Two patients can have the same infertility diagnosis, need the same treatment, and see the same specialist. Yet one may move forward with insurance coverage while the other is left staring at a bill for tens of thousands of dollars. In the United States, that difference is often not medical. It is geography. As a biomedical scientist, I’ve seen how evidence should guide care. Yet for infertility, your ZIP code often determines access more than science does.
In the laboratory, we pursue reproducible results. Data either supports a conclusion or it does not. Yet when it comes to building a family through assisted reproductive technology such as in vitro fertilization (IVF), the “results” for patients often depend less on medical need and more on geography.
Infertility is widely recognized as a medical condition affecting the reproductive system and is estimated to affect roughly 1 in 8 couples in the United States who are trying to build a family. IVF represents one of the most effective treatments for patients with conditions such as blocked fallopian tubes, severe male factor infertility, or unexplained infertility after other treatments fail. But for too many patients, the deciding factor isn’t evidence or medical need. It’s whether they live in one of the roughly 15 states that require insurance coverage for IVF or in a state where many families still face tens of thousands of dollars in out-of-pocket costs.
As of 2026, 25 states and the District of Columbia have some form of infertility insurance coverage law, and roughly 15 states require coverage for IVF itself. In other words, meaningful IVF coverage is not a theoretical policy idea. It is already a reality for many patients in the United States. Yet large portions of the country still lack comprehensive IVF coverage mandates, leaving many patients without meaningful coverage for the treatment they need.
The result is a clear two-tier system: In some parts of the country, IVF is increasingly treated as routine medical care covered by insurance, while in others it remains financially out of reach for many families.
Even in states with strong mandates, carve-outs remain the rule. Self-insured employer plans governed by the Employee Retirement Income Security Act (ERISA), which cover the majority of workers at large companies, are exempt from state insurance mandates entirely. Small employers and individual insurance plans may also fall outside these protections.
The financial reality is stark. A single IVF cycle typically costs $15,000-$30,000 when medications, monitoring, laboratory work, egg retrieval, and embryo transfer are included. Medications alone can cost $3,000-$8,000. Because many patients require more than one cycle, total costs can quickly climb to $40,000-$60,000 or more when additional services such as preimplantation genetic testing are included. Without coverage, families often turn to credit cards, home equity loans, retirement withdrawals, second jobs, or crowdfunding campaigns to finance care.
Surveys consistently show that cost remains the single largest barrier preventing patients from accessing fertility treatment. But that barrier is not distributed evenly. Two patients with the same diagnosis may face completely different financial realities simply because one lives in a mandate state or works for an employer that offers fertility benefits. In mandate states with favorable insurance coverage, patients may face only copays and deductibles. Elsewhere, IVF can effectively become a luxury available only to those who can afford it.
Disparities compound across income levels and communities. Research has consistently shown that higher-income patients are far more likely to access IVF than those without financial resources, even when medical need is identical. Access to fertility treatment can become less about medical need and more about financial privilege.
Data also shows what happens when coverage improves. Studies comparing states with comprehensive infertility insurance mandates to those without them have found IVF utilization rates more than 100 percent higher in mandate states, demonstrating how strongly coverage influences access to care. Expanded coverage has also been associated with greater use of single-embryo transfer protocols, which can help reduce the risk of multiple pregnancies.
None of this is cost-free. Insurance mandates can increase premiums and shift costs across the insured population. Implementation gaps persist even in states with strong laws. Yet the alternative, leaving families facing life-altering debt or abandoning treatment entirely, carries its own human and societal costs. Clinicians witness the emotional toll daily: anxiety, depression, strained relationships, and the quiet grief that comes when patients must delay or abandon the hope of building a family.
At the national level, policy efforts have largely focused on encouraging employers to offer fertility benefits or reducing medication costs rather than creating a comprehensive standard for fertility coverage. Those efforts may provide incremental relief, but they do not address the geographic disparities that still shape who can realistically pursue treatment.
As someone who works at the intersection of genomics, pharmacology, and evidence-based medicine, there is a striking inconsistency in how infertility is treated compared with other medical conditions. Infertility remains one of the few recognized medical conditions for which access to effective treatment depends heavily on geography and insurance structure. We would not accept ZIP code lotteries for cancer screening, diabetes management, or cardiac care when effective treatments exist. Infertility should not be treated differently. Evidence shows that IVF works; the question is whether we are willing to structure access to that care fairly.
A better path forward does not necessarily require a single national mandate. But it does require acknowledging that the current system leaves many patients behind. Expanding insurance coverage, improving transparency around treatment costs, encouraging employers to offer fertility benefits, and creating targeted financial assistance programs could all help reduce the inequities that patients currently face. Access to evidence-based medical care should not depend on geography. Infertility, a recognized medical condition, should not become a financial crisis simply because treatment falls into a gap in the insurance system.
The science of IVF has advanced remarkably. Our policies should strive to keep pace, so that more families can turn laboratory success into the lived reality of parenthood, regardless of where they live.
Laurel A. Coons is a scientist with a background in genomics and biomedical research. She completed her doctoral training in pharmacology and cancer biology at Duke University and conducted research at the National Institute of Environmental Health Sciences. Her work has focused on genomic regulation, endocrine signaling, and translating complex scientific data into insights relevant to medicine and patient care.
She shares professional updates on X at laurelcoons.
