Fertility and IVF leave in the United States
Reviewed by Mellow Editorial Team, HR & payroll content team
Employers are not federally required to offer fertility or IVF-specific leave, but a growing number do — and a handful of states are starting to mandate it. Understanding what the law requires, what employees actually need, and how to build a policy that works is increasingly important for hiring and retention.
What federal law currently covers
No federal statute creates a standalone right to fertility or IVF leave. However, several existing laws touch the edges of it.
The Pregnancy Discrimination Act (PDA) prohibits discrimination on the basis of pregnancy, childbirth, or related medical conditions. Courts have split on whether IVF treatment falls under that umbrella, though recent EEOC guidance leans toward broader protection.
The Americans with Disabilities Act (ADA) may apply if a fertility condition — such as polycystic ovary syndrome or endometriosis — qualifies as a disability or a condition with a substantial limitation on a major life activity. In those cases, an employee may be entitled to a reasonable accommodation, which could include time off for appointments.
The Family and Medical Leave Act (FMLA) covers serious health conditions, but it requires the employee to have worked for a covered employer (50 or more employees) for at least 12 months and logged at least 1,250 hours. FMLA leave is unpaid and job-protected, and it applies to the employee's own serious health condition — which can include complications from fertility treatment, though routine monitoring appointments are a harder fit.
The practical reality: federal law gives employees some protection against discrimination and potential accommodation rights, but it does not guarantee paid or unpaid time off specifically for IVF or fertility treatment in the way it does for, say, parental leave under state laws.
State-level developments
A small but growing number of states have moved ahead of federal law.
Illinois requires employers with 25 or more employees to cover fertility treatments under group health insurance plans and prohibits retaliation against employees who use that benefit. California, New York, and New Jersey have strong pregnancy and disability discrimination protections that courts and agencies have applied to fertility-related conditions. Several other states are actively considering dedicated fertility leave legislation.
This is a fast-moving area. If you operate in multiple states, it is worth reviewing each state's employment and insurance mandates separately, rather than assuming a single federal floor covers everyone.
Building a voluntary fertility leave policy
Many employers are getting ahead of this through voluntary policy rather than waiting for legal compulsion. Here is what a workable policy typically includes.
Define the scope clearly. Specify what the policy covers — IVF cycles, egg freezing, intrauterine insemination, fertility preservation related to medical treatment (such as before chemotherapy), and consultations. Decide whether it covers spouses and domestic partners as well as the employee directly.
Set the leave entitlement. Common approaches include a set number of days per treatment cycle (often five to ten), or a broader annual bank of paid leave for fertility-related appointments and recovery. Some employers integrate this into an expanded sick leave or medical leave bank rather than creating a separate category.
Address pay. Leave is only useful if employees can actually afford to take it. Paid leave — whether through a dedicated fertility leave bucket or by treating IVF appointments the same as any other medical appointment under your sick leave policy — removes a significant barrier. Remember: the US has no federal statutory paid leave requirement, so whatever you offer here is genuinely above the baseline.
Keep the policy confidential and non-stigmatizing. Employees going through fertility treatment are often dealing with significant physical and emotional stress. Require only enough documentation to administer the policy (for example, a letter from a licensed provider confirming treatment), not detailed medical records.
Apply it consistently. A policy that covers one group of employees but not another with similar needs creates legal and morale risk. Make eligibility criteria clear and apply them uniformly.
Payroll and benefits considerations
Fertility leave has payroll implications worth planning for in advance.
If leave is paid, you continue to run payroll normally — federal income tax withholding, FICA deductions (Social Security at 6.2% up to the wage base, Medicare at 1.45%), and applicable state taxes all apply to paid leave in the same way they apply to regular wages.
If your benefits package includes an infertility insurance mandate (required in states like Illinois, Massachusetts, and others), verify that your group plan actually complies — carriers sometimes require explicit confirmation that fertility treatment is covered to the statutory level.
Employers using a health reimbursement arrangement (HRA) or flexible spending account (FSA) may be able to help employees cover fertility costs with pre-tax dollars, which is worth surfacing to employees during open enrollment.
Handling employee requests before a formal policy exists
If you do not yet have a written fertility leave policy and an employee asks for time off for IVF, do not ignore or delay the request. Evaluate it under whatever leave frameworks you already have — FMLA if applicable, your existing sick or medical leave policy, or a reasonable accommodation under the ADA if a qualifying condition is involved. Document your reasoning. Inconsistent handling of similar requests is one of the more common sources of discrimination claims, even where no specific fertility leave law applies.
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