Fertility’s access problem
Fertility treatments are expensive and difficult to access. Confusing guidelines and a lack of financial support also prevent patients from receiving
The desire to start a family is a powerful biological imperative, but not everyone is given the same chance.
A single cycle of IVF treatment can cost £5-10,000 in the UK or $20-60,000 in the US, with no guarantee of a successful outcome.
Access to state-funded IVF varies wildly, depending where you are in the UK. In England, decisions about who can have NHS-funded IVF are made locally by Clinical Commissioning Groups (CCGs). The provision of IVF treatment varies from zero to three funded IVF cycles, depending on location and different eligibility criteria, often based on age. While NHS Scotland funded 62% of cycles in 2019, this figure fell to 20% in some parts of England¹.
Fertility treatments are also typically not covered by private medical insurance, which results in high and unpredictable out-of-pocket expenses for the one in seven couples who have difficulty conceiving ².
The level of NHS funding for fertility treatment varies across the UK, with 62% of cycles funded by the NHS in Scotland, falling to 20% in some parts of England ³.
One cycle of IVF can cost £5-10k in the UK or $20-60k in the US. With success rates around 30%, couples can pay $60-180k across three cycles, with no guarantee of success.
There is huge disparity of ART access globally. Countries like Belgium and Australia provide 5 times more cycles per million of population per year than the USA ⁴.
Explore the key issues below
Treatments are unaffordable, funding is limited and clinical guidelines are not enforced
According to the UK’s National Institute for Clinical Excellence (NICE) guideline “IVF should be offered to women under the age of 43 who have been trying to get pregnant through regular unprotected sex for two years” ⁵. This two year wait is regardless of age and ignores the fact that the likelihood of live birth rates decreases from 29% for those aged under 35 years old, to 3% for women aged 43 to 44 ⁶. Even then, NICE’s guidelines are ultimately just guidelines and the CCGs within the NHS are not required to act on them. This means there is relatively limited public funding available.
Treatment is costly and uncertain
For those who choose to fund IVF privately, the lack of personalised data available means they are required to pay for something with very little knowledge of the likelihood of success, something which is almost unheard of elsewhere in healthcare.
This can result in multiple cycles of IVF being undertaken at huge cost, despite very slim chances of a positive outcome. Meanwhile, others with better chances may be put off by the high costs and avoid it altogether.
Low health insurance coverage
Fertility treatments are rarely covered by private medical insurance, despite a clear market need, and progress to shift this position has been limited.
There has been some improvement in the US, where 17 states have passed laws that require insurers to either cover or offer coverage for infertility diagnosis, however, there is still a lot of disparity. While some states have laws requiring insurance companies to provide coverage for IVF as part of their treatments for infertility, others – such as California, Louisiana and New York – have laws that specifically exclude IVF from private health insurance coverage.
With limited national funding, expensive treatments and relatively low probability of successful outcomes, it’s not hard to see why insurers choose to exclude fertility treatments from their policies and instead continue to perceive it as “niche and experimental”. This is despite the 8 million IVF babies born since the first treatment in 1978.
“Menopause, fertility, pregnancy and parenthood are natural life journeys that can quickly become workplace issues. Organisations need to provide support to their people through these periods in life when their health is most vulnerable.”
Dr Mridula Pore, CEO and Co-Founder, Peppy
Pioneering solutions to accessibility and pricing barriers are being developed
Startups are tackling the infertility challenge by developing novel pricing models, launching digital platforms and adopting new distribution channels.
Outcome-based fertility financing
These startups are essentially replacing the role of insurers by providing smart risk pricing for treatments such as IVF. The ultimate cost of IVF does not change for users, but unsuccessful patients pay less, and successful patients pay a little more.
Employer-focused fertility benefit providers
With companies offering an expanded benefits package in a bid to boost employee retention and satisfaction, employers have become an attractive new distribution channel for startups committed to addressing the infertility taboo.
Fertility insurance unicorn Progyny, which has a market cap of $5.7bn, was one of the first startups to offer fertility benefits to employers. Now startups in Europe – such as Carrot, Fertifa, Peppy, and Oviavo – are following Progyny’s lead, using employers as a channel to distribute their solutions and platforms.
Digital fertility clinics
On average, a patient is required to go to a fertility clinic nine times during an IVF cycle, according to Caroline Noublanche, the CEO and founder of digital fertility clinic startup, Apricity.
Her team is aiming to improve patient experiences and accessibility by digitising as many of the processes as possible, reducing the need for in-person visits to a clinic.
The rise of employers as a go-to-market strategy
The pandemic has further accelerated this trend, having underlined the crucial role of employers in supporting employee wellbeing. This is a significant shift, and in the short term represents the most effective lever to improve patient outcomes by dramatically increasing access to treatment. For fertility startups, treatment as part of an employee benefit package also represents a sizeable new distribution channel.
The need for inclusive employer support
More employers are offering fertility support as a benefit, but it is still rare and remains focused on IVF and egg-freezing. While some communities, including many in the LGBTQIA+ community, have fallen back on adoption, financial support for this is limited. More inclusive employer/employee fertility support will not just present a further opportunity for innovation, but also expand the reach of ART, making it more accessible to a wider cross-section of society.
Companies to watch
Future Family offers loans for IVF and egg freezing to make it easier to get started quickly with fertility treatment.
Gaia combines reproductive health data with financial technology to make IVF treatments more accessible, affordable and personal.
Apricity is a fully digital fertility clinic delivering individualised patient care across all stages of the fertility journey, from diagnosis, to egg matching and donation, to early pregnancy monitoring.
Fertifa bridges the privacy gap between employers and employees, debunking taboos around fertility and offering valuable support in the form of employee benefits.
Apryl helps companies overcome inequalities, supporting all employees in family planning and helping individuals to thrive in their careers with a comprehensive fertility benefits platform.
Woom uses machine learning across a fertility app, ovulation tracker and menstrual cycle calendar to allow women to better know their body and optimise their fertility.
Get in touch with our Health team to find out more
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