Infertility In America 2015

INFERTILITY
IN AMERICA 2015
SURVEY AND REPORT
RMANJ: Infertility In America 2015
Executive Summary
It’s time to make way for Generation Alpha—the children who will be born to the 80 million Millennials over the
next fifteen years. This new generation will be part of “new normal” when it comes to defining family. While
researchers will begin to evaluate their levels of education, future job markets, and spending trends, Reproductive
Medicine Associates of New Jersey (RMANJ) wanted to take a step back and examine what family planning
actually looks like for Millennials – What are the gaps between myth and reality?
We know there is a trend across previous generations to start having children later in life, but we have reached
a crucial tipping point where the science and education around fertility and assisted reproductive technologies
need to be better aligned. Thanks to RMANJ’s inaugural Infertility in America 2015 survey and report, we have
deeper insights into current and future issues and concerns for Americans as they plan their families.
In general, our report found that many misconceptions remain about infertility procedures that can impact patient
outcomes. As Millennials age and plan on having children as late as their mid-30s, they need to, at the very least,
be aware of how these misconceptions could impact their fertility and ability to build a family through traditional
methods.
For Millennials and Generation X, knowledge is power. Millennials greatly benefit from knowing that if they
experience infertility, there are treatment options that are available, some of which – like cryopreservation, In Vitro
Fertilization (IVF), Single Embryo Transfer (SET), Comprehensive Chromosome Screening (CCS) and others – can
help ensure they will be able to have a family when they are ready.
Businesses must also beware. As Millennials embark on their careers, our report found that they will be looking
to employers to offer insurance that includes fertility coverage and will be more willing to change jobs for one that
caters to their needs. This was true for more than two-thirds of both male and female Millennials in our survey.
We believe that businesses forgoing or offering minimal fertility coverage will see this impact their ability to retain
talent.
With more dialogue about infertility, there will be better understanding among Millennials that infertility treatment
methods are ever evolving and paving the way for those currently struggling with infertility to experience the joys
of parenthood – one healthy baby at a time.
Reproductive Medicine Associates of New Jersey
140 Allen Road, Basking Ridge, NJ 07920
908.604.7800 | www.rmanj.com
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Infertility In America 2015
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RMANJ: Infertility In America 2015
Introduction
We are seeing a fundamental shift in society when it
comes to family planning. No matter what the reason –
commitment to career, financial stability or finding Mr.
or Mrs. Right – individuals are starting to have families
later in life. While there are clear benefits and advantages
to the above, there are also tradeoffs that must be
considered.
It is well known that age plays a critical factor in
infertility and often causes unforeseen challenges and
complications. The Center for Disease Control and
Prevention recently released a report showing that
birth rates in the U.S. are declining despite a larger
population.1 Furthermore, our own proprietary survey
found that Millennials aren’t planning to start having
children until their early to mid-30s, which could drive
infertility rates even higher and birth rates even lower.
As Millennials plan on starting their families even
later, what will the implications be and how will they
overcome them?
This year alone, nearly seven million men and women
in the U.S. will experience infertility and will need help
through some sort of assisted fertility treatment, such
as in vitro fertilization (IVF). According to the Society
for Assisted Reproductive Technology (SART), nearly
175,000 cycles of IVF were conducted in 2013, a six
percent increase since 2012.2 And while advances in
research and science will help many of these individuals
grow their families, some will find they may have waited
too long.
Even as stories surrounding IVF, surrogacy and infertility
continue to flood the media, the general public still
grapples with myths and misinformation regarding
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Infertility In America 2015
STRESS AND*
THERE’S BEEN
A 65% INCREASE
IN IVF SINCE 2003
INFERTILITY
55%
BELIEVE IT’S MORE STRESSFUL
THAN UNEMPLOYMENT
61%
BELIEVE IT’S MORE STRESSFUL
THAN DIVORCE
NEARLY 175,000 CYCLES
WERE CONDUCTED IN 2013!
the various programs and procedures available to help
responsible adults become loving parents. That is why
RMANJ decided to launch our own exploration into
what individuals understand about infertility; what family
planning looks like for the next generation; and what the
biggest concerns are when it comes to starting a family
and coping with infertility.
Facing the challenges associated with infertility can
be extremely stressful, even competitive with more
commonly discussed stresses. In fact, our survey
discovered that 55 percent of individuals who have
experienced infertility believe it is more stressful than
unemployment, and 61 percent of that same group
believes it is more stressful than divorce. Clearly, more
attention needs to be given to those individuals facing
infertility and more education needs to be provided to
*AMONG THOSE WHO HAVE EXPERIENCED INFERTILITY
help overcome current misconceptions about IVF and
infertility.
RMANJ’s inaugural survey and report – Infertility in
America 2015 – was conducted among 1,000 nationally
representative U.S. adults ages 25-40, plus oversamples
of up to 200 men or women actively trying to get
pregnant or expecting to try within the next five years,
between February 12 – 23, 2015.
The results of our survey have led to the development
of following report focusing on:
•
•
•
•
Not Your Mother’s IVF
Timing is Everything
Peace of Mind
The Money Factor
rmanj.com
Not Your Mother’s IVF
AMERICANS ARE
CONFIDENT IN THEIR
ABILITY TO HAVE THEIR
FIRST OR NEXT CHILD
OF THOSE
ACTIVELY TRYING
OF THOSE EXPECTING
TO TRY WITHIN 5 YEARS
REALITY CHECK
EACH MONTH A FERTILE
30-YEAR-OLD WOMAN ONLY
HAS A 20% CHANCE OF
CONCEIVING NATURALLY
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Infertility In America 2015
Over Confident
Here’s the bad news: Americans are overly confident
in their ability to conceive. Our results showed that
those most confident in their ability to have their first or
next child when ready were those individuals actively
trying (91%) or expecting to try within five years (95%).
However, we know that even a healthy, fertile 30-yearold woman only has a 20 percent chance of conceiving
naturally each month.3 Individuals must be prepared – or
at least more aware – about what their options are if they
are unable to get pregnant on their own.
According to our survey, most respondents plan on
starting their family in their early to mid-30s. Over the past
few years, this number has continued to increase, which
is significant because, for women, age remains the single
most significant factor impacting fertility. However, there
is good news: before visiting a fertility specialist, those
opting to start a family later in life can meet with their OB/
GYN to run a 30-day evaluation that can assess their egg
supply with a simple blood test.
• Women over the age of 30 should ask their OB/GYN
to perform a simple blood test that measures the levels
of the anti-mullerian hormone (AMH) in their system.
The presence (or lack of) this hormone helps determine
the viability of a woman’s egg reserve before visiting a
fertility specialist. Unfortunately,
many women don’t know about this until it is too late for
them to start exploring fertility treatment options.
It’s important to remember that fertility is not just about
the number of eggs available – it is also about the quality
of those eggs.
There is no perfect test to evaluate a woman’s fertility.
Even reassuring testing cannot fully predict whether
a woman can conceive. The greatest predictor we have is
a woman’s age.
• Women over 35 should start considering testing for
egg quality. As women age, their eggs become more
susceptible to chromosomal imbalances and the
frequency of chromosomal mistakes increases in human
embryos, which limits their reproductive potential.
Comprehensive Chromosome Screening (CCS), a
process by which fertility specialists can
safely identify whether embryos have a normal number
of chromosomes, allows physicians to eliminate
embryos which would not implant or lead to successful
pregnancies and deliveries.
In general, if a woman is under the age of 35 and unable
to achieve pregnancy or stay pregnant after 12 months of
trying, or is 35 and over and actively trying for six months
without conceiving, she should reach out to
a fertility specialist.
While some women are able to have healthy babies into
their 40s and 50s, widespread media coverage on this
rarity has also contributed to Americans becoming overly
confident in their ability to conceive. When asked if the
advancements in science mean that younger adults don’t
have to worry about infertility, 64 percent agreed that it
was true. And while science has made great strides, there
is no better advice than to start gathering information
early and to be informed on your fertility and on specialists
who can help.
Do your research before visiting and selecting a fertility
center. Don’t just look at pregnancy rates – take into
consideration live birth rates, location, convenience,
financial and wellness resources as well as the clinical
expertise of their physician before making a final decision.
rmanj.com
Not Your Mother’s IVF
Singletons vs. Multiples
While more than two-thirds (67%) of respondents
claim they are familiar with infertility treatment options,
in reality they are not. Even after years of scientific
advancements and a large push by many industry
experts, an overwhelming 87 percent of respondents
believed that in order to increase their chances of having
a child through IVF they must be willing to transfer more
than one embryo. Even more concerning was that this
number climbed further with individuals actively trying
to get pregnant (94%) and those expecting to try within
five years (90%).
This exact sentiment has contributed to an explosion
of twins, high-risk pregnancies and unnecessary health
and financial burdens to both patient and child. In fact,
according to the CDC, twin birth rates in the U.S. nearly
doubled over the last three decades, rising from 1 out
of every 53 in 1980 to 1 out of every 30 babies in 2009.4
A simple look at the data even shows that while fertility
treatments are used for approximately 1 percent of U.S.
births, they account for nearly 20 percent of the nation’s
twin and multiple deliveries.5
In the United States, twin pregnancies account for
approximately 30 percent of IVF pregnancies.6 While
this has tapered off and showed a slight reduction last
year, the number is still too high. RMANJ’s Blastocyst
Eupoloid Selective Transfer (BEST) trial7 was the first ever
in the U.S. to study transferring one embryo screened
vs. two embryos without screening. The study found that
the health complications and financial impact associated
with double embryo transfers resulting in multiple births
(twins, triplets, etc.) were significantly higher than
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Infertility In America 2015
single embryo transfers. The unintended consequence
of pregnancies that result in multiples has led to more
obstetric complications and annual costs of almost $1
billion.8
Industry leaders are working to reverse the trend of
multiples and low-birth-weight babies. Through its
ongoing mission to help patients have “one healthy baby
at a time,” RMANJ is educating patients about other
lower-risk and healthy options with equal success rates.
The combination use of comprehensive chromosome
screening (CCS) and single embryo transfer (SET)
provides delivery rates equivalent to double embryo
transfer, while resulting in fewer multiple deliveries and
a lower total cost of care.
RESPONDENTS BELIEVE
THEY MUST USE MULTIPLE
EMBRYOS TO INCREASE
THEIR CHANCE OF HAVING
A CHILD THROUGH IVF
REALITY CHECK
ONE
EMBRYO
( WITH CCS )
( WITHOUT CCS )
65%
61%
TWIN DELIVERY RATES
0%
46%
12%
MISCARRIAGE
20%
PRETERM DELIVERY RATE
8%
28%
TOTAL NICU DAYS
80
373
BIRTH WEIGHT
94
3,408g
90
OF THOSE
EXPECTING TO
TRY WITHIN 5 YEARS
$48,576
%
TWO
EMBRYOS
LIVE BIRTH RATES
OF THOSE ACTIVELY
TRYING
%
VS
2,745g
TOTAL COSTS
$90,583
Forman EJ, Hong KH, Franasiak JM, etal. Obsterical and neonatal outcomes from the BEST Trial:
single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization
without compromising delivery rates. Am J Obstet Gynecol 2014;210:157.e1-6.
rmanj.com
Timing Is Everything
Procrastinating Parenthood
In 2006, the average age of a mother at the birth of
her first child was 25 (up from 21.4 in 1970).9 In our
survey, Millennials reported that they plan to wait to
have children until after they turn 30. While individuals
may be planning on starting a family later than previous
generations, having a family is still a priority for those
who have never had children. For those planning to
try within the next five years, 92 percent reported that
having children was important. The top reasons cited
among those as to why they have not had children
include focusing on their career first (48%) and an
inability to afford it (33%).
Interestingly, 27 percent of the survey respondents who
are actively trying to get pregnant reported that they are
facing infertility issues – this figure is more than double
what the CDC has estimated (12%)10, demonstrating that
infertility, as a whole, is underreported. It is important
to take the time to learn about your options. While you
don’t have to start your family when you are younger,
you should, at the very least, start planning your path to
parenthood and consider options that can increase your
chances of having a child later.
The report also unearthed a growing belief that advances
in science mean that younger adults don’t need to worry
about infertility; 57 percent of Gen Xers increasing to
67 percent among Millennials. This could be a case of
getting wiser with age, but it also shows that Millennials
need to be more aware of the issues and less reliant on
science and technology to overcome the health issues
they may face in the future.
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Infertility In America 2015
REASONS FOR DELAYING
STARTING A FAMILY
FERTILITY ISSUES
IN SCIENCE WE TRUST
MILLENNIALS
FOCUSING ON CAREER: 48%
CAN’T AFFORD IT: 33%
TOO YOUNG: 19%
One option that Americans are increasingly turning to
is cryopreservation, or freezing their eggs/sperm or
embryos. In fact, 73 percent of Millennials surveyed
reported that they would use cryopreservation to ensure
that they would be able to have children in the future.
Technology has made this particularly effective with a
survival rate for eggs (oocytes) that is near 90 percent11
and over 95 percent for embryos.12
67%
BELIEVE ADVANCES
IN SCIENCE MEAN
YOUNGER ADULTS
SHOULDN’T WORRY
ABOUT INFERTILITY
73%
WOULD USE
CRYOPRESERVATION
GEN XERS
57%
BELIEVE ADVANCES
IN SCIENCE MEAN
YOUNGER ADULTS
SHOULDN’T WORRY
ABOUT INFERTILITY
64
WOULD USE
CRYOPRESERVATION
%
rmanj.com
Peace of Mind
Genetic Testing
Genetic testing remains on the forefront of fertility
treatments. Individuals who carry a genetic disease can
now be easily identified. These future parents can now
breathe a sigh of relief. More and more diseases can
now be screened for, giving parents an opportunity to
protect the health of their future children. In the last five
years alone, our understanding of genetics has improved
IVF success and safety. This is thanks to genomic
sequencing, which was originally mapped for $2.7 billion
(The Human Genome Project) but sequencing a patient’s
genetic makeup can now be done within a matter of
hours for about $1,000.
The survey revealed that more than three-quarters (79%)
of Americans say that if they had a genetic disease they
would choose in vitro fertilization and have cells from
the embryo tested for the disease-causing gene to help
ensure they could have a healthy child. This number
increases drastically among those who are actively trying
to get pregnant (90%). For those who know of a genetic
disease in their family, 91 percent reported that they
would likely choose IVF with genetic testing.
The most common types of genetic disease currently
tested for include:
As science advances and we are able to detect more
genetic disorders, specialists are able to help more
and more couples with genetic disorders have healthy
babies. Unfortunately, all too often these screenings
are not covered by insurance providers. While they may
cover the disorder, they view these screenings as nonessential even though they can ultimately determine the
health and livelihood of a child.
• Tay-Sachs
• Cystic Fibrosis
• Down syndrome
• Sickle cell disease
• Some cancers
AMERICANS WOULD UNDERGO GENETIC TESTING
TO HELP ENSURE THEY HAVE A HEALTHY CHILD
91
90%
79% %
96%
%
79
Genetic testing is a huge asset for parents who face the
burden of potentially passing genetic diseases to their
children. RMANJ continues to work to expand the types
of genetic diseases for which testing is available.
IF THEY HAD A
GENETIC DISEASE
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Infertility In America 2015
IF THEY HAD A
GENETIC DISEASE
(
ACTIVELY TRYING
TO GET PREGNANT
)
WHO KNOW OF A
GENETIC DISEASE
IN THEIR FAMILY
WHO KNOW OF A
GENETIC DISEASE
IN THEIR FAMILY
(
ACTIVELY TRYING
TO GET PREGNANT
)
rmanj.com
The Money Factor
Cost & Insurance: The Biggest Burden
For many individuals (58%), cost remains a leading
cause for why they would forgo fertility treatments. IVF
cycles may not always be covered by employer insurance
or categorized as an Essential Health Benefit (EHB),
which varies on a state-by-state level. Concerns around
stress of the process (34%), physical and psychological,
followed by the potential health impact (30%) were the
second and third most common responses among those
surveyed.
The rules and stipulations (or “fine print”) in many
insurance plans often make it difficult to understand
and/or obtain fertility benefits. Currently, just 15 states
have mandates for fertility coverage and these current
mandates run the risk of being eliminated by the end
of 2015 due to recent changes in healthcare law, which
could make it nearly impossible for individuals facing
infertility to have the opportunity to conceive and deliver
their own children.
Of even greater concern is the lack of a fertility coverage
mandate in 35 states, despite the World Health
Organization classification of infertility as a recognized
disease.13 Misinformation, underreporting, and a lack
of conversation about infertility have created a perfect
storm, making many believe that procedures involving
artificial reproductive technologies are elective, rather
than the treatment to a very complicated disease.
The majority of Americans (52%) want insurance
companies to cover fertility treatments, while in the
meantime, hopeful parents look to access to various
financial programs (like shared-risk programs) that help
cover costs. High costs can cause individuals to take
misinformed or unhealthy risks when it comes to seeking
treatment – such as using multiple embryos. However,
recent research has shown a 40 percent savings
when patients rely on the right treatment paradigm: a
paradigm that includes a combination of comprehensive
chromosome screening (CCS) with single embryo
transfer (SET) resulting in higher birth weights (which is
explained on pages 2-3 of this report), less time in the
NICU and greater savings when it comes to downstream
costs. By offering coverage to those who adhere to this
paradigm – one that results in healthier pregnancies and
babies – we all serve to gain the most reward.
LEADING CAUSES FOR
FORGOING FERTILITY
TREATMENTS
58
%
COST
34
%
PHYSICAL AND
PSYCHOLOGICAL STRESS
RESEARCH SHOWS 40% SAVINGS WHEN PATIENTS RELY ON THE RIGHT TREATMENT PARADIGM
30
%
COMPREHENSIVE
CHROMOSOME SCREENING
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Infertility In America 2015
SINGLE EMBRYO
TRANSFER
HEALTHY
BABY
POTENTIAL HEALTH IMPACT
rmanj.com
The Money Factor
Workplace and Infertility
Infertility is not an issue that stays at home, as it has
the potential to profoundly impact the workplace. As
people start to plan families later in life, there will be
an increasing need for fertility coverage and benefits.
The survey found that more than two-thirds (68%) of
respondents were willing to change jobs to ensure they
had infertility coverage. This number jumps to 90 percent
among those who have experienced fertility issues.
In the current business climate, where organizations are
already struggling to retain top talent, offering fertility
coverage can be a unique benefit that may help close the
talent gap. And it’s not just women who said they would
leave their jobs.
• Among those who have experienced fertility issues,
this figure increases to 90 percent
• 70 percent of Millennials reported they would switch
jobs to gain fertility benefits if they have difficulty
getting pregnant
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Infertility In America 2015
Businesses can benefit in the long run by offering
coverage that encourages one healthy baby at a
time, instead of leaving it to the employees to select
treatment options that may result in twins or other
high-risk pregnancies. Employers spend 12 times as
much on healthcare costs for premature or low-weight
babies as they do for babies without complications.14 In
fact, it is estimated U.S. businesses spend $5.7 billion15
just to cover these healthcare costs – many of which
were tied to the delivery of multiples as a result of IVF.
Furthermore, studies show that while 1 out of 9 babies
are born prematurely16, for an employer, the cost of that
one premature baby will be more expensive than the
other eight healthy babies combined.14
If businesses are able to plan ahead, they can ensure
their employees are given an option to have one healthy
baby at a time – ultimately saving individual businesses
thousands of dollars and increasing the ability to attract
and retain top talent.
WILLING TO CHANGE JOBS TO
ENSURE INFERTILITY
COVERAGE
68%
90%
GENERAL
RESPONDENTS
THOSE FACING
FERTILITY ISSUES
68%
70%
MEN
MILLENNIALS
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RMANJ: Infertility In America 2015
Conclusion
There is no turning back. As family planning is beginning at a later life stage, individuals must be better informed about
the available options they have, businesses need to prepare to deal with how this will impact their workforce, and
public policy needs to be in place to ensure that we are caring for the increasing population
that will, inevitably, face infertility.
An overall shift in how we perceive infertility needs to take place, focusing more on the patient and offering support
and transparency to those who are struggling with infertility. New programs and cost structures need to be introduced
to encourage individuals to make healthier medical decisions which will create substantially better outcomes for the
individual, the businesses, the insurance companies, and, most importantly, the family.
While science is making great strides when it comes to helping families with genetic disorders have healthy babies
and with extending fertility option for older patients, the solutions we have now are not a panacea. There is a need
for more dialogue, more research, more understanding and more financial support for individuals facing infertility to
ensure that the next generation is able to raise the same healthy – or even healthier –families as the generations
before.
It is our belief that this needs to be done one healthy baby at a time.
Links and More Information
www.asrm.org | www.cdc.org | www.resolve.org | www.sart.org
Methodology
The RMANJ Survey was conducted by Wakefield Research (www.wakefieldresearch.com) among 1,000 nationally
representative U.S. adults ages 25-40, plus oversamples of up to 200 men or women actively trying to get pregnant or
expecting to try within the next 5 years, between February 12th and February 23rd, 2015, using an email invitation and
an online survey. Quotas have been set to ensure reliable and accurate representation of U.S. adults ages 25-40.
Results of any sample are subject to sampling variation. The magnitude of the variation is measurable and is affected
by the number of interviews and the level of the percentages expressing the results. For the interviews conducted
in this particular study, the chances are 95 in 100 that a survey result does not vary, plus or minus, by more than 3.1
percentage points from the result that would be obtained if interviews had been conducted with all persons in the
universe represented by the sample.
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