Recent state legislative rulings have thrust the topic of in vitro fertilization (IVF) into the national conversation, simultaneously highlighting both the need for assisted reproductive technology (ART) services and the difficulties patients experience trying to access them. Fertility care is no exception to the all-too-frustrating paradox of high demand and low supply, with patients facing major barriers to access despite the industry representing a significant market opportunity.
As such, healthcare leaders must consider their strategy related to fertility care services and improving access. It is clear that couples and individuals need—and want—to invest in their family-building goals, and all healthcare leaders can positively impact patient access in this space, whether it be through providing direct patient care, partnering with other organizations to provide care, or simply offering fertility treatment and preservation coverage to employees. By adapting to meet the evolving needs of the communities they serve, organizations will earn a competitive advantage while positively contributing to population health.
In a three-part blog series, our women’s health service line experts will provide you with essential information to consider as you develop your organization’s plan for fertility care, including an overview of the increasing demand for services, industry trends and growth potential, and key components of providing patient-centric fertility care. In part one, we take a deeper look at both the trends driving the rise in demand and the access issues underscored by this uptick.
Demand for Fertility Care Services Continues to Rise
The US fertility care space has grown significantly over the past decade. As shown in figure 1, the number of infants born in the US who were conceived through ART increased by almost 50% from 2012 to 2021. And with the US market for fertility services projected to reach approximately $16.8 billion by 2029, there is no end in sight.
FIGURE 1: Number of Infants Born in the US Who Were Conceived through ART, 2012–2021
There are multiple factors behind this increase.
- Individuals are electing to have children later in life, which is correlated with a higher incidence of fertility issues. A World Health Organization report published last year found that one in six adults worldwide are affected by infertility, an increase from the previously reported statistic of one in eight.
- Fertility preservation, the process of saving or protecting eggs, sperm, embryos, or reproductive tissue for future use, has become increasingly common. Egg-freezing cycles in the US increased by approximately 22% from 2018 to 2019 and 31% from 2020 to 2021, demonstrating a year-over-year rise in demand over time, pre- and postpandemic.
- Awareness of and knowledge about ART has risen in numerous patient populations, and the following groups are increasingly turning to these services for their family-building needs:
- Heterosexual couples
- LGBTQ+ couples
- Individuals pursuing single parenthood and/or surrogacy
- Individuals electing to preserve their fertility (e.g., egg freezing, sperm freezing, embryo freezing)
- Individuals with certain medical conditions looking to preserve their fertility ahead of treatments (e.g., a patient with cancer who must undergo chemotherapy)
- Couples with known genetic conditions who utilize IVF and genetic testing to avoid passing these conditions to their children
In recognition of the wide array of people seeking fertility services, the American Society for Reproductive Medicine updated its definition of infertility in 2023 to be more inclusive. This may open the door for insurers to widen their eligibility for fertility treatment coverage (e.g., LGBTQ+ patients, individuals pursuing single parenthood), which will, in turn, expand the number of people seeking services.
Access Remains Limited, Highlighting Health Inequities
Despite the rise in demand for fertility care services, access remains notably difficult for a variety of reasons, as outlined below. It is imperative to note the clear racial disparities inherent in many of these hurdles, a fact that continues to highlight the inequities embedded deep within the US healthcare system. Lowering barriers to care should be an essential element of your organization’s fertility care strategy in order to both meet demand and address inequities.
- Lack of Insurance Coverage: While some large employers in the US have expanded their healthcare coverage to include fertility treatment, the majority have not. And even when coverage is offered, it often comes with the requisite of an infertility diagnosis, thereby excluding many of the patient groups seeking services (e.g., members of the LGBTQ+ community, patients pursuing single parenthood or fertility preservation). According to RESOLVE: The National Infertility Association, less than half of US states have passed any sort of infertility insurance coverage laws, most of which still restrict patients via caps on spending or the number of allowed treatment rounds per year
- Cost of Care: Given the lack of sufficient insurance coverage, most patients seeking ART must bear the cost as self-pay patients. Even with coverage, patients must pay thousands of dollars out of pocket for recommended procedures. One round of IVF costs between $15,000 and $30,000, and many patients undergo multiple rounds during treatment.
- Long Wait Times: Many fertility clinics have lengthy wait times to see a reproductive endocrinology specialist. Highly regarded physicians can have months-long waitlists just for a consult, after which patients must wait again before they are able to begin treatment.
- Care Deserts: Geographic proximity to a fertility clinic or IVF center can also hinder patients from seeking care. Fertility treatment is highly specialized and concentrated in urban and suburban markets, creating fertility care deserts in rural regions. Black and Hispanic women have reported traveling twice as far as White and Asian women to seek treatment.
- Sociopolitical Factors and Legislative Limitations: State-by-state laws vary greatly when it comes to ART and women’s health services overall, leading to two distinct yet equally harmful consequences. First, patients in states with more restrictive laws around the use of embryos, clinical treatment options, and medications may feel discouraged to seek care or are prohibited from accessing care entirely. Second, providers in these states may choose to limit or completely stop services due to the legal risk and lack of clear and consistent legislation.
- Lack of Information and Stigma of Treatment: Patients may wait to seek help for their fertility-related concerns for a variety of reasons, including limited knowledge about their reproductive health, a perceived social stigma around infertility, and the invasive and burdensome nature of certain fertility treatments.
Now Is the Time to Invest in Fertility Care
In recent years, some health systems have had to make the difficult decision to close or reduce their women’s health services, further exacerbating access and health equity issues. Those that have remained open have done so by strategically evaluating opportunities to build scale and expertise across the care continuum.
The current fertility care landscape, which includes a high demand for services and a more inclusive definition of infertility, offers health systems a unique opportunity to invest in ART, which will allow them to not only diversify their service portfolio but also improve the health of the communities they serve.
About ECG’s Women’s Health Services
ECG can help your health system build its strategy for women’s health offerings and think about the whole spectrum of care, from annual well-woman exams, to reproductive care, to menopausal medicine.
Learn more about ECG’s women’s health services.
Edited by: Emily Johnson
Published April 4, 2024
