Michelle Obama recently revealed that in her 30s, she underwent in vitro fertilization to conceive daughters Sasha and Malia.
"It turns out that even two committed go-getters with a deep love and robust work ethic can't will themselves into being pregnant," Obama writes in her memoir, "Becoming."
It's an example of how fertility has reached an inflection point of sorts: Problems that were once whispered about are now becoming part of a public conversation. And as women become first-time mothers later in life (most are now over 30) and as more single people and same-sex couples opt to have children, fertility treatments have become a more mainstream option.
Yet despite the cultural shift, navigating the world of fertility treatments, which can cost tens of thousands of dollars, is still incredibly complicated for many hopeful families. New York City-headquartered fertility benefits start-up Progyny is trying to help change that.
Progyny negotiates contracts for fertility treatments, then bundles those services, as well as access to a network of fertility specialists, into coverage plans that it offers to large, self-insured companies. Procedures including IVF and egg freezing as well as options including surrogacy and adoption are covered and patients have access to services from more than 600 fertility specialists nationwide, according to its website.
"We only focus on fertility," Progyny CEO David Schlanger tells CNBC Make It. "We have shown that by having a hyper focus on one condition that you actually can solve a few problems. You can have better patient experience, you can have better clinical outcomes and you can actually spend an employers' dollars that are devoted to fertility treatments much more efficiently and effectively."
The company, which was created in 2015, currently has 110 employees. Progyny declines to share revenues, but its roster of clients includes the likes of Facebook and Microsoft, and that list is growing rapidly.
"We're entering 2019 with 77 large employer customers...up from five in 2016," CEO Schlanger says.
"In general, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex," the CDC says on its website. In the United States, about 12 percent of women between the ages of 15 and 44 have trouble either getting pregnant or carrying a pregnancy to term, the CDC says, with men contributing to a couple's infertility in about one third of those cases.
Fertility is big business: In 2016, the global fertility services market was valued at $16.8 billion in 2016, according to a report published by Allied Market Research. By 2023, it's expected to be worth $31 billion.
Yet, according to FertilityIQ, a digital database for information about fertility benefits and treatments, in 2018, only about 250 U.S. employers offer some sort of fertility benefit (including companies like Bain, Boston Consulting Group, Chanel, Bank of America, Spotify, Unilever, News Corporation and Gates Foundation), though that is a 10 percent increase from last year and will go up again in 2019. In 2017, reports FertilityIQ, 63 percent of people who underwent IVF fertility treatments had zero coverage.
That's problematic because of the high expense of treatments. Progyny puts the average the cost of a "successful outcome" (which Progyny defines as a pregnancy) at $70,000. This estimate is based on Progyny's internal data, company spokesperson Selena Yang tells CNBC Make It.
According to Progyny, the typical "road to pregnancy" without coverage from Progyny involves an average of three intrauterine insemination (IUI) treatments (a procedure where a sperm is placed inside a woman's uterus, thereby increasing the chances of fertilization), the medications for those treatments, and two in vitro fertilization (IVF) cycles (where an embryo is implanted in the lining of the uterus), as well as the corresponding associated medications, Yang says.
FertilityIQ says IVF costs are "now comfortably above" $20,000 for a single cycle of treatment "in every major American city" (costs are lower in smaller cities) and it takes an average of two IVF cycles to become pregnant, the research company says. (Fertility IQ data is the result of information provided by over 10,000 verified IVF patients in the United States. It only considers IVF, medication and pre-authorizations as fertility benefits worth tracking as rates of success with other treatments, like IUI, are very low, according to FertilityIQ co-founder Jake Anderson-Bialis.)
"Even for couples that have good jobs, that burden is too high. As a result, probably around half the people who would like fertility treatment don't get treatment because they can't afford it. Without employer sponsorship ... those couples will never pursue treatment because it is just too expensive — beyond the means of most people," Schlanger tells CNBC Make It.
Even with traditional health insurance coverage, there are often dollar maximums, so coverage may be used up before treatment is over or people may be forced to elect less expensive and potentially less effective treatments.
With Progyny, the employer can cover "most of" the costs of fertility treatments for an employee, though there's often a deductible or co-insurance payment, Yang says. Progyny says all services and treatments offered by its network are covered, so coverage doesn't run out mid-treatment.
Also, Progyny patients get a fertility specialist to guide them through the process and the start-up helps patients get to the most effective treatment the first time, Yang says.
Additionally, with Progyny, patients don't require a pre-authorization.
"With Progyny, whether you are gay, straight, single, partnered you can access the benefit. Traditional insurers and benefits manager[s] are imprisoned by a thinking that only partnered women should be able to access the benefit — which is retrograde beyond belief," Anderson-Bialis tells CNBC Make It.
Part of Progyny's potential lies in the fact that fertility treatment coverage is becoming an important benefit among the millennial workforce.
"That's the bulk of, the most productive part of most companies' work forces, people between the ages of 25 through 44," Schlanger tells CNBC Make It. "The benefit managers know that and in a full employment environment like we have now, they want to have a robust set of benefits that can help them attract and retain top employees."
Tech companies, often flush with cash and staffed by millennials who focus on their careers early on, largely spearheaded the movement to offer fertility benefits.
"Despite the technology field's reputation for being 'male-dominated' and 'family unfriendly,' it was the field's inclusive nature of its benefits packages, and the pervasiveness of such packages," that helped fuel the trend, according to FertilityIQ's report on fertility benefits distribution.
Bellwethers like Facebook and Salesforce "offer benefits worth over $100,000 per employee," according to the report, but smaller tech companies are also starting to offer such benefits, and Progyny has expanded to large employers in other fields like media, financial services, pharmaceuticals and education, according to CNBC.
"Many employers are finding it's very important to make a cultural statement about the importance of diversity in their workforce, the importance of their female workforce. And offering this benefit really shows that as an employer, you stand for diversity in the work force, you stand for family building values," Schlanger tells CNBC Make It.
That all equals opportunity for Progyny: As Beth Seidenberg, a managing partner at Westlake Village BioPartners and a general partner at Kleiner Perkins Caufield & Byers (which backed Progyny in three funding rounds) told CNBC in 2017, "We're seeing tremendous demand and an opportunity to innovate on [our business] model and the services we provide."
— Video by Helen Zhao
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