Fertility misinformation, myths, and overutilization: recapping our Q&A with Dr. Wael Salem

The fertility industry is at a tipping point: although more people are gaining access to fertility treatments, misinformation and misaligned incentives are rampant. For employer-sponsored health plans, new approaches are needed to provide inclusive support for all people to build their families with dignity.

On April 26, 2022, Kate Ryder, Founder and CEO of Maven, sat down with Dr. Wael Salem, a board-certified reproductive endocrinologist at CCRM San Francisco, for a conversation about the past, present, and future of fertility benefits in the workplace, and how to design them.

Fertility benefits are evolving alongside the science

The fertility industry has grown dramatically in the past five years alone. Before 2015, only a handful of large employers offered any kind of fertility benefits, but as of 2021 over 40% are adding coverage for treatments like IVF, in addition to hormone treatments and consultations. Similarly, over $176 million has been raised by fertility startups in the 2021 alone. There’s been tremendous progress in fertility medicine as well, opening the doors for more people to build their families with new technologies and techniques.

With progress comes new approaches to fertility benefits. “We’re seeing more approaches that involve shared decision making for fertility benefits,” says Dr. Salem. Instead of putting the onus on one partner, many fertility benefits are now empowering employees and their partners, no matter what configuration they’re in, to access services.  “People no longer have to meet strict definitions of infertility, usually defined in terms of heterosexual couples, to receive coverage for fertility treatments.” 

However, as access expands, usage—and over-usage—of fertility benefits has followed. Dr. Salem has noticed that some of his patients are seeking fertility treatments “simply because they have access to them.” In particular, he’s noticed more people disregarding risk or expense when pursuing fertility treatments because they believe they’ll have a higher chance of reaching the outcome they want through assisted reproductive technology. 

To Dr. Salem, this poses a particular challenge: “these types of patients are effectively cost insensitive. And if they are not worried about the risks and can afford to go through cycle after cycle [of fertility treatments], then we become more concerned about their risks than they are.”

Fertility misinformation is compounded by anxiety

Because treatments like IVF are invasive, there are physical risks to both the birthing parent and the baby, notwithstanding the financial risks. However, a recent survey by Maven found that nearly three in four women believe at least three falsehoods about fertility, suggesting that there is a high level of misinformation about fertility. Those myths include:

• The impact of birth control on fertility
• Frequency of fertility testing needed
• The relationship between diet and fertility

The same survey found that a majority of women (over 80%) feel some anxiety about their ability to get pregnant. The result: “Many women that come to see us are already at such a heightened level of anxiety, their decision making can very be significantly affected,” says Dr. Salem.

“People are no longer coming into our clinics only after many years of infertility. Some of them are coming in very early, in part because there’s a high level of anxiety around the possibility they may experience involuntary childlessness.” In Dr. Salem’s eyes, it’s clear that there needs to be more proactive education about fertility before, during, and after treatments commence. 

The growing need for fertility education and preconception care

“The journey to build a family doesn’t start with a fertility clinic, and it doesn’t start with an OB-GYN,” said Dr. Salem. “It starts when someone makes the decision to build a family. Within that time frame, there’s at least a whole year where we’re not supporting people—before they arrive at our clinic—and they’re coming to us already stressed out. Unfortunately, people don’t have a single point of contact to go back to.” To Dr. Salem, the lack of consistency and guidance leaves gaps in care between when people decide to build a family, visit a fertility clinic, get pregnant, and bring home their child.

As a result, many people are subject to misinformation while they strive to build their families, whether it’s from advertisements, social media, or from family members and friends. And as more companies offer fertility benefits without respect to mental health support and evidence-based care, it exposes more people to overusing treatments they don’t need.

Realigning goals for a fertility benefits program

Dr. Salem agrees the solution requires taking a look at the bigger picture. “By focusing on having a healthy mom and a healthy baby,” says Dr. Salem. “Not too long ago, our technology wasn’t good enough to guarantee that. But now that we’ve gotten so much better at delivering outcomes, the fertility space and fertility benefits need to think more holistically about how we’re caring for people.”

For employers, that means working with vendors that focus on evidence-based approaches. He suggests that HR decision makers ask questions about their care model to tease out what they’re optimizing for. If they’re pushing people toward IVF, then it’s likely they’re only concerned about IVF usage and success. “We should focus on things like general health of the person, and more importantly, time to desired outcome—how long it takes for people to achieve their goals.” 

Additionally, Dr. Salem felt strongly that fertility benefits should offer more guidance for people  about what will work best for their unique needs. “If we’re going to allocate a dedicated amount of dollars, we should put them toward things we know actually work, rather than providing a menu of options and expecting people to pick the best one for them."

“If we’re going to support fertility, we need to recognize that the fertility journey starts at different places for different people. If we started supporting people in the time between when they decide to have a baby and when they actually start trying, we could help a lot more people get pregnant naturally.” 

To learn more about how Maven supports the fertility journey from end-to-end, contact us today.

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