When a doctor told an Apple employee and his wife that in vitro fertilization was their only shot at a second child, they worried whether the procedure would work. But they didn’t worry about paying for it out of pocket, as most people in the United States would.
Because of the husband’s health insurance, Apple covered their IVF costs. Their son was born last year. “It feels like the company cares about their people, that they realize this is something that can be financially hard and emotionally hard, and it offers you options,” said the 34-year-old woman, who requested to not be identified.
Two years ago, Apple and Facebook made headlines when they started to foot at least of part of the bill for services like IVF and egg-freezing in an effort to recruit and retain talented employees, particularly women. And overall, the tech industry pours more money into fertility benefits than any other industry, including finance, fashion, and pharmaceuticals, according to a poll released Tuesday by FertilityIQ, a startup that collects patient feedback about fertility clinics. Google, Intel, Spotify, Facebook, Microsoft, Amazon, and the e-commerce site Wayfair all also offer fertility benefits.
Based on a survey of about 1,000 users, FertilityIQ collected data about how much dozens of major companies are willing to spend on fertility benefits — information that most of the companies do not publicly advertise. Coverage varies: Google and Facebook, for example, require employees to go to certain clinics, while other companies lack such restrictions, according to FertilityIQ.
These services aren’t cheap. Egg-freezing costs about $10,000, storage is $500 to $1,000 a year, and one IVF round goes for around $15,000.
“We’ve heard for so long and for forever that it’s all out-of-pocket and that companies never pay for it,” Jake Anderson-Bialis, FertilityIQ’s co-founder, told BuzzFeed News in reference to fertility benefits. He added, “That’s what’s extraordinary about the tech companies, the extent to which they’ll totally cover you. It’s uncommon.”
Critics see egg-freezing subsidies as a ploy to chain female employees to their desks. “Rather than saying, ‘have your children in your own time and we’ll support you with well-paid parental leave and subsidised childcare,' they’re saying, ‘work really hard through your most fertile years and then when you may not be able to have kids anymore, you can give it a shot with the eggs we froze for you as a perk,’” Harriet Minter wrote in The Guardian in October 2014, when news broke of Apple and Facebook’s subsidies.
But proponents say these benefits are a good thing. More women in the United States in general are having children later in life, partly because they’re busy with school or careers, or haven’t found their ideal partner.
“Anything that gives women, and ultimately women and their partners, more options and more choice is good,” said Valerie Baker, chief of the reproductive endocrinology and infertility division at Stanford University School of Medicine, where she’s seen an uptick in patients affiliated with tech companies like Apple, Google, Facebook, and Cisco. Many patients don’t put off starting families because they’re overworked, but more often because they aren’t in an ideal relationship. “Maybe they just separated from a relationship that was longer-standing, maybe it’s that they just haven’t met a person that they want to be with long-term, or a relationship’s very new,” Baker said.
Paula Amato, an associate professor of obstetrics and gynecology at Oregon Health and Science University, said, “I don’t think providing this sort of coverage gives companies a pass so they don’t have to think about providing work-life balance for women. But I think the reality is, that doesn’t exist right now. Why deprive women of that option if it’s available?”
After a woman’s twenties, which are her best reproductive years, her fertility declines in her thirties. Most women are unable to have a successful pregnancy by their mid-forties. But egg-freezing does not guarantee a family later in life. While frozen eggs lead to live births after IVF nearly half the time, the odds of a live birth are higher for IVF using fresh eggs, according to a 2015 study.
And aside from working for companies that volunteer to pick up the tab, people who want fertility services have limited financial help. Although some insurers may cover egg-freezing for patients with diagnosed infertility, virtually none cover it for non-medical reasons. Wounded veterans can receive IVF coverage through the Department of Veterans Affairs, and 15 states mandate some form of infertility insurance coverage, but otherwise, few health plans cover IVF.
Nor does the Affordable Care Act mandate coverage for infertility treatment. That’s highly unlikely to change under President-elect Donald Trump, who has said he will repeal some or all of the law.
“I don’t think that coverage is going to come from the ACA,” said Judith Daar, interim dean of Whittier Law School and a clinical professor of medicine at UC Irvine. “Instead, we may be looking to this model this study talks about — the provision of care by private companies who view it as a way to compete in the marketplace for certain types of employees.”
Intel, for example, started covering IVF, artificial insemination, and other treatments in 2007. In October 2015, it announced that it would increase coverage for fertility medical services (from $10,000 to $40,000) and medication expenses (from $5,000 to $20,000). The company also made coverage available to all employees, not just those with diagnosed infertility, and began covering the costs of freezing and storing eggs, embryos, sperm, and cord blood. On top of fertility benefits, Intel recently started reimbursing adoption costs (up to $15,000 per child) and offering eight weeks of paid “bonding” leave for new parents, both men and women, in addition to as many as 26 weeks of maternity leave.
“You also have to make sure you’re creating a really supportive work environment where everybody, especially working parents, can really thrive.”
“We talk about setting goals for retention and hiring and pay parity and promotion, and all those things are really important,” Danielle Brown, Intel’s chief diversity and inclusion officer and vice president of human resources, told BuzzFeed News. “But you also have to make sure you’re creating a really supportive work environment where everybody, especially working parents, can really thrive.”
In 2015 and so far in 2016, female employees stayed at Intel at higher rates than male employees, Brown noted. It is a reversal of a decadelong trend, she said, although it’s unclear whether the expanded fertility benefits were the direct cause.
FertilityIQ ranked Intel as one of the most generous tech companies, second only to Spotify, which offers unlimited dollars for fertility treatment. Benefits are also generous at Apple, which covers $20,000 worth of fertility treatments, and Facebook, which covers four IVF cycles. Wayfair covers up to $40,000, according to a spokesperson, who declined to comment further.
As far as restrictions go, Google and Facebook limit the fertility clinics where employees can go, according to FertilityIQ. (Daar noted that this requirement may not be unusual if the companies also limit where employees can seek other kinds of medical care.) And while some companies open up their fertility benefits to all employees, others, like Bank of America, require that employees are diagnosed as infertile. That effectively cuts off coverage for women who want to become single mothers and same-sex couples, for example. A spokesperson confirmed the policy, and noted that the bank also reimburses employees up to $8,000 for adopting a child.
Of the tech companies named in this story and contacted by BuzzFeed News, Intel alone provided an executive to discuss its fertility benefits. Spotify and Amazon did not return requests for comment, and Google, Microsoft, and Wayfair declined to comment. Apple declined to comment beyond a statement from 2014 that said in part, “We continue to expand our benefits for women, with a new extended maternity leave policy, along with cryopreservation and egg storage as part of our extensive support for infertility treatments. ... We want to empower women at Apple to do the best work of their lives as they care for loved ones and raise their families.”
Last year, Anderson-Bialis and his wife, Deborah, founded FertilityIQ after they struggled to navigate fertility doctors and clinics while conceiving their child. For this survey, FertilityIQ polled more than 5,000 users, then honed in on about 1,000, most of whom said their workplaces paid for their treatments in the previous 18 months. Then they asked those people, or their companies, to provide details about their coverage.
However, employers were not always willing to talk, so FertilityIQ was not able to confirm all coverage details with them. Sometimes, to figure out a company’s reimbursement policies, the team resorted to contacting the billing departments of clinics where employees sought care.
“You imagine anyone on this planet wants to be seen as female-friendly, family-embracing — all these things that companies bend over backwards to prove to themselves and others that they are,” said Anderson-Bialis, who says workplace-covered fertility services saw an uptick beginning around 2013. “There’s probably no benefit that’s more emblematic of that kind of gesture, and yet so few are really comfortable talking about it to anyone outside their own employees.”
Privately, he said, they still have concerns such as: “‘If we widely advertise this to everybody, what does that invite? Does that invite people applying for jobs and getting jobs because they know this will be paid for?’ That can cost more than their salary. At a lot of places, it probably does.”
While it’s unclear what kinds of returns on investment companies are seeing, at least some women appreciate that their bosses are picking up the costs. In FertilityIQ’s survey, employees whose companies fully covered their fertility treatments said they were more grateful, more loyal, and inclined to stay longer at their workplaces than they would have been had they not had the option.
“Maybe you always thought you’d be married with kids by age 30 — but here you are, you’re 31 and single still and you love your job,” said the wife of the Apple employee who gave birth last year. “Now you have the option of, ‘maybe you can freeze your eggs and have a family in the future.’ What an awesome gift, in my opinion.”