The dream of having a child remains financially out of reach for many Americans struggling with infertility.
That could change as the Trump administration considers new policies to make fertility treatments more accessible and affordable.
One in six people face infertility challenges, and while many insurance plans cover diagnosis, they often don’t cover treatment. However, a new proposal under consideration could dramatically expand coverage for federal employees, military personnel, and those with coverage through the Affordable Care Act.
Breaking down the costs
Many people assume all fertility treatments involve expensive in vitro fertilization (IVF), but Dr. Kaylen Silverberg, fertility specialist from the Texas Fertility Center and chair of the Medical Advisory Board of Americans for IVF, says that’s a misconception.
“Forty percent of our practice does IVF. Sixty percent of practice doesn’t even do IVF - they never get there,” Silverberg explains. “They either get pregnant with something simple like pills, maybe they need a minor surgical procedure to correct a problem, or maybe we need to do something like intrauterine insemination if the man’s sperm count is low.”
These treatments can cost as little as $150 to $200, making them significantly more affordable than IVF.
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Potential impact on insurance premiums
A study commissioned by Americans for IVF found adding comprehensive fertility treatment coverage would increase insurance premiums by just 58 to 76 cents per member per month, according to Dr. Silverberg.
“Under good conditions, what we think is the best-case scenario, there’s actually a surplus. It actually reduces overall spend,” Silverberg says.
Current insurance coverage gap
Silverberg illustrates the current coverage gap with a striking comparison: “Substitute breast cancer for infertility. What do you think would happen if, God forbid, Suzy Smith finds a lump in the shower, gets a mammogram, gets a biopsy, is told she has breast cancer and then to make it worse, they say, ‘Well, I know your insurance has covered the diagnosis, but you don’t have any treatment coverage.’”
He argues for basic fairness in coverage. “We’re not asking for a favor, we’re not asking for favorable treatment. We’re just asking for fairness. I want my patients, when their money is deducted from their paychecks every two weeks, to be able to use their own funds.”
Looking ahead
Proposals have already been submitted to the White House for consideration. The administration could announce initial plans for fertility coverage in the coming weeks, potentially bringing hope to Americans struggling to build their families.
For doctors like Silverberg, this issue goes beyond policy. “One reason I chose infertility is because of the quality of the relationships that a fertility doctor develops with their patients,” he says. “Our patients are with us, unfortunately, sometimes over years and we get to know them extraordinarily well... because we have too much insight into the suffering that they’re going through. It’s a heartbreaker.”
