“We needed to feel like we gave it every shot we could,” Julie, 32, tells Fortune. She asked that her last name be withheld to protect her privacy. 

Roughly 1 in 8 couples, or 7.4 million people, struggle with infertility, according to the latest figures from RESOLVE, the National Infertility Association. But in many cases, employer-sponsored health insurance and benefits don’t offer comprehensive fertility coverage. Employees find themselves struggling to pay out of pocket for expensive procedures, such as IVF, which can cost upwards of $16,000 per cycle. And most women, like Julie, go through multiple cycles. 

About a third of small U.S. employers with less than 500 employees and 61% of large employers cover some type of infertility service, according to Mercer’s 2021 survey on fertility benefits. And only about 19 states mandate insurers to cover IVF. Minnesota isn’t one of them. 

The nonprofit where Julie worked for nearly seven years didn’t offer comprehensive fertility benefits, so in May 2021, she took a second, full-time job at an online retailer’s warehouse facility so she could get access to the company’s fertility benefits that covered IVF treatments starting on day one. 

After spending her daytime hours working as a social worker, Julie spent her nights fulfilling online grocery orders and stocking shelves. But the 80-hour weeks with little time to sleep and eat quickly took their toll. “It just wasn’t sustainable,” Julie says. 

After completing online training and working about three weeks on the floor, Julie left and continued on the company’s health insurance through the Consolidated Omnibus Budget Reconciliation Act (COBRA). It was cheaper for Julie to pay $700 a month for continuing COBRA medical insurance than it was to pay for IVF out-of-pocket. 

Costly fertility treatments force some couples to get creative 

Nearly half of today’s workers (45%) say fertility benefits are an important component when considering a new job, according to a recent survey conducted by The Harris Poll on behalf of Fortune. Coverage for adoption, fertility medications, and IVF treatments are seen as the most beneficial offerings, according to the Harris poll. 

Amid the current worker shortage, a growing number of employers have rolled out new or expanded employee benefits, including fertility benefits, to bolster their attempts to attract and retain workers. But those benefits can vary widely.

For Julie, finding an employer-sponsored health plan that covered IVF treatments was necessary after she and her husband spent about $41,000 on previous cycles.

The couple tried two rounds of the less-invasive (and less expensive) intrauterine insemination (IUI) procedure before moving onto IVF in 2019. They paid about $26,000 for their first IVF cycle using a combination of savings and help from their parents to cover the cost. 

But it wasn’t successful, so the couple took out a $15,000 loan to finance their second retrieval and embryo transfer in March 2021. “That was pretty crushing,” Julie admits, saying they still haven’t paid off the loan yet. 

Julie says she and her husband felt like they weren't yet at the point where they wanted to seriously consider options like surrogacy, but they also didn't know how they were going to afford another round of IVF. "It was really, really hard." 

Feeling like they were running out of time and options, Julie looked at loans again and all types of fundraising avenues, as well as employer-sponsored benefits. But she felt nervous about leaving a job she loved.

“My husband and I both really enjoy our jobs. So it felt really hard to say that one of us [should] walk away," she says. "As much as we really want to expand our family, that also still might not work out and then you've also given up your job.” 

As she did her research, she also realized that there were a lot of restrictions on what types of employees were covered — many companies only offered these benefits to their corporate employees or full-time team members. Some companies also required their workers to have been with the company for a certain time period before the benefits kicked in. 

“With infertility, it’s often like the younger the better,” Julie says. So she worried about having to wait months for the benefits to kick in while her biological clock was ticking.

Getting a second, full-time job was the best way to access fertility benefits 

In the end, Julie found an overnight job that offered IVF coverage starting on day one. But this was a physically active job that required she be on her feet all day after putting in a full day of work at her primary job. Undeterred, Julie decided to give the role a try and see if it worked out. Once she was hired, she got off her husband’s health insurance and applied for medical coverage with the new company. 

The job was demanding, and Julie acknowledges she felt very privileged that she got to choose to work in the secondary role only for a short time. “Some families have to work overnights to afford to live and take care of their family or they have to do two jobs,” she says. “It helped bring perspective.”

After about three weeks on the job, Julie gave her notice. The lack of sleep and physical demands of an 80-hour work week were tough to overcome, even though the extra money had been nice. 

But the company’s benefits proved to be a much-needed lifeline. Julie spent about $5,000 on COBRA benefits in order to continue to use the fertility insurance plan benefits. That covered two egg retrievals and one transfer, which was ultimately successful for Julie. The couple is expecting a baby in August.

“I do feel super, super grateful and lucky that the coverage was so good,” Julie says. The last round of IVF wasn’t free by any stretch, but the employee benefits made it financially do-able for Julie and her husband. 

And she even returned to the warehouse operations part-time at a different site last fall until COVID-19 case numbers were too high. Her part-time status meant she was ineligible for health insurance, but the more flexible position brought in much-needed extra income to help cover the couple’s medical costs and other expenses. 

Julie's story has a happy ending, but she's frustrated that she and other women have to go to such extremes to afford fertility treatments. "People deserve to have fertility coverage through their primary employer,” she says.

“It is pretty incredible how far people have to go and will go. Yet if just everyone just had medical access through their job, it would be a lot easier.”