Getting fertility benefits right isn’t easy

The desire to have a baby, Dr. Shefali Mavani Shastri said, often is a primal driving force for human beings.

“That is why I don’t believe infertility treatment is elective,” she said. “I believe it should be treated as any other medical condition.”

Infertility treatment is not easy and usually not fast, either, she added.

Shastri, a top reproductive endocrinologist, obstetrician and gynecologist, and partner with Reproductive Medicine Associates of New Jersey in Basking Ridge, said it often can take multiple cycles of in vitro fertilization to result in a successful pregnancy.

This often results in frustration.

“The injections, the hormones, the 6 a.m. office appointments, the ultrasounds, the bloodwork — there are a lot of procedures a woman must go through before she even undergoes an embryo transfer,” Shastri said. “That is why we have psychologists, social workers, acupuncturists, nutritionists and more on staff, because many participants cannot take the stress when there is no guarantee.”

The other reason women and families often give up early? Cost — even though New Jersey is one of the 15 states in the country where insurers are mandated to offer coverage for infertility treatment.

“It (often) doesn’t quite work out that way due to insurance loopholes and diagnosis requirements,” Shastri said. “And employers who are self-insured don’t need to follow state mandates.

“Many of these employers either don’t provide coverage or usually provide dollar limits that are too low to cover successful procedures.”

It is just one element of health care that is inequitable and sexist, Karin Ajmani said.

“Almost everything for a man, when it comes to fertility or even sexual issues, generally is covered by insurance, but for women, fertility treatments are still considered voluntary,” she said. “Why is it that, when my husband tears his anterior cruciate ligament playing basketball, that his tests and surgeries are covered, despite the bill costing way more than an IVF cycle? Why is the treatment for infertility treated differently when I am paying the same premium for my insurance as he is?

“Me, a single woman, same-sex couples, we’re all paying the same insurance premiums, yet, many of the services we need are not covered.”

As president of Progyny in New York City, Ajmani works with some of the nation’s leading employers to offer all-inclusive, innovative fertility treatment and health benefits to employees.

She said one of the key elements to offering fertility benefits, therefore, is the absence of limits.

“The right coverage is one that covers all of the most effective and latest technologies to be able to sustain a successful pregnancy,” Ajmani said. “It is not just about going to your insurance carrier and asking to include a $15,000 benefit.

“As an employer, even though you are trying to do the right thing, you may be shooting yourself in the foot. If you are not covering the entire procedure, you may be forcing your employees to make economic decisions about their treatment when the only decision that should be made is by the doctor regarding the most effective treatment for that patient to have the most successful outcome, which is one healthy baby.”

Ajmani said that, if employers do want or need to cap their health care benefits, $40,000 may help 94 percent of those struggling to get pregnant find success.

Progyny itself gives its employers the option to provide unlimited fertility treatment or benefits for just two or three cycles.

“Everyone is starting to recognize that this is the right thing to do, but getting the attention of the chief financial officer to discuss budget dollars to cover this is a different conversation,” Ajmani said. “About 60 percent of our employers had prior coverage and chose to change the way they deliver it or increase their level of coverage. The other 40 percent had no coverage at all, yet we sold them on why this is an important health care event and that there is a way to cover it that is more holistic and inclusive than a fixed dollar benefit.”

By focusing on outcomes rather than costs, Progyny fertility benefits have allowed employees to pursue the most effective treatments the first time without risking exhausting coverage midway through.

The company also works with the largest network of premier providers in the U.S. and employs patient care advocates to provide emotional support and clinical guidance throughout the process.

“By taking away the financial stress of making medical decisions, patients are having much higher success rates with IVF treatments, as well as lower rates of multiples and miscarriages,” Ajmani said. “Between the counseling and the services we provide to our patients, we really have been promoting the best outcomes.”

Conversation Starter

Reach Dr. Shefali Mavani Shastri at Reproductive Medicine Associates of New Jersey, at:

To learn more about Progyny, contact Selena Yang, director of communications and strategy, at: 646-768-9719.

Read more from ROI-NJ’s Special Report: