Fertility and pregnancy: 'Equal pay' won't be truly equal until fertility care is covered

It’s been a half century since the Equal Pay Act—legislation that made it illegal for men and women to be paid differently for the same work—was passed. When earnings data were first collected in 1979, women made 63% of what men earned for the same job. That number has since risen to 82%.

This may look like progress, but if we dig deeper, it’s clear that the number is leaving out something important: That figure doesn’t account for tens of billions of dollars women in the United States forgo during their career in order to pay for fertility treatments. In order to unlock the enormous economic potential of pay parity, we must broaden the conversation beyond pay. We must also talk about fertility care.

Fertility care is health care that involves treatments like fertility analysis, egg freezing, and in vitro fertilization (IVF), as well as family-forming programs like gestational carrier services (often referred to as surrogacy) and adoption. Until recently, when we spoke of fertility, it was a conversation about infertility, and it was painted by society as a “women’s issue.” This bias was—and is—incredibly harmful to women who, in addition to receiving most of the blame for the inability to become pregnant, had to bear the brunt of any costs related to their fertility treatments.

A perfect storm of events has dramatically shifted the conversation around fertility and brought it out in the open. In 2012, the Society for Assisted Reproductive Technology (SART) removed the “experimental” label from oocyte cryopreservation, or egg freezing, making it much more accessible and acceptable for women. Shortly after, same-sex marriages became legal in all 50 states, opening up more options for LGBTQ+ individuals and couples building families. For the first time in history, women above the age of 30 like me are having more babies than women below the age of 30. The timing and the way people pursue parenthood has changed, but our biology hasn’t. This relatively new discourse about fertility is a good thing. It will certainly lead to fundamental change in how we view fertility as it relates to our health care. But for now, the cost of fertility care falls disproportionately on women and LGBTQ+ people, who often end up paying tens of thousands of dollars out of pocket for their care.

I know because I’ve been there. Like many millennial women who seek egg freezing treatments in order to preserve their fertility, I considered the procedures to be investments in my health, just like medical, dental, and vision care. But unlike medical, dental, and vision coverage, fertility coverage was not offered by my employer. Despite having dutifully paid health insurance premiums for more than a decade, I spent $35,000 of my personal savings to undergo three egg freezing cycles.

That cost had far-reaching repercussions on my life. Investing in my health limited my options for buying a house or car. By forgoing the opportunity to invest those dollars in a retirement vehicle like a mutual fund, 401(k), or the stock market, I lost, by my estimates, more than $150,000 in potential investment earnings. Soon after this experience, I left my job to launch Carrot Fertility, which helps companies deliver better fertility coverage for millions more people—and especially women.

By investing millions of dollars in fertility care collectively each year, U.S. women are losing billions of dollars of earnings over the course of their careers. To understand the magnitude of the financial burden, it’s important to frame how many people are affected. One in eight couples experience infertility in the United States. More than 300,000 assisted reproductive technology (ART) cycles were performed in 2018 alone, and that number is growing. The cost of using ART like IVF isn’t cheap—especially since most insurance plans don’t cover it. It averages around $23,000 per cycle. More than half of women must undergo a second cycle, and a third will undergo three or more treatments. As a result, women can pay anywhere from $40,000 to $60,000 out of pocket for their fertility care. Egg freezing is also on the rise and has accelerated because of the pandemic. The collective costs of these fertility treatments cost women millions of dollars each year.

Most people don’t have tens of thousands of dollars at their disposal. So how do they pay? Some turn to credit cards or medical loans—imperfect solutions, since medical debt is the No. 1 reason Americans file for bankruptcy. This is especially problematic for young college-educated women, who already carry nearly two-thirds of the nation’s student loan debt. By tapping our savings or going into debt, fertility care, a vital part of our health care, is costing billions of dollars over our lifetime. We can’t afford to spend half a century, or even five years, inching toward pay equity as it relates to fertility care.

As we work for gender pay equity, we should also be thinking about how to close the gap by making fertility care accessible and affordable to all. The workplace is a logical first step.

Today, 180 million Americans receive their health coverage through work. When we look at the history of employer-sponsored health care, we can see that the catalysts for change have always been the workers. This still holds true today. Many world-class companies already understand the value of offering workplace benefits to support their workforce and attract and keep great employees.

As an employee, know your negotiating power. Ask your HR leader whether the company offers fertility benefits and, if so, whether there are any restrictions to care—some plans cannot be unlocked without a formal medical infertility diagnosis. If coverage is only accessible for some, discuss ways for your employer to better meet your needs. Fertility is a fundamental part of health care. And as such, fertility care should be accessible to everyone regardless of age, sex, sexual orientation, gender identity, expression, or marital status.

Though companies cannot—and should not—break the bank to provide financial coverage for fertility care, every company can provide some coverage. As an employer, learn what similar companies are doing to attract and retain talent, control health care costs associated with unmanaged fertility care, and establish inclusive workplace policies.

Truly equal pay is impossible without equal access to fertility benefits—but both are well within our reach. We must work together to accelerate widespread access to fertility benefits and get one step closer to pay equity for all.

Tammy Sun is the cofounder and CEO of Carrot Fertility, a global fertility benefits provider for employers.