IVF coverage proposals could crush US fertility clinics without improving access

Every family deserves reproductive choices, including a chance to become parents. For families struggling with infertility, in vitro fertilization (IVF) is a promising avenue. But that hope often comes with a prohibitive price tag of $20,000 per cycle and a national average of 2.5 cycles to have a healthy baby.

Although recent signals appear mixed, the Trump administration had initially considered classifying IVF as an “essential health benefit” under the Affordable Care Act (ACA), attempting to fulfill a campaign promise that it would bring transformative change in reproductive health care and address troubling demographic trends. It parallels efforts in Congress by Democrats, who introduced H.R. 3480, the Inclusive and Valued Families Health Coverage Act of 2025, also seeking to expand access to fertility treatment to more families. What these plans fail to address is what happens when you boost demand without increasing supply, which inevitably leads to a rollout that would further increase the cost of IVF without adding significant capacity.

Let’s just look at Medicaid, which covers about 18 million women ages 20 to 45, accounting for 40% of all births in the United States. If access to IVF were offered to this population through an expansion of insurance coverage, based on recent averages, we could expect 2% of this cohort to continue treatment, resulting in approximately 360,000 additional cycles per year. As a reminder, in 2023, American fertility clinics reported having performed more than 430,000 IVF cycles.

And of course, if insurers followed suit, the problem would get worse. We must put downward pressure on prices while remaining focused on quality results.

Historically, adding coverage through the U.S. health insurance industry has had the opposite result. Why should we expect any difference if its scope were extended to IVF? Let’s imagine a better model, something akin to LASIK, where costs have fallen 30% since 2008, without sacrificing quality.

The infrastructure deficit

The most significant challenge facing any large-scale expansion of IVF coverage is the severe shortage of essential infrastructure and specialized personnel. Unlike routine outpatient care, IVF is a very complex and manual intensive procedure that involves several steps, from ovarian stimulation and egg retrieval to fertilization, embryo culture and transfer. Each of these steps must be performed with extraordinary precision in tightly controlled laboratory environments. IVF treatment depends solely on a limited cadre of highly qualified professionals, notably embryologists. These specialists are responsible for manipulating eggs, sperm and embryos at the cellular level, often making split-second decisions that can determine the outcome of a cycle. According to industry data, there are only about 1,500 board-certified reproductive endocrinologists and about 5,000 embryologists actively working in the country. At the same time, the number of accredited training programs for embryologists in the United States is limited, and certification can take several years.

These figures have remained relatively stable over the past decade despite growing demand. This bottleneck has led to capacity constraints, most visible outside major urban centers. While metropolitan areas like New York, Los Angeles, and Chicago may have several full-service fertility clinics, rural and underserved areas often lack enough trained people and properly equipped facilities. Some states have only one IVF clinic.

This geographic imbalance leads to long wait times and travel difficulties, particularly for people living in low-income or medically underserved communities. And given the highly manual nature of many sensitive steps, the process has become artisanal, with worrying inconsistency in quality and results between clinics, between experienced and inexperienced embryologists, and between well-rested and overworked staff.

Access addressing

All of this raises serious questions of equity for all the suggested “solutions”: expanding insurance coverage for IVF without first addressing the underlying infrastructure gap may actually widen the gap between those who can access fertility care and those who are only entitled to it on paper.

If insurance coverage requirements lead to a sudden increase in demand for IVF services, many clinics – already under strain – could struggle to accommodate the influx of new patients. This may result in longer wait times for appointments, diagnostic tests and treatment cycles, which could delay patients’ ability to begin or complete their fertility treatments. For individuals and couples facing infertility, these delays are particularly distressing because of the decline in fertility with age.

Furthermore, even if coverage is mandatory, insurance will do nothing to reduce systemic costs – in fact, the history of health insurance in the United States suggests otherwise.

To truly expand access, we must focus on reducing bottlenecks so that the money spent on solving the problem cannot solve the problem. This means robust, parallel investments in workforce development, recruitment incentives and clinical infrastructure. Yet at best these are longer-term projects that will not keep up with the expected growth in demand for IVF due to changing demographics – here and around the world.

The missing piece is modernizing the technology used in IVF, particularly automation. If implemented correctly, automation alone could help standardize quality in several ways. This would reduce staff workload by reducing the number of manual steps and allow those with less experience to perform procedures in the same way as those who have spent their entire careers performing them. This would speed up certain procedures and eliminate process failures.

Automated potential

A good example is the fertilization process itself, which requires a delicate manual protocol called ICSI, which risks destroying a potential embryo when sperm is forced into an egg. It can take months to learn and years to become proficient. Newer technology called piezo-ICSI makes the injection process gentler, resulting in higher quality eggs and blastocytes. Automated piezo-ICSI robots have recently come onto the market, simplifying the process so that less experienced embryologists can perform the complex procedure as well as experts.

Improving the overall quality of processes would lead to better outcomes, reducing the average of 2.5 IVF cycles we see today. Having healthier babies with fewer cycles will quickly unlock more systemic capabilities.

To go further: Automation has the most impact when it goes beyond simple step optimization with robots. Creative design can change paradigms. Watch the very manual and delicate step of vitrification, where the eggs are carefully frozen for later use. As more young professionals decide to delay starting a family until later in life, egg freezing is an increasingly critical part of reproductive planning. But like other complex steps, it must be carried out in a controlled embryology laboratory, in a clinic specializing in IVF. For anyone wondering why we don’t have more clinics in more places: They cost about $4 million to open and $1 million a year to operate.

New platforms are coming to market that can automate vitrification in a tabletop device, with minimal, non-expert training required. As these technologies become more widespread, they promise to expand access even further. We soon foresee a world where these devices are commonplace in OB/GYN offices, distributed much more widely and closer to where patients are.

Whether or not we expand insurance coverage, there are many things the government can do to reduce the direct costs of IVF. For example, the promotion of biosimilars – already available in Europe – for the cocktail of hormones necessary to stimulate ovulation would reduce costs per cycle by a third. But cost is not the main limitation to access; it’s a symptom. If we fail to address supply constraints, government-mandated insurance coverage will become just another subsidy for insurers, without denting the growing demand for IVF.

Photo: luismmolina, Getty Images

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