Back in 2020, when doctors first told Jaclyn and Dustin Glass that in vitro fertilization (IVF) was their best bet for having a child, the New Jersey couple had no clue what the process entailed or how much it cost. Jaclyn, then 31 and working remotely as a fashion stylist, knew her employer didn’t offer anything labeled fertility benefits. But she and her lawyer husband were relieved to discover her employer’s insurance was subject to a New Jersey mandate that it cover IVF and in 2022 she had a son. “It’s definitely life-changing,” she says of the mandate.

Still, when she looked for her next job, Jaclyn made sure fertility coverage was explicitly part of the benefits package and in 2024 had a daughter, also via IVF. Her new employer uses Carrot Fertility, a venture capital backed 10-year-old private company that offers a menu of fertility support and interventions, including for men, both as a benefit, and a way to control costs. Carrot boasts more than 1,000 employers (including Forbes), as clients.

Even with insurance, the Glasses figure they paid $8,000 out-of-pocket for two rounds of IVF—a bargain, considering their success and the fact that the average cost of a single IVF cycle in the U.S. is $23,474. “There's enough things in life that are determined by your finances and I think the ability to have a child shouldn't be one of them,” Dustin says.

The couple’s experience shows two big reasons more workers are now getting fertility treatments at least partly paid through their jobs: increasing state mandates and employers' moves, particularly at the start of this decade, when workers were in short supply and healthcare costs seemed somewhat tamed, to voluntarily add benefits.

These days, by contrast, employers have a stronger hand and have been moving to control resurgent growth in healthcare premiums. Yet two recent surveys show fertility benefits coverage holding up—and even growing at the largest employers.

This all comes against a backdrop of a falling and now record low birth rate in the U.S.—except for older mothers, who are more likely to need fertility services. The Centers for Disease Control and Prevention (CDC) reports that from 2015 to 2024, the birth rate for women aged 35 to 39 increased 5% and for those 40 and older by 24%.

The CDC says a record 98,289 infants were born with the help of assistive reproductive technology (mostly IVF) in 2022, up 45% from 2013. While the agency hasn’t updated the IVF numbers, the Society for Assistive Reproductive Technology (representing IVF clinics) reports more than 100,000 babies born through IVF in 2024.

On the 2024 campaign trail, President Donald Trump promised free IVF services for all and even called himself “the father of IVF.” So far, the administration has made two limited moves to boost IVF availability: The TrumpRX drug platform offers discounted IVF drugs for women paying in cash, without insurance, and the Department of Labor last month proposed regulations which would make clear that under existing law employers can legally offer limited fertility coverage as an extra employees can opt to pay for with pretax dollars, the way many now pay for dental or vision benefits.

The Current State of IVF Coverage

Half of the states and Washington, D.C. now have some sort of infertility insurance laws, according to RESOLVE: The National Infertility and Family Building Association. But just 14 states (and D.C.) require at least some employer health insurance plans to help pay IVF costs, RESOLVE’s state tracker shows. A chunk of the IVF mandates, including those in California, Colorado, New Jersey and New York, have been adopted or broadened since 2020. It’s worth noting, however, that mandates sometimes explicitly exempt the smallest employers, who are the ones most likely to be subject to state insurance mandates.

That’s because under federal law, employers who are technically “self-funded”—meaning they retain at least some financial risk for employees’ medical claims—are exempt from state mandates. The 2025 employer health benefit survey by non-profit think tank KFF found 67% of insured workers, including 27% of those in firms with fewer than 200 employees and 80% of those at larger firms, are covered by exempt plans.

So what employers do voluntarily is crucial, particularly in the absence of a federal mandate. In its 2025 survey of large health plans released in November, benefits consultant Mercer found IVF was covered by 50% of employers with more than 500 workers, up from 27% in 2020. Among employers with 20,000 or more workers, 77% covered IVF, up from 42% in 2020.

A just released 2026 survey by the International Foundation of Employee Benefit Plans of 495 employers of all sizes, including small ones, found 30% covered IVF, down a tick from 32% in 2024, but still double the 14% who paid for it a decade ago.

Overall, there’s no authoritative data on the share of IVF patients who get help from insurance. The procedure is not covered by Medicaid, the federal-state program for the poor, and the Affordable Care Act (i.e. Obamacare) doesn’t contain a requirement for coverage, though some plans offered in some states offer it.

Intriguingly, one fertility benefit has continued to grow, according to IFEBP’s 2026 survey: Egg harvesting and freezing is now covered by 18% of employers, up from 2% a decade ago. That’s an obvious bid by employers to appeal to younger women keen to keep their family options open. (Today, the cost of an egg freezing cycle is around $16,000, with costs varying by location.)

Why Growth in Coverage Could Stall

Any voluntary growth in benefits would seem to fly in the face of reduced worker bargaining power and a few recent high-profile examples of cutbacks in family benefits. For example, Deloitte, the largest accounting firm in the U.S., last month announced cuts in new parent leave and parent building stipends (for adoption and surrogacy) for some of its administrative, finance and IT support workers. (As a Forbes contributor suggested, it may be no coincidence that those jobs, which aren’t core to Deloitte’s client-facing accounting and consulting work, are most vulnerable to being eliminated by artificial intelligence.)

“Deloitte US is modernizing its talent architecture to provide a more tailored experience reflective of our professionals’ broad range of skills and the work they do serving our clients,” the accounting firm said in a statement to Forbes. “Benefits are regularly updated and will be tailored for a small subset of professionals to better align with the marketplace.”

Dr. Neel Shah, chief medical officer at women and family health platform Maven Clinic (a 12-year-old, VC-backed competitor to Carrot), insists that his firm isn’t seeing any widespread retreat from fertility coverage. “As a general market trend, [Maven] is seeing employers double down on this benefit because it is always important to be able to recruit a reproductive-age workforce,’’ Shah says.

“That demographic is a core part of what drives any business,” he adds. “And beyond recruiting them, you have to retain them through, what in America at least, is a really disruptive process of starting your family and trying to earn a living wage at the same time.”

Shah also points to the Trump administration’s fertility push: “I think because of these confluence of factors, this is a benefit that nobody's eager to uninstall and it's a benefit that’s needed just to be competitive as a business.”

Carrot cofounder and CEO Tammy Sun concedes that rising healthcare costs may make it difficult for some employers who don’t already offer fertility benefits to get in the game. But she uses cost control as a sales pitch, arguing that firms already paying for those benefits can control spending with a more comprehensive approach that offers earlier, lower cost interventions for women trying to get pregnant (say, improving metabolic health) and more guidance on the use of services if infertility is diagnosed.

"Every IVF cycle that is avoided or reduced is an approximately $30,000 cost that is also avoided for the plan sponsor and small employer,” says Sun. “It's also a physical and mental cost that is avoided for the employee and the family.”

Employers, Sun adds, should think about “what is the right combination of interventions—both small, medium, and large—that can help a person get to a healthy outcome with as short a time as possible and as little cost because you can only bend the cost curve if you're thinking in this way.”

Beyond using such platforms, employers hold down their costs by capping services, either in terms of how many cycles of IVF they’ll pay for, or with dollar caps. According to Mercer, 54% of large employers providing IVF coverage have lifetime dollar limits, with the median being a modest $20,000, just shy of the average cost of one cycle. Another 23% have limits on the number of cycles covered, with a median of three cycles. The DOL proposal for a standalone fertility benefit would have a comparatively generous $120,000 lifetime cap and would limit coverage to diagnosis or treatment of infertility (in other words, no elective precautionary egg freezing).

What Workers Value Most

Workers, no surprise, would be grateful for even more help with the financial, emotional and time drain of starting a family. (At the bottom of this story we’ve got some tips for advocating for benefits at your workplace.)

When Maven surveyed employees who have used its services, 93% said their careers have been impacted by an infertility diagnosis and 70% said they had to use sick days to go through fertility treatments.

“We were at the doctors twice a week for almost two years,” recalls Phil Scaffidi, a 36-year-old employee benefits consultant at Lawley Insurance in Buffalo, New York, who started infertility treatments with his wife back in 2023. His wife, then 32, went through multiple rounds of intrauterine insemination (IUI) and IVF before having their daughter in April 2025. Looking back, he says, he “cannot put a value” on how much it meant for them to have employer support.

“I remember at the time, and still currently, the number one priority in me and my wife's life was starting a family and now it’s growing our family,” he says. “So giving people the time they need to do these things is huge.”

Jaclyn Glass, for her part, is enthusiastic not only about her success with IVF, but also about the extra support she got through Carrot. “It doesn't make you feel like you're choosing between your fertility journey and being committed at work,” she says. “I always say everybody should have access to fertility benefits for all the stages of fertility…I know two men who used the benefit and had a surrogate.”

4 Steps to Gain Workplace Benefits

Fertility benefits aren’t yet a standard workplace offering the way wider health insurance plans and 401(k)s are, but worker demand has driven a big increase over the last decade. If you’re looking to get fertility coverage at work, it pays to be proactive. Here are a few tips.

1. Find out what type of insurance plan your employer has. If your company doesn’t seem to cover fertility services, ask HR whether your health plan is fully insured or self-insured. Fully insured plans are required to follow any state insurance laws around fertility coverage, while self-insured ones are exempt from these laws. Use this state tracker to check the mandates in your state.

2. Team up with other employees who care about coverage. If you want to lobby the company to expand coverage, try to get buy-in from colleagues. A workplace women’s network or a parents’ group is a good place to start.

3. Frame it as a workforce issue, not a personal one. Bring the broad support for this benefit into your discussions with HR. Come armed with data about how widely fertility benefits are offered elsewhere and frame this as a competitive issue.

4. Look beyond IVF. If your company is leery of covering IVF, discuss a range of benefits that might help more employees at a lower cost, including fertility counseling, adoption assistance and allowing workers to take time off (including partial days) with pay, to deal with family building and support issues.

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