New Executive Order Aims to Enhance IVF Accessibility

Recently, President Donald Trump took a significant step by signing an executive order designed to improve access to in vitro fertilization (IVF) and lower the costs associated with it, which can soar to $25,000 per treatment cycle.

Trump has indicated that a proposal to expand IVF access nationwide is expected within the next 90 days. However, the timeline for seeing changes in out-of-pocket expenses remains uncertain.

Currently, insurance coverage for fertility treatments like IVF is available in at least 40 states, and many employers are beginning to offer fertility benefits to their employees.

The issue of infertility is increasingly pressing in the U.S., affecting approximately 1 in 8 women.

Despite these developments, the president has not clarified the funding sources for the proposed treatments, as many insurance companies in the U.S. still do not cover infertility treatments.

While some employers provide shared cost fertility benefits to alleviate the financial burden of assisted reproductive technologies, many individuals still bear the costs themselves. The price for a single IVF cycle can fall between $12,000 and $17,000, potentially reaching up to $25,000 if medications are included.

Importantly, an IVF cycle does not guarantee a successful pregnancy and often necessitates multiple attempts.

“Thus, in support of American families, my Administration is committed to ensuring consistent access to IVF treatments by removing unnecessary legal or regulatory hurdles to significantly reduce the costs associated with IVF,” Trump stated.

State Variability in IVF Access

The availability of IVF services varies across the country, with 22 states plus Washington, DC having different laws regarding infertility coverage. Notably, states like Massachusetts and Illinois require insurers to offer coverage for IVF treatments.

In response to the growing demand for IVF services, an increasing number of employers are stepping up to provide fertility benefits that help share the financial load. Such benefits can significantly reduce expenses related to infertility testing, diagnostics, and treatments.

“It’s entirely feasible to mandate insurance coverage for IVF, given that some states have already implemented such measures,” 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’ve seen progress at the state level in enhancing IVF coverage through mandated insurance benefits—now is the time to build on this success nationally,” he shared with Healthline.

However, both state and federal policy changes are typically slow to materialize.

Trump’s executive order has set a deadline of 90 days for the Assistant to the President for Domestic Policy to present “a set of recommendations aimed at preserving IVF access and actively decreasing out-of-pocket and health plan expenses related to IVF treatments.”

This indicates that immediate changes to IVF costs or accessibility are unlikely. After the 90-day period, it remains unclear when policy adjustments regarding IVF might begin to take effect.

“Typically, changes like these require time, as the system needs to adapt to the demand,” explained Christy Lane, Co-Founder of Flora Fertility, a fertility insurance provider.

“Access is often dictated by financial capability. It’s crucial for individuals to have ownership over their health outcomes through private coverage whenever feasible, shielding them from political shifts that could impact their healthcare access,” she added.

Lane also pointed out that proposals like Trump’s IVF plan aim to widen coverage for individuals with health insurance to help them avoid steep out-of-pocket expenses. While this is a positive move, she cautioned that increased demand could overwhelm fertility clinics, potentially leading to longer wait times.

“It’s essential to consider all available treatment options prior to IVF (such as medications and IUI), which can yield successful results with early intervention. Unfortunately, these alternatives are not addressed in the executive order,” she concluded.

Political and Ethical Challenges Surrounding IVF Access

Trump’s initiative to enhance IVF access faces opposition from certain conservative factions and political leaders who have raised concerns regarding the status of frozen embryos created through IVF.

In February 2024, a ruling from the Alabama Supreme Court classified frozen embryos as children, leading to the conclusion that discarding them—common practice following a successful IVF birth—could be regarded as murder under state law. Subsequently, 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 the eligibility of frozen embryos under the proposed expansions.

Additionally, the order does not address whether transgender couples would benefit from improved access to IVF, a situation that could conflict with the federal “gender ideology” policy that acknowledges only male and female identities.

In Congress, Republican support for expanding IVF access remains limited. In June 2024, the party rejected a Democratic proposal aimed at guaranteeing nationwide IVF access.

“Fertility treatments should be treated as medical services and covered accordingly,” Shedlin noted.

“Merely providing limited financial assistance falls short — we require comprehensive insurance coverage that ensures timely access to necessary treatments.”

Understanding Rising Infertility Rates

Increasing infertility rates can be attributed to various factors, prompting couples facing such challenges to explore assisted reproductive technology (ART) as a means to conceive.

One common intervention is intrauterine insemination (IUI), which has varying success rates that tend to decrease for women over 40. IUI involves injecting sperm directly into the uterus via a catheter to enhance the chances of fertilization during a woman’s peak fertility period. This method generally requires less medication and is more budget-friendly than IVF.

In contrast, IVF begins with self-administered hormone injections designed to stimulate the ovaries to produce multiple eggs. Once the eggs are ready, they are retrieved, fertilized in a lab, and subsequently transferred to the uterus or frozen.

Fertility specialists often recommend IVF over IUI due to its higher success rates, particularly for older couples or women classified as having “advanced maternal age” (over 35).

Nevertheless, the success rates of IVF are not as high as many might hope. A 2021 study indicated that implantation was successful in only 19% of individuals undergoing fresh embryo transfers.

Interestingly, frozen embryo transfers have demonstrated higher success rates than traditional IVF methods, with recent studies showing implantation rates as high as 29%, which in turn boosts pregnancy rates and live births within this demographic.

For numerous couples embarking on the IVF journey, the initial attempt might not lead to a successful pregnancy, resulting in challenging decisions about whether to pursue another cycle. The emotional and financial toll of repeated fertility treatments can be daunting.

Shedlin emphasized the necessity of making IVF and fertility support accessible to everyone, regardless of their financial situation. He believes that both governments and private companies possess the ability to provide more robust support for individuals aspiring to start families through well-structured care.

As infertility rates continue to rise in the United States, President Trump’s recent actions signal a commitment to expanding access to IVF treatments. However, the timeline for reducing out-of-pocket expenses, which may reach as high as $25,000 per cycle, remains uncertain.

While some states offer fertility treatment coverage, many employers are also stepping up to provide fertility benefits to help offset costs. Shedlin advocates for a shift toward more personalized and comprehensive coverage for fertility treatments, emphasizing the need to enhance success rates and lower overall expenses over time.

In conclusion, the call for expanded access to fertility treatments is vital in addressing the growing demand for these services. By implementing well-structured care pathways and comprehensive insurance coverage, more individuals can pursue their dreams of starting a family without the weight of financial burdens.