President Trump signed an executive order requesting a list of policy recommendations to improve access and reduce costs for in vitro fertilization (IVF), without altering existing policies. Despite campaign promises to make IVF free, the order does not address this. Concerns about the future of fertility treatments heightened after the Supreme Court’s 2022 decision on Roe v. Wade. IVF use has increased, yet insurance coverage remains inconsistent, with only a few states mandating it. Experts believe that while the executive order is a positive step, significant legislative action is required to effectively enhance access to IVF treatments.
On Tuesday, President Trump issued an executive order requesting a compilation of policy suggestions aimed at safeguarding access to in vitro fertilization and “significantly lowering out-of-pocket expenses and health plan costs associated with such treatments.”
The president has instructed his domestic policy advisor to submit that list within 90 days.
This executive order does not alter any current policies and does not address certain campaign commitments made by Mr. Trump, such as making the treatment free. Here are the key points to understand.
Campaign Pledges
Following the Supreme Court’s decision to overturn Roe v. Wade in 2022 — a ruling Mr. Trump claims responsibility for — there has been rising concern among patients and physicians regarding the future of fertility treatments, particularly after a ruling by the Alabama Supreme Court in February 2024 that classified frozen embryos in test tubes as children.
Later in the year during his campaign, Mr. Trump started to voice support for fertility treatments and amusingly dubbed himself the “father of I.V.F.” at a town hall focused on women’s issues. His campaign later clarified that the remark was meant humorously.
Last summer, Mr. Trump claimed that if he were to win the election, he would mandate insurance companies or the federal government to cover all expenses related to in vitro fertilization treatments, effectively making them free for patients. However, the announcement lacked specifics on how this proposal would be implemented. The executive order signed on Tuesday does not reference such a policy or coverage mandate.
Fertility Treatment Utilization
While only a minority of couples opting for conception utilize I.V.F., interest in fertility treatments is rising, as indicated by the Pew Research Center. In 2023, 42 percent of adults reported having used fertility treatments or knowing someone who had, marking a 33 percent increase compared to five years earlier.
Among those, Pew found that the majority of individuals who reported using I.V.F. came from upper-income backgrounds.
Health Insurance Coverage
Whether I.V.F. treatment is covered by insurance varies depending on the patient’s insurance type and geographical location.
The cost for a single round of treatment can reach up to $25,000, with no guarantee of success. Many prospective parents may require multiple rounds.
“Only a few states mandate some form of coverage for I.V.F. within state-regulated insurance plans,” the executive order notes, and merely a quarter of employers provide coverage for this treatment.
However, making government funding a reality could be a challenge. This would effectively require the establishment of a single-payer health care framework for one specific condition, necessitating Congressional funding for a new federal division to manage the program.
Similarly, mandating insurers to cover I.V.F. could prove difficult, likely requiring legislative action in Congress or persuading a panel of experts to include I.V.F. as a covered preventive women’s health service under the Affordable Care Act (commonly referred to as Obamacare), which Mr. Trump sought to repeal.
“Millions are excluded from accessing I.V.F. through Obamacare,” stated Barbara Collura, CEO of Resolve, a patient advocacy organization.
However, changing the law is expected to be challenging, partly due to the lack of consensus among Congressional Republicans regarding Mr. Trump’s stance on this issue. Last year, they rejected bills aimed at safeguarding the legality of I.V.F. on two separate occasions.
Declining Birth Rates
The executive order mentions that Mr. Trump has “long advocated for increased birth rates.”
Since the conclusion of the baby boom in the mid-1960s, fertility rates have been on a general downward trend. This decrease accelerated following the 2008 economic crisis, according to the Pew Research Center. The birthrate in the U.S. had been increasing annually from 2003 to 2007 before reversing direction.
As of 2023, the total fertility rate in the United States fell to 1,616.5 births per 1,000 women, according to the Centers for Disease Control and Prevention, marking a historic low that falls short of the 2,100 births per 1,000 women needed to sustain the population.
What’s Next?
“I view this order as an initial step,” stated Ms. Collura of Resolve. “We intend to ensure accountability from the administration.”
She further remarked that her organization has undertaken substantial efforts on this front and is ready to present proposed policy changes to the administration “on a silver platter.”
Dr. Lucky Sekhon, a fertility specialist based in New York, expressed her support on social media for any initiatives aimed at improving access to I.V.F. treatment. However, she cautioned that “an executive order alone won’t resolve the deep-seated issues concerning access to fertility care.”
In addition to high out-of-pocket expenses, Dr. Sekhon noted in the video that healthcare providers often engage in a “game of cat and mouse” with insurance companies.
“Frequently, the insurance coverage available contradicts what we are medically recommending,” she commented. “For this type of executive order to benefit patients, we would need to see tangible actions at both state and federal levels.”