Since in vitro fertilization was invented nearly 50 years ago, at least 10 million children who would not otherwise exist have been brought into the world. New constellations of families — older moms, same-sex parents, single dads — have flourished. This is one of the major scientific success stories of modern life. But despite these advances, I.V.F. in the U.S. today is far from a sure path to parenthood. Fertility care is still so unevenly available that it feels almost like entering a lottery, in which the state you call home, the company that employs you, or your relationship status determines whether or not you become a parent.
Access to fertility care is not a niche problem. The ranks of the infertile, already estimated at one in six people of reproductive age globally, are poised to grow: One recent study estimated that as more women worldwide age and delay childbearing, infertility cases among women over 35 will increase by nearly 50 percent by 2036.
In the U.S., the rising number of births to women over 40 masks the fact that many others in the same cohort fail to get pregnant — and that delaying parenthood is often a downstream effect of the greater time and effort it now takes to establish middle-class stability. Queer and single people, also a growing demographic, need assistance getting pregnant too. As more people seek fertility treatment, this necessary care remains out of reach for a significant share of the population.
The choice to become a parent is profoundly personal. Everyone, not just couples who are heterosexual and fertile, should have the ability to make this decision for themselves. So what if we thought of starting a family as a fundamental human experience that should be available to all? What if we extended the ability to have a family — one that many possess as a matter of good fortune — into a basic human right?
The desire for a child comes from somewhere deep and unfathomable. Many people will risk upending their lives for the chance to try to have a baby, and success is nowhere near guaranteed. They seek out strangers online for sperm donation. They max out credit cards, start GoFundMe campaigns, or take out loans through fertility lenders like Future Family, which has extended upward of $200 million in credit since 2016. People apply for “baby scholarships,” or grants from charities to help pay for fertility care. They give away half their eggs in exchange for the chance to freeze some of their own for free. They wait for years to adopt. They go to countries where fertility treatment is one-third to half the American cost. I traveled to Europe twice to freeze my eggs, and a third time for I.V.F., all for less than the price of a single I.V.F. cycle in New York City.
“People scrimp and save; sometimes they take second mortgages out, go into IRAs, all sorts of things like that,” Dr. Jonathan Van Blerkom, who helped invent a simplified I.V.F. system designed to lower costs, told me. “And if they don’t get pregnant, which many don’t even in the best programs, they don’t have the baby — but they still have the debt.”
There is increasing institutional and political recognition that more people need help to build their families. In 2023, the American Society for Reproductive Medicine expanded its definition of infertility to acknowledge same-sex couples and single people. This year, at least five states have introduced bills requiring insurance plans serving large employers to cover I.V.F. If passed, they would add to the 25 states that currently require insurance plans to provide at least some level of fertility care, and the 15 that require coverage of I.V.F.
The generous fertility benefits that were once the province of corporate employees at tech and finance firms are now routinely offered to retail workers at companies like Target. President Trump, who declared himself the “fertilization president” at the beginning of his current term, lowered the prices of some I.V.F. drugs and sought to make it easier for employers to offer fertility benefits.
At the same time, religious conservatives emboldened by the Dobbs decision have put I.V.F. in their cross hairs, seeking to curb a technology that allows gay people to have families and that results in unused and discarded embryos. In a June notice, the Department of Health and Human Services referred to embryos frozen in storage as “children who already exist and are in need of a family” — a clear attempt to equate embryos with living people in order to limit access to abortion. Resolve, a fertility advocacy group, has documented 134 proposed bills since 2024 that potentially threaten I.V.F. across 46 states. These attacks are thinly veiled attempts to assert a particular vision of the family: married and heterosexual, getting pregnant early and often, and exclusively the old-fashioned way — what fertility doctors sometimes jokingly call I.B.F., or in-bed fertilization.
Even in progressive locales, the right to a family is not universal. In 2024, a married gay couple sued the City of New York, which had employed one of the men, for discrimination because although the city’s health plan covered I.V.F. for heterosexual couples, the gay men were denied it. “So many employee benefits policies are based on this kind of 1950s version of the family,” said the couple’s lawyer, Peter Romer-Friedman.
Societies have often expressed preferences about who should and should not reproduce, both explicitly — with discriminatory laws and policies, and even coercive and often racist sterilization programs — or implicitly, through social and cultural messaging. In the 1980s, the Wisconsin State Legislature passed a bill that deemed it medical malpractice to artificially inseminate a woman receiving public assistance. The governor eventually vetoed the bill, but even today, Medicaid generally does not provide I.V.F. coverage. (In July, Senator Tammy Duckworth of Illinois and several Democratic colleagues re-introduced a bundle of bills that, among other things, would require Medicaid to cover a full range of fertility care.) The historian Laura Briggs has described this as a “precisely eugenic” system in which “insurers pay for the poor to get birth control and for the rich to get I.V.F.”
Fertility discrimination can be perpetrated even within a single company. This spring, Business Insider reported that Deloitte planned to cut a $50,000 family-building benefit for support staff in I.T., finance and administrative roles. Accountants and consultants would still get the benefit. The result is a two-tiered system that subsidizes people with accounting skills to become parents, while leaving colleagues in I.T. on their own.
Renee Codsi, 49, recently went through a costly and time-consuming journey to become pregnant that reveals the holes in this country’s patchwork system of care. Ms. Codsi lives in Washington State, which does not require insurers to cover fertility care. Her employer, a public university, does not offer meaningful coverage. When she started I.V.F., she relied on her fiancé’s insurance to cover many of the costs beyond a $4,000 annual deductible. After three unsuccessful I.V.F. cycles, she and her partner broke up. That left her paying out of pocket. She created embryos with donor eggs and sperm at a clinic in Portugal where the cost was lower, then had the embryos shipped to a clinic in Los Angeles. Today, she is, at long last, pregnant. It took six years.
The idea that Ms. Codsi and others in her circumstances might call on the state for assistance is not novel. It is a foundational insight of the reproductive justice movement, founded by Black women activists more than three decades ago. They asserted that in matters of family making, having a right to bodily autonomy, as was theoretically ensured by Roe, is not enough. These women argued that it was a human right to have children, or not have children, and to be able to parent in a safe environment — and that governments were responsible for ensuring these rights that had been historically denied to women of color. Their philosophy draws inspiration from the Universal Declaration of Human Rights, which affirms that “Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family.”
Of course, such a right is not clear-cut. Is it the right to pass on one’s genetic material? To gestate a child and experience giving birth? To be a parent to someone, irrespective of genetic ties? How we answer those questions has profound implications for policy, and for what kinds of families we welcome into the world. But recognizing family life as a human right would be a useful starting point and a way to push back against the narrow and exclusionary vision of the family that many on the right are promoting.
Pro-choice activists say that abortion bans don’t eliminate abortion, because a woman who needs an abortion will often figure out a way to get one. In my observation, the same is true for people who fiercely desire a family. Poland banned I.V.F. for single women in 2015, but the law only hardened many women’s determination to become mothers, while forcing them to cross borders to get treatment in nearby countries.
Such obstacles are both prejudiced and cruel. Ms. Codsi is now waiting eagerly to meet her baby, but her path to motherhood cost more than $56,000 and left her with tens of thousands of dollars in unpaid bills that someone working for a different employer or living in a different state could have avoided. Our current system makes becoming a parent accessible to some, but a costly and bureaucratic nightmare for others. Let’s remember that family life is first and foremost an experience of joy and love — one that we can open the door to for the many people who want it.
Anna Louie Sussman, a contributing Opinion writer, writes about gender, economics and reproduction and is the author of the forthcoming book “Inconceivable: The Impossibility of Family in an Age of Uncertainty.”
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