The United States is facing a steady shift toward declining birthrates and delayed parenthood, turning reproductive healthcare into a mainstream workplace necessity. The average cost of a single in vitro fertilization (IVF) cycle currently sits at $23,474. Despite climbing healthcare premiums across the board, fertility benefit coverage remains remarkably resilient. Companies continue to fund these programs to attract scarce labor while state governments expand legislative mandates to protect access.
Currently, 21 states and Washington D.C. mandate some level of fertility coverage for workers. The financial impact of these laws is immediate and tangible for families trying to conceive. New Jersey couple Jaclyn and Dustin Glass recently paid just $8,000 out-of-pocket for two complete rounds of IVF, avoiding tens of thousands in medical debt. They described the state insurance mandate that covered their treatment as “life-changing,” according to Forbes.
The current wave of expanded fertility requirements traces its origins to 1984, when Maryland became the first state to legally require insurance coverage for IVF treatments. However, large gaps remain today. Self-funded employer plans, which cover the majority of U.S. workers, are generally exempt from state mandates under ERISA laws. This leaves millions without guaranteed care and pushes private benefit administrators to step in and fill the void.
Carrot Fertility, a venture-backed company, now boasts over 1,000 employer clients, including Forbes. They help companies offer private, comprehensive fertility care to bypass the fragmented state laws and provide uniform coverage for their workforce.
How California’s SB 729 Alters the Definition of Infertility
The fertility coverage terrain experienced a major adjustment on January 1, 2026, when California’s Senate Bill 729 went into effect. The new law requires large group health plans to cover up to three egg retrievals and unlimited embryo transfers. The legislation also explicitly redefines the medical term “infertility” to guarantee coverage for LGBTQ+ and unpartnered individuals, according to a detailed implementation report.
While self-funded plans maintain their ERISA exemptions, the national momentum is pushing more private companies to voluntarily add family-building benefits to their compensation packages. The growing expectation for employer-sponsored care is rapidly shifting how workers choose their jobs, according to a comprehensive national guide on the state of U.S. insurance coverage.