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Provider Perspectives
Written by
Sarah Isquick, MD
Published on
August 27, 2025
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As an OB/GYN who has practiced in the Bay Area for over a decade and as an LGBTQ+ parent who has personally navigated the fertility journey, I've witnessed both sides of the fertility care delivery equation. With California's groundbreaking SB 729 mandate taking effect January 1, 2026, the imperative for OB/GYN-led fertility care has never been more clear.
California's SB 729 mandate will fundamentally transform demand dynamics for fertility care. The law requires fully insured large group health plans (covering 100+ employees) to provide coverage for infertility diagnosis and treatment, including up to three completed egg retrievals and unlimited embryo transfers. The mandate is inclusive, covering LGBTQ+ individuals, same-sex couples, and single parents without requiring proof of a medical infertility diagnosis.
The numbers highlight a pressing concern. The field of reproductive endocrinology and infertility (REI) is overwhelmed; as stated in an American Society for Reproductive Medicine publication in 2023, there is a mismatch between demand for reproductive endocrinology, infertility and assisted reproductive technology (ART) services, and availability of care. With approximately 1,500 board-certified REI subspecialists in the United States, and only ~1,250 in active practice, we're facing a shortage that will only worsen as demand continues to grow.
With approximately 1,500 board-certified REI subspecialists in the United States, and only ~1,250 in active practice, we're facing a shortage that will only worsen as demand continues to grow.
Recent research conducted by ASRM projects that to meet true fertility care demand in the United States, REIs would need to move from managing an estimated 233 ART cycles per year to an estimated 1,600. This isn’t a problem of the future—it’s already impacting patients seeking fertility services.
Here's what both my clinical experience and the data confirm: our patients already come to us first. During my UCSF residency, and throughout my decade in practice, I've seen how patients naturally turn to their OB/GYN when they're ready to start or grow their family. They trust us because we've cared for them through all stages of their reproductive health.
Recent survey data from Branch Care's survey of over 150 practicing women's health providers validates this: 86% of us recognize that we play a primary or significant role in fertility care. Yet 62% of practitioners find ensuring their patients have access to fertility care very or extremely challenging. This disconnect between the care that we hope to offer and what we feel equipped to provide is exactly the gap we need to address.
SB 729 transforms this dynamic by creating economic incentives for OB/GYN practices that align with clinical necessity. Previously, many patients delayed or avoided fertility care due to cost barriers. Now, covered patients will expect immediate, comprehensive care. With limited REI availability, OB/GYNs will increasingly become the point of care for these patients.
What I find most compelling, both from my clinical training and what I see in practice, is that we're already equipped to handle much more than we're currently doing.
The biggest barrier to supporting our patients' fertility needs isn't clinical competency.It's the amount of uncompensated time that these patients rightly require when physicians are the only ones supporting them. I've been encouraged to see new care models coming online that acknowledge and address these very real barriers. Rather than offering expensive, direct-to-consumer fertility services available to a small percentage of patients who need these services, innovative companies are embedding directly into OB/GYN practices to handle the time-intensive patient education, care coordination, and administrative work that traditionally falls on physicians.
OB/GYN providers are not alone in recognizing this need. A report from The Society for Reproductive Endocrinology and Infertility’s Future of REI Taskforce recommends that the field of reproductive endocrinology “aggressively implement courses of action to increase the number of and appropriate usage of non-REI providers to increase clinical efficiency under appropriate board-certified REI physician supervision.”
This collaborative approach is exactly why I'm excited to be advising Branch Care. They've built a model that recognizes what I've long believed: OB/GYNs can handle the initial evaluation, basic diagnostics, and early treatment while maintaining strong partnerships with REI specialists.
What sets Branch apart is their comprehensive support system. When patients express fertility concerns, Branch becomes a simple referral order in your EMR. Their fertility nurses handle the heavy lifting of patient education, benefit checks, and care coordination, while the OB/GYN practice maintains the primary patient relationship. For treatments within our scope like ovulation induction (OI) and IUI, we deliver the care while the Branch team supports patient education and manages inbound questions. For non-complex patients needing IVF or cryopreservation cycles, monitoring can be delivered locally at the OB/GYN office while the REI sets the treatment plan and Branch nurses manage callbacks, medication teaching and more. More complex cases transfer seamlessly to REI partners with complete preparation.
This allows us to offer patients a more comprehensive suite of fertility care while reducing uncompensated time and building sustainable revenue through our fertility service line.
The mandate creates unique California dynamics that forward-thinking practices must prepare for:
Immediate Patient Expectations: Coverage begins January 1, 2026, for fully insured large group plans, though timing varies by employer plan renewal schedules. Patients with coverage will expect immediate access to care, not referrals to overwhelmed specialists.
Capacity Crisis Prevention: With up to three completed egg retrievals and unlimited embryo transfers covered, utilization will surge beyond current REI capacity. Practices that build collaborative models now will be positioned to serve this demand.
Competitive Differentiation: The law explicitly includes LGBTQ+ individuals, same-sex couples, and single parents, ensuring equal access without exclusionary definitions of infertility. OB/GYN practices that develop cultural competency and care pathways for these populations will have significant competitive advantages.
Revenue Model Validation: The mandate validates the economic case for fertility service line expansion given expected patient volume increases.
As an LGBTQ+ individual who navigated REI appointments and treatment protocols while building my family, I have a deep appreciation for the vital role providers play in meeting patients’ unique needs and guiding them with both clinical expertise and genuine empathy. I recently had the pleasure of discussing this on my friend Dr. Onouwem Nseyo's Golden Hour podcast, sharing insights about the medical, legal, and emotional aspects of family planning for LGBTQ+ folks.
These conversations remind me why this work matters so much. Building a family can be both a vulnerable and challenging journey, and every patient deserves timely, comprehensive fertility care from providers they trust. The traditional model of immediate referral to overwhelmed REI specialists isn't serving our patients well.
The future of fertility care lies in partnership, not silos. SB 729 highlights the essential role of OB/GYNs in delivering this care. By collaborating closely with REIs and integrating nursing support and patient education, we can work together to provide high-quality care efficiently while expanding access and meeting rising patient demand.
