At $23,000 An IVF Cycle, Fertility Benefits Are ‘Life Changing’ For Workers. Will They Keep Growing?

At $23,000 per cycle, IVF coverage is among the most expensive employee benefits—and workers say it's 'life changing.' But as the labor market cools, many employers are wondering whether to keep paying. A new wave of state insurance mandates and a national obsession with declining birthrates may force their hands.

Employers across the United States added fertility benefits—especially in vitro fertilization (IVF) coverage—during the white-hot labor market of 2021–2023. Tech giants, law firms, and financial services companies competed for scarce talent by offering packages that could include up to $100,000 in lifetime fertility treatment. For workers struggling with infertility, the benefit often made the difference between becoming a parent and giving up.

Now the economy has changed. Layoffs have hit many of the same sectors that were first to offer IVF benefits. Employers have regained the upper hand in recruiting, and some are quietly scaling back or dropping fertility coverage to trim costs. Yet fertility benefits remain a bright spot in an otherwise retrenching benefits landscape.

The reason is a rare alignment of interests. Workers want the benefit—demand is consistently high, especially among millennials and Gen Z employees who plan to delay childbearing. Employers, meanwhile, face a demographic drag: the U.S. birthrate has fallen below replacement levels, and a shrinking workforce threatens long-term economic growth. Policymakers, from state capitals to Washington, are beginning to see fertility treatment as a solution to the baby bust.

Sixteen states and the District of Columbia now require insurers to cover IVF in some form, according to the National Conference of State Legislatures. In 2024 alone, four states enacted new fertility coverage mandates. Federal legislation—such as the Access to Infertility Treatment and Care Act—has bipartisan sponsorship and could, if passed, require employer-sponsored plans to cover IVF.

For companies, the calculus is shifting. A Mercer survey found that 45% of large employers with 500 or more workers offered IVF or other fertility services in 2024, up from 36% in 2020. But the growth rate has slowed. Some self-insured employers that absorbed the full cost of IVF—which can run $15,000 to $30,000 per cycle, plus medication—are exploring alternative models, such as bundled pricing or carve-out vendors that offer discounts.

The bigger question is whether employer-provided IVF coverage will become a permanent fixture of the benefits package or a temporary perk. "The workforce is shrinking, and policymakers are panicked about it—that's a powerful force," says Jennifer Benz, a benefits strategist. "But if a recession hits, the first thing companies cut is anything that's not legally required. IVF coverage is expensive, and it's not yet mandated everywhere."

The most likely path forward is a gradual expansion of state mandates, followed eventually by federal action. In states like New York and California, where IVF mandates already exist, employer compliance has been uneven, but coverage is widespread. The real test will come in states without mandates, especially in the South and Midwest, where fertility benefits remain rare.

Outlook: Expect more state legislatures to take up IVF mandates in 2025 and 2026, driven by both advocacy groups and business coalitions worried about workforce demographics. Meanwhile, employers in competitive industries will continue to use IVF benefits as a differentiator, albeit with more cost-control measures. The long-term trend is toward greater access—but the path is fragile, and a sharp downturn could stall progress. For workers, the message is clear: if you want IVF coverage, act now, while the benefit is still being handed out.