For 31-year-old Christine Carroll, after three years of infertility, it was time for her to begin her IVF journey with her husband Chris. After being told a single round of IVF cost $22,000 to $30,000, she also learned her employer covered up to three rounds. To her, this provided her with a unique opportunity to have peace of mind over her professional and family goals—in addition to relieving the financial pressures that accompany fertility treatments [1].
In recent years there has been growing popularity incorporating fertility benefits into company insurance coverage. This includes companies like Apple, Google, Facebook and other giants that cover over $20,000 worth of services to support their employees fertility and familial goals [2]. As of 2021, over 800 companies are now offering fertility benefits—and the number is only growing [3]. Fertility benefits include egg freezing, IVF treatments, and more. For Amazon employees, they are given access to over 900 physicians and fertility specialists—going beyond just covering the cost of care and allowing them the flexibility to choose their provider [4]. Now 59% of women say they would choose an employer that had fertility benefits over one that doesn’t [2]. Therefore, this new initiative not only supports women, but also allows for company expansion and popularity.
Egg freezing begins with removing eggs and freezing them to be used at a later time, which are then fertilized and implanted back into the uterus through IVF [5]. IVF begins with the fertilization of a mature egg from the donor with a sperm. This fertilized egg is then transferred into the uterus where it implants to become an embryo. This allows heterosexual parents to both use their sperm and eggs, and for single or same-sex individuals to use a sperm donor. IVF decreases chances of miscarriages and genetic abnormalities through screening before implantation, but also increases the chances of twin or multiple pregnancies [6].
Both IVF and egg freezing allows people with female reproductive systems to take control of their own fertility by choosing when they get pregnant. This keeps them from being pressured by a ‘biological clock’ to begin a family. Without being concerned about a time limit for reproduction, they get more time for interests outside of having a family, such as a career, travel or hobbies. Therefore, they can dictate the trajectory of their lives and lifestyles free from the biological restrictions of reproduction and age.
This biological factor heavily intertwines with social value, which expands with reproductive technology access. It is still difficult for women to reconcile ideals of family, while also being valued and supported in the workplace. With less fertility support, women might be pressured to work more to support themselves and may be unable to cut out time for family planning. Additionally, women without these opportunities may end up having children anyways and be stretched thin between work and trying to provide which can exacerbate financial stressors. There is a social constraint where those who do choose to have children may not experience motherhood as a real choice, and may be lacking in other opportunities for personal or professional development [7]. Alternatively, they may feel resentment as a result of having to make a ‘sacrifice’ to have a family instead of a career. This is a binary that has made women feel that they have a ‘duty’ to have children instead of prioritizing their own growth and values. This continues to place women within the rigidity of motherhood, while giving value to them only if they choose to have children. Providing these benefits begins to dismantle these social norms by expanding the flexibility of women to choose themselves, but also a family—removing their mutual exclusivity.
Another perspective on providing these benefits would be its ability to reinforce the biological role of women by encouraging them to take advantage of IVF and other reproductive resources. There was initial concern for having to spend more money on fertility benefits, however, companies have actually decreased their spending. This is because otherwise, women doing fertility treatments would be taking paid leave—costing the company time and money [8]. Beyond this, if a patient does out of pocket IVF they may be more inclined to ask the physician to increase embryo transfer numbers, compromising their own safety and leading to more sick time taken. Therefore, with the prioritization of family planning for top companies, women’s safety and company time are both improved.
Providing IVF support is not only a step forward in not forcing women to choose between career and family goals, but also supports LGBTQ+ individuals in having biological children. One way IVF and egg freezing allows for LGBTQ+ couples to have their own children is reciprocal IVF—having one partner donate an egg while the other acts as a gestational surrogate [2]. LGBTQ+ access to these technologies breaks down the restrictive nuclear family that often excludes and diminishes the role of same-sex parents. This expands how we view and define the parenting process, allowing each individual to take part in different aspects of the birthing process. Companies improving access to these technologies for LBGTQ+ couples legitimizes and validates their identity, while allowing partners to feel equal in the creation of a child.
However, there continue to be ethical challenges to fertility treatments. One of the major questions regarding IVF and egg freezing treatments is the upper age limit. With women having the ability to have children older, even with a healthy pregnancy they may have an increased risk of disease or death that could hinder their ability to parent [9]. Furthermore, fetal and maternal safety—particularly for high-risk twin pregnancies that often result from IVF—may be in jeopardy as age increases. Lastly, if women are using donated eggs, there is concern for older women being prioritized over younger women struggling with infertility who may have a better chance of a successful pregnancy. Therefore, these companies would be inadvertently encouraging more dangerous or high-risk pregnancies to jeopardize the safety of the woman and the child, in addition to decreasing resource allocation to younger women. This brings into question who exactly is considered valued in their role as a mother and if we should provide donor eggs to those who want them or those who have the best chance for viable pregnancies? This would be giving medical institutions the power to decide who is best suited for reproducing—not the mothers themselves.
As a counter to this argument, I believe it boils down to creating a space for reproductive autonomy and allowing any woman at any time to choose how and when she wants a child. In order to prevent age being something that limits reproductive access, other factors should be considered in conjunction with age that are more valuable parameters including cardiovascular health, lifestyle, and drug and alcohol use. This would expand reproductive access to older women—without age being a limiting factor—while allowing for a more scientifically-accurate analysis that would assess the safety of assisted reproductive technologies. Despite this rationale, evaluation on lifestyle or biological traits may open up more room for bias—incorporating prejudice to profile individuals as ‘unfit’ parents based on assumptions related to race, drug use, and socioeconomic status.
Another argument that questions these policies bring into question is who exactly gets access to them. For certain employees, their job status may not entitle them to these benefits, which ostracizes low-income individuals who may not have access to the quality education needed to qualify for these jobs at top companies. This provides overwhelming access to middle-class white individuals while overlooking the gaps at companies dominated by disadvantaged individuals such as fast food giants like McDonalds and Taco Bell. At McDonalds, 1 in 5 workers makes less than $10 an hour—putting them below the poverty line, forcing them to work more, with fewer benefits and less family planning flexibility [10].
Despite this, the move towards supporting women’s rights and choices is inspiring a new movement towards reproductive autonomy and equality in the workplace. This creates a huge step towards dismantling the binaries of gender roles and motherhood, while also improving the safety of the birthing process. However, as someone who is a woman entering into the high-intensity and rigid field of medicine, I acknowledge my bias in wanting more flexibility in family planning with holistic considerations beyond age. These are policies that would directly affect my ability to exercise my reproductive rights, while allowing me to pursue my career goals. A question I would pose is how one might question the motivations of companies to do this—do they want to just prioritize productivity, or women’s health? A last consideration could be how this might lead to the potential enticement of women to utilize artificial wombs or surrogacy to improve company productivity. Is this the beginning of a new feminist movement, or leading to an ever-worsening emphasis on capital gain?
Resources:
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2. Vinopal, C. (2022, March 3). Large employers remain the best hope for Women Seeking
Fertility Benefits. Quartz. Retrieved February 25, 2023, from
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Mayo Clinic. Retrieved February 25, 2023, from https://www.mayoclinic.org/tests-procedures/egg-freezing/about/pac-20384556
6. Mayo Foundation for Medical Education and Research. (2021, September 10). In vitro fertilization (IVF). Mayo Clinic. Retrieved February 25, 2023, from https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-2038 4716
7. OLIVER, K. (2010). Motherhood, Sexuality, and Pregnant Embodiment: Twenty-Five Years of Gestation. Hypatia, 25(4), 760–777. http://www.jstor.org/stable/40928655
8. Homepage | resolve: The National Infertility Association. (n.d.). Retrieved February 25,
2023, from https://www.resolve.org/wp-content/uploads/2022/01/2021-Fertility-Survey-Repo rt-Final.pdf
9. Asplund K. (2020). Use of in vitro fertilization-ethical issues. Upsala journal of medical sciences, 125(2), 192–199. https://doi.org/10.1080/03009734.2019.1684405
10. Crosbie, J. (2022, April 19). America's biggest companies are systematically
short-changing workers. Rolling Stone. Retrieved February 25, 2023, from https://www.rollingstone.com/politics/politics-news/dollar-tree-mcdonalds-low-w age-workers-1339928/