Communities We Serve

Across the U.S., the need for fertility preservation is growing, yet financial assistance options for sperm freezing remain limited. We support access to sperm freezing for a variety of life circumstances, including medical treatment, gender-affirming care, and military service.

Limited Coverage, Despite Significant Need

  • Only 21 states mandate coverage of medically indicated fertility preservation, and those mandates generally apply only to certain state-regulated plans.

  • Among large employers, only 12-20% report coverage for elective sperm freezing or cryopreservation.

  • In the ACA Marketplace, only 2% of silver plans in one 2025 study fully covered cryopreservation costs.

  • Lower income and lack of adequate insurance coverage, such as those with Medicaid or no insurance, are associated with lower sperm-banking rates among counseled patients.

Unmet Need at A Glance

Cancer

  • About 1 in 10 cancer cases occur in adults of reproductive age.

  • An estimated 15-30% of male cancer survivors lose fertility potential after treatment.

  • Despite this need, sperm banking remains underutilized, with financial burden cited as a major barrier to access.

Sperm freezing should be accessible before treatment

Rare Disease

  • Gene therapies have increased rare disease treatment options, yet many can threaten fertility.

  • Rare diseases often occur in younger patients and can disproportionately affect families relying on Medicaid or facing other health inequities.

  • Rare disease treatment pathways are expanding faster than financial support options.

Access should pace keep with innovation

Gender-Affirming Care

  • Fertility preservation should be offered before gender-affirming hormonal or surgical treatment.

  • Although many patients value future family-building options, fertility preservation remains underused due to cost and equitable access to fertility services.

Future family-building options matter

Active-Duty Service

  • Military life creates family-building barriers through deployment schedules, frequent separations, and limited coverage.

  • DoD reported 547,343 fertility-care encounters from 2013-2023.

  • TRICARE generally does not cover elective sperm cryopreservation and only 8 military hospitals offer fertility preservation services.

Service should not mean fewer options

Cancer Diagnosis and Treatment

For many cancer patients, sperm freezing is a narrow window of opportunity before treatment begins, yet cost can delay or prevent timely access to fertility preservation. We support patients whose clinicians identify a meaningful fertility risk from cancer treatment and for whom preserving future family-building options is an important part of care.

  • ASCO treatment guidelines recommend offering sperm cryopreservation before cancer-directed treatment, yet many patients lack adequate insurance coverage.

  • The American Cancer Society estimates that about 85,480 adolescents and young adults ages 15–39 will be diagnosed with cancer in the U.S. in 2025, accounting for over 4% of all new cancer cases.

  • The share of cases diagnosed among certain cancers, like colorectal, in adults younger than 55 rose from 11% in 1995 to 20% in 2019, with fertility-relevant cancer diagnoses affecting more people in their reproductive years.

  • In a St. Jude study of adolescent and young adult cancer patients at risk for infertility, only 44% banked sperm before treatment. Another study found that lower income and lack of adequate insurance coverage were associated with lower sperm-banking rates among counseled patients.

  • Despite advances in cancer care that have expanded treatment options beyond chemotherapy and radiation, newer therapies — like CAR-T therapy — can still jeopardize future fertility.

Rare Disease Treatment

As more patients gain access to gene therapy and other advanced treatment pathways, fertility counseling and sperm freezing may become increasingly relevant before treatment starts.

  • FDA has approved 49 cell and gene therapy products, increasing the number of treatment options available for patients with rare diseases. Many gene therapy treatments require lymphodepletion, which can impair future fertility.

  • Rare diseases often begin early in life: about 75% manifest in childhood, making fertility preservation an important consideration for patients pursuing treatment.

  • Financial barriers can be especially acute for rare-disease patients and families — many of whom rely on Medicaid to access complex care.

  • Rare diseases can also intersect with broader health inequities. For example, sickle cell disease affects about 100,000 people in the United States; more than 90% are non-Hispanic Black, and an estimated 3%–9% are Hispanic or Latino.

Gender-Affirming Care

People seeking gender-affirming care may face important fertility decisions before hormones or surgery. For many, sperm freezing may be the only opportunity to preserve the possibility of having a biological child in the future.

  • Fertility preservation should be offered before gender-affirming medical treatment, as hormone therapy and surgery can affect future fertility. Treatments may cause irreversible reproductive changes, and cessation of treatment later on can worsen gender dysphoria.

  • ASRM states that transgender and nonbinary individuals should have equitable access to fertility services and counseling about options for future family-building before treatment, yet coverage may be denied or treatment refused.

  • Annual U.S. gender-affirming surgeries rose from 4,552 in 2016 to 13,011 in 2019. About 48,019 patients underwent gender-affirming surgery from 2016–2020, more than tripling over the last decade.

  • Transgender and gender-diverse individuals value the option of biological parenthood, but barriers including cost, access, timing, and limited counseling prevent patients from using fertility preservation services.

Active-Duty Service

Military service can create unique barriers to fertility care, including deployment, relocation, separation from partners, and inconsistent access to specialty services. Sperm freezing may be relevant before deployment or after service-related illness or injury, yet coverage remains limited.

  • A 2025 DoD study reported 547,343 fertility-care encounters from 2013-2023 across the Military Health System.

  • The uniformed services health care program, known as TRICARE, generally does not cover elective assisted reproductive technology services, including cryopreservation.

  • Fertility preservation services are available through only 8 military hospitals with reproductive endocrinology and infertility programs.

Why Support Is Needed

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Growing Demand

The need for sperm freezing is rising as more patients pursue treatments and care pathways with fertility implications.

Time-Sensitive Need

Fertility preservation decisions often must be made quickly, before treatment or care begins, leaving little time to navigate cost or coverage barriers.

Coverage Gap

Insurance coverage for sperm freezing is inconsistent and often insufficient, leaving many patients to face meaningful out-of-pocket costs at the exact moment care is most urgent.

Limited Support

Dedicated funding options for sperm freezing remain limited, and existing resources are often fragmented.

References