Leave for Fertility Treatment

A direct reference to the federal protections, state laws, and insurance mandates that govern time off for IVF, IUI, egg retrieval, monitoring appointments, and failed cycles in the United States.

What this page is

Fertility treatment is a substantial commitment of time — daily monitoring visits, blood work, scans, the retrieval procedure itself, recovery, transfer, and a two-week wait. None of which line up neatly with a 9-to-5 schedule. There is no dedicated US federal "fertility leave" law, but the protections that do apply are broader than most patients realize.

This page covers what time off is legally protected for active treatment, what's available after a failed cycle, what insurance is required to cover, and the practical conversation with HR. Every legal claim links to its primary source.

Time off during active treatment

The Pregnant Workers Fairness Act (PWFA)

The most directly useful protection. Effective June 27, 2023, the PWFA requires employers with 15 or more employees to provide reasonable accommodations for "pregnancy, childbirth, or related medical conditions." The EEOC's implementing regulations published in 2024 explicitly include fertility treatment as a related medical condition. Reasonable accommodations can include time off for monitoring appointments, flexibility for egg retrieval and recovery, modified duties during high-medication cycles, and similar adjustments. The employer must accommodate unless doing so would impose "undue hardship."

Reference: EEOC — What You Should Know About the PWFA.

The Family and Medical Leave Act (FMLA)

FMLA covers fertility treatment when the patient's provider certifies the condition as a "serious health condition." For most patients actively going through IVF — particularly the egg retrieval procedure, recovery, and treatment of any underlying infertility diagnosis — a provider can document this. FMLA gives 12 weeks of unpaid, job-protected leave per year. Crucially for fertility, FMLA can be taken intermittently — you can use it for individual appointments and treatment days across the year rather than as a continuous block.

Eligibility: 50+ employee employer within 75 miles, 12+ months of tenure, 1,250+ hours worked in the prior year.

State sick-leave laws

Many states require paid sick leave that can be used for medical appointments and procedures, including fertility care. Most accrue at roughly 1 hour per 30 hours worked, capped between 24 and 80 hours per year, though specifics vary.

California — Healthy Workplaces, Healthy Families Act
Connecticut — Paid Sick Leave Act (the first state law, 2011). See the Connecticut page.
DC — Accrued Sick and Safe Leave Act. See the DC page.
Massachusetts — Earned Sick Time Law. Notably, the November 2024 expansion covers both the employee's own fertility treatment and their spouse's, including recovery from a failed cycle. See the Massachusetts page.
New Jersey — Earned Sick Leave Law. See the New Jersey page.
New York — NY Paid Sick Leave Law. See the New York page.
Oregon — Sick Time Law. See the Oregon page.
Rhode Island — Healthy and Safe Families and Workplaces Act. See the Rhode Island page.
Vermont — Earned Sick Time Act
Washington — Paid Sick Leave (I-1433). See the Washington page.

The Americans with Disabilities Act (ADA)

Infertility can sometimes qualify as a disability under the ADA when it "substantially limits a major life activity" (which courts have interpreted to include reproduction). When it does, the ADA's reasonable-accommodation requirement applies at employers with 15 or more employees. The bar for ADA coverage of infertility is higher than for PWFA, so PWFA is usually the more useful path.

Leave after a failed cycle

Five states have explicit reproductive-loss leave laws that include unsuccessful fertility treatment as a qualifying event:

California — SB 848: 5 days per event, 20 days max per 12-month rolling period, employers with 5+ employees, 30-day tenure.
Illinois — Family Bereavement Leave Act: 2 weeks per event, 6 weeks max per year, FMLA-covered employers (50+).
Massachusetts — Earned Sick Time expansion: up to 40 hours per year, paid at 11+ employee employers, all MA employers covered.
Minnesota — Pregnancy and Parental Leave Act: up to 12 weeks unpaid, all employers, no tenure requirement.
Washington — PFML expansion (SB 5217): 7 paid days starting July 1, 2026, paid through state PFML.

Each is detailed in the state-by-state breakdown on our pregnancy-after-loss page, along with federal protections and recovery resources.

State insurance mandates for fertility care

Insurance coverage and leave are separate questions. About half of US states require commercial insurance plans to cover some level of fertility diagnosis or treatment, but the requirements vary widely and most apply only to certain plan types — typically large-group fully-insured plans. Self-insured plans (common at Fortune 500 employers) are governed by federal ERISA rules and are not subject to state mandates.

Strongest mandates (broadest treatment requirements)

California (SB 729, effective January 1, 2026): large- and small-group fully-insured plans must cover diagnosis and treatment of infertility including IVF. One of the most comprehensive mandates in the country.
New York: large-group plans must cover up to 3 cycles of IVF.
New Jersey: must cover diagnosis and treatment including IVF (up to 4 cycles), with religious exemptions.
Illinois, Massachusetts, Connecticut: comprehensive IVF coverage requirements with various cycle and patient-age limits.

Limited mandates (diagnosis-only or specific scenarios)

Maryland, Rhode Island, Hawaii: cover IVF with restrictions.
Arkansas, Texas, Montana, Ohio, Louisiana, West Virginia: mandate offering coverage but not requiring purchase.
Several states: cover fertility preservation only for iatrogenic infertility (e.g., before cancer treatment) — including California (separate from SB 729), Connecticut, Delaware, Illinois, Maryland, New Jersey, New York, Rhode Island, Utah.

The Kaiser Family Foundation maintains a current state-by-state tracker: Mandated Coverage of Infertility Treatment.

How to talk to your employer

You generally do not need to disclose that the leave is for fertility treatment specifically. FMLA requires a serious-health-condition certification, but providers can complete the form without naming the specific condition — "medical appointments and procedures" typically suffices. PWFA accommodation requests need enough information for the employer to evaluate, but you control the level of detail.

HR is bound by confidentiality rules that direct managers are not. Start there. If your employer has an employee assistance program (EAP), it's typically confidential and can be useful for the navigation help itself, separate from any formal leave.

Practical: document the request in writing. A short follow-up email to HR confirming what leave or accommodation you're requesting, even after a verbal conversation, creates a record both sides can refer back to. For PWFA accommodations specifically, the EEOC encourages an "interactive process" — that's exactly what such a written record supports.

Many large employers have moved well beyond the legal minimums. If you work for a Fortune 500 company or a benefits-rich industry (finance, tech, consulting, law), ask HR directly about fertility-specific benefits like Carrot, Maven, Progyny, or Kindbody partnerships, which are increasingly common.

Resources

RESOLVE: The National Infertility Association: Peer support groups (in-person and virtual), educational resources on insurance coverage by state and family-building options, a Workplace Coverage Checklist for asking employers about fertility benefits, and ongoing legislative advocacy (National Infertility Awareness Week, state and federal campaigns). The largest patient-side infertility nonprofit in the US.
Cofertility: Practical fertility-and-finance resources, including current tracking of state insurance mandates and employer benefit programs.
American Society for Reproductive Medicine (ASRM): Patient education, practice guidelines, and the affiliated SART clinic outcomes database for comparing IVF success rates across US clinics.
A Better Balance — Know Your Rights: Free legal helpline (1-833-NEED-ABB) for workers navigating fertility treatment, PWFA accommodation requests, and related discrimination concerns.
Family Equality: Resources for LGBTQ+ family building including fertility, surrogacy, and adoption.
KFF State Health Facts — Infertility Coverage: State-by-state tracker for insurance mandates, maintained by the Kaiser Family Foundation.

Frequently asked questions

Do I get time off work for IVF or IUI cycles?

Not automatically through a dedicated fertility-leave law in most of the US. Time off for active fertility treatment typically comes from a mix of: accrued sick leave or PTO (under your employer's policy), reasonable accommodations under the federal Pregnant Workers Fairness Act if you're at a 15+ employee employer (this includes IVF and other fertility care), FMLA if your provider certifies the treatment qualifies as a serious health condition, and any state sick-leave law that applies. A handful of states require fertility care to be covered by insurance (different from leave) — California (SB 729), Connecticut, Illinois, Massachusetts, Maryland, New Jersey, New York, Rhode Island, and others.

Does FMLA cover fertility treatment?

Yes, when the treatment qualifies as a 'serious health condition' under FMLA's definition. For most patients undergoing active IVF — particularly the egg retrieval procedure and any recovery, plus any treatment of an underlying infertility diagnosis — a provider certification will support FMLA coverage. This gives 12 weeks of unpaid, job-protected leave per year at FMLA-covered employers (50+ employees within 75 miles), and you must have 12+ months of tenure and 1,250+ hours worked in the prior year. FMLA can be taken intermittently for treatment cycles. It does not need to be continuous.

Does the Pregnant Workers Fairness Act cover fertility treatment?

Yes. The PWFA (effective June 27, 2023) requires employers with 15 or more employees to provide reasonable accommodations for 'pregnancy, childbirth, or related medical conditions' — and the EEOC's implementing regulations explicitly include fertility care as a related medical condition. Reasonable accommodations might include time off for appointments, flexibility around egg retrieval and recovery, modified duties during high-medication cycles, or sitting/standing accommodations. The accommodation must be reasonable to your employer (not impose 'undue hardship'). PWFA is broader than FMLA in employer-size threshold (15 vs 50) and doesn't require any tenure.

What if my fertility cycle fails — is there leave specifically for that?

Yes, in five states with reproductive-loss leave laws: California (SB 848 — 5 days per event, 20 days/year, 5+ employee employers), Illinois (Family Bereavement Leave Act — 2 weeks per event, 6 weeks/year, FMLA-covered employers), Massachusetts (Earned Sick Time expansion — accrued sick time, all employers), Minnesota (Pregnancy and Parental Leave Act — up to 12 weeks unpaid, all employers), and Washington (PFML expansion via SB 5217 — 7 paid days, effective July 2026). Most explicitly include unsuccessful IVF and IUI cycles. See our pregnancy-after-loss page for detailed coverage of these laws.

Does my insurance have to cover IVF?

Depends entirely on your state and the type of insurance. About half the US states have some mandate for fertility coverage in commercial insurance plans. Coverage typically requires the plan be 'large-group' (50+ employees) or fully-insured (not self-insured), so the protections drop off for small-employer plans and self-insured plans subject only to federal law. California's SB 729, effective January 1, 2026, is one of the broadest: large- and small-group fully-insured plans must cover diagnosis and treatment of infertility including IVF. Other strong-mandate states include New York, New Jersey, Illinois, Massachusetts, Connecticut, Maryland, and Rhode Island. The Kaiser Family Foundation tracks state mandates: kff.org/state-health-policy-data/state-indicator/infertility-coverage/.

Do I have to tell my employer the leave is for fertility treatment?

No, in most cases. FMLA requires a serious-health-condition certification, but providers can complete the form without naming fertility treatment specifically — 'medical appointments and procedures' typically suffices. PWFA accommodation requests do require enough information for the employer to evaluate the request, but you control the level of detail. Sick leave under most state laws requires no disclosure of the condition. HR is bound by confidentiality rules that direct managers are not, so HR is usually the right first conversation.

What if I'm at a small employer with no formal benefits?

Your protections shrink but don't disappear. PWFA still applies at 15+ employee employers regardless of any other benefits. State sick-leave laws (California, Connecticut, Massachusetts, etc.) apply to all employers in those states regardless of size. Your best paths are typically: ask HR to formalize an accommodation in writing, use whatever PTO and sick leave you've accrued, request schedule flexibility for monitoring appointments (often easy to grant), and document everything in case the request is denied. RESOLVE: The National Infertility Association (resolve.org) publishes a Workplace Coverage Checklist and state-by-state insurance guides that help frame the request to HR; A Better Balance runs a free legal helpline (1-833-NEED-ABB) for accommodation and discrimination concerns.

What this page isn't

A reference, not legal or medical advice. State laws change every legislative session, federal regulations are interpreted and re-interpreted by the courts, and individual employer policies often exceed legal minimums. For a specific situation, confirm with your HR department, an employment attorney, your state's Department of Labor, or an advocacy organization with a workers' rights helpline such as A Better Balance.

We update this page when laws change. Let us know if you find an error or want additional coverage.

Leave after pregnancy loss — federal and state-by-state coverage for miscarriage, stillbirth, and failed cycle bereavement
Maternity leave calculator — for the typical case (pregnancy that proceeds to birth), with state-by-state math
Methodology — how the calculator works and what it doesn't model