In a significant move, President Donald Trump has signed an executive order aimed at enhancing access to in vitro fertilization (IVF) and making it more affordable for families. Currently, the cost of a single IVF cycle can soar to around $25,000, creating a financial barrier for many hopeful parents.
Trump foresees introducing a nationwide proposal for IVF expansion within the next 90 days, although the timeline for any changes in out-of-pocket costs remains unclear.
It’s worth noting that fertility treatments, including IVF, are covered by insurance in at least 40 states, with numerous employers also providing fertility benefits to their employees.
Infertility is becoming increasingly common in the U.S., affecting approximately 1 in 8 women.
However, the specifics of how these treatments will be funded have not yet been detailed. Many insurance companies in the U.S. do not cover infertility treatments.
While some employers offer shared-cost fertility benefits to help ease the financial strain associated with assisted reproductive technologies like IVF, many individuals still face significant out-of-pocket expenses. A typical IVF cycle can range from $12,000 to $17,000, and can reach up to $25,000 when factoring in medication costs.
It’s essential to remember that undergoing an IVF cycle does not guarantee a successful live birth; often, multiple cycles are required.
“To support American families, my Administration is committed to ensuring reliable access to IVF treatment, which includes reducing unnecessary statutory or regulatory barriers to make it significantly more affordable,” Trump stated.
The availability of IVF can differ greatly from one state to another. As it stands, 22 states and Washington, DC have laws concerning infertility coverage, but these vary widely. For instance, Massachusetts and Illinois have established laws that require insurance providers to cover IVF treatments.
To address the rising demand for IVF, more employers are beginning to offer fertility benefits to their workforce, assisting with the costs associated with infertility testing, diagnostics, and treatment.
“Mandating insurance coverage for IVF is certainly achievable, given that several states are already implementing such measures,” remarked Roger Shedlin, MD, CEO of WIN, a provider of fertility and family wellness benefits.
“This executive order recognizes the importance of access to fertility care. We’ve witnessed success at the state level in expanding IVF coverage through mandated insurance benefits, and now we have a chance to replicate that success on a national scale,” he shared with Healthline.
Nonetheless, changes in policy, whether at the state or federal level, don’t occur instantaneously.
Trump’s executive order has set a 90-day timeline for the Assistant to the President for Domestic Policy to present “a list of policy recommendations focused on protecting IVF access and significantly lowering out-of-pocket and health plan costs for IVF treatment.”
This means that while the executive order is a step forward, it won’t immediately affect the costs or availability of IVF. Beyond the 90-day horizon, the timeline for potential policy changes regarding IVF is still uncertain.
“Generally, such changes take time and are dependent on the system adapting to meet demand,” explained Christy Lane, Co-Founder of Flora Fertility, a fertility insurance provider.
“Financial capability often dictates who can access these treatments. It’s crucial for individuals to take control of their health outcomes through private insurance whenever possible to navigate the shifting political landscape that can affect healthcare access,” she advised Healthline.
Lane further indicated that initiatives like Trump’s IVF plan could expand coverage for insured individuals, potentially alleviating high out-of-pocket expenses. However, she cautioned that the increased demand might overwhelm fertility clinics, resulting in longer wait times.
“It’s vital to explore all available treatment options prior to IVF, such as medications and IUI, which can yield successful outcomes with early intervention. Unfortunately, these options are not currently addressed in the executive order,” she noted.
Trump’s efforts to enhance IVF access have encountered opposition from some conservative groups and political figures who challenge the notion of personhood concerning frozen embryos produced through IVF.
In February 2024, an Alabama Supreme Court ruling classified frozen embryos as children, declaring that their destruction—often part of the IVF process following a successful live birth—constitutes murder under state law. Following this, Alabama Governor Kay Ivey signed legislation providing legal protections for IVF providers and patients.
While Trump continues to advocate for IVF access, the executive order does not clarify whether frozen embryos conceived through IVF would be included in the proposed enhancements.
Additionally, the order does not address the eligibility of transgender couples for improved IVF access, which may conflict with the federal “gender ideology” policy that recognizes only male and female genders.
Meanwhile, there is a lack of consensus among Republicans in Congress regarding the expansion of IVF access. In June 2024, they blocked a Democratic initiative aimed at guaranteeing nationwide access to IVF.
“Fertility treatments are medical procedures and should be treated as such in terms of insurance coverage,” Shedlin asserted.
“Merely offering limited financial assistance is insufficient—what we need is structured insurance coverage that guarantees individuals can access the appropriate treatments when they need them.”
The rising infertility rates can be linked to various factors, prompting couples struggling with fertility to seek assistance through assisted reproductive technology (ART) to conceive.
Intrauterine insemination (IUI) is a frequently utilized method with varying success rates that tend to decline for women over 40. During IUI, sperm is injected directly into the uterus via a catheter to enhance the likelihood of fertilization during a woman’s peak fertility period. This method requires less medication and is generally more affordable than IVF.
IVF treatment begins with self-administered injections of estrogen-blocking medications and follicle-stimulating hormones, aimed at increasing egg production. Once it’s time to induce ovulation, the eggs are retrieved, fertilized in a lab, and then either transferred to a uterus or frozen for future use.
Fertility specialists often recommend IVF over IUI due to its higher success rates, particularly for couples where the female partner is considered to be of “advanced maternal age” (over 35).
However, IVF success rates are not guaranteed. A 2021 study revealed that only 19% of those undergoing fresh embryo transfers experienced successful implantation.
Interestingly, frozen embryo transfers tend to yield higher success rates compared to standard IVF procedures. Recent research indicates that implantation rates for frozen embryo transfers can reach as high as 29%, resulting in increased pregnancy rates and live births within this group.
For many couples, the initial IVF attempt may not lead to a successful pregnancy, forcing them to make difficult decisions about pursuing additional cycles. The emotional and financial toll associated with multiple fertility treatments can be considerable.
Shedlin emphasizes the need for improved accessibility to IVF and fertility support for all individuals, regardless of their financial situation. Both government and private sectors have the capacity to provide enhanced support for those wishing to start a family through effective and comprehensive care.
With infertility rates on the rise in the United States, President Trump’s initiative to broaden access to IVF treatments is a timely and necessary step. However, the path to reducing out-of-pocket expenses for IVF, which can reach $25,000 per cycle, remains uncertain.
While certain states offer coverage for fertility treatments like IVF, many employers are also stepping up by providing fertility benefits to ease the financial burden. Shedlin highlights the importance of moving towards more personalized and comprehensive insurance coverage for fertility treatments, with an emphasis on enhancing success rates and gradually lowering overall costs.
In summary, the demand for expanded access to fertility treatments is critical in addressing the needs of those seeking to start families. By establishing well-structured care pathways and comprehensive coverage, more individuals can embark on their family-building journeys without the heavy weight of financial concerns.
