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Women’s Health

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Caroline Catherman

Healthcare Brew delivers the latest news and trends in healthcare.

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Getting pregnant can be more expensive than a new car. Don’t believe us? Ask someone who’s done in vitro fertilization (IVF).

According to fertility education site FertilityIQ, a single IVF cycle is $23,000+ depending on location and whether services like medication and pre-implantation genetic screening are included. Patients complete an average of 2.3 to 2.7 cycles, which can total up to $50,000.

And it’s a growing industry: The US fertility industry is set to increase from $5.3 billion in 2023 to $8.7 billion by 2033, according to market research and consulting firm Precedence Research.

, and offer programs that provide refunds if IVF is unsuccessful.

San Francisco-based startup Future Family offers both. The company introduced an insurance program in February with a “baby or your money back” guarantee. If a patient using the company’s IVF insurance doesn’t have a live birth after two cycles, they can file a claim and get a refund up to their coverage limit. Depending on the policy, that can be $15,000, $30,000, or $50,000.

“If you fail two cycles, you could lose $40,000–$50,000. It’s a huge amount of money, and it sets you back when you’re starting your family. So it’s really important that we can insure IVF and make sure that if someone does fail, they have an opportunity to try again, or at least get the money back if they’re going to go a different path,” Claire Tomkins, founder and CEO of Future Family, told Healthcare Brew. 

Founded in 2016, Future Family has raised over $148 million in venture capital funding from firms such as Aspect Ventures, Portfolia, and Correlation Ventures. Following the launch of its insurance program, the company announced in April it had secured a $400 million financing program from Clear Haven Capital Management to expand its lending platform.

The price of Future Family insurance is individualized based on each patient’s health information. Patients who are more likely to conceive due to factors like age and lifestyle pay lower premiums, but on average, insurance through Future Family is about 20% of the cost of treatment, Tomkins explained.

“So if you were doing IVF for $40,000 for two cycles, then you’d pay about $8,000 for insurance. But the good news is your $40,000 is protected completely,” she said.

The cost of that insurance premium can also be paid through financing, she added.

There are caveats, though. For instance, the insurance has a time limit: Patients have 20 months to complete two cycles of IVF and transfer viable embryos and 30 months of total coverage, according to the company’s website. For reference, one full cycle of IVF takes about four to six weeks, and most treatment centers recommend waiting at least another four to six weeks between IVF cycles, according to Cleveland Clinic. 

The website also notes there are restrictions on who qualifies. Patients 38 and older can’t get coverage unless they’re using donor eggs, nor can patients who have already started an IVF cycle or have failed to conceive after an IVF cycle in the past.

Separate from this new insurance product, Tomkins says Future Family has also given out $200 million in credit to 10,000 patients through its fertility financing program.

Patients pay $300 to $500 a month on their loans on average, Tomkins added. Interest rates vary and depend on factors like credit score, income, and the loan’s size.

Though it’s not a fertility clinic, Future Family has a nationwide network of fertility clinics it works with.

“People are struggling to figure out the best way to pay for fertility treatment, and then on top of that, they’re trying to figure out, if it’s not successful, what happens next? And so now we’re able to really address that and help consumers,” Tompkins said.

IVF can cost $50k. Future Family wants to make it refundable 

The company began offering a “baby or your money back” guarantee in February.

Cassie McGrath

, the Centers for Medicare and Medicaid (CMS) announced in a statement it would rescind 2022 guidance from the Biden administration that allowed patients to have abortions in emergency situations.

Former President Joe Biden sought to override state laws banning abortion and ensure pregnant people had access to reproductive care in emergencies, like if their life was at risk.

Biden’s guidance cited the Emergency Medical Treatment and Active Labor Act (EMTALA), a national law that requires hospitals to examine and treat all patients even if they can’t pay for their care. Under CMS’s new directive, EMTALA is still in place as federal law and encompasses treating “identified emergency medical conditions” for a pregnant person and/or an unborn child, but the federal government is no longer directly asking states to provide abortions during emergencies.

As a result, some experts worry a lack of directive could lead to more 

Melissa Simon, an ob-gyn at Northwestern Medicine in Chicago, told us she is “deeply concerned” about CMS’s decision.

“The current administration is trying to rescind this but is not changing the EMTALA law, which still obligates hospitals to provide emergency care,” she said. “However, what this will do is promote more confusion, which leads to a dangerous climate of legal uncertainty under which physicians and health professionals should not operate.”

Even with Biden’s guidance in place, the 

 reported last August “dozens” of pregnant people have been turned away from emergency rooms since the 

 ruling, including patients with life-threatening pregnancy complications. In some cases, 

In the June 3 announcement, CMS said it would enforce EMTALA, which protects patients who show up to emergency departments seeking treatment, including cases where a pregnant person and/or their unborn child is “in serious jeopardy.”

 from former Department of Health and Human Services Secretary Xavier Becerra that explicitly directed clinicians to provide abortions if “stabilizing treatment” is required to resolve a medical issue.

Simons said the new CMS’s guidance “undermines” clinicians ability to provide “evidence-based life-saving care without delay or discrimination,” and that patients will now be exposed to higher pregnancy health risks. She also said this may erode trust between patients and their providers.

“No patient should be forced to suffer, and no healthcare provider should be forced to choose between their oath and the law,” she said.

A clinic chair and monitor on a sound block with large sticky notes placed around. Credit: Anna Kim

New CMS directive adds legal confusion for pregnancy care in cases of emergency 

CMS creates more confusion and revokes Biden-era guidance to allow abortion care for patients experiencing emergency health concerns. 

 becomes increasingly popular, more and more patients are coming to a harsh realization: It’s not cheap.

A single cycle including medications can cost anywhere from $10,000 to $15,000 according to drug discount company GoodRx, plus between $300 to $1,000 a year for storage. In most circumstances, it’s also not covered by insurance.

Enter Cofertility. The 2022 startup offers a unique trade: freeze your eggs for free when you donate half to a family who wouldn’t otherwise be able to conceive.

Lauren Makler—who previously worked at Uber and founded Uber Health—co-founded Cofertility with entrepreneur Halle Tecco after looking into egg donation for herself several years ago. After Makler conceived a daughter unassisted in 2021, she said she built the service she would have wanted if she had gone the egg donation route.

“I really wanted to do something about access, and then at the same time, I felt intended parents deserved more options and deserved options that felt more in alignment with the way they wanted to grow their family,” she said.

 The startup finished its nearly $7.3 million Series A 

 in April, and though she declined to give exact numbers, Makler said the program has matched intended parents with donors “well into the quadruple digits.”There are some caveats, however. Not everyone who’s interested in what the company calls the “split” program qualifies. Makler said Cofertility limits participation in the program to criteria recommended by the FDA and the 

American Society for Reproductive Medicine

, such as limiting egg donors to ages to 21–34 and barring people with certain genetic conditions. All donors must also have an anti-Müllerian hormone (AMH) level above 2.0, which is associated with successful retrievals.

Those who don’t qualify for the split program can still freeze their eggs through the startup, Makler said. A single cycle and 10 years of storage with Cofertility costs about $16,000 for patients in New York City, compared to an industry average of $17,773 for a single cycle and five years of storage in the same location, according to 

Cofertility also prioritizes transparency in egg donation. The majority of Cofertility’s egg donors and recipients so far have chosen to disclose their identities, meet each other, and exchange contact information, Makler said, though a small number still choose not to.

 around egg donation is this idea that you could be walking down the street someday and see someone who looks like you and wonder if that’s the child born from the donation. And with a disclosed donation, that fear entirely evaporates,” Makler said.

She made it clear that donors who don’t exchange info aren’t promised complete anonymity, because, let’s face it—with 

, there’s no way to guarantee your biological kid won’t do a DNA swab and find you one day through a random cousin.

 Colleen Denny, a New York-based ob-gyn, told Healthcare Brew she thinks it’s a promising concept but what really defines the quality of models like this is whether they’re transparent with their donors about what happens if things don’t go according to plan, who pays in the case of multiple cycles or medical complications, and what the realistic chances of conceiving with egg donation are.

“You really want to understand what it means to ‘split your eggs,’” she said.

Nearly 40,000 people froze their eggs in 2023, according to 

 from the Society for Assisted Reproductive Technology. But there’s 

 pregnancy will be possible through this route. Only about half of in vitro fertilization cycles resulted in successful births in 2023.

“A lot of people think that if they freeze three eggs, they’re going to have three babies in the future, and that’s just not how egg freezing works,” Denny said. “This is something of a backup plan, but not a guarantee.”

Makler said Cofertility makes this and other technicalities clear in legal agreements that donors sign with the business and with their egg donation recipients.

For instance, intended parents get to keep the extra egg if an odd number of eggs are retrieved.

The agreements also state that intended parents—not the donor—will pay a premium for temporary health insurance for the donor and front the bill for unexpected medical costs up to a previously agreed-upon amount.

For recipients, Cofertility also offers a 

Correction 06/13/2025: The headline of this story has been corrected to reflect Cofertility is making egg freezing free, not donation.

Headshot of Cofertility founder Lauren Makler

Meet Cofertility, the startup making egg freezing free—for some

If you thought grocery store eggs were getting expensive…

 a “baby bonus,” i.e., cutting $5,000 checks to incentivize families to have more children in response to 

While still just an idea, it spurred concern among reproductive health experts. They told Healthcare Brew pregnant patients face many challenges, from 

For instance, it costs $18,865 to have babies in hospitals, including pregnancy, birth, and postpartum care, 

 of people who give birth are on Medicaid, and with Congress considering 

, patients may soon pay those costs out of pocket.

“$5,000…is probably a drop in the bucket in terms of raising a child. But is it maybe a step in the right direction? Yes,” Monica Cepak, CEO at women’s digital health company Wisp, said. “I think it should be part of a broader policy around reproductive health and childcare in our country.”

 First and foremost, the number of places to give birth in the US is on the decline.

March of Dimes, a nonprofit that works to support maternal and infant health, reported that in 2021 and 2022, about 1 in 25 obstetric units closed in the US and 70% of birthing units are located within 10 states. The organization also 

 35% of US counties don’t have a single birthing facility or obstetric clinician.

“To have wide swaths of this country without the presence of a maternity ward makes it seem more like a developing nation as opposed to one of the most industrialized nations with one of the best healthcare systems on the planet,” Melissa Simon, an ob-gyn at Northwestern Medicine in Chicago, said.

 was overturned in 2022, there’s been a rise in 

 in the US, meaning it’s more dangerous to have children now.

Research from nonprofit research organization the 

 found that in Texas, which has a strict six-week ban on abortion with no exceptions for rape or incest, maternal mortality rates rose by 56% between 2019 and 2022, compared to an 11% increase across the US overall.

Infant death rates have also risen, with 

 5.6 deaths for every 1,000 live births in 2022, up from 5.4 in 2021.

“Women who are in states where there’s restrictive reproductive healthcare laws…

Pregnant people living in states with “full support of reproductive healthcare,” like Illinois, New York, or California are also hesitant to travel to states with bans, she added. Some people from states with bans are choosing to stay in states with abortion access throughout their pregnancy, she said.

“It is unconscionable to think that the president or the government would give $5,000 to incentivize having a child while not taking care of the woman herself,” she said.

A woven basket filled with stacks of $100 bills and a sticky note with a baby stroller icon.

Birthing unit numbers are on the decline, and patients are facing greater risks 

With more labor and delivery departments closing and a decline in reproductive health access, it’s harder and more expensive to have children. 

June 24 marks nearly three years since the 

Dobbs v. Jackson Women’s Health Organization

 decision that overturned the constitutional right to abortion in the US.

 have banned or restricted abortion before fetal viability across the country, according to the NYT abortion law tracker. Independent abortion clinics in some states are 

, while companies offering telehealth have seen a 

. At the same time, maternal mortality rates 

, and stories have emerged about pregnant 

We spoke with reproductive health experts around the US to learn more about how maternal care has changed in the last three years. Here’s what they told us.

These interviews have been edited for length and clarity.

Melissa Simon, ob-gyn at Northwestern Medicine in Chicago, where abortion is legal

In states that are supportive of reproductive care and health, care hasn’t changed with respect to the quality of care. It’s more volume based. The volume of care has increased with patients coming from other states, and some of them travel very long distances from all over the country.

Any clinician who’s trying to get trained in reproductive health of any form can’t get trained well—or let alone at all—in states where they passed restrictive laws as a result of the overturning of 

. That leaves half the country pretty much unavailable for access to training, which is a real problem when about 50+% of the US population is female.

People get triggered or emotional around the word abortion, and they connect it to so many other things, but in reality, women’s health care is being completely demolished and undermined because of emotion connected to a word.

Monica Ruehli, clinical director of reproductive and gender-affirming health at Blue Cross Blue Shield of Massachusetts, where abortion is legal

We developed our own internal reproductive health and gender-affirming team just after the 

 decision, and that was one of the factors that led us to really concentrate and think more about women’s health. Luckily, here in Massachusetts, we have a huge commitment to reproductive health and gender-affirming care by our governor and at the state level.

There are still a lot of people who are traveling to Massachusetts for abortion care and that the state has seen a huge number of people coming in, especially initially after the 

 providers and allows providers from Massachusetts to provide access to patients in other states.

 decision, there was a contraceptive access law that got passed. It required insurers to cover access to contraception with no cost share. And then immediately after the 

 decision, that same bill had a provision for mandating coverage for abortion and abortion-related care without cost share.

Alice Crisci, co-founder and CEO of Ovum Health, which provides virtual reproductive care in states with and without bans

In the state of Idaho, we have one of the most restrictive laws in America that prevents even a dilation and curettage (D&C) procedure from being performed. If you perform a D&C procedure, even if it’s to save a woman’s life because she had a partial miscarriage, it is a criminal offense, and a physician can lose their medical license.

In some of these really restrictive states, it’s nerve-wracking to deliver care to high-risk patient populations. Ob-gyns are 

 medical professions out there. We’re concerned about medical malpractice rates rising in some of these states where these restrictive laws could cost someone’s life.

 was overturned, I can say that I was terrified, I was disappointed, but I can’t say that I was surprised.

Beverly Gray, ob-gyn at Duke Health in North Carolina, which has a 12-week ban

We’ve had a lot of changes over time in North Carolina. Initially, right after

 that went into place, and so access to reproductive care was dramatically curtailed very quickly. Many of those folks would travel to North Carolina for care. Approximately a year after the 

 decision, North Carolina enacted a very strict abortion ban that has restrictions after 12 weeks, with multiple different layers of exceptions. But there are also many other components of the law that make it very challenging to care for patients day to day, including an in-person, 72-hour biased mandated counseling by the state.

Many patients are traveling, and North Carolina was one of the top four states for receiving travelers for care. Let’s say you needed some type of urgent surgery, and you were told, “Well, no one in your state does this surgery. You need to go to another state. And I’m not going to give you a referral—good luck finding somebody to care for you.” Even for someone who is very well resourced and knowledgeable, that’s a really hard barrier to overcome. Many patients seeking care are receiving Medicaid for their insurance coverage, and Medicaid doesn’t cover [abortion] care, and so they’re paying out of pocket.

How reproductive health has changed 3 years since Roe v. Wade was overturned 

Reproductive health experts share how patients and clinicians are concerned about safety in a post-Roe world. 

 the first at-home device to help screen for cervical cancer—no stirrups, speculums, or awkward small talk required.

The device, made by women’s health company Teal Health, is a wand with a sponge-like end that patients can use to self-collect vaginal samples. The service also includes a virtual visit with a Teal provider to discuss your history before receiving a device and another after if follow-up care is needed.

The samples are mailed to a lab for primary human papillomavirus (HPV) testing, the American Cancer Society’s recommended method for cervical cancer screening since 2020. (It’s an alternative to the dreaded Pap smear, which is a 

As co-founder and CEO Kara Egan told us: “It’s not the ‘Pap smear from home’ because you shouldn’t be doing the Pap smear anymore. You should be doing primary HPV [testing].”

Product shot of Teal Health's FDA approved at-home cervical cancer screening device.

 found Teal’s wand was just as effective as a test done by a doctor.

The hope is patients will be more willing to get tested when they can do so themselves from home. Right now, 1 in 4 patients aren’t up-to-date on their screenings, and a 

 of 20,557 women found most who had missed their screenings didn’t know they needed to get them.

Ahead of the device’s planned California rollout in June, Egan talked to Healthcare Brew about the significance of its approval and the company’s future plans.

This interview has been edited for length and clarity.

We’ve been testing for cervical cancer for decades. Why do you think no one has invented an at-home collection method sooner?

I think the biggest reason was we never asked women if they wanted something better.

And then there’s the technical component…When you were looking at just the Pap smear, you had to get cervical cells, and that’s really hard to do. Primary HPV can be done just as well with vaginal cells.

I would say for the wand, it was making sure that it was comfortable, making sure that it actually could collect an adequate sample…The other part is giving a woman confidence that she did do it right.

It feels like someone’s holding your hand a little bit…Most women will have negative results, but for the few that have positive results, how does that feel? Do you feel like you got the information that you need? And are you able to speak to a provider right away to understand your next steps? And so we built that whole journey in.

We are in-network for the telehealth side—and then you start to work with [insurers] once you’re through the FDA to get the full thing covered. But what we would say is it has been really positive. We’ve had a lot of large national payers proactively reach out to us, even ahead of the FDA [approval], to understand how it’s going to work and make sure that they can get it for their members. So we are in negotiations right now to get this covered nationally with no cost-sharing.

You’re launching in California in June. How are you preparing to manufacture and distribute the wand after that?

We are encouraging everybody to join the wait list no matter what state you’re in because how we move to other states, or just start to address the other states, will be through the wait list. In the beginning, we’re going to start smaller…We want to make sure everything’s perfect in terms of the experience on the telehealth platform side. So we’ll start in the hundreds in the first couple months, but then the idea is we can quickly scale. All of our manufacturing, all of our lab partners, everything can handle hundreds of thousands, if not millions [of patients].

How did receiving FDA breakthrough device designation influence the development and approval process for the wand? 

The FDA breakthrough was [based on] our clinical trial data, which was already wrapped and exceptional. So it didn’t affect development, but it did put us on what’s considered the fast track for the FDA. It was great. The FDA was super responsive. We had almost daily interactions with them.

Are you investing in any particular marketing or awareness campaign?

We’re working on educational campaigns…I think education is going to happen on its own because everybody is gravitating toward the fact that they want a better way [to test]. It is hard to find a doctor’s appointment, it is hard to find time out of your work or childcare, and then the experience itself is not positive, whether it’s painful for you or just kind of violating and uncomfortable.

Healthcare brew's Q&A series featuring Kara Egan. 

Teal CEO Kara Egan talks FDA approval of at-home cervical cancer screening

Say goodbye to the stirrups! 

Teal CEO talks FDA approval of at-home cervical cancer screening

Maia Anderson

 women receive but also in how that care is reimbursed, according to a group of experts speaking before Congress on April 29.

The group—which included ob-gyn experts from Harvard, Northwestern, and more—held a briefing to say systemic inequities within the healthcare reimbursement system lead to providers making more money for some procedures performed on male anatomy than those performed on female anatomy, and therefore, those procedures on male anatomy get prioritized.

“A lot of people say, ‘Oh, you’re doing as much work, but do you have as much training? Do you have as much expertise? Are your procedures as complicated?’ It’s very easy to think that women’s issues are not as complicated or that their surgeons are not as well trained, and that is not that case,” Jocelyn Fitzgerald, a urogynecologist at the University of Pittsburgh Medical Center, said during the briefing.

 The amount of money a hospital makes for a surgery is partially based on what are called relative value units (RVUs).

RVUs measure clinical and nonclinical aspects of a procedure including the amount of work, type of equipment, and malpractice liability costs. Some procedures—like a Whipple, which is a surgery to remove tumors on the pancreas, small intestine, or bile duct—have more RVUs than others, so generally speaking, the more RVUs a hospital can bill per procedure, the more money it’ll get.

While RVUs technically only apply to patients enrolled in Medicare, other insurers tend to mirror the system when determining their reimbursement rates, too, according to Louise Parker King, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. 

During the briefing, experts called out several disparities in the reimbursement system.

For one, when RVUs were developed, “there was very little work put into quantifying the work of surgeons who cared for women,” Parker King said during the hearing.

Gynecologists “were adjudicated to have less required skill” 

 like cardiologists or orthopedists, she added, so RVUs for procedures involving female anatomy were generally set lower than those involving male anatomy.

More than 100 codes for surgeries performed on female anatomy were reimbursed an average of 30% lower than similar surgeries performed on male anatomy, according to a 

The researchers found that surgery on a male urinary tract makes on average 35% more than surgery on a female urinary tract, Fitzgerald said. Biopsying a penis brings in 45% more than biopsying a vagina, she added.

Beyond the overall lower RVUs, there simply aren’t many RVUs to bill for some procedures on female anatomy, according to Fitzgerald. Endometriosis surgery, for example, has only a single RVU.

“Surgical facilities are not going to want to give a surgeon who’s billing one low reimbursement code an operating room for eight hours if [an] orthopedic surgeon can do 16 shoulder surgeries in that time and make 16x the amount of money,” she said.

The experts said Congress could take action to eliminate these inequities.

Lawmakers could pass legislation requiring the Centers for Medicare and Medicaid Services (CMS) to use “objective measures” when setting RVUs rather than reimbursing procedures differently based on whether they’re performed on male or female anatomy, Christopher Robertson, a health law professor at Boston University, said.

Congress could also write to CMS about the issues laid out during the briefing and press the agency to explain why such disparities exist as well as hold formal hearings to raise awareness, Robertson added.

Overall, “this idea that gynecologic surgery isn’t valuable has profound, significant downstream consequences,” Oluwateniola Brown, assistant professor of obstetrics and gynecology at Northwestern University, said during the hearing. “It’s not about professional recognition…It’s about a systemic inequity that threatens the financial sustainability of health systems, the viability of our workforce, and most importantly, access to care and the quality of care for our patients.”

Doctor and patient during endoscopy exam in clinic.