What “Fertilization President” Trump Can Learn From States Expanding IVF Access

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Struggles of Families Seeking IVF

Mariah Freschi and her husband have spent nearly three years trying for a second child. After surgery to remove her blocked fallopian tubes, IVF became their only path to pregnancy. However, with a price tag of $25,000 quoted by a Sacramento-area clinic, the cost remains far beyond the reach of the preschool teacher and her warehouse worker husband.

They are not alone. About 13% of women and 11% of men in the U.S. experience infertility, and many others need fertility services for reasons such as same-sex partnerships or medical treatments. Yet, access to IVF remains limited largely due to the lack of insurance coverage.

Trump’s Push for IVF Access

During his campaign, President Donald Trump promised to expand access to IVF and even signed an executive order in February seeking recommendations to make fertility treatments more accessible. Embracing the nickname “fertilization president,” Trump positioned himself as a champion for struggling families.

Still, the administration’s concrete policy actions remain uncertain. State-level efforts, however, reveal the complex mix of financial, political, and ideological challenges involved in expanding fertility coverage.

States Lead the Way — and Face Big Hurdles

To date, 22 states have passed laws requiring insurers to cover some fertility treatments, with 15 specifically mandating IVF coverage. However, the breadth of coverage varies widely, often limited by concerns over costs.

Opponents, including insurers and employer groups, argue that mandates drive up premiums and strain budgets, especially for state employees. Meanwhile, IVF advocates point to data suggesting that fertility care adds less than 1% to overall premium costs. Despite this, affordability and access gaps persist — particularly among lower-income populations and Medicaid recipients.

California’s Comprehensive but Limited Approach

California’s recent legislation, SB 729, serves as a case study. After years of failed attempts due to cost concerns, the state passed a mandate requiring large employers to cover infertility treatment, including IVF. The law, effective July 1, is considered among the most inclusive, extending eligibility to single parents and same-sex couples.

However, major populations — such as those on Medicaid, ACA marketplace plans, or self-insured employer plans — remain excluded. The final law will extend IVF coverage to around 9 million people, fewer than initially proposed. Premiums are expected to rise by approximately $40 per covered person in the first year.

Disparities in Coverage Across the U.S.

Even in states with broad mandates like Massachusetts and New York, large segments of the population still lack coverage. Many patients, while grateful for the assistance, still face significant out-of-pocket expenses.

In states with narrow mandates, like Utah, fertility coverage is mostly limited to specific medical scenarios, such as preserving fertility for cancer patients. Other states, such as Oklahoma and Kentucky, restrict coverage to particular medical conditions only.

Beyond Costs: Moral and Political Resistance

Beyond financial concerns, ideological opposition has shaped IVF policy debates. Some religious groups oppose IVF on moral grounds, citing the destruction of embryos. In states like Georgia, efforts to protect IVF access have become intertwined with broader battles over abortion laws, creating additional hurdles for expanding fertility coverage.

Trump’s IVF expansion initiative also faces challenges from within his own political base, with divisions over how IVF relates to the anti-abortion movement. The lack of clarity surrounding his executive order leaves many wondering what real impact it will have.

A Future Still Uncertain

While more companies now offer IVF benefits, most Americans must still navigate high costs alone. Many turn to loans, crowdfunding, or grants to finance fertility treatments. Families like the Freschis, relying on credit cards and outside funding, continue to carry the heavy emotional and financial burden of pursuing their dreams of growing their families.