The Cost of Hope: Why Evidence Matters in Fertility Benefits

For employers, expanding access to fertility care has been an important step forward. But as fertility benefits have evolved, a more complex question has emerged: What does it mean to provide not just more access to care, but better care?

The answer requires looking beyond whether an IVF cycle is covered to what happens within that cycle. Fertility treatment can include additional tests, procedures, medications, and laboratory techniques, often referred to as IVF add-ons. Some may benefit certain patients. Others have not been demonstrated to improve the likelihood of a live birth, and for some, the available evidence remains too limited to know.

For employers investing significant resources in fertility benefits, that distinction matters.

Recent research published in The Lancet Obstetrics, Gynecology & Women’s Health1 provides an important perspective on the evidence supporting ten commonly used IVF add-ons. The review found that most either had not been demonstrated to improve live birth or were supported by evidence too uncertain to reach a reliable conclusion. The researchers also identified broader concerns about the quality of the evidence itself, excluding nearly half of the potentially eligible randomized trials they assessed due to trustworthiness issues.

The findings point to an important opportunity for employers: fertility benefit design can help create an environment where evidence, rather than availability or promotion, guides care.

The cost of hope

Hope is fundamental to fertility care. Patients understandably want to know that they have considered every reasonable opportunity to improve their chance of success, particularly after an unsuccessful treatment cycle.

The challenge is that in fertility care, the line between possibility and demonstrated benefit is not always clear.

IVF has advanced because physicians and scientists have continued to test new approaches. Treatments that are standard today were once innovative and unproven. The appropriate response, therefore, is not to discourage innovation or assume that every add-on lacks value. It is to establish a thoughtful standard for determining when emerging interventions should become routine care.

That standard matters because every additional intervention has a cost.

There is the direct financial cost, which can reach thousands of dollars for some add-ons. There can also be additional appointments, procedures and delays in treatment. For patients, particularly those for whom age is an important factor, time is itself a valuable resource. Some interventions can also introduce additional physical or psychological burdens.

A thoughtful fertility benefit should therefore help patients and physicians answer a more meaningful question than simply "What else is available?"

It should help them ask, ‘What does the best available evidence suggest is appropriate for this patient and most likely to improve the outcome that matters?’

Better information supports better decisions

One of the most meaningful findings from the Lancet research was the impact of giving patients clearer, evidence-based information.

In a randomized trial of 1,217 IVF patients, researchers compared an evidence-based educational resource with information representative of what patients commonly encounter through Google searches and clinic websites.

Patients receiving the evidence-based information demonstrated substantially greater understanding of the evidence, costs, and appropriate patient populations for different add-ons. Their interest in treatment also changed meaningfully.

Interest declined significantly for interventions where evidence showed no benefit or remained unclear. But interest did not decline for an intervention with evidence of potential benefit.

In other words, better information did not simply lead patients to choose less care. It helped them make choices more consistent with the evidence.

For employers, this demonstrates why patient education should be considered an important component of benefit design, not simply a supporting service. Members need access to information that clearly explains what is known, what remains uncertain, potential risks and costs, and how the evidence applies to their individual circumstances.

Moving from access to accountability

The evolution of fertility benefits has created meaningful access to care for millions of employees. The opportunity now is to build on that progress.

A comprehensive benefit can cover IVF and still leave unanswered questions about the services being delivered within each treatment episode. Employers should be able to understand not only how much care is being provided, but whether that care is aligned with current evidence and meaningful clinical outcomes.

This is where Pendant believes fertility benefits are headed: from access alone toward greater accountability for the quality and value of care delivered.

That requires measuring the outcomes that matter. The Lancet review used live birth per woman randomized as its primary outcome rather than relying on intermediate measures such as implantation or clinical pregnancy. Dr. David Adamson, Pendant Medical Advisor, argues that this distinction should also matter to benefits leaders, as different denominators can yield very different impressions of treatment success.

It also requires recognizing that evidence evolves. Some interventions have evidence suggesting little or no benefit. For others, the appropriate conclusion is simply that we do not yet know. A responsible benefit should be able to distinguish between those categories and evolve as the science does.

A more thoughtful approach to fertility benefits

Employers should not have to choose between providing broad access and managing costs. The more important goal is to ensure that the resources committed to fertility care help members pursue the best possible outcomes.

That means supporting clinical decision-making with rigorous evidence, giving members clear and balanced information, aligning with providers on meaningful outcomes, and continually evaluating whether covered care delivers value.

Hope will always be an important part of fertility treatment. A thoughtful benefit does not limit that hope. It helps ensure that hope is supported by evidence, informed decision-making, and care designed around the outcome members are ultimately seeking.

1Barad, David (2026). IVF add-ons: evidence, trust, and what patients are told. The Lancet. https://www.thelancet.com/journals/lanogw/article/PIIS3050-5038(26)00142-1/fulltext