, she rested her hand on her swollen belly and took in a deep breath.
In a few days Rios would undergo a procedure to extract and freeze her eggs. She'd been saving up for years to afford it, hoping to preserve her dream of becoming a later-in-life parent. (The medical community often refers to pregnancy after age 35 as a "geriatric" pregnancy. The American College of Obstetricians and Gynecologists has said that carrying a pregnancy later in life could increase the risk of various complications, including preeclampsia.)
Rios, 36, said she grew up wanting to build a family of her own but also saw value in focusing on her career in her early 20s before becoming a parent. Rios said she hoped she'd meet someone and get pregnant with them after settling into a stable career. But that wasn't the case by the time Rios was in her early 30s, so she looked into freezing her eggs.
Rios, who works as an office-and-facilities manager in New York City, said she anticipated the egg-freezing process would be a major financial investment, and that she was willing to dip into her retirement savings to afford the treatment.
Rios said she was able to afford the nearly $15,000 egg-freezing procedure — which involved blood work, hormone injections for ovarian stimulation, and egg retrieval — because her employer, Chegg, covered the up-front costs through its partnership with the fertility-benefits startup Carrot.
Carrot is one of several fertility-benefits startups that have emerged in recent years to address the evolving family-planning landscape. As more people choose to have children later in life, fertility treatments like IVF, hormone therapy, and cryopreservation are more frequently sought-after. And with more married LGBTQ+ couples interested in starting families, there's been greater interest in treatments like surrogacy, egg donation, and sperm donation. In a 2023 Pew Research Center survey, four in 10 adults said that they knew someone who had used fertility treatments or that they had used the services themselves.
As interest in fertility-related care has increased, so has the number of US workers asking their employers for healthcare benefits for fertility-specific treatments — services that typically cost people tens of thousands of dollars. Enter startups like Carrot, Progyny, and Kindbody that partner with employers to help cover pricey fertility treatments when employees' healthcare plans lack that coverage.
Many American workers want fertility benefits
In a survey conducted in March by Harris Poll and HR Brew, three in five Americans said they wanted their workplace to offer fertility benefits.
This year, the US government began offering fertility benefits to federal employees through its healthcare plan with Blue Cross Blue Shield. But a swath of US workers are without healthcare plans that cover fertility-treatment expenses.
Public and private insurance companies often don't consider fertility treatments medically necessary, meaning services to address infertility typically aren't covered, even partially.
Because of these coverage restrictions, hopeful parents-to-be might carefully consider the jobs they apply for and take. Some have chosen to work a second job at Starbucks because fertility services are included in the company's health-insurance packages. Others are considering positions only at companies that offer fertility benefits.
Dr. Asima Ahmad, the cofounder and chief medical officer of Carrot, said it's common for adults who want children to exhaust all their options while family planning.
"I have patients who come for a fertility consultation and they don't have coverage," Ahmad said. "Then I don't see them for six months, 12 months, or three years. But they come back, and it's because they got a new job or a new part-time job with fertility coverage." She added that many of Carrot's employer partnerships start after a company's employee tells their human-resources department they want the benefit.
That's what Rios found herself doing in her employee-engagement surveys at Chegg until January 2022, when the company announced it would offer Carrot to full-time employees. A few days later, Rios said, she signed up for a session with one of Carrot's fertility consultants to start her egg-freezing process.
Fertility-specific startups can fill in gaps in employee healthcare plans
Ahmad said she cofounded Carrot after seeing a need for more accessible and affordable fertility treatments during her medical training.
When an employer partners with Carrot, Progyny, or another fertility-benefits company, it commits a set amount of money toward each employee who elects to use fertility benefits. The employer's investment translates to a menu of options for employees, like a round of IVF or a round of egg freezing for each billing cycle.
Rios said treatment funds were loaded on her Carrot debit card at two separate times. She used the card to pay for treatments; later, Chegg reimbursed her the full $14,291 to her bank account.
Though fertility startups can increase access to expensive services, many people still face challenges in seeking fertility treatments.
In online forums, some people have described experiencing long wait times and complicated paperwork to get reimbursed for out-of-pocket costs while using fertility benefits through work. Rios and others online said they had to pay taxes on their covered fertility costs — which they didn't anticipate, considering most employer-paid healthcare plan premiums are tax-exempt.
And since fertility coverage through these startups requires an employer to opt in, some employees may never gain access to such benefits.
An investment in employee satisfaction
Offering fertility benefits to workers can help employers attract talent and keep their employees satisfied for longer.
"While not a lot of employers offer it yet, you see a lot of signals in the market that there's consideration and thoughtfulness about how to offer it in the future, to signal that they're kind of a future-ready company that has their values aligned with next generational talent," Libby Rodney, the chief strategy officer at Harris Poll, told HR Brew.
In 2022, while Rios waited for her sheets to print in the Chegg office, the company's CEO, Dan Rosensweig, entered the room to sign papers. With her egg-freezing procedure approaching, Rios decided to tell Rosensweig how appreciative she was of the access to fertility benefits, she said.
Rios said that after she had her eggs extracted, she elected to freeze the ones viable for creating an embryo, even though her doctor said it was a lower number of viable eggs than typical. Rios added that she'd pay for another round of cryopreservation tomorrow if she could afford it. "Should I hit the lotto or an additional $15,000 falls into my lap, that's what I would definitely use it for," Rios said.
She's still at Chegg and has no plans to leave, saying the fertility benefits contributed to her happiness as an employee.
"It set the bar really high," Rios said.
