Between student loan debt, stagnant wages, and the ways in which career trajectory is structured in our workforce, it's become virtually impossible for people to plan having kids at a time when it's medically safest and easiest to do so. Big tech companies with famously progressive workplace ideals have, of course, begun to take notice of the would-be millennial parent's dilemma and are beginning to offer employees fertility benefits such as egg-freezing to improve their family forming options down the line. More comprehensive benefits, however, such as in vitro fertilization (IVF), acquisition of donor eggs or donor sperm, and surrogacy, are frequently reserved for employees who receive a medical diagnosis of infertility. But a Silicon Valley startup called Carrot is trying to level the playing field.
Carrot was founded in 2016 by Tammy Sun, and its mission is to help employers extend fertility benefits to all employees and their partners, without hinging on an infertility diagnosis.
"When we work with a company, we eliminate the medical diagnosis for infertility requirement altogether, and so that's not even an issue," Sun tells Bustle. "We cover everybody equally, regardless of sexual orientation, gender identity, age, sex, marital status. The company designs a customized plan for themselves about how much they can cover their employees on an annual basis for fertility care — for valid fertility care. And Carrot is the administrator for that."
People with uteruses are generally most fertile in their teens and twenties, with fertility dropping slightly in their early thirties, and then dropping off significantly in their late thirties. Obviously, most people in their twenties are not economically stable enough to have kids, nor does the workforce make it easy for people to start forming families in the early years of their career. Academia doesn't create much more space for parents, either — my own mom attended grad school throughout her pregnancy with me, but after giving birth, had no access to reasonable accommodations for new mothers. She was forced to drop out and never finished her MBA.
With few resources for family forming in their twenties, people are, quite obviously, putting off having kids until they have better support systems in place. But that's leading to a decline in fertility, and a bunch of millennial-blaming handwringing over the supposed real-life Handmaid's Tale we've wrought. (To be clear, millennials aren't becoming medically infertile like on The Handmaid's Tale; we're simply choosing to delay childbirth for entirely responsible reasons, potentially until it's too late to conceive. If older generations have a problem with that, then perhaps they can start shifting public support systems to foster younger family planning.)
"Fewer than six percent of all IVF cycles in this country are received by African American women, and there are economic barriers there," says Sun. "For the LGBT community, it's potentially even more severe. The classic definition of infertility is important because it unlocks coverage in the traditional infertility insurance products."
This means that a straight couple who tries and fails to conceive for anywhere from six to twelve months would be covered for IVF through traditional fertility benefits. Meanwhile, a lesbian couple who is reproductively healthy — but for obvious reasons would need the same IVF treatments to conceive — isn't covered. An infertile straight couple who needs a surrogate would have their surrogacy covered under these employee benefits while a gay male couple wouldn't. A cisgender male employee with a low sperm count can opt to have his sperm frozen, while a transgender employee who'd like to preserve their eggs or sperm before starting hormone replacement therapy — which can make sperm or egg harvesting impossible later on — can't.
In other words, traditional fertility benefits arbitrarily privilege straight couples creating nuclear families while discriminating against people in other types of family make-ups, like queer romantic partnerships or non-romantic chosen family households. But, Sun says, queer employees are leading the charge in urging companies to be more inclusive of their specific health care needs.
"The culture and the zeitgeist around these issues are evolving so rapidly," she says. "People are more comfortable than ever before going into work and talking with their friends and even their HR managers about why this aspect of health care isn't covered inside their health plan. So I think companies are starting to feel pressure, not just from women who are interested in preserving their fertility so that they can make decisions later, but from gay and lesbian employees who are like, "Hey, I called [my insurance company], they asked me if I'm infertile. I'm gay, and I can't access this benefit."
Sun does well to point out that while the Googles and the Facebooks of the world can afford to cover all their employees and their spouses or partners up to, say, $100,000 in fertility care costs, not every company can. So Carrot offers "deep customizations" for companies of every size and budget to create fertility care coverage for all employees, regardless of an infertility diagnosis. Furthermore, Carrot is able to scale benefit offerings with the company as it fluctuates in size.
What does this mean for employees? Once a company designs and purchases its fertility benefits plan with Carrot, employees unlock access to an app with a dashboard that tracks and manages benefit amounts. They also receive unlimited voice, video, and text chat with Carrot's team of fertility experts. And once a fertility plan is in motion, the app can generate video reminders for things like how and when to administer hormone injections, or even live video chats with fertility nurses, who can help should users get really freaked out about how to administer their own shots.
"All of these underrepresented use cases for fertility technology — you know the ones in the media that are constantly on a loop are IVF and egg freezing — but there's a myriad of other stories as well when it comes to how people are using fertility coverage and fertility technology to plan and form families in unique ways," Sun says.
Hopefully, by educating employers, and by extension, their employees in these benefits, we can create more fluency and visibility for all types of family makeups.