Fertility Matters Survey

It’s time to talk about fertility at work

A report by Carrot Fertility and RESOLVE

In recent years, conversations about fertility have entered the mainstream.

We discuss fertility treatments at the dinner table with our partners, talk about egg or sperm freezing at brunch with our friends, and learn about the fertility struggles of athletes and celebrities in the news and on social media. However, there is still one place where fertility remains taboo — the workplace. Why?

Infertility is common. One in eight couples experience infertility in the U.S., outpacing diseases like diabetes and cancer. 50 million couples worldwide experience infertility. Infertility affects our mental health, prevents us from bringing our best selves to work, influences our career decisions — and can even send us into financial debt. Most insurance companies don’t cover fertility treatments, and if they do, an infertility diagnosis is required, excluding LGBTQ+ people, single intending parents, and more. For those who experience infertility or the challenges of family forming of any kind, the silence can preclude them from seeking the support they need from their employers. And with one third of our lives spent at work and the majority of Americans receiving health insurance through their employer, it makes sense that the workplace plays an important part of a support system.

We partnered with RESOLVE: The National Infertility Association to survey people on how they feel about fertility topics at work, learn what programs are currently in place, and gain a better understanding of how people can be supported in their fertility and family-forming journeys. Our aim with this report is to use data and stories to shine a light on the importance of supporting employees in their fertility and family-forming journeys at work and normalize conversions about this vital part of human healthcare.

HIGHLIGHTS

As detailed in this report, the findings from our first annual Fertility at Work Report unearth the trends, priorities, and preferences that govern how we form families against the backdrop of our careers. Read on to better understand the fertility landscape today and what the future holds for employees, employers, and the industry at large.

Of the respondents, an astounding 89% said that fertility and family forming has negatively impacted their mental health.

Ultimately, employees are looking for a fertility conversation that is open, honest, and free from stigma.

COVID-19 didn’t slow down family forming and, in some cases, accelerated it

During COVID-19, fertility clinics abruptly closed, disrupting fertility treatments for people around the world. Family-forming journeys were put on hold. At the same time, millions of people started working from home who hadn’t before. In the face of a global pandemic, fertility care emerged as a core part of people’s healthcare priorities. For our survey respondents, the pandemic largely did not impact family-forming plans — just 8% said that they are delaying parenthood. And for at least some respondents, the pandemic accelerated their decision making — 10% of respondents decided to start fertility treatments because of the increased convenience of doing so while working from home.

Was your family-forming journey affected by COVID-19?

There has been progress bringing fertility conversations out in the open, but stigmas remain in the workplace

While survey respondents generally felt comfortable discussing fertility and family forming with friends, they reported that these topics are rarely talked about in the workplace, whether between colleagues, between an employee and their manager, or from leadership. In fact, 76% of respondents have never heard company leadership use terms such as “infertility,” “IVF,” or “miscarriage.”

The lack of open conversation leads to apprehension regarding time off requests for fertility treatments. When asked why they would feel uncomfortable telling their boss they need time off for fertility treatments, over half said it was because people don't openly talk about fertility at work. Another 34% were concerned it would not be seen as professional, and 30% were worried it would put their job at risk.

How comfortable are you sharing your fertility and family-forming journey with your...

Why would you feel uncomfortable talking to your boss about fertility?

Where do you give yourself injections?

Which of these terms have you heard at work?

People are aware of fertility benefits, but coverage varies, is confusing, and is not inclusive of all paths to parenthood

A majority of respondents (79%) were aware of fertility benefits, and more companies offer fertility benefits each year. But many employees remain uncovered, and for those who do have some fertility coverage, options are often limited and confusing. 30% of employees that have fertility benefits are unsure who in the company is covered. 31% of respondents wouldn’t feel comfortable bringing the topic of fertility benefits up with their employer for reasons ranging from not knowing who they should talk with to concerns over confidentiality.

Do you have access to fertility benefits through your employer?

For those who have fertility benefits, what do they cover?

Do you feel like your company’s benefits are enough to cover all of your family-forming needs?

Fertility and family forming impacts employee mental health

The financial burden of fertility treatments is known, with the majority of people paying out-of-pocket for their care. In fact, about 80% of people who undergo IVF treatments have hardly any or no coverage. Fertility treatments can have serious emotional and physical impact, as well. One study found that half of women and 15% of men said that infertility was the most upsetting experience of their lives. Not only does it make the pursuit of parenthood that much more overwhelming, but it can also trigger a flood of emotions — shame, guilt, and low self-esteem. These emotions, in turn, may eventually lead to varying degrees of depression and anxiety, both of which can have a cascading effect on work and family life.

Said fertility and family forming has negatively impacted their mental health: 89%

Fertility and family forming impacts employee mental health

Fertility and family-forming support impacts productivity and influences career decisions

For Millennials and Generation Z, fertility benefits may be the key to attracting great talent, winning the loyalty of current and prospective employees, and keeping people productive and engaged at work. Our survey found that 77% of employees would stay at their company longer if their employer offered fertility benefits. A large majority (88%) would even consider changing jobs for access to fertility benefits, and 74% said they’ve spent time researching fertility treatments and family forming while at work.

The majority of people use sick days and PTO for fertility care

Stigma around fertility at work is a global phenomenon

A recent study carried out in Ireland by Carrot partner and leading fertility clinic Sims IVF found that 79% of respondents did not feel adequately supported in their workplace when undergoing fertility treatment. The respondents, who were primarily female (97%), reported being hesitant to approach their male managers, fearing stigma and concerns over the potential impact on promotion and career progression.

People will pay for fertility and family forming but there are lasting financial implications

Fertility and family-forming care is financially out of reach because most people have to pay out-of-pocket for medical treatment and services. The average cost of an IVF cycle is $21,600. More than half of women must undergo a second cycle, and a third will undergo three or more. As a result, people can pay anywhere from $40,000 to $60,000 out-of-pocket for their fertility care. Private adoption costs range from $30,000 to $50,000, and gestational carrier services (commonly known as surrogacy) typically cost between $75,000 - $200,000. With limited fertility coverage, our survey found that nearly 70% of people will dip into, if not drain, their savings or go into debt to pursue parenthood.

Will use their savings: 37%

Will incur debt: 32%

Leadership demographics have little impact on the likelihood of offering fertility support

Does having leaders that identify as women and/or parents increase the likelihood that a company will support fertility care and family forming? Our results found that there was not, in fact, a correlation between women and parents in leadership and companies that offer fertility benefits.

Percentage of companies that offer fertility benefits with women in leadership

Percentage of companies that offer fertility benefits with parents in leadership

Financial services leads in fertility and family-forming support, followed by professional services and technology. Education trails most industries.

Once the domain of large tech companies, today companies that offer fertility benefits span industries including retail, professional sports, financial services, food and beverage, transportation, entertainment, and more. But there is still more work to do. Our survey found that 25% of financial services companies offer fertility benefits, followed by 21% of professional services, and 21% of technology companies. Education trails most industries with 65% of employees who don’t have access to fertility benefits through their employer.

Industries most likely to have designated fertility benefits

Now is the time to talk about fertility in the workplace

Fertility and family-forming care is a fundamental part of healthcare. For those undergoing fertility treatments or navigating complex family forming such as adoption and surrogacy, the experience is often isolating and can take a heavy toll on their physical and mental health. It can last many months or even years and have a cascading effect on the workplace, impacting recruitment and retention, productivity, and employee health and morale.

There are many ways employers can support employees in their fertility journeys. Normalize conversations around fertility and create a safe space for employees to share their plans. Recognize that fertility care is a vital part of all healthcare for all genders and equally support all paths to parenthood. Provide manager training on how to communicate about fertility and family-forming topics. Designate a private space in offices for injections. Carve out flexible leave policies so employees can care for their physical and mental health without having to use their sick and vacation leave.

Many world-class companies already understand the value of offering financial, medical, and emotional fertility and family-forming support to attract and keep great employees. Though companies cannot — and should not — break the bank to provide financial coverage for fertility care, every company can provide some coverage. Every company can adopt some internal practices to support their employees in this vital part of human healthcare. But it all starts with a conversation.

So let’s start. It’s time to talk about fertility at work.

How could your workplace better support you on your fertility and family-forming journey?

Demographics and methodology

In May 2021, Carrot Fertility and RESOLVE: The National Infertility Association conducted an online survey to explore the effects of fertility and family forming on employee well-being, retention, and recruitment. The survey was shared via email and social media to RESOLVE’s constituent database and followers and garnered 1,061 responses.

Demographically-speaking, the majority of our respondents were female (97%), followed by male (2%), non-binary (0.3%), and transgender / transgender male (0.1%). Respondents were split across age groups with 7% in the 25-29 range, 31% in the 30-34 range, 37% in the 35-39 range, and 5% in the 45-49 range. The majority of respondents are married or in a domestic partnership (94%), followed by single (3%) and dating seriously (3%). Less than 1% responded that they are dating casually.

About Carrot and RESOLVE

Carrot Fertility is the leading global fertility benefits provider for employers, built to support employees through their entire fertility healthcare journey. Companies use Carrot to customize a fertility benefit that provides employees financial, medical, and emotional support as they pursue parenthood, reducing healthcare costs and resulting in better clinical outcomes. Carrot's clinically-managed program includes fertility preservation like egg, embryo, and sperm freezing; in vitro fertilization (IVF), donor and gestational carrier services, and adoption; Carrot Rx®, a premium pharmacy experience, at significant savings; Carrot Pregnancy; and the Carrot Card®, a flexible fertility benefits debit card employees can use to pay for their care. Carrot supports companies in more than 55 countries across North America, Asia, Europe, South America, and the Middle East.

Established in 1974, RESOLVE: The National Infertility Association is a non-profit organization with the only established, nationwide network mandated to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders. One in eight Uus couples of childbearing age is diagnosed with infertility. RESOLVE addresses this public health issue by providing community to these women and men, connecting them with others who can help, empowering them to find resolution and giving voice to their demands for access to all family building options.