Back in 2020, when doctors first told Jaclyn and Dustin Glass that in vitro fertilization (IVF) was their best bet for having a child, the New Jersey couple had no clue what the process entailed or how much it cost. Jaclyn, then 31 and working remotely as a fashion stylist, knew her employer didn’t offer anything labeled fertility benefits. But she and her lawyer husband were relieved to discover her employer’s insurance was subject to a New Jersey mandate that it cover IVF and in 2022 she had a son. “It’s definitely life-changing,” she says of the mandate.

Still, when she looked for her next job, Jaclyn made sure fertility coverage was explicitly part of the benefits package and in 2024 had a daughter, also via IVF. Her new employer uses Carrot Fertility, a venture capital backed 10-year-old private company that offers a menu of fertility support and interventions, including for men, both as a benefit, and a way to control costs. Carrot boasts more than 1,000 employers (including Forbes), as clients.

Even with insurance, the Glasses figure they paid $8,000 out-of-pocket for two rounds of IVF—a bargain, considering their success and the fact that the average cost of a single IVF cycle in the U.S. is $23,474. “There's enough things in life that are determined by your finances and I think the ability to have a child shouldn't be one of them,” Dustin says.

The couple’s experience shows two big reasons more workers are now getting fertility treatments at least partly paid through their jobs: increasing state mandates and employers' moves, particularly at the start of this decade, when workers were in short supply and healthcare costs seemed somewhat tamed, to voluntarily add benefits.

These days, by contrast, employers have a stronger hand and have been moving to control resurgent growth in healthcare premiums. Yet two recent surveys show fertility benefits coverage holding up—and even growing at the largest employers.

This all comes against a backdrop of a falling and now record low birth rate in the U.S.—except for older mothers, who are more likely to need fertility services. The Centers for Disease Control and Prevention (CDC) reports that from 2015 to 2024, the birth rate for women aged 35 to 39 increased 5% and for those 40 and older by 24%.

The CDC says a record 98,289 infants were born with the help of assistive reproductive technology (mostly IVF) in 2022, up 45% from 2013. While the agency hasn’t updated the IVF numbers, the Society for Assistive Reproductive Technology (representing IVF clinics) reports more than 100,000 babies born through IVF in 2024.

On the 2024 campaign trail, President Donald Trump promised free IVF services for all and even called himself “the father of IVF.” So far, the administration has made two limited moves to boost IVF availability: The TrumpRX drug platform offers discounted IVF drugs for women paying in cash, without insurance, and the Department of Labor last month proposed regulations which would make clear that under existing law employers can legally offer limited fertility coverage as an extra employees can........

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