Maven research finds IUI-first approach reduces average cost to pregnancy by more than $14k

What you need to know:

• New Maven research finds that employees who start fertility treatment with IUI have an average cost to pregnancy of $14,626 — compared to $28,891 for those who start with IVF
• Among clinically appropriate IUI candidates, a specific benefit design choice is associated with 25% higher odds of employees choosing a less expensive and physically intensive treatment first 
• How your fertility benefit is structured — not just what it covers — may be quietly driving up costs and steering employees toward higher-intensity care than they need

Fertility benefits have become a standard part of competitive total rewards packages. Most employers offer a dollar maximum or a set number of cycles — but this has an impact on the choices employees make around their fertility journey. 

When fertility benefits typically offer a fixed amount of coverage, that coverage has to stretch across an employee's entire fertility journey, which may include multiple treatment types and multiple attempts. When IUI and IVF draw from the same pool, employees face a quiet but consequential tradeoff: try IUI first and use up some of that coverage now, or go straight to IVF and protect the full benefit for a treatment that costs significantly more per cycle. 

Yet for many employees, IUI is the clinically appropriate starting point. Skipping it doesn't just affect their journey, but drives up cost, too. New research from Maven's managed fertility benefit found that when using IUI meant having less IVF coverage left over, employees were less likely to start there — even when it was the right clinical starting point, and a more affordable option.  

But among members who were strong IUI candidates, those whose benefit covered IUI without reducing their available IVF coverage had 25% higher odds of initiating treatment with IUI — compared to members whose IUI use drew down their remaining IVF benefit. 

The cost difference is significant: members who started with IUI had an average cost to pregnancy of $14,626, compared to $28,891 for those who started with IVF — nearly double. Critically, the effect only appeared among strong IUI candidates. For members who needed IVF from the start, benefit design didn't push them toward IUI. The benefit is doing exactly what it should: increasing appropriate IUI use without getting in the way of IVF for the people who need it.

Appropriate care for the appropriate case

IVF is the right treatment for a significant share of people seeking fertility care. For patients with blocked fallopian tubes, low ovarian reserve, severe male factor infertility, or a history of failed IUI cycles, IVF is often the fastest and most effective path to pregnancy. For those patients, starting with IVF is the right investment, and benefit design should support that fully.

Maven's research highlights that when a benefit design creates a financial tradeoff between trying IUI now and having IVF coverage available later, some employees will skip IUI to protect their options. That's a rational response to a poorly designed incentive — and it carries real consequences in cost, physical burden, and emotional toll for the employee, and in claims spend for the employer.

"We don't want the benefit design to be the barrier to seeking appropriate care." Caitlin Ardrey, Maven's Senior Director of Fertility Program

IUI and IVF: What each treatment actually involves

For benefits leaders designing or evaluating fertility coverage, understanding the differences in these treatments provides important context:

IUI — intrauterine insemination: a relatively simple, outpatient procedure. Prepared sperm is placed directly into the uterus around the time of ovulation, shortening the distance to the fallopian tubes and improving the chances of fertilization. It's typically completed within a single menstrual cycle, requires only a few clinic visits, and most people return to normal activities the same day. It's commonly recommended as a first-line treatment for unexplained infertility, mild male factor infertility, and for single people or same-sex couples using donor sperm. Per-cycle costs range from a few hundred to a few thousand dollars depending on medications and clinic.

IVF — in vitro fertilization: more involved and expensive than IUI. It requires daily injectable medications over one to two weeks to stimulate egg production, followed by monitoring appointments, a minor surgical egg retrieval under sedation, laboratory fertilization, and an embryo transfer. A full cycle typically runs four to six weeks and costs $12,000 to $20,000 before medications, which add several thousand more. Success rates are meaningfully higher per cycle than IUI — 40–50% for women under 35, compared to 10–20% for IUI — and for patients with more complex diagnoses, those higher rates often make IVF the more efficient path overall.

The right starting point depends on the individual clinical picture. The problem arises when benefit structure — not clinical guidance — becomes the deciding factor.

Creating an unnecessary incentive

Fertility benefit design has historically focused on how much coverage to offer, and the structure of offering it. Whether dollar maximum or cycle-based, and how many cycles to include, are decisions that matter, and they're worth getting right.

Maven's research points to the tradeoffs the benefit structure may create — and whether those tradeoffs are sending employees in the wrong direction.

A benefit that covers IUI but counts it against an employee's IVF allotment creates a subtle but consequential incentive to skip IUI. Instead, a benefit that treats IUI as its own category of coverage removes that tradeoff entirely — and as this data shows, clinically appropriate patients respond to that difference.

"We don't want the benefit design to be the barrier to seeking appropriate care," said Caitlin Ardrey, Maven's Senior Director of Fertility Program. "The right benefit structure has flexibility, and with that flexibility comes the ability to reduce costs — while freeing people up to do what's right for them, with enough coverage left to complete their fertility journey."

The physical and emotional cost that doesn't show up in claims data

Cost-to-pregnancy is the most straightforward way to measure the impact of treatment initiation. But it isn't the only cost worth considering.

Any fertility treatment carries a significant physical and emotional burden. Research consistently shows that between 25% and 60% of people experiencing infertility report symptoms of anxiety or depression, with intensity increasing the further into treatment they go. IVF involves weeks of daily injections, monitoring appointments, egg retrieval, and recovery. For employees going through it, it affects their focus, their energy, and often their relationships.

IUI is meaningfully lighter by comparison — fewer medications, fewer appointments, no surgical procedure. For employees who are strong candidates, starting there isn't just a financial savings. It's a less demanding path to the same goal.

A benefit structure that makes that path accessible — without penalizing employees for taking it — is one that supports employee wellbeing alongside cost management.

"Fertility journeys are rarely linear," Ardrey said. "They're full of questions, unexpected turns, and emotional highs and lows. Employees shouldn't have to wait until their next appointment to get support."

What to look for in your benefit design

This research adds to a growing body of evidence that fertility benefit design has real downstream effects — on treatment selection, cost to pregnancy, and the experience of the employees going through it. A few practical questions worth asking of your current or prospective fertility benefit:

Does IUI coverage draw down IVF benefit, or is it structured separately? If employees have to choose between using IUI now and preserving IVF coverage for later, some will skip the lower-intensity option — even when it's clinically appropriate.

Does the benefit support employees throughout the full journey — not just during active treatment? Preconception care, mental health support between appointments, and connected maternity care after a successful cycle all affect outcomes and costs downstream.

Is clinical guidance built into the benefit, or is treatment selection left entirely to the employee and an out-of-network clinic? Access to care navigation and reproductive health expertise helps employees make decisions that are right for them — and reduces unnecessary utilization on the employer's side.

The goal of a well-designed fertility benefit isn't to choose IUI over IVF for employees. It's to make sure the benefit structure isn't doing that choosing — in either direction — by default.

Fertility is just the entry point

For employees who go through fertility treatment and become pregnant, support shouldn't stop at a positive test. Pregnancy, birth, postpartum recovery, and early parenting each carry their own demands. The employers seeing the strongest outcomes — and the strongest ROI on their fertility benefits — are the ones who've built connected care across the full journey, from preconception through parenthood.

"Fertility benefits are a powerful entry point — but maternity and parenting support are what carry that value through," Ardrey said. "That's how you move from 'offering a benefit' to truly supporting your people."

Ready to rethink your fertility benefit? Maven works with employers and benefits leaders to design fertility programs that support employees at every stage — and deliver measurable results. See what that looks like for your organization. →