Right care, right time: How fertility benefit design can support clinical judgment

Infertility is a disease, and the path to building a family is different for every patient. Diagnosis, age, medical history, prior treatment, partner evaluation when applicable, and family building goals all shape the appropriate next step. Care should be guided by the patient’s clinical circumstances, goals, and provider recommendation — not a fixed, predetermined sequence. 

For some patients, the next step may be education, testing, medication, ovulation support, or intrauterine insemination (IUI). For others, it may be in vitro fertilization (IVF), fertility preservation, consultation with a reproductive urologist, donor tissue and/or gestational carrier support, adoption support, or another path to parenthood. The goal always is appropriate care based on evidence and individual needs. 

Benefit design can either support or constrain that individualized approach. Rigid requirements may delay care or require treatment steps that are not clinically appropriate for a particular patient. Flexible, clinically grounded benefits give patients and providers more room to choose the care that best fits the clinical picture. 

We spoke with reproductive endocrinologists and reproductive urologists in the Progyny network about evidence-based fertility care, clinical flexibility, and what helps patients receive the right care at the right time. 

Why benefit design matters

A strong fertility benefit preserves access to clinically appropriate options without imposing a fixed treatment sequence or unnecessary administrative barriers. This allows patients and providers to make decisions based on clinical evidence, individual circumstances, and family building goals. 

Peter Klatsky, MD, MPH, of Spring Fertility New York, described why that flexibility matters: 

“The best outcomes happen when physicians and patients can make decisions together based on clinical evidence, the patient’s unique circumstances, and their goals for building a family. The best benefit design is one that allows us to recommend the care that is clinically right for the patient sitting in front of us, then move efficiently to enact that plan.” 

That flexibility matters because fertility care is rarely linear. Some patients need additional diagnostic testing before treatment selection; others may benefit from evaluation by both reproductive endocrinology and reproductive urology. In time-sensitive situations — including advancing reproductive age, diminished ovarian reserve, cancer treatment, or other conditions affecting fertility — unnecessary delays can also matter clinically. 

Evidence-based care is individualized care 

Evidence-based fertility care starts with the full clinical picture. Depending on the patient, that may include age; medical and family history; ovulatory status; Fallopian tube patency; sperm parameters; sexual function; genetic risks for intended parents and potential offspring; prior pregnancy loss or treatment; and family building goals. When applicable, timely evaluation should include both partners. 

Rashmi Kudesia, MD, MSc, of CCRM Houston, described evidence-based care as both comprehensive and collaborative:

“Evidence-based fertility care is highly individualized and sensitive to the patient or couple’s family building goals as they see them in that moment. We begin with thorough education on the fundamentals of fertility and infertility treatment, emphasizing comprehensive assessment of the patient or couple, and using a shared-decision-making model to match a patient to the right next step.” 

The “right next step” will not look the same for every patient. It may range from less intensive treatment, such as IUI with fertility medication, to IVF or another specialized pathway. The care plan should reflect diagnosis, prognosis, preferences, and family building goals. 

When is IUI the right treatment? 

IUI can be a valuable option for appropriately selected patients, including some with unexplained infertility, mild male-factor infertility, or those using donor sperm. 

Nicole Marchetto, MD, MPH, of Shady Grove Fertility, said:

“IUI is a valuable treatment for the right patient — unexplained infertility, mild male factor, donor sperm. Whenever I can help someone succeed with IUI, I do.” 

But IUI is not appropriate for everyone. When benefit design incentivizes or requires IUI before IVF — even when clinical factors make IUI unlikely to succeed — it can delay timely, clinically appropriate care and add emotional and financial burden. 

Dr. Marchetto added, “But IUI is not a box to check before IVF.” She also noted, “For tubal disease or severe male factor, IUI is simply not effective.” 

Benefit design should support IUI when it is appropriate while allowing patients and physicians to pursue IVF or another pathway when the clinical picture supports a different approach. 

IVF can be the right treatment — but it is not the default path 

IVF is an essential treatment for many patients, but it is also physically, emotionally, logistically, and financially demanding. Providers recommend it when the clinical picture supports it—not simply because it is a more intensive treatment. 

Dr. Marchetto explained: 

“No one chooses IVF because it is easy. When I recommend it, it is because the clinical picture supports it — and I make sure patients understand exactly why.” 

For some patients, IVF may be the most appropriate first-line treatment; for others, it may not be. The distinction matters because delaying an indicated treatment can have consequences, particularly when age, ovarian reserve, tubal disease, severe male-factor infertility, or genetic testing considerations are part of the clinical picture. 

“The goal is never more treatment — it is the most appropriate treatment. The real question is not whether IVF utilization is too high, but whether the care pathway is clinically appropriate.” 

Reproductive urology shouldn’t be overlooked 

Individualized fertility care should include reproductive urology when male-factor infertility may be involved. 

Akash Kapadia, MD, of Georgia Urology, identified equal access to male fertility care as an important remaining challenge: 

“One of the important remaining and unmet challenges in infertility medicine today is equal access to male fertility care. It is still true that infertility medicine continues to be driven by female care with male partner evaluation being an accessory.” 

Early involvement of a reproductive urologist can identify factors that may change the treatment plan, including sperm abnormalities, hormonal deficiencies, varicoceles, erectile or ejaculatory dysfunction, obstruction, and other conditions. 

In some cases, reproductive urology evaluation may identify treatable issues; in others, it may help clarify whether IVF or another treatment is the most appropriate next step. In either situation, timely involvement of the appropriate specialist can improve the quality of decision-making. 

How Progyny supports evidence-based decisions  

Flexible benefits are most useful when they preserve access to clinically appropriate options and keep treatment decisions centered on patient needs. Dr. Kudesia described how Progyny’s model supports that work:

“The Progyny benefit is immensely helpful to me as a physician trying to practice evidence-based care. It allows me to offer realistic statistics and expectations of different levels of treatment without worrying that the patient may not be able to access the types of care that would ultimately benefit them most.” 

In Dr. Kudesia’s experience, Progyny does not dictate whether a patient begins with basic or advanced treatment, and Progyny Care Advocates help patients understand evidence-based care pathways.  That structure is intended to keep decisions focused on medical needs, preferences, and priorities rather than a prescribed sequence of treatment. 

What employers, plan sponsors, and consultants should understand 

Members enter fertility and family building care with different diagnoses, timelines, and goals. Benefit design should reflect that variation. 

Some members may need help trying to conceive; others may need fertility preservation, reproductive urology, genetic testing, donor tissue or gestational carrier support, adoption support, or another specialized pathway. Some may achieve their family building goals without fertility treatment. 

Supporting different paths to parenthood means reducing unnecessary friction across clinically appropriate options while preserving shared decision-making between patients and providers. 

Dr. Klatsky said:

“Supporting family building starts with recognizing that every person’s journey looks different. A meaningful fertility benefit should provide access to high-quality, evidence-based care while allowing patients and their physicians to determine the path that best fits their needs. When benefits are designed around the patient rather than a predefined process, more people are able to access the care that is right for them.”

That patient-centered approach is what Progyny’s model is designed to support. 

The right care isn’t one path 

No single treatment pathway is right for every patient. An effective fertility benefit should neither push patients toward the least intensive option nor assume that more intensive treatment is preferable. It should support the treatment that is most appropriate at that point in time, based on diagnosis, medical history, prognosis, goals, evidence, and shared decision-making. 

That may mean IUI, IVF, reproductive urology, fertility preservation, donor tissue, gestational carrier support, adoption, or another path to family. It may also mean additional education, testing, or support before treatment begins. 

Progyny’s model is designed to support individualized, clinically grounded care led by patients and their providers — so the next step is determined by what is appropriate for each person, at the right time. 

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