White House staff are researching ways to lower the cost of in vitro fertilization in response to an executive order that President Donald Trump issued earlier this week.
Massachusetts, an IVF mecca with generous insurance coverage for the procedure, may not feel as much impact as other states from policy changes, experts said.
Here’s what the order does and doesn’t do and how it could affect families.
What is IVF?
IVF, which stands for in vitro fertilization, is a fertility treatment that involves fertilizing a woman’s egg with sperm in a laboratory dish. The resulting embryo is then implanted into the uterus in an attempt to create a pregnancy, said Dr. Michael Alper, medical director of Boston IVF, the largest IVF center in the country.
The procedure, which has been available in the US since the 1980s, is used to treat a range of fertility disorders, including low sperm count, blocked fallopian tubes, and endometriosis. Alper said it offers couples the hope of having a child when they may not otherwise be able to. The process can be done using a couple’s own eggs and sperm or those from a donor.
The number of infants born through assisted reproductive technology, of which IVF is the most common, increased by 44 percent from 2013 to 2022, according to the CDC. In Massachusetts, 5.4 percent of infants born in 2021 were a result of IVF, well above the national average of 2.3 percent, the Globe previously reported.
According to Trump’s executive order, IVF treatments can range from $12,000 to $25,000 per cycle. For women under 35, about half of IVF cycles lead to a live birth, and if a woman does three to five cycles, her odds increase to 90 percent or higher. For women over 44, success rates are far lower.
“IVF costs are high because the technology is very labor and technology dependent,” Alper said. “If you were to come by our lab facility, you would see the lab requires special air handling equipment, backup power, special incubators, microscopes, and experienced embryologists and staff to make it happen.”
What does the order do, and why did Trump issue it?
The order directs the White House’s Domestic Policy Council to investigate what’s driving up the cost of IVF and recommend ways to lower it, said Aziza Ahmed, professor of law at Boston University and a visiting professor of constitutional law at Harvard.
“It doesn’t necessarily say they’re going to do anything about those costs,” she said.
Ahmed said the order is “interesting” given the split in the Republican party over support for IVF. Questions about IVF arose after the Supreme Court’s ruling in Roe v. Wade made reference to “unborn human beings.” In February last year, the Alabama Supreme Court ruled that frozen embryos are children and deserve protection under the law, which some interpreted to mean they cannot be frozen or destroyed. The IVF process involves creating several embryos, implanting one, and freezing or discarding the rest, which becomes questionable if embryos are considered children.
Despite the party’s battle over the issue, Trump supported IVF in his 2024 presidential campaign, saying he would advocate for public funding for the procedure or mandate insurance companies to cover it.
“It’s going to divide people who have supported him for anti-abortion reasons,” Ahmed said. “I’m not sure why he’s doing that, if he doesn’t feel like he needs that base anymore, or he’s not as interested in supporting a deeply pro-life mission anymore.”
Ahmed added that another reason behind the order could be due to pro-natalist influences on Trump, including from Elon Musk and JD Vance. Pro-natalism is the belief that having more children is important for society; the executive order cites the nation’s historic low fertility rate and Trump’s advocacy for “more babies and expanding American families.”
I. Glenn Cohen, professor of law at Harvard and the faculty director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, said he was hopeful but surprised by the order.
“I’m happy the president has identified this as an issue worth mentioning and worth discussion,” Cohen said. “The actual executive order itself doesn’t change the law in any respect.”
What kind of policies could come out of the order?
Cohen said the most probable way the Trump administration could lower IVF costs is by expanding insurance coverage for the procedure. Mass. is one of 15 states that already mandates insurance coverage for IVF, but not all plans are beholden to the law.
The federal government, through Congress, could expand the number of insurance plans and companies that cover IVF because it could mandate that self-insured companies — large employers that pay for employees' medical care directly rather than through an insurance plan — cover the treatment, according to Cohen.
Because Mass. already has mandated coverage for IVF, Ahmed said it’s unlikely it would impact the state, at least not immediately.
“If they map states where there’s already good coverage for IVF, Massachusetts will lead the pack there,” she said. “I don’t know that Massachusetts is going to feel that deep an impact of that type of order to simply understand costs or even if they follow through with action to support IVF care.”
Alper said insurance coverage for the procedure has been “one of the greatest benefits to patients,” with some couples even moving to the state to have more affordable treatment.
What the order says and doesn’t say
The order, which Ahmed said is “more of a grand statement than anything very tangible,” leaves out language about LGBTQ+ couples, racial inequalities, and other already-known barriers to treatment.
“I would like to be sure [the order] is inclusive of the LGBTQ population, which in many cases needs access to fertility care,” Alper said. “I want to advocate that it’s for all people of all backgrounds.”
Ahmed said that common barriers to IVF include its high cost and the time required for treatment. According to the Mayo Clinic, one full cycle of IVF can take about two to three weeks or longer, which can require taking time off work, a luxury Ahmed said many don’t have.
Studies have also shown that racial, ethnic, and geographic disparities affect access to fertility treatments.
The order also doesn’t mention the government-run insurance programs Medicare or Medicaid. Only one state Medicaid program covers fertility treatment, and no Medicaid program covers IVF.
“As a practitioner for 40 years, there’s nothing more sad to me when you have a couple of a certain socioeconomic group that just cannot afford treatment,” Alper said. “So I would hope [the policies] would be very inclusive.”
Emily Spatz can be reached at emily.spatz@globe.com. Follow her on X @emilymspatz.