New Tennessee Fertility Insurance Bill is Pro-Family

Tennessee is on track to pass a law requiring insurers to cover treatment for infertility, joining 19 other U.S. states that mandate coverage for either fertility treatment such as IVF or for “fertility preservation” services for patients with cancer or other severe disease.

The Tennessee Pro-Family Building Act (SB 425/HB 1379), if enacted into law, would require Tennessee insurance plans by 2023 to cover the diagnosis of infertility, fertility treatment including medications, and medically necessary fertility preservation services, such as cryopreservation of eggs or sperm.

Some 17 percent of Tennesseans of reproductive age will be diagnosed with infertility and require treatment in order to reproduce, according to a report by WMC Action News 5. Without insurance coverage, cost of treatment can spiral. “More than half of patients ages 25-34 incur about $10,000 in debt, and 26 percent of those have more than $30,000 in debt by paying for treatment costs,” The Daily Memphian reported.

Supporters of the new legislation say the impact on insurance premiums is expected to be minimal. For example, after Massachusetts passed similar legislation, insurance premiums in that state rose less than 1 percent, according to The Memphian article.

Sponsored by two Republicans, Becky Massey (R-Knoxville) in the state Senate and by Dr. Sabi Kumar (R-Springfield) in the General Assembly, the bill was championed by the grass-roots advocacy organization Tennessee Fertility Advocates.

Infertility Insurance Good for Families

This measure, part of a growing trend requiring insurers to cover infertility as they do other types of medical conditions, will be enormously impactful on would-be parents. Because each step—and each new attempt—incurs additional cost, the lack of insurance coverage can distort the fertility treatment process itself.

For example, if a heterosexual couple is going through an in vitro fertilization (IVF) cycle, they currently have every incentive to have as many embryos formed as possible, because each new round of IVF comes at a significant cost. This creates an incentive to transfer more than one embryo at a time to avoid the cost of another embryo transfer, resulting in higher-risk pregnancies with multiples. This concern about uninsured costs also results in more unused embryos left in cryopreserved storage (a mounting problem we wrote about earlier) and in the discarding of excess embryos due, in part, to a lack of funds to pay for continued storage after having spent so much on IVF.  Extending insurance coverage to fertility treatment alleviates these cost-related distortions—fewer embryos left over, and less pressure for the intended parents to discard embryos for financial reasons.

The issue of unused and abandoned embryos is at the heart of much of the controversy surrounding infertility insurance legislation: Are such laws anti-abortion, pro-choice or do they open up a can of worms regarding whether embryos are entitled to “personhood” status? Believe me, proponents of all those positions get involved whenever these bills are presented. Often anti-abortion factions will ask the question: Why isn’t there anything in this bill to prevent unused embryos. There is some concern that Tennessee Governor Bill Lee, a conservative Republican who in July 2020 signed a bill criminalizing abortion from the time a fetal heartbeat can be detected, will veto this bill if it passes.

Definition of Infertility 

It’s unclear what the new law will mean for LGBTQ couples and single people who want to become parents using assisted reproductive technologies such as egg or sperm donation, in vitro fertilization (IVF) or surrogacy. While the language of the bill does not specifically address coverage treatment for LGBTQ and single intended parents, it defines “infertility” in gender-neutral terms, as a “disease or condition characterized by (A) the failure to conceive a pregnancy or to carry a pregnancy to live birth; (B) a person’s inability to cause pregnancy and live birth either as an individual or with the person’s partner; or (C) a licensed physicians findings and statement based on a patient’s medical history, sexual and reproductive history, age, physical findings, or diagnostic testing…”

As we wrote recently, even though many of the new state fertility insurance mandates require insurers to treat same-sex couples equally, the laws’ and insurance companies’ reliance on traditional definitions of infertility, most of which stipulate an inability to conceive after a year of sexual intercourse, have served to discriminate against gay men. “And the insurance industry, which has always opposed laws that mandate specific types of coverage, appears to use legalistic definitions to deny coverage, even as it promises not to discriminate based on sexual orientation.”

Failure to include gay men in fertility insurance mandates is not uncommon. New York’s fertility insurance law, effective in January 2020, creates the same dilemma for gay men by relying on a heterosexually focused definition. As we wrote earlier:

While the New York legislature’s expansion of access to IVF for millions of women, it falls short of providing equal reproductive rights for same-sex couples and members of the LGBT community. As RESOLVE reports, under the new law, straight couples, lesbian couples and single women who need IVF and are in large-group insurance plans, will be covered. The new law also “prohibits delivery of insurance coverage from discriminating based on age, sex, sexual orientation, marital status, or gender identity, as RESOLVE reports. However, as I told The New York Post, the law also relies upon a standard and limiting definition of infertility to determine who is and is not eligible for IVF treatment:

The state of New York defines infertility as a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined by a physician or by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse, or after six months of regular, unprotected sexual intercourse for women 35 or older.

Because of this definition, additional fine-tuning will be needed—either via legislation or court cases—to ensure that gay men or single men are not unfairly discriminated against. 

In 2013 California updated its fertility insurance law to clarify that insurers cannot deny coverage to LGBTQ intended parents due to any limiting definitions of infertility. But California’s law, which requires plans covering more than 20 employees to offer fertility insurance and does not cover Medi-Cal patients, does not require coverage for in vitro fertilization (IVF)—a procedure necessary in order for a gay man to become a father.

We at IFLG applaud the increasing availability of fertility insurance, which will help thousands of families manage the steep costs of high-technology infertility treatments. For many intended parents, the availability of insurance coverage will be the deciding factor in whether they can afford to pursue their dreams of parenthood. Expanded insurance coverage will expand access to assisted reproduction. But unless and until the law and the insurance industry stop relying on outdated concepts of what families look like and how they are formed, gay and single men will continue to be denied full equality.

Even with its limitations and potential inequities, the Tennessee bill to provide infertility treatment coverage is an important step in the right direction. Universal insurance coverage will allow more people who want to become parents avail themselves of modern medical technologies, strengthen families and help reduce the number of excess embryos created and possibly discarded—all positive outcomes regardless of where one falls on the political spectrum.

Richard Vaughn

Attorney Rich Vaughn is founder and principal of International Fertility Law Group, one of the world’s largest and best-known law firms focused exclusively on assisted reproductive technology, or ART, including in vitro fertilization (IVF), surrogacy, sperm donation or egg donation. Rich is co-author of the book “Developing A Successful Assisted Reproduction Technology Law Practice,” American Bar Association Publishing, 2017.

Peiya Wang
Paralegal (律师助理)

Peiya Wang joined IFLG as a paralegal in 2015, where she manages surrogacy, egg donation and parental establishment cases and provides translation services for many of IFLG’s international clients. Peiya moved to the United States in 2012 to attend Northeastern University in Boston, Massachusetts, receiving a Master of Science degree in Global Studies and International Affairs in 2014. Peiya moved to Los Angeles in 2015, received her paralegal certification from UCLA Extension, and obtained her second Master of Science degree in Legal Studies from Loyola Law School. Peiya relocated back to her hometown, Beijing, China in 2019 and works from IFLG’s Beijing office. When away from the office, Peiya is a dragon boat paddler and a ballroom dancer, where she favors Rumbas and Cha-chas. She is fluent in Mandarin and English.

Luis Sosa

Luis R. Sosa joined IFLG as a paralegal in 2016, where he enjoys pursuing his passion for family and reproductive law. While working toward his bachelor’s degree at Florida International University which he received in 2013, Luis worked as a paralegal and legal assistant for family law litigation firms in Miami and Washington, D.C. As a paralegal and case manager for IFLG, Luis, who is bilingual in English and Spanish, manages surrogacy, egg donation and other reproductive law cases. Luis has worked for IFLG in both Los Angeles as well as San Francisco, and is currently based in Dallas, Texas. In addition to spending time with husband Randy and dog Marty, Luis enjoys being outdoors and appreciating the arts.

Toni Hughes

After receiving her B.S. in Business Management, Toni joined IFLG to pursue her dream of working in the legal field. As a Paralegal with over 10 years of experience in the assisted reproduction technology field, Toni is our Managing Paralegal, responsible for training and managing our paralegal staff. From drafting legal documents to assisting our clients with post-birth matters, Toni embraces the challenge of learning something new in this field each day. Besides spending time with her son, Jordan, Toni enjoys exploring new things, cooking, spending time with family and friends, and serving as a Youth Advisor for “Next Generation.”


Kim has over 30 years of experience in the legal field and has worked exclusively in surrogacy and assisted reproduction law since 1999. Kim is a senior case manager responsible for managing parental establishment cases and interacting with IFLG’s Of Counsel attorneys across the country. With three children of her own, Kim understands the importance of family and finds working in this area of law a rewarding experience.

Rich Vaughn

Attorney Rich Vaughn combined his personal passion as a father of twin boys born via assisted reproductive technology (ART) with more than 20 years of experience in business and technology law to build International Fertility Law Group. Today IFLG is one of the most successful and best-known law firms in the world focused exclusively on fertility law, helping thousands of intended parents through empathetic listening, compassionate guidance, and unmatched legal expertise. As an advocate for reproductive freedom, Rich also contributes his knowledge and time to improving the understanding and practice of ART law, most recently as a founder of and speaker at the first Cambridge University International Surrogacy Symposium held in June 2019, as immediate past chair of the American Bar Association ART Committee, and as a popular presenter to law schools, faculty and advocacy organizations all over the world.

Elizabeth Tamayo

Elizabeth received her Bachelors of Science degree in Criminal Justice from California State University of Los Angeles. Shortly after graduating, she continued her education at the University of California, Los Angeles where she obtained her Paralegal certificate. Elizabeth is fluent in Spanish and has been in the legal field since 2009. She is excited to be a part of the IFLG Team helping families realize their dreams.

Sunny Chien

Sunny joined IFLG as a paralegal in 2017, where she manages surrogacy, egg donation and parental establishment cases for many of IFLG’s international clients. She holds a Bachelor of Arts degree in Philosophy from California State University of Los Angeles, where she graduated cum laude. Sunny is bilingual in English and Mandarin and has extensive experience as a legal assistant and paralegal at Los Angeles-area law firms. She is excited to be part of the IFLG team. In her spare time, Sunny enjoys spending time with her family and their dog, going to the beach, cooking, and being outdoors.

Los Angeles

5757 Wilshire Blvd., Suite 645

Los Angeles, CA 90036

Phone:  +1 323 331 9343

Email:  info@iflg.net

Website:  www.iflg.net

New York

501 Fifth Avenue, Suite 1900

New York, NY 10017

Phone:  +1 844 400 2016

Email:  info@iflg.net

Website:  www.iflg.net

Molly O'Brien

Fertility law attorney Molly O’Brien began working in the field of assisted reproduction technology (ART) in 2005, at an egg donation agency and a surrogacy agency where she became familiar with all aspects of in-vitro fertilization, egg donation and the financial aspects of surrogacy. Since becoming an attorney in 2011, Molly has drafted and negotiated surrogacy, egg donation, sperm donation embryo donation agreements for hundreds of her clients all over the world.

Phoebe Sadler

Fertility law attorney Phoebe Sadler has a background in family law and has been practicing exclusively in the area of assisted reproduction technology (ART) law since 2018.

Rubina Aslanyan

Rubina has an extensive background in the legal field as a paralegal in Family Law and has worked in surrogacy and assisted reproduction law since 2012. Her area of focus is in managing and assisting clients with surrogacy, egg donation, and parental establishment cases for many of IFLG’s domestic and international clients. During her spare time, Rubina enjoys spending time with her family and dog Bella, traveling and cooking.

Alexander Espinoza
Legal Assistant

Alexander joined IFLG as a legal assistant in 2019, where he manages surrogacy, egg donation and parental establishment cases. Alex is bilingual in English and Spanish and has been in the legal field for 23 years. Alex is excited to join the IFLG team and pursuing his will to help others in the reproductive law process. In his spare time he loves spending time with his family and friends, being outdoors, road trips, loves music and dancing.

Cara Stecker
Senior Paralegal

After receiving her paralegal certificate in 2005, Cara began working in assisted reproductive law. During the fifteen years Cara has worked in this field, she has gained a wide range of experience and knowledge that she uses to help better assist clients and those involved in the assisted reproductive journey. Cara’s primary roles involve managing parental establishment matters and coordination with IFLG’s Of Counsel attorney network, drafting contracts and parental establishment court documents and providing support to other team members. Cara finds great joy in being a small part of a team of caring people who help others achieve their dream of having a family. In her spare time, Cara enjoys spending time with her husband and three children, watching her children play the sports they love, and she enjoys, running, cycling and exploring the outdoors in the sun.

Stephanie Kimble

Stephanie received her BS in History and Political Thought from Concordia University Irvine in 2015 and her Paralegal Certificate from University of San Diego later that same year. She has been working as a Paralegal since 2016 in Family and Reproductive Law. She is excited to be part of International Fertility Law Group working on managing Surrogacy, Egg donation and Parental Establishment Cases.

Trish Pittman
Assistant Financial Coordinator

With more than 20 years of experience in the field of accounting, Trish joined the IFLG team in 2019 as Assistant Financial Coordinator. Her client-facing focus at IFLG is to assist with all client trust accounting. Trish is the mother of two daughters and enjoys spending time teaching and learning new things from them. In her free time, she loves long walks in the park and reading suspense and mystery novels.

Katie Deaquino
Senior Paralegal

Katie is a Senior Paralegal with IFLG and has dedicated over sixteen years to the areas of surrogacy and reproductive law. She received her Paralegal Certificate from Coastline Community College and has worked with some of the top law firms in the assisted reproduction community. Katie is also a commissioned Notary Public. With IFLG, Katie manages Surrogacy, Egg Donation, and Parental Establishment cases and provides support to other IFLG team members. Katie truly enjoys helping others build their families through assisted reproduction and is thankful she has had the rewarding experience of assisting IFLG clients. Katie often spends her free time with her Husband, four young children and her bulldog “Bella”.

Elsa Jimenez
Legal Assistant

Elsa joined IFLG as a Legal Assistant in 2019, bringing more than 35 years of experience working in the legal profession (concentrating in tort and litigation matters). At IFLG she assists surrogates with their surrogacy and parental matters. The oldest of five siblings, born and raised in East Los Angeles to Mexican immigrant parents, Elsa loves “seeing the beauty of families forming” through assisted reproductive technology. She and her husband Carlos have four children and one grandson. Elsa enjoys jazz and ’80s music, being outdoors in nature, collecting teacups and tea pots, and spending time with her close-knit family.