Guidance along the fertility journey

For thousands of Americans, the path to becoming a parent is fraught with obstacles. Some challenges are biological, with 10%–15% of couples struggling with infertility,¹ while reproductive treatment costs add an additional steep barrier. Consider that one cycle of in vitro fertilization (IVF) alone can cost anywhere between $15,000 and $30,000.²

While roughly 40% of American employers offer fertility benefits to their employees,³ this coverage often results in significant gaps in care. Chief among them may be the breakdowns in understanding along the way, since many members report experiencing inconsistent and fragmented care during their fertility journey. One survey found that 65% of respondents routinely left the fertility clinic with “more questions than answers,” and 55% said they had no idea what was covered by their company’s fertility benefits when they started trying to conceive.⁴

What is needed, then, is a more holistic approach to helping members become parents. It’s not enough to piece together disparate specialists who may not confer about the patient’s big-picture needs and separate programs/benefits that the member must reconcile. Patients need a comprehensive guide through the entire process, from the runup to conception to the moment they become pregnant. Such a program can help members address any logistical, financial or medical challenges that may arise, all while delivering greater value to health plans and better outcomes for patients. Here’s what such an approach might look like at each stop on the fertility journey.

Members evaluate their options and decide to pursue fertility assistance

This initial step on the path to parenthood can be especially overwhelming, as members may struggle to understand the benefits available to them. This may include what is and isn’t covered and how certain fertility options differ from others. But when a case manager is available to provide answers, the daunting task of deciding on a way forward becomes far simpler. These trained professionals are available by phone to talk through options and the member’s individual concerns.

Ideally in this phase of care, the member’s digital and in-person care experience should continue to expand. That could include the addition of a fertility nurse case manager to:

• Walk the patient through the authorizations, procedures and hormone regimens to come
• Make educated recommendations about next steps
• Handle the patient’s referral to top-tier fertility clinics with a proven track record of high-value, high-quality care

In this stage, this high-touch approach serves not only to simplify the process for patients, but also to mitigate the disparities in fertility care that have long plagued certain populations. Research shows that fertility assistance is most often accessed by women who are white, with high incomes and private insurance.⁵ Indeed, one study estimates that white women constitute upwards of 75% of all those who receive fertility assistance.⁶ On the flipside, only 6% of Hispanic women and 7% of Black women report ever even discussing fertility assistance with their doctor, let alone pursuing the option. But with this hands-on, bespoke approach to case management, many of the barriers these populations face when accessing care are greatly lessened.

Members undergo fertility assistance

As the member begins this most critical stage of their fertility journey, they should continue to be able to reach out to their case manager about everything from nutrition guidance to resources for mental health support. Their interventions can help:

• Reduce stress for the parent-to-be
• Keep fertility assistance costs predictable and manageable
• Steer patients toward better outcomes and the most appropriate interventions
• Ensure that the member’s experience is deeply supported and meaningful

Today’s standard mode of fertility treatment is often characterized by too little understanding of what members should expect from the process. By guiding members along their journey to parenthood, payers can help to create a more streamlined and accessible model of family-building care.

Learn about Optum Fertility Solutions for Health Plans.

Sources

1. Mayo Clinic. Infertility. Accessed October 6, 2023.
2. Conrad M. How much does IVF cost? Forbes. March 7, 2023. Accessed October 6, 2023.
3. International Foundation of Employee Benefit Plans. Fertility benefits rapidly rising as employers look to attract and support talent. Accessed October 6, 2023.
4. Cision. New study from Maven Clinic reveals critical gaps in fertility patient care. Accessed October 6, 2023.
5. Kaiser Family Foundation. Coverage and use of fertility services in the U.S. Accessed October 6, 2023.
6. Galic I, Negris O, Warren C, et al. Disparities in access to fertility care: who’s in and who’s out. F&S Reports. 2021; 2(1)109–117.