The use of fertility treatments has been steadily increasing over the years, with more people than ever using fertility treatment to start their family. Data from the Human Fertilisation and Embryology Authority (HFEA) has shown that there was a 9% increase in IVF cycles from 2019 to 2021, yet, during the same period, a 10% decrease in the number of cycles funded by the NHS.

Due to lack of funding, most NHS Integrated Care Systems are not able to offer infertility services for most patients, and there are lots of restrictions and eligibility criteria individuals and couples need to meet in order to access care. As a result, more and more people are turning to private clinics for infertility services.

Fertility benefits for employees are no longer a 'nice to have', but seen as a necessity

With the rising cost of living and an increased demand for private fertility treatment, there is a call from employees for fertility coverage in their benefits packages to relieve the financial burdens private medical treatment can impose by picking up some of the medical costs. One of the first things most reward managers and benefits leads look to is their insurance benefits.

Understandably, lots of people assume the cost of infertility treatment, menopause medication, and a whole host of other reproductive health issues would be covered by health insurance companies or the NHS, and whilst more providers are expanding their infertility insurance coverage, more often than not employees cannot access adequate support using their health insurance policy alone.

Fertility treatment is defined by the World Health Organization as 'medical interventions designed to help couples or individuals who are struggling to conceive naturally' 

We know fertility treatment can be a minefield if you've never been through it or don't know anyone who has, so we're going to be outlining it in this article to hopefully demystify it for you.

The term fertility treatment encompasses a range of medical interventions and can be anything from fertility drugs to help a woman ovulate, to assisted reproductive technologies like in vitro fertilisation (IVF) or intrauterine insemination (IUI).

There are lots of different reasons why someone might need fertility treatment, but the ultimate goal or purpose is to increase the chances of conception for people who are struggling or unable to get pregnant naturally, and therefore require support and help from medical professionals. Often, fertility treatment will be advised if 12 months of regular, unprotected sex have failed to create a clinical pregnancy.

1. In Vitro Fertilisation (IVF): IVF is one of the most well-known fertility treatments. It involves controlling a menstrual cycle to ensure the ovaries release multiple eggs. The eggs are then removed from the ovaries and fertilised with sperm in a laboratory, creating embryos. The best-quality embryo (or embryos) is then transferred back into the uterus. If a single embryo transfer is used, any surplus embryos will be frozen. Whether you use a frozen or fresh embryo transfer will depend on what you and the clinic decide. IVF is often recommended for people with blocked fallopian tubes or in cases of unexplained infertility, and the benefit is always weight against any risk factors. Before IVF treatment begins, fertility clinics will typically assess your reproductive organs and check for any pre-existing conditions that may be contributing to infertility issues.
2. Intrauterine insemination (IUI): IUI is when sperm is directly inserted into an individual's womb to try and fertilise an egg. IUI increases the chances of sperm reaching the egg by decreasing the sperm's travel time to the egg. IUI can be performed with or without fertility medications.
3. Artificial insemination: Artificial insemination is a broader term that encompasses IUI. It includes any method of placing sperm into the reproductive tract through non-sexual means. This can mean placing sperm in the cervix, uterus, or fallopian tubes.
4. Intracytoplasmic sperm injection (ICSI): ICSI is a specialised form of IVF which involves injecting a single sperm into an egg, rather than leaving multiple eggs and sperm in a petri dish for self-fertilisation, which is the case for standard IVF. It's often used when there is a male cause for infertility, such as low sperm count or poor sperm motility.
5. Ovarian stimulation: Ovarian stimulation, sometimes also called ovulation induction, is a fertility treatment that uses medications to regulate the menstrual cycle and encourage the ovaries to release eggs. It's often used for people with irregular ovulation. By stimulating follicle growth and timing ovulation, it aims to improve the chances of conception through sexual intercourse.
6. Egg freezing: Egg freezing, also known as oocyte cryopreservation, allows an individual to store their eggs to be used at a later date. This can be for medical reasons or if someone needs to delay conception. 
7. Sperm freezing: Sperm freezing, also known as sperm cryopreservation, allows people to store their sperm for future use. This can be for medical or personal reasons to delay conception. It can be done from home through an at-home kit or at a fertility clinic.
8. Embryo freezing:  Embryo freezing, cryopreservation, is when eggs are fertilised, either using partner sperm or donor sperm and stored for future use. After IVF, a couple may have surplus embryos which can be frozen for future use. This allows couples to try again without going through the entire IVF process.
9. Frozen embryo transfer: This is usually done after a cycle of IVF where embryos have been frozen. The embryos are thawed and transferred back to the uterus. 
10. Surrogacy: Surrogacy is when a person carries a pregnancy and gives birth to a baby for another person or couple. It can be used when a woman cannot carry a pregnancy herself due to medical reasons, and is an option for LGBTQ+ who cannot carry a pregnancy, for example, same-sex male couples. An assessment of the surrogate's reproductive organs typically takes place before the embryo is implanted.
11. Donor egg or sperm: Egg or sperm donors are most commonly used when a person is unable to use their own, due to quality or quantity. LGBTQ+ couples may also need to use an egg or sperm donor.

The National Institute for Health and Care Excellence (NICE) fertility guidelines recommend women under 40 should have 3 treatment cycles of IVF if they have been trying to get pregnant through regular unprotected sexual intercourse for a total of 2 years or have tried to use artificial insemination to conceive and have not become pregnant after 12 treatment cycles. However, in most cases, private medical insurance providers in the UK will not offer fertility treatment coverage, including IVF and infertility tests or investigations.

As a result of lack of funding via the NHS, and lack of coverage by PMI schemes, the only option for many people who are struggling to conceive is to turn to private clinics and pay out of pocket to cover the cost of treatment.

Around 22% of adults in the UK have a private health insurance policy

In the UK, health insurance, often referred to as private medical insurance (PMI), provides individuals with the option to access private healthcare services and facilities when they make an insurance claim. While the National Health Service (NHS) offers publicly funded healthcare, private health insurance is an alternative for those seeking to avoid the long waiting period and have quicker access to medical treatments as well as a wider range of options. Most people who have PMI in the UK access it via their employer, but some do take out individual policies from an insurance carrier.

Health plans in the UK typically cover various aspects of medical care, including consultations, diagnostics, specialist treatments, and surgical procedures, often provided by private doctors and hospitals. Policyholders pay regular premiums to their insurance provider, and in return, they gain access to the services covered by their policy.

Health insurance policies in the UK vary widely in terms of coverage and cost. Some policies might cover only specific treatments or conditions, while more comprehensive plans can encompass a broader spectrum of healthcare services.

The majority of health insurance providers do not provide coverage for fertility treatment

The majority of private medical insurance providers in the UK do not offer infertility treatment coverage, the main reason for this being that they see fertility treatment as a 'lifestyle choice' and not as a medical necessity.

One exception to this is when a private health insurance provider covers fertility preservation treatment, including sperm or egg freezing, before cancer treatment. Additionally, fertility insurance coverage is not usually provided for consultations with a reproductive endocrinologist, genetic testing if needed, or counselling for associated mental health issues.

If a health insurance company does offer coverage for infertility treatment, however, it is unlikely to be comprehensive coverage, and more likely limiting with lots of qualifying factors such as specific age restrictions. One of the main qualifiers to accessing fertility treatment from a private health insurer is that you need to have a diagnosis of infertility. In order to do this, a heterosexual (straight) couple would either need to have a medical condition meaning they cannot carry a pregnancy or become pregnant, or they would have to have been trying, so having unprotected sexual intercourse, for at least one year, sometime two years.

These criteria can lead to discrimination based on sexual orientation. For example, LGBTQ+ couples will not be able to access coverage for fertility treatments, as they often cannot prove infertility. A female same-sex couple would have to have 12 rounds of IUI, paid for privately, before receiving an infertility diagnosis which can cost upwards of £20,000 once you account for the cost of medication and treatment cycles.

Other restrictions include:

• Age limits (those over 42 years old are usually ineligible) 
• Pre-existing health conditions
• Relationship or marital status
• Sexual orientation
• Existing children (if you have a child or stepchild, some providers will not offer treatment for infertility or investigations)
• BMI
• Smoking habits
• Previous treatment cycles (most fertility health insurance schemes impose a 3-cycle lifetime maximum on IVF procedures)

Some health insurance plans cover diagnostic testing for infertility but not the treatment itself.

Usually, after trying for 12 months, or sometimes 6 depending on other medical conditions, a doctor might recommend some initial infertility investigations for a couple. This usually includes a hormone (AMH) blood test for the female partner to make sure her ovaries still contain enough eggs, along with a pelvic ultrasound. It should also include a semen analysis test for the male partner to check the quantity and quality of sperm. These tests are important to identify any underlying causes of infertility and to help put together a treatment plan.

It is important to note that coverage of infertility treatment is rarely comprehensive and if offered, it's often partial coverage. For example, some health insurance companies, like BUPA, cover diagnostic fertility testing as an add-on to their standard health insurance coverage, but again this can be limited based on factors like age, other health conditions or medical history, BMI, and marital or relationship status. Single people are often not covered or supported in their family-forming journeys. Individuals may also be limited by the number and types of tests covered. For example, an insurer may offer a semen analysis but no further investigations for male fertility issues. Coverage from other providers may be limited to in-network providers.

Additionally, if there is no obvious reason for infertility after initial investigations, the insurance provider might not cover further testing or investigations, so the couple or individual will have to turn back to paying upfront, 'from pocket expenses', at a private clinic.

Fertility benefits are a good alternative to private healthcare schemes

Over the years, we've seen employers supplement their traditional private health insurance scheme with additional health benefit plans, including dental plans, online GP services, eye care vouchers for eye tests and glasses, health cash plans, and mental health benefits such as employee assistance programmes or counselling services.

As private fertility treatment costs rise, NHS and public health funding dwindle, and demand for fertility treatment increases, it's becoming increasingly commonplace for employers to provide fertility insurance coverage, or infertility benefits, as well.

If fertility benefits are something you want to find out more about for your employees, reach out to us today 💜