On the campaign trail, President Donald Trump declared himself the “father of IVF” and announced that the government or insurance companies should pay for it. 

IVF (in vitro fertilization) is a medical procedure in which an egg is fertilized by sperm outside the body. It is used by couples who are unable to get pregnant naturally. Last week, Trump took a step towards expanding access to IVF treatments via an executive order, asking the Assistant to the President for Domestic Policy to submit a list of recommendations on “protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment” within 90 days.

“It’s just asking for recommendations within 90 days,” said Barb Collura, president and CEO of RESOLVE: the National Infertility Association, in an interview. “So it doesn’t actually do anything. It’s not a fulfillment of the campaign promise. I’ve seen some posts and comments where people have said, ‘Promises made, promises kept.’ This executive order does not fulfill that promise. It’s a step in that direction, but it does not, in and of itself, fulfill that promise.”

RESOLVE is a nonprofit focused on advocacy and policy related to infertility. Collura did say she was pleased with the way IVF was positioned in the fact sheet of the executive order, which noted that the cost of IVF can range from $12,000 to $25,000 per cycle and multiple cycles are often needed. In addition, IVF is frequently not fully covered by insurance.

She added that the fact the administration is taking time to come up with recommendations could be beneficial, as it gives RESOLVE and other organizations focused on infertility the opportunity to influence those policy recommendations. She would have been more concerned if the administration had made a specific policy change without receiving input from experts in the infertility space. 

“In a way, this is not a bad process, whereby we might be able to have patients at the table [and] physicians at the table,” she said.

That said, RESOLVE has not been contacted by the government yet, and neither has any other infertility organizations to Collura’s knowledge. And receiving a list of recommendations related to IVF doesn’t necessarily mean the administration has to follow through on those recommendations.

Even though much remains unclear at the moment, an executive from Kindbody, a fertility and family-building company, is hopeful about the executive order.

“In order to improve access to care, I think we do need bipartisan support,” said Dr. Amber Cooper, chief medical officer of genomics and lab operations and a reproductive endocrinologist at Kindbody. “I hope this is a step in the right direction to improve access for the many, many, many that need assistive reproductive technologies.” 

Maven Clinic’s chief medical officer, Neel Shah, echoed Cooper. Maven Clinic is a virtual clinic for women and families.

“Having advocacy rise to the level of the White House is potentially a watershed moment. … This is an exciting opportunity for a lot of people in the industry to make sure that at least in the public discourse, the needs of people who are undergoing fertility journeys are top of mind,” he said in an interview. “I’m hopeful about it for sure.”

What policy changes advocates want to see

If the administration does seek input from RESOLVE, Collura said the organization would like to see IVF access for active duty service members, as well as access for veterans through the Department of Veterans Affairs. Currently, these government insurance plans for both of these groups make it “extremely difficult” to get IVF, she said. 

Federal employees can choose from a couple of different plans that offer IVF, but these plans change every year, according to Collura. So the organization would also like to see a mandate that requires the Office of Personnel Management to offer IVF via the Federal Employee Health Benefits Program every year. 

In addition, RESOLVE wants there to be a policy change that provides access to IVF in health plans offered on the state exchanges.

“From my perspective, those are all things that I believe the administration can do without Congressional involvement,” Collura said. 

She added that there is a bill in Congress that was introduced last session that she would like to see passed. It’s called the HOPE with Fertility Services Act and it would require private insurance and employers to cover IVF.

Kindbody, which serves employers, would also like to see policy change that expands access to IVF through employer-sponsored insurance, Cooper said.

Shah of Maven Clinic, meanwhile, wants efforts to reduce the cost of IVF and increase the supply of people providing the service. Since people often have to undergo a few rounds of IVF, the actual cost can be around $75,000 per baby.

“When I think about why it’s $75,000 per baby for IVF, there are like two things that control price. One is the willingness to pay, which building a family is existential for people,” he said. “So at the top of the income bracket, there’s a very high willingness to pay. The other thing is just supply and demand. And the demand for IVF is seven times the supply for services.”

Shah added that there are only 1,200 reproductive endocrinologists and 200 reproductive urologists in the country. 

To combat this issue, there need to be policies that increase fellowship programs and incentivize more people to enter the field, he argued.

But increasing access to IVF treatment only does so much. Collura would also like to see efforts to protect access.

For instance, some state-level legislative actions have been proposed that could restrict people’s access to IVF. Last year, the Alabama Supreme Court issued a ruling declaring that embryos created through IVF should be considered children, making providers legally responsible if the embryos do not survive IVF-related procedures. The Alabama legislature passed a law to shield IVF providers, but this isn’t a long-term fix as it doesn’t change the status of frozen embryos being considered people, according to Collura.

“Protecting access and expanding access are connected,” she said. “In other words, why go to all that trouble to expand access when that access could be taken away by a state legislature? We would love to see a federal protection of IVF, and that way we would not have to worry about state actions. And then expansion of coverage is really meaningful and long-lasting.”

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