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Fertility & Infertility 101: Why Fertility Benefits Are A Necessity and Not A Luxury
- 1. © 2022 Carrot. Confidential; not for distribution. 1 Main title here
- 2. © 2022 Carrot. Confidential; not for distribution. 2
- 3. © 2022 Carrot. Confidential; not for distribution. 3 Main title here
- 4. © 2022 Carrot. Confidential; not for distribution. 4 Main title here
- 5. © 2022 Carrot. Confidential; not for distribution. 5 Today’s agenda • Understanding fertility and infertility • Overview of common causes of infertility • What treatments are available • How employers can support employees going through these journeys Jackie Blanco Senior Manager, Medical Operations jackie@get-carrot.com Nate Fournier Enterprise Account Executive nate@get-carrot.com
- 6. © 2022 Carrot. Confidential; not for distribution. 6 What do you think of when you hear the phrase “fertility health”?
- 7. © 2022 Carrot. Confidential; not for distribution. 7 What is fertility? For people with ovaries, fertility describes someone’s ability to get pregnant and carry a pregnancy to term. For people with testes, fertility refers to semen health parameters like sperm shape, volume, and speed.
- 8. © 2022 Carrot. Confidential; not for distribution. 8 What is infertility? An infertility diagnosis is made after 1 year of frequent, unprotected different-sex intercourse or 6 months if the partner with ovaries is 35 or older. 1 in 8 different-sex couples face infertility — more than diabetes
- 9. © 2022 Carrot. Confidential; not for distribution. 9 What causes infertility? • Advancing age or “age related” decline in fertility • Abnormal sperm production or function • Problems with the delivery of sperm • Ovulation disorders • Uterine or cervical abnormalities • Fallopian tube damage or blockage • Endometriosis • Overexposure to certain environmental factors • Damage related to cancer and its treatment
- 10. © 2022 Carrot. Confidential; not for distribution. 10 Menopause and low testosterone Menopause is the time that marks the end of the menstrual cycle. It’s diagnosed after someone has gone 12 months without a menstrual period. Common symptoms include hot flashes, sleep disturbances, and mood changes. Low testosterone: Male testosterone levels decline on average about 1% a year after age 30. 40% of males aged 45+ have low testosterone
- 11. © 2022 Carrot. Confidential; not for distribution. 11 Infertility treatments and typical coverage
- 12. © 2022 Carrot. Confidential; not for distribution. 12 Terms you should know Intrauterine insemination (IUI): During an intrauterine insemination (IUI) procedure, sperm is placed directly into the uterus using a small catheter to improve the chances of fertilization by increasing the number of healthy sperm that reach the fallopian tubes when the woman is most fertile. In vitro fertilization (IVF): “In vitro” means outside of the body. IVF works by using a combination of medicines and surgical procedures to help sperm fertilize an egg, and help the fertilized egg implant in the uterus.
- 13. © 2022 Carrot. Confidential; not for distribution. 13 Fertility and family-forming options • Trying to get pregnant without intervention • Fertility care (IUI, IVF) • Fertility preservation • Donor-assisted reproduction (donor eggs, sperm, embryos or gestational carrier services) • Adoption • Hormone replacement therapy for menopause and low-T
- 14. © 2022 Carrot. Confidential; not for distribution. 14 Limits of infertility coverage • More than 80% of people who undergo fertility treatments have little to no coverage and, on average, accrue $30,000 in debt. • The medical definition of infertility leaves out most LGBTQ+ couples and single-intending parents • Average cost of adoption: $50,000 • Average cost of a gestational carrier journey: $150,000
- 15. © 2022 Carrot. Confidential; not for distribution. 15 Meet Sarah and Gina SAME-SEX COUPLE DENVER, CO • Accessing IVF coverage through work is challenging as a same-sex couple • The couple tries IUI first, but isn’t successful and decides to pursue IVF • The couple has a healthy baby after accruing $30,000 in debt
- 16. © 2022 Carrot. Confidential; not for distribution. 16 Why is this an employer issue?
- 17. © 2022 Carrot. Confidential; not for distribution. 17 Fertility care impacts nearly everyone in your organization 1 in 8 different-sex couples face infertility — more than diabetes Fertility preservation is now mainstream 63% of LGBTQ+ people say they intend to pursue parenthood through fertility treatments or adoption Employees going through hormonal aging (e.g., menopause) suffer silently without support Black women are almost twice as likely to experience infertility than white women but are less likely and take longer to seek treatment. 30% of U.S. pregnancies result in often unnecessary C-sections CDC National Survey of Family Growth, Family Equality Council, Carrot member data, CDC birth data
- 18. © 2022 Carrot. Confidential; not for distribution. 18 Competitive benefits are a must to attract and retain your talent would stay longer if fertility benefits were offered 36% 77% would consider changing jobs for access to fertility 88% Carrot & RESOLVE Fertility at Work survey, SHRM survey looking for jobs with better benefits
- 19. © 2022 Carrot. Confidential; not for distribution. 19 Medical expenses and productivity concerns add to the challenge CLAIMS RISK PRODUCTIVITY IMPACT MULTIPLE BIRTHS The average cost of multiple births is five times that of a single birth IVF Potential cost of a poorly managed IVF cycle ending up in the NICU C-SECTION Cost for a C-section vs. a vaginal delivery MULTIPLE BIRTHS Multiple births more than quadruple the risk of absenteeism ~$1M AMA, AJOG, Truven 5x 1.5x 4.4x
- 20. © 2022 Carrot. Confidential; not for distribution. 20 What to look for in an inclusive fertility benefit
- 21. © 2022 Carrot. Confidential; not for distribution. 21 Support for lifelong fertility care Comprehensive fertility healthcare must serve all of your employees, from those just entering the workforce to your most experienced managers and leaders 20s 30s 40s 50s 60s
- 22. © 2022 Carrot. Confidential; not for distribution. 22 The most inclusive fertility solution Heterosexual couple, donor eggs and IVF Heterosexual couple, IVF then adoption Transgender woman with a cisgender woman, spontaneous pregnancy Single female, IUI, with a sperm donor Single female, oncofertility, egg freezing Heterosexual couple, sperm donor and IVF Single female, adoption Same sex couple, egg donor Same sex, female couple, double IUI Transgender man with a cisgender woman, IVF with ICSI and donor sperm Same sex, female couple, IUI Single male, oncofertility, sperm freezing Single female, egg freezing Same sex couple, IUI Heterosexual couple, gestational carrier
- 23. © 2022 Carrot. Confidential; not for distribution. 23 Access to a vetted network of providers, agencies, and attorneys • OB/GYNs • Urologists • Reproductive endocrinologists (REIs) • Nutritionists • Therapists • Adoption and gestational carrier agencies • Sperm and egg banks • Pregnancy support (midwives and doulas)
- 24. © 2022 Carrot. Confidential; not for distribution. 24 Culturally sensitive, inclusive care supporting all fertility health journeys LGBTQ+-inclusive resources Guidance to culturally competent care including BIPOC providers Support for income diversity Fertility care for all ages
- 25. © 2022 Carrot. Confidential; not for distribution. 25 Meet Sarah and Gina SAME-SEX COUPLE DENVER, CO • Sarah and Gina complete fertility testing to decide who will go through IVF • The couple connects with a nutritionist and learns how to improve their fertility through diet • They find a fertility clinic through their fertility benefit and move forward with IVF • All of their costs are covered through their fertility benefit
- 26. © 2022 Carrot. Confidential; not for distribution. 26 The largest global clinical network + a complete telehealth solution Eligible clinics 3,600+ Countries in which Carrot is available 120 2,500+ Attorneys, agencies, and providers supporting adoption and gestational carrier arrangements Vetted annually using Carrot’s Standards of Excellence
- 27. © 2022 Carrot. Confidential; not for distribution. 27 Questions? LETS@GET-CARROT.COM
- 28. © 2022 Carrot. Confidential; not for distribution. Thank you 28
Editor's Notes
- [speaker note: this slide is OPTIONAL. No need to go through agenda slide if you would prefer to jump straight into content] Here’s what we’ll be discussing today: Understanding fertility and infertility Overview of common causes of infertility What treatments are available How employers can support employees going through these journeys
- First, I want you all to take a moment and think about the first thing that comes to mind when you hear the phrase “fertility health.” If you’re like most people, a woman going through IVF is probably the first thing that popped into your mind. And that’s a totally fair thing to think of – after all, with infertility becoming more common, most people at this point have either gone through IVF themselves or know someone who has. Or maybe this is a topic you don’t know much about — and you’re not sure how fertility and infertility are impacting your employees. Today, I’m going to take us through the basic definitions of fertility and infertility and explore some of the fertility journeys your employees are most likely taking right now. We’ll also get into the impact these journeys can have on employees emotionally and financially — and why employer support is so important.
- So what do we mean when we say “fertility”? In basic terms, it’s someone’s ability to get pregnant and carry a pregnancy to term.
- You can probably see right away the situations this definition leaves out. A same-sex female couple or female single-intending parent would need to try to get pregnant using donor sperm for 6 to 12 months to meet this definition of infertility. A same-sex male or single male would also be unable to meet this definition. So you can see how more people need access to fertility and family-forming resources even beyond the 1 in 8 couples who are diagnosed with medical infertility.
- For unknown reasons, as we age, we start to see a decline in our ovarian reserve, so this means, the quantity of eggs, the amount we have left, starts to decline or decrease over time, and this decline gets steeper especially after the age of 35. And as aging occurs, the egg quality, or the likelihood of an egg being genetically normal, decreases overtime as well. Hence, why the ability to achieve a healthy pregnancy decreases or can be more challenging as we get older. Other factors that can lead to infertility include problems with sperm production, function, or delivery; exposure to chemicals or radiation; ovulation disorders; and structural problems with the uterus or other parts of the reproductive system.
- I want to mention one other aspect of hormone health — age-related hormone changes. Fertility support isn’t just pertinent in someone’s reproductive years — it is important throughout life. The same key hormones that govern whether IVF, egg freezing, or pregnancy will be successful also govern an important part of fertility care, which is hormonal aging. Symptoms can be disruptive, but it’s common for employees going through these challenges to suffer in silence.
- So what treatments are available for individuals and couples going through fertility health challenges? In the next few slides, we’ll discuss some common treatment options and how people typically pay for these treatments.
- First, I wanted to introduce a few terms we’ll use throughout this presentation. Some of you might be familiar with these terms if you know someone who went through a fertility journey, or if you’ve been through one yourself. But if you’re not familiar with them, I know all of these acronyms can get confusing. So here’s a quick overview of two key terms you’ll hear through this presentation.
- Most different-sex couples start out by trying to get pregnant without intervention. For same-sex couples, the process starts with researching options for donor eggs or sperm, or for gestational carrier services or adoption. For different-sex couples, same-sex female couples, and single-intending parents, treatment typically starts with IUI, because it’s less invasive, and then moves to IVF. Depending on coverage, some people choose to start with IVF — we’ll get more into that later. Other fertility care options include fertility preservation. Some people pursue fertility preservation before getting treatment that can damage fertility, such as cancer treatment. Others choose fertility preservation if they’re not ready to grow their family but know they want to in the future. For those going through hormonal aging, the most common treatment option is hormone replacement therapy. But a lot of people going through menopause don’t actually seek treatment or talk to their doctor about it.
- Many fertility treatments are not considered “medically necessary” by insurance companies, so they are not typically covered by private insurance plans or Medicaid programs. When coverage is available, certain types of fertility services (e.g., testing) are more likely to be covered than others (e.g., IVF). Accessing donor sperm and eggs, gestational carrier services, and adoption are not covered by insurance — and get very expensive. More than 80% of people who undergo fertility treatments have little to no coverage and accuse $30,000 in debt. Even if someone has coverage, the types of situations covered are very limited. Let’s get into an example to share more.
- Sarah and Gina, a same-sex female couple, are looking forward to starting their family. Sarah asks her HR team about their current insurance coverage and learns that she would need to be diagnosed with infertility to get coverage. As a same-sex female couple, that means that she or her wife will need to go through 12 unsuccessful rounds of IUI before being able to try IVF. The problem is that their preferred sperm donor only had a few vials available, so they want to maximize their chances of getting pregnant in as few attempts as possible. They decide to get fertility testing done, which isn’t covered by their insurance because it’s not considered medically necessary. Based on their test results, they decide Sarah will be the one to go through IUI first. Unfortunately, their first attempt isn’t successful. They start to worry about being able to get pregnant using their donor sperm, so they decide to take out a loan to pursue IVF. It costs $15,000 per cycle out of pocket. While their first embryo transfer isn’t successful, their second one is. They’re excited to welcome a healthy baby nine months later — but it will take them time to pay down their debt.
- So we’ve established what fertility health is and what kinds of care people need — but why is this an employer issue? As we talked about, existing support for family forming and fertility through insurance is very limited for most people. Fertility benefits are a flexible, inclusive way to provide all your employees with the resources they need to pursue their fertility and family-forming goals. More job seekers and employees are actively looking to join companies that offer them. In a tight job market, they’ve become an essential part of a benefits package. Let’s get into what you should consider if you’re looking to bring fertility benefits to your employees.
- How big is this issue? It impacts nearly everyone in your organization. Fertility care is a lifelong journey. Egg freezing is now mainstream, and sperm preservation is following suit. Those facing menopause and low testosterone also need real support. Nearly everyone in your organization needs support 1 in 8 opposite sex couples face infertility, which is more than diabetes. 63% of LGBTQ+ say they intend to pursue parenthood, whether through fertility treatments or adoption. In the U.S, more than 30% of pregnancies are shepherded into potentially unnecessary C-sections, an invasive procedure with additional recovery time. And, your most senior leaders are silently managing menopause or low testosterone and it’s hurting their productivity at a time when you can least afford it.
- Another reason why a comprehensive approach is required - employees expect competitive benefits: Over 40% of U.S. workers are actively searching for a new job right now — and 36% of people say that’s because they want better benefits. With the average cost of retaining a highly skilled employee sitting at 213% of salary, it’s critical to keep top performers happy in their roles. Considering that 88% of people would consider changing jobs for access to fertility benefits and 77% would stay in their current role longer if fertility benefits were offered, now is the time for employers to consider the role fertility benefits play in their recruitment and retention strategy. https://www.get-carrot.com/fertility-at-work Sources: 77% and 88%: https://www.get-carrot.com/fertility-at-work 213%: https://www.americanprogress.org/article/there-are-significant-business-costs-to-replacing-employees/ 36%: https://www.shrm.org/about-shrm/press-room/press-releases/pages/shrm-research-highlights-lasting-impact-of-the-%E2%80%98resignation-tsunami%E2%80%99-on-workers-who-choose-to-stay.aspx
- Another major problem I am sure you face daily: Risk of unnecessary claims and productivity concerns: Without a program to manage fertility care, employers expose themselves to unnecessary claims that can run upwards of $1M if a poorly managed IVF cycle ends up in the NICU. Multiple births — an easily avoidable result that occurs in 14% of IVF births compared to only 3% of non-IVF ones — are the most common reason for this, with lower birth weights and increased chance of NICU stays increasing the average cost of giving birth more than 5x compared to a singleton birth. Unnecessary C-sections, which can cost 1.5 times the amount of vaginal deliveries And beyond medical expenses that quickly add up, this impact spills over into workplace productivity, with multiple births leading to 4.4x greater risk for time absent from work. Still, over 60% of fertility clinic patients have stated a preference for multiples — largely due to a lack of education around the risks of multiple births.
- Comprehensive fertility healthcare, supporting all the ways people pursue parenthood – and beyond. Your fertility benefit should support all of the journeys and parts of life that we’ve discussed in this presentation, from fertility testing and preservation, to fertility treatments, donor-assisted reproduction, and adoption. At Carrot, we support all people – of every age, sex, and gender – through every aspect of their fertility journey, starting from folks who are just entering the workforce through career crescendos as critical managers and leaders hit their stride.
- So our mission at Carrot’s is to provide a path to parenthood for everyone regardless of their gender, marital status, sexual orientation, and all ages…
- Inclusive fertility benefits should also include access to a suite of experts and resources to support employees on whatever path they take.
- Speaker Notes: Women of color are two to three times more likely to die of childbirth related clauses in the United States than white women. Research shows that people who feel supported by their providers will show up for their doctor visits, have better adherence to medications, and trust their doctors more. Carrot works one-on-one with members of color to help them find an eligible provider who shares their background. Members can indicate that they would like this support within the initial onboarding questionnaire. As a result, members feel safer and more empowered in their treatment. LGBTQ+ inclusion is also a top priority for us here at Carrot. Here are a few ways we support our LGBTQ+ members: LGBTQ+ Expert Chats (U.S. members) Carrot Experts on adoption and GC journeys Support finding LGBTQ+-inclusive and affirming care in their area Guidance through Carrot’s vetted attorneys and agencies supporting either adoption or GC journeys Equitable coverage for all fertility journeys and a payments platform that supports income diversity by removing the need to pay for expensive care up front Mental health support every step of the way, including emotional support experts and resources
- Let’s go back to the couple we introduced earlier and take a look at how their journey would have been different if they’d had access to fertility benefits from the start. Because they have fertility benefits available through Gina’s employer, they’re able to start the process without needing an infertility diagnosis — something that would be time consuming and expensive to prove as a same-sex female couple. They start by taking fertility tests to learn who might be the best candidate to go through IVF. Based on their test results, they decide Sarah will be the one to go through IVF. They also learn that they have access to a nutritionist as part of their fertility benefits, so they set up a call to learn if there’s anything they can do to improve their fertility before starting IVF. They learn about what to eat and what to avoid to improve their chances of getting pregnant and decide to make the changes together to make it easier for both of them to adjust their diets. While their first embryo transfer isn’t successful, their second one is. They’re excited to welcome a healthy baby nine months later. Their fertility benefit covered the full cost of their treatment, and with the money they saved, they’re able to put more money towards a down payment on a larger home for their new arrival.
- Here’s a quick look at Carrot’s global network - we have 3,600+ eligible clinics that we vet for quality and more than 2,500 attorneys, agencies, and providers supporting adoption and gestational carrier arrangements. Carrot is available in 120 countries, so you can provide true benefits parity to your teams worldwide.