By Kristen Hwang
CalMatters
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When Megan Meo, 36, and her husband decided to start a family, they knew they wanted two kids. They didn’t know they would have to endure multiple rounds of fertility treatment, causing much heartache and draining away thousands of dollars.
“It’s strange when my body isn’t working to do a thing it was made for,” Meo said. ”It hurts me at my core.”
Meo is among roughly 9 million Californians who will benefit from a new law requiring some insurers to pay for the diagnosis and treatment of infertility. On Jan. 1, large group health insurers in California — from employers with at least 100 workers — will be required to begin covering fertility preservation and in vitro fertilization services.
The law also redefines infertility in state statute, eliminating an exemption that prevented same-sex couples or single people from receiving fertility benefits.
The law does not apply to people who get their insurance through religious employers, federally regulated plans or Medi-Cal. Last month, a settlement in a class action lawsuit led by a Santa Clara couple required Aetna to extend fertility benefits to LGBTQ couples nationwide.
Advocates expect small group insurers will soon be required to offer the same coverage through a separate regulatory process that awaits federal approval. Once federal officials approve that process, most Californians with employer-sponsored health insurance should receive the benefit, said Sen. Caroline Menjivar, the law’s author and a Democrat from Van Nuys.
“I am so proud of this bill. I want this bill on my tombstone,” Menjivar said. “This impacts so many people from single people to heterosexual couples.”
Menjivar, who is lesbian, said the new law strikes a personal chord. For her to have children, she would have to rely on fertility treatments – and insurance companies have often excluded LGBTQ individuals from coverage for these services. One of her friends spent more than $20,000 on fertility treatments to have three children, she said.
“This brings into the fold a lot of people,” Menjivar said, tearing up. “I get emotional because I know these people. I know what this looked like for my friends.”
High cost prevents people from using IVF
In vitro fertilization, or IVF, commonly helps people struggling to conceive. About 9% of men and 11% of women of reproductive age struggle with infertility in the U.S. During a cycle of IVF, doctors retrieve eggs from the ovaries and fertilize them with sperm in a lab. The resultant embryos can then be transferred to the uterus.
The process, while simple sounding, can take months or even years before a successful pregnancy. It is also expensive. A 2010 survey on the cost for infertility treatment among 400 Northern California women found the average payment for one cycle of IVF was $24,000. The average cost for a successful pregnancy, which can take multiple cycles, was $61,000. Health care costs have grown since then.
Before insurance coverage kicked in, Meo’s fertility clinic told her one round of IVF would cost between $30,000 and $39,000.
“The idea of spending $40,000 on something that might not work was really scary,” she said. She and her husband have been trying to start a family for two years. Her infertility is partially related to uterine scarring left by a previous miscarriage. Insurance coverage lessens the emotional and financial burden for them, Meo said.
Alise Powell, director of government affairs with RESOLVE: The National Fertility Association, said cost is the No.1 barrier preventing people from accessing care. Congress has on multiple occasions shot down legislative efforts to require health insurers to cover fertility services, most recently in 2024. California is the 15th state to mandate coverage for state-regulated plans.
“Infertility is a disease and it should be covered by insurance like any other disease or ailment people have,” Powell said.
Jamie Falls, 44, has been trying to get pregnant for 11 years. She and her husband, who had an unsuccessful vasectomy reversal, took out a loan to afford the $13,000 it cost for one round of IVF in 2020. The procedure didn’t work. They’ve been saving since then to try another round.
Insurance coverage offers some relief, Falls said, but after trying for so long it almost seems too good to be true.
“I wouldn’t wish this journey on anybody. It’s the hardest thing I’ve ever gone through (but) I can’t picture myself not being a mom,” Falls said.
Health insurers who opposed the law before it was enacted have said it will raise overall insurance costs, pinching small businesses and people who buy individual policies.
Infertility often unexplained
Many people who struggle to conceive don’t know why they are unable to do so. Studies indicate around 30% are diagnosed with unexplained infertility.
It’s a frustrating diagnosis, said Sarah Jolly, 39, who has been trying to conceive with her husband for five years. Tests to check her ovarian reserve, hormone levels and ensure there were no blockages came back normal. The couple even sought out a urologist who specializes in male infertility to run tests on Jolly’s husband only for everything to return clean.
The couple has tried intrauterine insemination — a process where sperm is inserted directly into the uterus while a woman is ovulating — three times without a pregnancy.
Jolly said she and her husband are keeping IVF on the table as a last resort, but she doesn’t want to go through with a procedure without knowing what it’s treating.
Recently, after seeking out another specialist, Jolly learned that she had endometriosis, a chronic condition that can cause adhesions, scarring and inflammation around the reproductive organs. Multiple doctors had previously told Jolly endometriosis had nothing to do with her infertility, she said, but the specialist told her it was a common – and treatable – reason.
Studies suggest between 30% to 50% of women with endometriosis are infertile, according to the American Society for Reproductive Medicine.
Jolly said throughout this process she has felt unheard and undervalued, constantly having to advocate for more testing and more answers. Insurance also refused to pay for any of her fertility tests or appointments, but covered her husband’s visit to the urologist.
“I’ve gotten a lot of comments societally, even from a lot of men, like ‘You should have kids. It’s the biggest privilege.’ But our society also doesn’t support women and getting the health care they need to be able to achieve that,” Jolly said. “It feels like a punch in the face that I wasn’t expecting. I really thought it would be a much more supportive process medically.”
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.