IVF Coverage Proposals Could Squeeze U.S. Fertility Clinics Without Improving Access

Every family deserves reproductive choices, including a chance at parenthood. For families struggling with infertility, in vitro fertilization (IVF) serves as a promising path. But this hope often comes with the prohibitively expensive 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 lead a transformative shift in reproductive healthcare and address troubling demographic trends. It parallels efforts in Congress by Democrats, who introduced H.R. 3480, the Health Coverage for Inclusive and Valued Families Act of 2025, similarly seeking to expand fertility treatment access to more families. What these plans fail to address is what happens when you stoke demand without increasing supply, inevitably leading to a rollout that would further increase the cost of IVF without adding significant capacity. 

Let’s look just at Medicaid, which covers about 18 million women aged 20-45, accounting for 40% of all U.S. births. If IVF access were offered to this population through insurance coverage extension, based on recent averages, we might expect 2% of that cohort to pursue treatment, resulting in roughly 360,000 additional cycles annually. For context, in 2023, U.S. fertility clinics reported performing over 430,000 IVF cycles. 

And of course, if insurers followed suit, the problem would compound. We need to put downward price pressure while keeping focused on quality outcomes.

Historically, that’s been the opposite outcome of adding coverage through the American health insurance industry. Why should we expect any different if its scope were expanded to cover IVF? Let’s come up with a better model, something akin to LASIK, where costs have come down 30% since 2008, without sacrificing quality.

The infrastructure gap

The most significant challenge facing any large-scale expansion of IVF coverage is the acute shortage of critical infrastructure and specialized personnel. Unlike routine outpatient care, IVF is a highly intricate and manually intensive procedure that involves multiple stages, from ovarian stimulation and egg retrieval to fertilization, embryo culture, and transfer. Each of these steps must be executed with extraordinary precision in tightly controlled lab environments. IVF treatment is uniquely dependent on a narrow cadre of highly skilled professionals, most notably embryologists. These specialists are responsible for handling eggs, sperm, and embryos at a 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 roughly 5,000 embryologists actively working in the country. Meanwhile, 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 stagnant over the past decade despite growing demand. This bottleneck has led to capacity constraints, most visible outside of large urban centers. While metropolitan areas like New York, Los Angeles, and Chicago may have multiple full-service fertility clinics, rural and underserved regions often lack enough qualified individuals and properly equipped facilities. Some states have a single IVF clinic.

This geographical imbalance results in long wait times and travel burdens, particularly for those in lower-income or medically underserved communities. And given the highly manual nature of many sensitive steps, the process has become artisanal, with a worrisome inconsistency in quality and outcomes between clinics, between experienced and inexperienced embryologists, and between well-rested and overworked staff.

Addressing access

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

If insurance coverage mandates lead to a sudden increase in demand for IVF services, many clinics – already stretched pretty thin – may struggle to accommodate the influx of new patients. This can result in longer wait times for appointments, diagnostic testing and treatment cycles, potentially delaying patients’ ability to start or complete fertility treatments. For individuals and couples facing infertility, such delays are especially distressing because of the decline in fertility with age.

In addition, even if coverage is mandated, insurance will do nothing to lower systemic costs – in fact, the history of U.S. health insurance suggests the opposite.

To truly expand access, we need to focus on alleviating the bottlenecks in a way that throwing money at the problem cannot fix. That means robust, parallel investments in workforce development, recruitment incentives, and clinic infrastructure. Still, in the best-case scenarios, those are longer-term projects that won’t keep up with the expected growth in demand for IVF due to changing demographics – here and globally.

The missing piece is modernizing the technology used in IVF, specifically automation. If properly implemented, automation alone could help to standardize quality in a few ways. It would shrink the burden on staff by reducing the number of manual steps, and allow those with less experience to perform procedures on par with those who have spent a career doing them. It would accelerate certain procedures and eliminate process failures.

Automated potential

A good example is the process of fertilization itself, requiring a delicate manual protocol known as ICSI that risks ruining 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 better quality eggs and blastocytes. Automated piezo-ICSI robots have recently entered the market, which simplify 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, bringing down that 2.5-IVF cycle average we see today. Having more healthy babies with fewer cycles will quickly unlock more systemic capacity.

Going a step further: automation has the most impact when it goes beyond simply optimizing steps with robots. Creative design can change paradigms. Look at the highly manual and delicate step of vitrification, where 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 component of reproductive planning. But like other complex steps, it must be performed in a controlled embryology lab environment, at a specialized IVF clinic. For anyone wondering why we don’t have more clinics in more places: they cost about $4 million to open and $1 million to operate annually.

Newer platforms are reaching the market that can automate vitrification in a tabletop device, with minimal, non-expert training required. As these become widespread, they promise to expand access much further. We see a world coming soon where these devices are commonplace in OB/GYN offices, which themselves are distributed much more broadly and closer to where patients are located.

Whether we expand insurance coverage or not, there are lots of things the government can do to bring down the out-of-pocket costs of IVF. For example, promoting biosimilars – already available in Europe – for the cocktail of hormones needed to stimulate ovulation would reduce per-cycle costs by as much as a third. But cost isn’t the core 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 making a dent in the growing demand for IVF.

Photo: luismmolina, Getty Images

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