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Members of the LGBTQ community are looking to employers for help having biological children.

Medical procedures commonly used to help LGBTQ folks conceive — like in vitro fertilization — aren’t covered by insurance. Only 16 states require employers to provide fertility coverage as part of their healthcare package, but the vast majority of those policies only cover infertility diagnosis.

“For gay men wanting biological children, in vitro is often the only option,” says Dr. Mark Trolice, director of Florida-based clinic Fertility CARE. “Refusing to cover these procedures is a clandestine discrimination of LGBTQ rights.”

Employers are stepping up to fill the need; 44% of employers with more than 20,000 workers offered a variation of in vitro fertilization benefits last year, compared to 37% in 2017, according to a Mercer study. Facebook, Cisco and MassMutual are among the most recent companies to boost fertility benefits.

Employee Benefit News spoke with Trolice on expanding fertility coverage to all Americans.

EBN: Why do you think current fertility coverage laws discriminate against the LGBTQ community?

Dr. Mark Trolice: Current laws cover infertility treatments and testing, which the World Health Organization defines as the inability to get pregnant after having unprotected sex for a year or more. That stipulation excludes LGBTQ people from coverage because they don’t necessarily need infertility treatments, but they do need assisted reproductive technology to have biological children. Their situation is often looked at as a choice that precluded fertility by biologic means.

EBN: Why don’t most insurance companies cover in vitro, and other similar procedures?

Trolice: It’s extremely expensive. IVF typically costs $12,000 to $20,000 per round, and it can take multiple tries before you’re successful. A gay couple will also need a surrogate and egg donor, which puts the cost at over $100,000. Also, if you live in a state where surrogacy is illegal — like New York and Michigan — you’ll have to pay out of pocket to travel to a state where it’s legal. Lack of insurance coverage is a major barrier to folks interested in IVF.

I don’t think it has to be this expensive, but I’m working on it. There’s a device, it’s called INVOcell — I haven’t started using it yet, but I just got training. At the training they told us a story about a lesbian couple who used it because they were both able to share the experience of carrying their child. The process uses a micro-incubator, it’s only about three inches. One woman’s eggs are inseminated in a lab and placed in the micro-incubator, which is then placed in her partner’s vagina. She’ll carry it until it’s time to transfer the embryo inside the woman who provided the eggs. It’s almost like a relay; the women said it was special to have them both participate. And depending on the clinic, this process could be half the cost of in vitro.

EBN: Do you have any patients using employer-sponsored benefits to cover IVF?

Trolice: It’s definitely becoming more common. There are big industries offering their employees egg freezing services, like Apple and Facebook. I think Disney and Chase Bank have good insurance coverage for IVF. I obviously think more employers should consider offering fertility coverage.

EBN: As a fertility specialist, why do you think only 16 states have mandated coverage for infertility?

Trolice: Despite infertility being a disease, some states don’t recognize it as a disease. Even the Affordable Care Act covers contraception, but not infertility.

For infertility patients, when you’re trying to conceive the world is pregnant and there’s a high fence in your way. Your life becomes very confusing; you don’t know your place in the world, with your career and family. You don’t feel like you fit in. If you have a spouse, you feel that you’re broken. It’s a crippling disease. I’m not just speaking as a medical professional who sees it every day, I was a fertility patient for 10 years.

Fortunately, there’s increasing movement to include fertility insurance coverage. I think the millennials are standing up and demanding equality.

EBN: What would you like to see happen with fertility benefits?

Trolice: Obviously, mandated fertility insurance coverage for all, and fertility preservation for cancer patients.

Any medication cancer patients are given is going to be toxic to eggs or sperm or prevent production altogether. So prior to that we usually see them in an emergency IVF cycle; that’s the only approved method of fertility preservation. You take ovarian or testicular tissue to implant later in hopes it restores function after cancer. But the Holy Grail is being able to grow an embryo in a lab instead of growing inside the body.

Also, if we had mandated fertility insurance, we would reduce consequences of multiple gestation. Women are more likely to experience complications with each additional fetus. Carrying multiple babies to term also increases the risk of premature birth and other complications.

I’m also advocating for the Equality Bill that’s currently in Congress. It’ll really update the Civil Rights Amendment, and I believe it’s an important step to stop fertility discrimination toward LGBTQ people. I think there’s a wave happening that’s long overdue, and everybody deserves the right to healthcare.

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