Lessons from State Initiatives to Broaden IVF Accessibility for Federal Policy Guidance

For nearly three years, Mariah Freschi and her husband faced emotional and financial challenges while trying to conceive. After undergoing surgery to remove her blocked fallopian tubes, she was presented with the option of in vitro fertilization (IVF), which she found overwhelming due to the high costs—estimated at $25,000 by her Sacramento clinic. As a preschool teacher and her husband a warehouse worker, affording IVF was beyond their reach, highlighting a significant barrier faced by many Americans seeking fertility treatments.

Infertility affects approximately 13% of women and 11% of men in the U.S., with additional numbers including same-sex couples, single individuals, or those seeking fertility preservation before medical treatments. Despite the high demand for assistance, insurance coverage for IVF remains inconsistent and often inadequate.

During his campaign, President Donald Trump pledged to support IVF accessibility, including coverage mandates. In February 2025, he issued an executive order to explore policy options for expanding IVF access. However, the effectiveness of these federal efforts remains uncertain, especially in light of the significant variation in state-level mandates.

Currently, 22 states have legislation requiring insurance companies to cover some aspects of fertility care, with 15 of those requiring coverage for IVF. These laws differ considerably, primarily due to concerns over costs. Fertility treatments like IVF are some of the most expensive healthcare options, but data suggests that mandated coverage adds less than 1% to overall insurance premiums, raising questions about cost-based opposition.

California serves as a prominent example of progress through advocacy. After years of opposition rooted in budget fears, the state recently enacted a law (SB 729) mandating large employers with state-regulated health insurance to cover infertility treatments, including IVF. The law is expected to benefit around 9 million people but excludes many, such as those on Medicaid, marketplace plans, or insured through self-funded companies, who constitute the majority of insured individuals in California.

Coverage mandates also vary widely in scope from state to state. While some, like Massachusetts, offer broad IVF coverage, others restrict access, often limited to specific groups such as state employees or those with particular medical conditions. In many states, ideological and religious objections, notably from groups like the Catholic Church, oppose IVF on moral grounds, citing concerns over embryo disposal.

The political landscape complicates efforts further. Anti-abortion legislation and societal debates around the morality of IVF cause delays and obstacles in expanding coverage. For example, recent legal rulings recognizing embryos as children have threatened IVF services in some states, leading to legislative and legal battles. This contended environment leaves many patients, including some in Utah and Georgia, uncertain about future access.

While some companies are beginning to offer IVF coverage as part of employee benefits, most patients continue to struggle with out-of-pocket expenses, often resorting to loans, crowdfunding, or credit. For individuals like Freschi, the pathway to parenthood includes not only emotional resilience but also financial hardship, underscoring the need for comprehensive policy support.

State-level efforts demonstrate both the potential and the challenges in expanding IVF access. Moving forward, federal policies inspired by these initiatives could play a vital role in reducing disparities and making fertility treatment accessible for all who need it.

Source: https://medicalxpress.com/news/2025-04-trump-state-efforts-ivf-access.html