Fertility benefits in graduate medical education: impact of state mandates.

BACKGROUND

Graduate medical education (GME) in the United States coincides with peak reproductive years, yet institutional fertility benefit policies remain poorly characterized. This study examines coverage disparities and their relationship with state fertility insurance mandates among physician trainees.

METHODS

Cross-sectional review of fertility benefits conducted in the United States analyzing the top 50 U.S. medical schools (US News and World Report 2024). Data collected March-April 2025 from GME websites and employment benefits pages analyzed coverage for initial infertility workup, intrauterine insemination (IUI), in-vitro fertilization (IVF), cycle limitations, and fertility preservation. A chi-square test of independence was used to evaluate the association between state mandate status and the availability of fertility benefits. State mandates were verified through Resolve.org and state insurance department websites.

KEY OBSERVATIONS: 62% (31/50) of GME programs offered fertility coverage. Mandated states were significantly more likely to offer fertility benefits (78.1% vs 33.3%; p = 0.004), though coverage remained inconsistent due to Employee Retirement Income Security Act (ERISA) exemptions, vague descriptions, and lifetime caps. Only 3.2% (1/31) of covered programs explicitly included IVF or fertility preservation coverage.

CONCLUSIONS

State mandates improve but do not guarantee complete fertility benefit access for medical trainees. GME programs must proactively address structural gaps through comprehensive benefits, transparent policies, and fertility education to advance trainee wellness, gender equity, and workforce retention.