Enhancing reproductive access: the influence of expanded employer fertility benefits at a single academic center from 2017 to 2021.

Abstract

Recognized by the World Health Organization as a disease, infertility carries emotional and financial burdens. With treatments like in vitro fertilization costing approximately $12,400 (not including medications), many Americans may allocate a substantial portion of their annual income to a single assisted reproductive technology cycle. To mitigate this burden, a minority of states mandate varying levels of insurance coverage for fertility treatment. Independent of state legislation, individual employers can also provide fertility benefits. In 2019, 1 academic institution, in a nonmandated state, amended its insurance policy to begin providing up to $25,000 of fertility treatment. Coverage expansion may ease financial stress and promote diversity in treatment access, as data indicate racial disparities in infertility treatment uptake. Our study analyzed demographic shifts and treatment utilization in patients seeking fertility treatment before and after implementation of an expanded fertility treatment insurance benefit at a single institution. We conducted a retrospective chart review at a reproductive clinic in a large, urban academic hospital system from 2017 to 2021. Analyses included descriptive statistics (means, proportions) and preimplementation (2017-2018) and postimplementation (2019-2021) periods were compared with chi-square tests, Fisher exact tests, and Mann-Whitney U tests. From 2017 to 2021, 1586 new patients accessed fertility services, including 378 prior to expanded fertility benefit coverage (2017-2018) and 1208 after its implementation (2019-2021), representing a 162.9% increase from 2017 to 2021. There was an increase in the proportion of patients ages 38 to 40 years of age seeking care (12.4% vs 17.8%), a decrease in the proportion of older patients (ages 41-42: 9.3% vs 5.1%; age >42: 7.4% vs 6.7%), and no differences in the proportion of patients <38 years (P=.01). There were no differences in self-identified race or ethnicity before and after implementation, with patients most commonly identifying as non-Hispanic White (41.5% vs 40.0%), closely followed by non-Hispanic Black (38.6% vs 39.7%; P=.89). After implementation, a higher proportion of women without infertility sought care (17.5% vs 23.1%; P=.03) specifically in the form of oocyte cryopreservation (12.2% vs 16.7%) and preconception counseling (3.4% vs 5.6%; P=.02). There was an increase in patients pursuing oocyte cryopreservation as highest level of treatment (5.8% vs 15.4%), but no differences in proportions of patients pursuing other treatment (P<.001). Patient-reported infertility prior to first appointment also decreased (P<.001). Patient demographics and fertility treatment utilization changed after the adoption of fertility benefits at a single institution, highlighting that implementation of fertility benefits have potential to improve healthcare access and empower reproductively aged women in family planning. No changes were observed in the self-reported racial diversity of patients. However, the marked increase in oocyte cryopreservation utilization and the engagement of women without fertility issues in family planning options underscores the importance of fertility benefits in fostering proactive reproductive health management.