Supporting employees with PCOS: The overlooked opportunity in inclusive fertility benefits

The high prevalence of Polycystic Ovary Syndrome (PCOS)¹ among working age adults, affecting approximately 1 in 10² individuals of reproductive age, begs the question of why PCOS remains chronically underdiagnosed, undertreated, and largely unaddressed in employer-sponsored benefit programs

This oversight carries consequences well beyond reproductive health. Individuals with PCOS often experience a range of comorbidities that can contribute to absenteeism, presenteeism, and long-term disengagement at work, including metabolic, cardiovascular, and mental health conditions. When left unsupported, the burden of PCOS extends to both personal well-being and organizational performance.

As more companies begin to offer fertility and family-forming benefits, with 87% of large employers³ projected to expand these benefits to all types of families by 2027 without the need for an infertility diagnosis, there is a growing opportunity and responsibility to design these programs with inclusivity and medical equity in mind. By explicitly addressing PCOS within the scope of fertility benefits, employers can improve health outcomes, reduce unnecessary costs, and strengthen workplace retention and inclusion.

PCOS: A widespread condition with hidden workplace costs

PCOS is a complex hormonal disorder marked by irregular ovulation, elevated androgens, and insulin resistance. It affects between 6% and 13%⁴ of reproductive-age individuals, many of whom go undiagnosed for years. Symptoms can include irregular menstruation, weight gain, acne, hirsutism, and fatigue, but they often vary in intensity and are frequently dismissed or misattributed.

From a reproductive health standpoint, PCOS is one of the most common causes of anovulatory infertility. However, its impacts go much further. Many individuals with PCOS also experience depression, anxiety, and chronic inflammation, factors that can impair concentration, increase workplace absences, and diminish overall quality of life. Long-term, PCOS can have major health consequences because of associated insulin resistance, obesity, cardiovascular disease, endometrial cancer, and obstructive sleep apnea.

Despite these wide-ranging effects, PCOS is often excluded from mainstream conversations about workplace health and fertility. Few employer-sponsored health plans offer proactive screening or targeted support. Fertility benefits, where they exist, frequently focus on later-stage interventions like in vitro fertilization (IVF) rather than early diagnosis or condition-specific care.

The case for inclusive fertility benefits

Inclusive fertility benefits go beyond offering a single pathway to parenthood. They recognize the diversity of family-building experiences and the underlying health conditions that shape them. When benefits are designed to include conditions like PCOS, they can create significant value, clinically, financially and culturally.

Here’s how:

1. Retention and recruitment

Reproductive health support is increasingly seen as a critical workplace benefit. Surveys show that 88%⁵ of employees would consider changing jobs for better fertility coverage. Younger workers, LGBTQ+ employees and those managing chronic reproductive conditions are especially attuned to whether employers recognize and accommodate their family-building journeys.

For individuals with PCOS, inclusive fertility benefits send a clear message: Your health is valid, your experience is understood, and your future is supported. This fosters not just loyalty but trust, particularly among those who may have encountered stigma or dismissal in clinical or workplace settings.

2. Workplace productivity and mental health

Employees managing untreated or undiagnosed PCOS may experience fluctuating energy levels, mood changes, and physical discomfort that interfere with work. Missed diagnoses can prolong time-to-treatment, increase emotional strain, and escalate the need for costly interventions later.

By supporting early detection and tailored care, inclusive fertility benefits can reduce the emotional and logistical toll of navigating PCOS while working. They also reduce the likelihood of extended medical leave or burnout, especially during critical periods such as fertility treatment or pregnancy loss.

3. Cost avoidance and smarter spend

Fertility treatment is expensive, but so is inaction. A single IVF cycle can cost upwards of $15,000 to $30,000^6, and multiple cycles are often required. For patients with PCOS, initiating treatment without addressing ovulatory dysfunction or metabolic concerns can lead to unnecessary procedures, poor outcomes or inflated costs.

Conversely, inclusive benefits that incorporate PCOS-specific diagnostic testing, ovulation induction, or lifestyle interventions can lower the total cost of care while improving success rates. Bundled treatment packages, fertility preservation options, and medication support can further reduce financial barriers and employer liability.

Key components of a PCOS-inclusive fertility benefit

For ob-gyns advising employer clients or patients navigating benefit design, the following components are essential for fertility programs that meaningfully address PCOS:

• Early diagnostic screening: Benefits should cover hormone panels, ultrasound imaging, and insulin resistance testing as part of standard reproductive health assessments, not just for those already pursuing IVF.
• Condition-specific treatment pathways: Coverage for ovulation induction (e.g., letrozole or clomiphene), cycle monitoring, and dietary or endocrinology referrals can improve outcomes before more invasive options are necessary.
• Fertility preservation: PCOS can impact ovarian reserve and long-term reproductive planning. Sperm and egg freezing options should be available to those who may not be ready to conceive immediately but face time-sensitive decisions.
• Mental health support: Psychological support should be integrated into reproductive care benefits, with resources tailored to address the identity, self-esteem, and relationship challenges that often accompany PCOS.
• Inclusive eligibility criteria: Benefits should not require a diagnosis of infertility based on heterosexual, married norms. Individuals with PCOS, regardless of gender identity, sexual orientation, or marital status, should have equitable access to care.
• Flexible access and navigation tools: Concierge navigation, telehealth options, and culturally competent care coordination can help individuals with PCOS find the right providers and stay engaged throughout treatment.

The role of ob-gyns in advancing inclusive fertility support

Ob-gyns play a pivotal role in shaping how reproductive health is perceived, not just in the exam room but in broader workplace and policy contexts. For patients navigating PCOS, this guidance can be transformative. Beyond diagnosis and treatment, ob-gyns are uniquely positioned to influence both individual care decisions and the systems that support them.

One of the most critical areas of impact is early intervention. Many individuals with PCOS present with irregular menstrual cycles, metabolic symptoms, or unexplained weight fluctuations well before they consider parenthood. Encouraging proactive evaluation and diagnosis, long before conception becomes a goal, can significantly reduce time-to-treatment and prevent avoidable delays when fertility becomes a priority.

Ob-gyns can also serve as vital sources of information about fertility benefits. Many patients are unaware that their employers may offer coverage for reproductive health services, including diagnostics and treatments relevant to PCOS. By initiating conversations about workplace benefits during consultations, clinicians can help patients make more informed decisions about both their care and their financial options.

In addition to patient education, ob-gyns have the expertise to guide conversations with employers, HR leaders, insurers, and benefit consultants. When clinicians share real-world insights into how PCOS manifests, why it’s often overlooked, and which coverage components truly improve outcomes, they contribute to more inclusive and effective benefit design.

Finally, clinicians have the power to influence cultural norms. By speaking openly about PCOS and related reproductive health conditions in professional forums, conferences, and publications, ob-gyns help normalize fertility as a legitimate and important workplace concern. In doing so, they reduce stigma, elevate reproductive health equity, and ensure that more individuals receive the timely care and support they deserve.

From recognition to results: Addressing PCOS through inclusive benefits

PCOS is not just a personal health issue; it’s a public health and workplace equity issue. As fertility benefits become more common in employer-sponsored plans, there’s a critical opportunity to ensure that they are not only available but inclusive and effective.

By designing benefits that proactively address PCOS, employers can better serve their workforce, reduce unnecessary costs, and promote a culture of health and belonging. For ob-gyns, this moment calls for partnership, not only with patients but with the systems that support them.

Inclusion begins with recognition. For the millions living with PCOS, that recognition can change everything.

Disclosure/About the author: David Adamson, MD, FRCSC, FACOG, FACS, is a consulting reproductive endocrinologist and surgeon, Medical Director of Equal3 Fertility, Clinical Professor ACF at Stanford University, and Associate Clinical Professor at UCSF. He is Past President of the American Society for Reproductive Medicine (ASRM), Society for Assisted Reproductive Technology (SART), AAGL (women’s surgery), the Committee on Reproductive Medicine for the International Federation of Gynecology and Obstetrics (FIGO) and several other major gynecological societies. He is Chair of the International Committee Monitoring ART (ICMART), President of the World Endometriosis Research Foundation (WERF) and ex officio Board member of the International Federation of Fertility Societies (IFFS). He is a member of many prestigious professional societies and has been a board member and advisor to government, industry, professional and patient organizations. He has over 300 peer-reviewed and other scientific/medical publications and has lectured extensively nationally and internationally on assisted reproductive technologies, endometriosis, reproductive surgery and infertility, standards of care, cost-effective outcomes, equity and access. Dr. Adamson led the committee that created The FIGO Fertility Toolbox and the organization that created the global Endometriosis Phenome and Biobanking Harmonization Project (EPHect), and he created the Endometriosis Fertility Index, all electronic tools used globally to improve health care for reproductive age women.

He is Founder, Chair and Chief Executive Officer of Advanced Reproductive Care (ARC Fertility), the largest United States network fertility company. He has been recognized as one of the best 400 physicians for women in America and received the Outstanding Achievement in Medicine award from the Santa Clara County Medical Society, a Certificate of Special Congressional Recognition for contributions to the community, Distinguished Surgeon award from the Society of Reproductive Surgeons, Honorary Life Membership from the Canadian Association of Internes and Residents, the Barbara Eck Founders Award from RESOLVE, the national fertility consumer organization, several honorary memberships and professorships, and the ASRM Distinguished Service award for his outstanding achievements in advancing the practice of reproductive medicine. Dr. Adamson has been honored with the CEO of the Year Award by CEO Monthly.

References

1. Polycystic ovary syndrome support groups are helpful. PCOS Awareness Association. (n.d.). https://www.pcosaa.org/overview
2. Berg, S. (2025, September 26). What doctors wish patients knew about polycystic ovary syndrome. American Medical Association. https://www.ama-assn.org/public-health/population-health/what-doctors-wish-patients-knew-about-polycystic-ovary-syndrome
3. The path to family formation: Understanding the complexities and ... Business Group on Health. (n.d.). https://www.businessgrouphealth.org/en/resources/fertility guide part 2 the path to family formation
4. World Health Organization. (n.d.). Polycystic ovary syndrome. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome 
5. Klotz, Dr. N. (2024, January 25). How fertility benefits can help your company stand out in the race for talent. Employee Benefit News. https://www.benefitnews.com/opinion/how-fertility-benefits-can-help-your-company-stand-out-in-the-race-for-talent 
6. Peipert, B.J., Montoya, M.N., Bedrick, B.S. et al. Impact of in vitro fertilization state mandates for third party insurance coverage in the United States: a review and critical assessment. Reprod Biol Endocrinol 20, 111 (2022). https://doi.org/10.1186/s12958-022-00984-5