President Donald Trump on Tuesday signed an executive order aiming to reduce the costs of in vitro fertilization, a medical procedure that helps people facing infertility build their families.
“Americans need reliable access to IVF and more affordable treatment options, as the cost per cycle can range from $12,000 to $25,000,” the order said. “Providing support, awareness, and access to affordable fertility treatments can help these families navigate their path to parenthood with hope and confidence.”
The order instructed the assistant to the president for domestic policy to give Trump a list of policy recommendations on protecting IVF access and “aggressively reducing out-of-pocket and health plan costs for IVF treatment” within 90 days.
IVF became a talking point during the 2024 presidential campaign when Alabama agreed to protect in vitro fertilization providers from legal liability a couple of weeks after the state Supreme Court ruled that frozen embryos can be considered children under state law.
Trump said at the time he strongly supported its availability. And a June poll from The Associated Press-NORC Center for Public Affairs Research found that about 6 in 10 U.S. adults support protecting access to IVF, with 26% neutral and about 1 in 10 opposed.
In 2018, assisted reproductive technology, including IVF, contributed to 2% of all infants born in the United States, according to a report by the U.S. Centers for Disease Control and Prevention.
Here’s what to know about this increasingly common fertility treatment.
What is IVF?
The procedure offers a possible solution when a woman has trouble getting pregnant, and it’s normally tried after other, less expensive fertility treatments have failed.
It involves retrieving the woman’s eggs and combining them in a lab dish with a man’s sperm to create a fertilized embryo, which is then transferred into her uterus in an attempt to create a pregnancy.
IVF is done in cycles and may take more than one. The procedure can use a couple’s eggs and sperm or those from a donor.
Does insurance cover the procedure?
Insurance coverage of IVF and other fertility treatments can be patchy and depends on who provides insurance for the patient.
More large employers are offering the coverage to attract and keep workers. Many businesses also are extending coverage beyond those with an infertility diagnosis, making it accessible to LGBTQ+ couples and single women.
Government-funded programs such as Medicaid largely limit fertility treatment coverage. Coverage is less common among smaller employers.
Critics have said the lack of widespread coverage creates a divide, limiting treatments mainly to people who can pay thousands of dollars out of pocket.
What is the history of IVF?
The first baby conceived through IVF was born in 1978 in England. But the first in the U.S. was in 1981 in Norfolk, Virginia, with the birth of Elizabeth Carr.
Her mother, Judith Carr, had had three abnormal pregnancies, forcing the removal of her fallopian tubes. She and her husband sought treatment from Howard and Georgeanna Jones, doctors who opened a fertility clinic at Eastern Virginia Medical School.
The Norfolk clinic faced resistance before it even opened. When it sought a required state certificate in 1979, more than 600 people jammed into a public hearing. Several women voiced support for IVF and testified about wanting to start a family, while anti-abortion groups raised concerns about doctors interfering with human conception and embryos being discarded.
Despite proposed state legislation to stop the clinic, it opened in 1980, with others following soon afterward in California, Tennessee and Texas. By 1988, at least 169 in vitro centers were operating in 41 states.
The use of IVF continued to grow, but sentiments against it never really went away in the American anti-abortion movement, said Margaret Marsh, a history professor at Rutgers University in New Jersey.
Many abortion opponents had made an uneasy peace with the technology as a treatment for infertility, Marsh said. But opposition to IVF has gained momentum since the overturn of Roe v. Wade in 2022.
“Not everyone in the anti-abortion movement opposes these reproductive technologies, but many do,” she said.
How are embryos made?
The treatment often uses hormones to trigger ovulation so multiple eggs are produced and a needle is used to remove them from the ovaries.
Eggs can be fertilized by adding the sperm to the eggs in a lab, or a single sperm can be injected into each egg.
The fertilized egg is cultured over about five to six days to create the blastocyst—the early stage of an embryo—and is either transferred or stored for future use, said Dr. Jason Griffith, a reproductive endocrinologist in Houston.
Griffith said that on day three after fertilization, an embryo is anywhere from six to 10 cells. By day six, it’s between 100 and 300 cells. In comparison, he said, a person contains more than 1 trillion cells.
How are embryos frozen and stored?
Frozen embryos can be used for future pregnancies, and the vast majority survive the thawing process.
The freezing process involves replacing the water in embryo cells with a protectant fluid and flash-freezing with liquid nitrogen, according to Johns Hopkins Medicine.
Frozen embryos are stored in tanks containing liquid nitrogen at hospital labs or reproductive medicine centers. Griffith said they can also be kept in storage facilities contracted by health care facilities, especially when they are stored for many years. Frozen embryos can be safely preserved for a decade or more.
Griffith said conditions are monitored in these facilities and there are physical security mechanisms to safeguard the tanks and backup generators in case of power outages.
—Ungar reported from Louisville, Kentucky. Associated Press writers Tom Murphy in Indianapolis and Ben Finley in Norfolk, Virginia contributed reporting.
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