Not all fertility treatments result in pregnancy. According to the European Society for Human Reproduction and Embryology, 77 percent of assisted reproductive cycles performed globally every year fail. Without coverage, women are left to cope with the bitter combination of not having a baby and the tremendous costs of trying for one. “IVF has helped a lot of people, but there is a silent majority of people who haven’t been helped by it and don’t talk about it,” says Miriam Zoll, author of Cracked Open: Liberty, Fertility, and the Pursuit of High-Tech Babies, and a health and human rights advocate.

Kati, 32, from Columbia, Maryland, strategically maneuvered her career based on insurance coverage. “I was willing to downgrade what I was doing,” she says. “I was willing to do office work or work as an administrative assistant or do whatever I needed to do just to have that insurance.” She got lucky though, eventually landing a dream job with dream fertility benefits: 100 percent coverage for IVF up to three attempts per live birth.

But after three IVF retrievals and six embryo transfers, she hasn’t had a successful pregnancy. “I’ve had seven miscarriages. We’re exploring surrogacy or thinking about living child-free—it’s heartbreaking at this point,” she says. “I didn’t think we’d be here, but at the same time, I feel grateful for our insurance coverage. If I didn’t have it, we couldn’t even consider surrogacy—all of my money would have gone to one IVF cycle and that would be it.”

Fertility insurance does have its restrictions: Insurers require a medical diagnosis of infertility, which is defined as an inability for a heterosexual couple to conceive within 12 months. That excludes same-sex couples and single women who want to pursue IVF with donor sperm.

But some Silicon Valley companies are setting a new standard for fertility coverage. Female-founded benefits company Carrot works with companies like Foursquare and Coinbase to provide fertility benefits regardless of an employee’s diagnosis or treatment needed. Companies choose how much coverage they want to provide each employee (which could range from $10,000 to $50,000 or more per person) giving them full access to fertility testing, IUI (intrauterine insemination), IVF, egg freezing, sperm freezing, donor eggs, donor sperm, gestational carriers (surrogates), and adoption—regardless of age, gender, or sexual orientation.

A woman’s family planning goals should be respected just as much as her career goals, says Tammy Sun, CEO and co-founder of Carrot. She suggests that if you’re already in a role you love but your company doesn’t offer fertility benefits, advocate for them: “Go to leadership at your company or to your HR or benefits team and say, ‘Hey, here is the problem that we see with the lack of fertility coverage at work—we see fertility as a fundamental part of healthcare.’” If you’re job hunting, Fertility IQ, Glassdoor, and Monster compile lists of companies that offer remarkable fertility benefits. And when you’re in the negotiation phase for a new job, ask if fertility coverage is on the table. “We have many companies come to us and say that they have a candidate and she’s asking for fertility benefits but they have nothing, so they want to set something up right away,” Sun says. “Just by asking, you could get what you want.”

Fertility benefits should be considered as standard as any health insurance—treating infertility shouldn’t leave women broke or forced to derail their careers to find coverage, advocates say. “We are not choosing to be infertile, we’re not choosing to need this treatment,” Kati says. “The body is not working in the way it should be—that should be covered just like heart disease, diabetes, or any other illness.”

Minhae Shim Roth is an essayist, journalist, and academic. Follow her on Instagram @by_minhaeshimroth and on twitter @minhaeshimroth.

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