Fertility Justice NOW!

Understanding Fertility Justice

What is Infertility? Infertility is generally defined as the inability to become pregnant after 6-12 months of unprotected sexual intercourse. Often, insurance policies require enrollees to meet this definition before providing them coverage. This is the case even though assisted reproduction is also a critical method of family-formation for single people and same-sex partners. 

What is Assisted Reproduction? Assisted Reproduction refers to fertility care that is intended to help individuals and couples build their families. It includes information, counseling, products, medications, procedures, and services aimed at causing pregnancy through means other than by sexual intercourse. Fertility care includes a broad range of treatments, including intrauterine insemination (IUI), in vitro fertilization (IVF), and fertility preservation (collecting and freezing eggs or sperm), and may involve third parties (gamete donors or people who act as surrogates). 

What are the Barriers to Accessing Fertility Care? Numerous barriers—such as lack of insurance, high out-of-pocket costs, limited information, restrictive laws and policies, stigma, and provider bias—put AR out of reach for many. A single cycle of IVF can cost an average of $20,000, and multiple cycles are often needed to achieve a pregnancy and live birth. Without insurance coverage, this cost is prohibitively expensive for most people. Twenty-one states (and DC) have fertility insurance laws (known as state insurance mandates), but only 15 of them provide coverage for IVF. Nearly all these insurance mandates, though, only apply private insurance and not to state Medicaid programs, and none of them apply to large employers that are self-insured (e.g., pay for insurance directly as opposed to through an insurance company).

There are well-documented disparities in access to fertility care, showing that people of color, low-income people, people with disabilities, and the LGBTQ+ community access fertility treatment at disproportionately low rates in the United States.  For example, while Black women in the United States are nearly twice as likely to experience infertility than non-Hispanic white women, they are less likely than white women to receive care. Below-average rates of fertility care use have also been found among Hispanic and American Indian/Alaska Native non-Hispanic women, while Asian/Pacific Islander and Black non-Hispanic women have reported longer periods of infertility and access fertility care at later ages compared to their non-Hispanic white counterparts.  

As noted above, some insurers require enrollees to meet the definition of infertility before covering their fertility care. Of the 21 jurisdictions with state insurance mandates, only eight are LGBTQ-inclusive. Notably, three states require that the insured use their spouse’s sperm to undergo fertility care – presupposing that the insured is married, female cis-gendered, and in a heterosexual relationship.  

The Issue

Infertility is a recognized public health concern. In 2023, the World Health Organization (WHO) found that 1 in 6 people globally are affected by infertility.¹In the United States, however, well-documented disparities in access to fertility care reveal that people of color, low-income people, people with disabilities, and the LGBTQ+ community access fertility treatment at disproportionately low rates.² Discriminatory laws and policies, lack of insurance coverage, and deep-seated stigma and misconceptions around infertility all pose significant barriers to accessing fertility care.

Fertility Care in Georgia

Georgia does not mandate insurance coverage for fertility care despite recent data revealing that nearly 2.1 million women ages 20 to 49 experience infertility in the state.³ Nor does Georgia’s Medicaid program cover fertility care,  making the diagnosis and treatment of infertility prohibitively expensive for the nearly 2.2 million Georgians enrolled in the program.⁴ The average cost of a single round of in vitro fertilization (IVF),⁵ an assisted reproductive technology used to help people build their families, is $20,000 out of pocket. For those seeking to freeze eggs or sperm, fertility preservation can amount to $15,000, not including storage fees.⁷ Racial disparities persist in fertility care access. Black women in the United States are nearly twice as likely to experience infertility as non-Hispanic white women, but are 20% less likely to receive care.⁸ Hispanic and American Indian/Alaska  Native non-Hispanic women show below-average fertility care use. Asian/Pacific Islander and Black non-Hispanic women report longer infertility periods and delayed access to care compared to their non-Hispanic white counterparts.⁹  Additionally, LGBTQ and gender nonconforming individuals face challenges accessing non-judgmental as insurers and providers operate in and contribute to a health care system that is cisgender and heteronormative.¹⁰ For example, insurers often predicate coverage for IVF on a diagnosis of clinical infertility, which is the inability to become pregnant after six months or one year of unprotected sexual intercourse. This requirement discriminates against individuals unable to reproduce via sexual intercourse due to factors such as a lack of a partner or because of someone’s sexual orientation.