President Trump’s Executive Order on IVF Access
In a significant move, President Donald Trump has signed an executive order aimed at enhancing access to in vitro fertilization (IVF) while also working toward reducing the often staggering costs associated with the procedure, which can soar to around $25,000 for a single cycle.
Trump has promised a proposal for a nationwide expansion of IVF services within 90 days; however, the timeline for actual changes in out-of-pocket expenses remains uncertain.
Currently, IVF treatments are included in insurance coverage in at least 40 states, with numerous employers offering fertility benefits to their employees.
With infertility rates on the rise in the U.S., affecting about 1 in 8 women, the need for accessible fertility treatments is urgent.
Despite the executive order, specifics regarding the funding for these treatments have not been disclosed, as many insurance providers continue to exclude infertility coverage.
While some companies help their employees by covering part of the costs associated with assisted reproductive technologies like IVF, countless Americans are still burdened with high out-of-pocket expenses. The cost for a single IVF cycle can range from $12,000 to $17,000, with the potential to reach as high as $25,000 when medications are factored in.
It is vital to note that undergoing an IVF cycle does not guarantee a successful live birth and often necessitates multiple treatment attempts.
“To support American families, my administration’s policy is to ensure reliable access to IVF treatment by reducing unnecessary regulatory hurdles, making it significantly more affordable,” said Trump.
State Variability in IVF Access
Access to IVF varies significantly across states. At present, 22 states along with Washington, D.C. have laws mandating some level of infertility coverage, though these laws differ considerably. Massachusetts and Illinois, for example, have enacted regulations that require insurance providers to cover IVF treatments.
To address the increasing demand for IVF services, a growing number of employers are stepping up to offer fertility benefits, which can mitigate the costs associated with testing and treatment.
“Mandating insurance coverage for IVF is entirely feasible, given that it is already being implemented at the state level,” remarked Roger Shedlin, MD, CEO of WIN, a provider of fertility and family wellness benefits.
“This executive order represents a crucial recognition of the importance of access to fertility care. We have witnessed successful state-level initiatives to expand IVF coverage through mandated benefits, and now we have a chance to amplify that success on a national scale,” he shared with Healthline.
However, it is important to understand that changes in policy—both at the state and federal levels—are typically slow to materialize.
Trump’s executive order requires the Assistant to the President for Domestic Policy to present “a list of policy recommendations aimed at safeguarding IVF access and aggressively lowering out-of-pocket costs for IVF treatment” within 90 days.
This means that immediate impacts on IVF costs or access are unlikely, and it remains to be seen when any potential policy shifts will take effect.
“Typically, such changes take time, and adjustments must be made to meet growing demand,” commented Christy Lane, Co-Founder of Flora Fertility, a fertility insurance provider.
“Access to treatment will often depend on individuals’ financial situations. It is crucial for individuals to maintain their health outcomes through private insurance to avoid being affected by political shifts that could alter their healthcare access,” she noted.
Lane also emphasized that proposals like Trump’s IVF expansion plan would broaden coverage for insured individuals, helping them manage exorbitant out-of-pocket expenses. However, she cautioned that this increased demand could overwhelm fertility clinics, leading to longer wait times.
“Before considering IVF, it’s essential to explore all available treatment options, such as medications and intrauterine insemination (IUI), which have proven to be effective with early intervention. Unfortunately, these options are not currently addressed in the executive order,” she explained.
Challenges and Controversies Surrounding IVF Access
Trump’s initiative to enhance IVF access has sparked pushback from some conservative factions and political leaders who challenge the notion of personhood for frozen embryos produced through IVF.
In February 2024, the Alabama Supreme Court ruled that frozen embryos are considered children, and their destruction, a common practice following a successful live birth via IVF, is classified as murder under state law. Subsequently, Alabama Governor Kay Ivey signed legislation that provides legal protections for medical professionals and patients engaged in IVF.
While Trump continues to advocate for IVF access, his executive order does not clarify whether frozen embryos conceived through IVF would be included in the proposed improvements.
Moreover, the order does not specify whether transgender couples would benefit from enhanced access to IVF services, as recent federal policies recognize only male and female genders.
In Congress, the Republican party has shown reluctance to support broader access to IVF. For instance, they blocked a Democratic proposal in June 2024 aimed at ensuring nationwide access to IVF treatments.
“Fertility treatments are medical necessities and should be covered just like any other medical treatment,” Shedlin stated emphatically.
“Merely providing limited financial assistance is insufficient—structured insurance coverage is essential to guarantee access to necessary treatments at the appropriate times.”
The Rise of Infertility and the Importance of Access to Treatments
The increasing rates of infertility may stem from various factors, prompting couples facing such challenges to seek assistance through assisted reproductive technology (ART) to conceive.
Intrauterine insemination (IUI) is a prevalent method with success rates that diminish for women over 40. During IUI, sperm is introduced into the uterus through a catheter, enhancing the chances of fertilization during the woman’s most fertile period. This method requires considerably less medication and is more affordable than IVF.
IVF treatment, on the other hand, starts with self-administered injections of estrogen-blocking medications and follicle-stimulating hormones, which stimulate the ovaries to produce more eggs. Once it’s time for ovulation, the eggs are retrieved and fertilized in a laboratory setting before being transferred to the uterus or cryogenically frozen.
Fertility specialists often advise couples to consider IVF directly instead of IUI, particularly if they are older or classified as “advanced maternal age” (over 35), due to its higher success rates.
Nevertheless, IVF success rates are not particularly high. According to a 2021 study, implantation was successful in only 19% of individuals who underwent fresh embryo transfers.
In contrast, frozen embryo transfers have demonstrated improved success rates compared to traditional IVF methods. Recent studies indicate that implantation rates for frozen embryo transfers reached as high as 29%, resulting in higher pregnancy rates and live births within this group.
For many couples undergoing IVF, the first attempt may not yield a successful pregnancy, leading to tough decisions about whether to pursue additional cycles. The emotional and financial burdens associated with multiple fertility treatments can be overwhelming.
Shedlin, a fertility expert, underscored the necessity of making IVF and fertility support universally accessible, regardless of financial limitations. He believes that both governments and employers have the capacity to provide comprehensive support for individuals seeking to start a family through well-structured care.
In conclusion, with rising infertility rates prompting President Trump to act on expanding access to IVF treatments, the journey toward lowering out-of-pocket costs for these procedures remains uncertain. While some states provide coverage for fertility treatments, and many employers offer fertility benefits, the need for more personalized and comprehensive coverage is critical. By implementing effective care pathways and ensuring extensive coverage, individuals will have a greater opportunity to build their families without the burden of financial strain.
