On Tuesday, President Donald Trump signed an executive order aimed at lowering the costs of in vitro fertilization (IVF), a procedure that supports those experiencing infertility in their journey to start a family.
“Americans deserve dependable access to IVF and more affordable treatment options, with cycle costs typically ranging between $12,000 and $25,000,” stated the order. “By providing support, awareness, and accessible fertility treatments, we can assist these families in pursuing parenthood with hope and confidence.”
The order called for the assistant to the president for domestic policy to present Trump with a set of policy suggestions focused on safeguarding IVF access and effectively lowering out-of-pocket and health plan expenses for IVF treatments within a 90-day timeframe.
During the 2024 presidential campaign, IVF emerged as a significant topic following Alabama’s decision to protect IVF providers from legal liability, shortly after the state Supreme Court declared that frozen embryos could be classified as children under state law.
At that time, Trump expressed strong support for ensuring access to the procedure. Additionally, a June poll conducted by The Associated Press-NORC Center for Public Affairs Research revealed that approximately 60% of U.S. adults favor safeguarding access to IVF, with 26% neutral, and about 10% opposed.
According to a report from the U.S. Centers for Disease Control and Prevention, assisted reproductive technologies, including IVF, accounted for 2% of all infants born in the United States in 2018.
Here’s what you should know about this increasingly popular fertility treatment.
IVF is typically pursued when a woman struggles to conceive and is usually implemented after more affordable fertility treatments have failed.
The process involves retrieving a woman’s eggs and fertilizing them with a man’s sperm in a lab, resulting in a fertilized embryo that is transferred into her uterus in hopes of achieving pregnancy.
IVF is conducted in cycles, and multiple cycles may be necessary. The procedure can utilize a couple’s own eggs and sperm or may involve donors.
Insurance coverage for IVF and other fertility treatments can be inconsistent and varies greatly depending on the provider.
An increasing number of large employers are offering this coverage in a bid to attract and retain employees. Many businesses are also extending coverage beyond individuals diagnosed with infertility, making it accessible to LGBTQ+ couples and single women.
However, government-funded programs like Medicaid primarily limit coverage for fertility treatments, and such coverage is less common among smaller employers.
Critics argue that the lack of widespread insurance coverage creates inequity, restricting treatments primarily to those who can afford the considerable out-of-pocket expenses.
The first successful IVF conception resulted in the birth of a baby in England in 1978, while the first in the United States occurred in 1981 in Norfolk, Virginia, with the birth of Elizabeth Carr.
Judith Carr, Elizabeth’s mother, had experienced three abnormal pregnancies leading to the removal of her fallopian tubes. She and her husband sought treatment from fertility specialists Howard and Georgeanna Jones, who established a fertility clinic at Eastern Virginia Medical School.
The Norfolk clinic faced backlash before its opening. When it sought state certification in 1979, more than 600 individuals attended a public hearing. Several women spoke in favor of IVF, sharing their desires to start families, while anti-abortion groups raised concerns regarding potential interference in human reproduction and the fate of embryos.
Despite attempts to block the clinic through proposed state legislation, it opened in 1980, followed by several other clinics in California, Tennessee, and Texas shortly thereafter. By 1988, upwards of 169 in vitro centers were operating in 41 states.
The popularity of IVF continued to rise, but opposition has remained rooted in the American anti-abortion movement, according to Margaret Marsh, a history professor at Rutgers University.
Many opponents of abortion have reached a cautious acceptance of this infertility technology, though criticism has intensified following the reversal of Roe v. Wade in 2022.
“While not all members of the anti-abortion movement oppose these reproductive technologies, a significant number do,” she noted.
The IVF procedure typically involves administering hormones to stimulate ovulation, leading to the production of multiple eggs, which are then extracted from the ovaries using a needle.
In the laboratory, eggs can be fertilized by either adding sperm to them or by injecting a single sperm into each egg.
The fertilized egg is cultured for approximately five to six days, developing into a blastocyst—an early stage of an embryo—which is then either implanted in the uterus or preserved for future use, explained Dr. Jason Griffith, a reproductive endocrinologist based in Houston.
Griffith pointed out that on day three post-fertilization, embryos typically consist of six to ten cells, and by day six, they contain 100 to 300 cells, whereas a fully developed person has over a trillion cells.
Frozen embryos can be later used for pregnancy attempts, with most surviving the freezing and thawing processes.
The freezing technique entails substituting water in embryo cells with a protective solution, followed by rapid freezing with liquid nitrogen, according to information from Johns Hopkins Medicine.
Frozen embryos are stored in containers filled with liquid nitrogen in hospital laboratories or reproductive medicine clinics. Griffith noted that they can also be held at storage facilities contracted with health care providers, particularly when preserved for extended periods. These embryos can remain safely stored for a decade or longer.
He added that conditions in these storage facilities are carefully monitored, including physical security measures for the tanks and backup generators to address power failures.
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Ungar reported from Louisville, Kentucky. Contributions to this report were provided by Associated Press writers Tom Murphy in Indianapolis and Ben Finley in Norfolk, Virginia.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
