Washington — On the campaign trail, Donald Trump made a pledge: Under his leadership, in vitro fertilization would be covered for all women and couples seeking the treatment. “We are going to be paying for that treatment,” he said in an interview in August 2024.
After taking office, President Trump signed an executive order directing his domestic policy council to make recommendations on IVF policy changes by May. But that deadline has come and gone, and the White House has said little about the issue. Advocates for better IVF coverage are wondering what the holdup is.
Mr. Trump, who has called himself the “father of IVF” and claimed to be a “leader on fertilization, IVF,” told NBC News, during that 2024 interview, that IVF would be covered for everyone who needs it.
“Under the Trump administration, we are going to be paying for that treatment,” Mr. Trump, then a candidate, said. He added, “We’re going to be paying for that treatment, or we’re gonna be mandating that the insurance company pay.”
Mr. Trump’s executive order, signed in February, fell short of his campaign pledge, stating that it would be administration policy “to ensure reliable access to IVF treatment, including by easing unnecessary statutory or regulatory burdens to make IVF treatment drastically more affordable.”
He directed his assistant for the White House Domestic Policy Council to submit within 90 days “recommendations on protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment.”
That deadline would have fallen on May 19. Asked for an update, the White House declined to comment.
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Cristina Gonzales and her partner, who live in New York City, have been struggling with infertility for about three years. Gonzales, who makes campaign ads for Democrats, is a part of a support group for women over 40 going through IVF. The women represent diverse political and ideological backgrounds, including liberals and those who support Mr. Trump, alike. When then-candidate Trump said IVF would be covered, Gonzales said some in her group “believed completely and wholeheartedly” that he would make coverage free.
“They deserve that promise to be kept,” Gonzales said.
“This struggle of IVF is nonpartisan,” she said. “It affects everybody.”
In February, a Washington Post interview with Trump supporter and fired federal worker Ryleigh Cooper went viral. She said she didn’t want to vote for Mr. Trump, but he’d promised to make IVF free. After reading the fact sheet from Mr. Trump’s February executive order, she told the Post she said, “‘That’s bullsh**.'”
IVF is a fertility treatment that has broad support; in 2023, over 95,000 babies were born as a result of IVF — about 2.6% of all births in the U.S. — according to the American Society for Reproductive Medicine.
An overwhelming majority of Americans — 86% — think IVF should be legal, according to a March 2024 CBS News/YouGov poll.
“Eighty-six percent of Americans support IVF. That is unheard of in almost any issue you could think of in modern times,” said Danielle Melfi, CEO of infertility advocacy nonprofit RESOLVE.
According to an April 2024 Pew survey, 79% of Democrats and those who lean Democratic say access to IVF is a good thing, as do 63% of Republicans and those who lean Republican. Even among Americans who told Pew abortion should be illegal in most cases, 60% view IVF access positively.
And Mr. Trump has introduced other concepts, including a “baby bonus” for babies born in the U.S., to help boost the U.S. birth rate. The fertility rate in the U.S. dropped to an all-time low in 2024, with fewer than 1.6 children being born per woman, according to new federal data. The bonus is available to parents who open so-called Trump Accounts, which were introduced in the president’s massive domestic policy bill that he signed into law last month.
Melfi is optimistic about the momentum the issue has picked up and has made recommendations to the White House, among them, to increase health insurance coverage of all fertility-related treatment, include fertility coverage for veterans and military families, and cover fertility care for all federal employees.
Out-of-pocket costs are the biggest barrier to undergoing IVF, Melfi said. Each cycle — and many couples undergo several cycles — costs between $12,000 and $25,000. Very few states require insurance companies to provide coverage for the treatment, so the vast majority of women and couples must pay out of pocket for IVF rounds.
“Each state looks a little bit different, which is why action at the federal level would be really meaningful,” Melfi said of state laws governing insurance coverage of IVF.
IVF is one of multiple infertility treatments available, and is often the last — and most expensive — step women take to become pregnant.
In the process, a woman typically administers expensive shots to herself every day to stimulate the growth of multiple eggs at once and regularly goes to a fertility clinic for ultrasounds and blood work to monitor progress. The eggs are retrieved, fertilized outside of the body and ideally, they develop into healthy embryos that can be implanted immediately or frozen for later use.
Many find it to be an exhausting process — physically, emotionally and financially.
Leading up to her first round of IVF, Gonzales was anxious. What if she and her partner were to spend all this money only for the procedure to not result in pregnancy?
“I don’t have enough money for this and I feel like there’s a lot of pressure on my body — what if it doesn’t perform?” she said.
For her, an unexpected year-end bonus had provided a way to pay. But otherwise, it might not have been possible.
“When you look at health insurance policies, almost none of them cover fertility,” Gonzales said. “Even so-called progressive states.”
Still, IVF provides no guarantees. Gonzales has undergone four rounds of IVF, none of which resulted in a baby, and now, she and her partner are pursuing other paths to parenthood. IVF has ultimately been successful for other women in her IVF support group, and she thinks every person should have the chance to pursue the procedure, regardless of their financial circumstances.
“I don’t regret it, I would definitely do it all over again,” she said.
Gonzales hopes the president follows through on his pledge to make sure IVF is covered for those who want and need it.
“It would be one of the smartest policies for them to actually make good on this promise,” she said.