How clinicians can help fight for better IVF access

Key takeaways:

• Most Democrats, Republicans and Independents showed support for IVF insurance mandates.
• Health care providers can help move IVF legislation forward by staying informed, providing testimony and speaking out.

There is strong bipartisan support for IVF insurance mandates, according to data presented at the ASRM Scientific Congress & Expo.

The findings come after the Trump administration made a deal with EMD Serono to expand access to IVF therapies by lowering its costs by up to 84%.

Leah E. Chapman, PhD, MPH, a postdoctoral research fellow at Harvard T.H. Chan School of Public Health, and colleagues surveyed 1,000 American adults in November 2024 to assess lifetime infertility prevalence, support for state-mandated IVF insurance coverage.

The researchers reported that the lifetime infertility prevalence was 8.9% (95% CI, 7.2%-11%).

They found that the majority of Democrats (75.9%; 95% CI, 71.2%-80.1%), Independents (60%; 95% CI, 51.2%-68.2%) and Republicans (55.3%; 95% CI, 50.1%-60.5%) supported state-mandated IVF insurance coverage.

However, Republican affiliation was tied to lower odds of supporting state-mandated IVF insurance vs. Democratic affiliation (OR = 0.54; 95% CI, 0.17-0.5) in adjusted models.

Chapman spoke with Healio about why health insurers limit coverage of IVF services, what health care providers can do to help advance legislation supporting better access and more.

Healio: Why do so many health insurers limit their coverage of IVF services?

Chapman: IVF is often viewed as an optional or nonessential treatment, so many plans either exclude it entirely or impose strict prerequisites (such as requiring a diagnosis of infertility after only 12 months of unprotected intercourse) that don’t reflect the realities of everyone seeking care, including single individuals and LGBTQ+ families.

Because there’s no federal mandate to cover IVF, and only 15 states currently require some form of IVF coverage, insurers often choose to limit or exclude it to control costs. This creates a patchwork system in which some states mandate a few rounds of IVF, others leave the details to employers, and coverage for donor gametes or surrogacy varies widely.

Culturally, infertility is still misunderstood and often perceived as the result of personal choice, such as delaying parenthood, rather than recognized as a legitimate medical condition. That misconception, combined with insurers’ financial risk aversion and the absence of consistent regulation helps explain why IVF coverage remains so limited.

Healio: Why did your study look at state-mandated coverage rather than federally mandated coverage?

Chapman: States have historically taken the lead in requiring fertility treatment coverage, so examining state-level mandates provides the clearest picture of where progress is being made and where gaps remain. Advocacy for IVF access at the state level is especially critical because state governments regulate areas that directly affect fertility care, such as medical licensing and family law.

Most meaningful changes to IVF access are currently happening through state legislation. These laws can both expand coverage, for example, by requiring insurers to cover IVF, and protect it by opposing restrictive policies like personhood bills that could ban or limit the procedure.

Federal action remains extremely important, but progress at that level often follows state momentum. When enough states enact coverage mandates or protections, it creates both a policy template and political pressure for federal lawmakers to act. We’ve seen this pattern in other areas of health policy, such as contraceptive coverage and same-sex marriage, where widespread state adoption ultimately paved the way for national standards.

Healio: Do you think federally mandated coverage is possible? Why or why not?

Chapman: A federal mandate for IVF coverage is unlikely in the near future, given the longstanding ideological divisions and ongoing debates around reproductive rights and personhood. There is limited legislative consensus, and some policymakers oppose federal mandates due to concerns about cost, religious liberties or moral objections to embryo creation and storage.

That said, federal action is not out of reach in the long term. The growing number of states enacting their own coverage mandates, combined with increased public awareness and bipartisan concern following recent legal threats to IVF, could help shift the conversation.

Federal progress often follows state momentum. For example, the federal government has already expanded fertility benefits for federal employees, signaling recognition of infertility as a legitimate health condition. Advocacy groups like RESOLVE: The National Infertility Association and the ASRM continue to push for federal legislation, such as the Health Coverage for IVF Act of 2025 (H.R. 3480), which would amend the Affordable Care Act to classify fertility treatment as an essential health benefit.

Healio: What legislation is out there that aims to better support IVF access?

Chapman: Most legislative momentum to expand IVF access is happening at the state level, where governments have the authority to regulate insurance coverage and medical licensing. There are currently dozens of state bills related to infertility and family building. RESOLVE: The National Infertility Association maintains a regularly updated database of these bills, which can be filtered by state, federal level, topic and keywords. It also summarizes each bill, shows its current status and links to the full text.

At the federal level, several proposed bills aim to protect or expand access to fertility care, including:

• Protect IVF Act of 2025 (S. 2035), which would establish a statutory right to choose to receive, provide and cover fertility treatments, ensuring protection for patients, providers and insurers who offer IVF care;
• IVF for Military Families Act (S. 1231/H.R. 2557), which would require TRICARE to cover fertility services, including IVF, for service members and their families; and
• Veterans Infertility Treatment Act of 2025 (H.R. 220), which would amend Title 38 of the U.S. Code to direct the Department of Veterans Affairs to provide coverage for infertility treatment and fertility preservation services.

In addition to supportive legislation, there are also proposed laws that could threaten IVF access, particularly so-called “personhood” bills that define embryos or fertilized eggs as “children” or “persons.” These measures create legal conflicts with standard IVF practices such as creating and freezing multiple embryos, discarding unused ones or conducting preimplantation genetic testing. By granting embryos legal rights, such bills could expose clinics to criminal or civil liability, leading some to halt or restrict IVF services, as seen in Alabama after the state’s Supreme Court ruled that frozen embryos are legally considered children.

For example, in South Carolina, the Unborn Child Protection Act (Senate Bill 323) would restrict abortion access to cases where the mother’s life is at immediate risk. Although IVF isn’t explicitly prohibited, the bill’s language could be interpreted in ways that make IVF legally risky or inaccessible.

Healio: What actions should physicians take to help advance this legislation?

Chapman: Physicians play a crucial role in shaping how policymakers understand fertility care. Their clinical expertise and patient stories bring data to life and can help bridge the gap between science and policy. Here’s what you can do as a physician or fertility care provider:

• Stay informed. Track bills in your state that could either expand access or pose threats to IVF, such as proposals that redefine embryos or restrict embryo disposition. Knowing what’s in your state legislature allows you to act early. RESOLVE maintains a comprehensive, regularly updated list here.
• Provide testimony. Offer your clinical perspective to legislative committees by explaining how lack of coverage, restricted access, or hostile legal environments affect patients in real time. Lawmakers listen closely to physicians who can speak to patient outcomes.
• Partner with advocacy organizations. For example, RESOLVE: The National Infertility Association’s Federal Advocacy Day invites physicians and patients to meet directly with lawmakers and educate them about fertility-treatment access.
• Speak out publicly. Use op-eds, interviews, or professional platforms to highlight how insurance or legislative barriers interfere with evidence-based care. For instance, physicians can clarify how alternative frameworks like “restorative reproductive medicine” may delay or replace medically indicated IVF and ultimately risk patient harm.
• Engage your institution and peers. Encourage your practice, hospital or health system to adopt policies that support patients in navigating insurance and to advocate for coverage at the state level.
• Connect with patients. Empower patients to share their stories through advocacy organizations like RESOLVE; personal stories paired with medical expertise can powerfully influence policy decisions.

Healio: What resources can physicians recommend to patients now to help them access IVF care?

Chapman: There are several resources physicians can share to help patients navigate the financial and logistical challenges of accessing IVF care:

For more information:

Leah E. Chapman, PhD, MPH, can be reached at primarycare@healio.com.