Child births decreased across the Bay Area during the pandemic — but not for a lack of effort.
In fact, most San Francisco reproductive health clinics are reporting growth in people seeking fertility treatments since the start of COVID-19. And providers say they don’t see the trend slowing down any time soon.
“We saw an increase in patients during the pandemic and initially thought, ‘Oh, this is just a backlog.’ But the increase has continued,” said Marcelle Cedars, who directs the UCSF Center for Reproductive Health. “I think there was a lot of reflection for people who were with their families a lot and there was reevaluation of priorities and work-life balance.”
Working from home shifted schedules and priorities for families. For some, it provided the time needed to research and follow through with time-consuming procedures like egg freezing or in vitro fertilization, a procedure that involves retrieving eggs from ovaries and fertilizing them with sperm in a lab, then placing the embryos in a uterus.
“With people working remotely, they had more flexibility and time so it could have been easier with remote work. It requires a lot of visits to do egg freezing or an IVF cycle,” said Cedars.
The increase in fertility services here in San Francisco mirrors a nation-wide trend during the pandemic when fertility clinics reported significant increases in egg freezing, the process of preserving eggs on ice that could be then fertilized at a later point.
But Cedars and other fertility experts point to another trend impacting their field as well: More and more companies are offering family-building benefits. And employees are taking advantage.
Family-building benefits on the rise
Tech companies based in San Francisco pioneered offering family-building benefits like IVF and egg freezing, which can quickly add up to tens, if not hundreds, of thousands of dollars. But the list of industries offering such benefits is expanding, and it now includes retail, industrial production and healthcare services.
A 2020 report by Mercer estimated that more than 50% of employers cover fertility services beyond infertility diagnosis.
About 72% of surveyed companies said they began offering family-friendly benefits in order to keep workers. The benefits are particularly in demand among women, who left their jobs at a higher rate than men during the Great Resignation, when quitting work was at an all-time high in 2021, according to data from the Bureau of Labor Statistics.
Fertility treatment has been in increasing demand for many years at UCSF, Cedars said, typically growing at about 10% more patients each year. But more recently, she’s seen a 20% spike in patients seeking services, particularly IVF.
Clinics across The City are experiencing similar trends.
Laurel Fertility Care, a boutique clinic near Nob Hill, said they had an 83% increase in new patients in 2021. The San Francisco company expanded to open a new clinic in Oakland during the pandemic and now operates four facilities across the Bay Area and Central Valley.
KindBody, a reproductive health startup that has raised more than $181 million in venture capital, opened its first San Francisco brick-and-mortar location in 2020. The company has doubled overall fertility cycles with patients since opening, including with egg freezing, embryo freezing and IVF, according to Dr. Geraldine Ekpo, a reproductive endocrinology and infertility specialist at KindBody San Francisco.
There, a standard IVF cycle costs $13,800-$15,800, not including pre- and post-procedure medications that can add several thousand dollars.
Kelli Richardson and her spouse began trying to have kids in San Francisco in 2019. After they were unable to conceive on their own, they began different fertility treatments and have been on an emotional and financial journey since.
Richardson, who now lives in Daly City, estimates she and her husband have spent nearly $200,000 on fertility services including four rounds of IVF, three rounds of intrauterine insemination, supplements and other holistic practices aimed at boosting fertility.
Her partner’s employer covered 50% of their intrauterine insemination courses, at about $300 each. But the much pricier IVF came from savings and the couple’s future house fund, she said.
“It has been extremely challenging and not anything I or my husband was ever prepared for,” said Richardson, who now runs a support group for people trying to conceive. “When you are taught about the birds and the bees, you’re never taught there’s actually a lot of people who end up not being able to have children for one reason or another. We knew IVF existed, but we never thought it would affect us in our personal lives.”
Baby steps to broader coverage
Providers say a key reason more patients are coming through the door is more companies are covering fertility services for their employees.But family-building is still extremely niche as far as benefits go, and few companies provide beyond what’s required at the state level for insurers.
In California, insurance companies are required to offer fertility treatment — but not IVF. And it’s up to the employer to decide if that’s included as a covered benefit. In practice, it means many people can obtain an infertility diagnosis, but they often don’t have coverage for treatment.
California is behind the 17 states that already require health insurance companies to cover fertility treatments including in vitro. Bills aimed at changing that, such as AB 2029 in the most recent legislative session, have failed to pass.
Increasingly, women like Joanna Winter are leaving the Bay Area, where fertility treatments are abundant but expensive, for places like Greece and the Czech Republic to get IVF for a fraction of the price, even with travel costs.
“We were dumbstruck by the cost,” said Winter, 41, who lives in San Francisco and did two rounds if in vitro in Prague. “The Czech Republic has lower cost but a high standard of care. It was kind of like, well, even if the IVF round didn’t work, at least we could save money and get to go somewhere new.”
Winter and her partner estimate that overall they have spent nearly $85,000 out of pocket on the different treatments they have tried abroad and in the U.S.
“I am in debt at this point,” said Winter, who added that the national pause on student loan payments has eased some of her financial stress, but only temporarily. “I find it shocking that it’s not on more insurance plans. A lot more women are delaying having children.”
For the majority of people whose employers don’t cover fertility treatments, accessing these services often means making other financial sacrifices, tapping into or even wiping out savings, taking out loans or refinancing mortgages.
“As more people get coverage, it makes it easier to do these procedures,” said Cedars of UCSF. “It’s a good thing, because there are a lot of people who still don’t have access to fertility coverage. The majority of the population does not have that, and it’s a basic human need.”
