The cold reception to Trump’s proposal is certainly due in part to its enormous financial costs. Although the government or insurance companies would pay for IVF under Trump’s proposal, the treatment would be anything but free. It would either be subsidized by taxpayers, or its costs would be passed on to consumers in other ways, such as higher insurance premiums.
A back-of-the-envelope calculation indicates that subsidizing IVF would cost the government around $7 billion annually. This figure supposes, based on 2021 data from the Centers for Disease Control and Prevention, that 413,776 assisted reproductive technology cycles are performed annually, that IVF constitutes more than 99% of all assisted reproductive technology procedures/cycles and that the average IVF cycle costs between $15,000 and $20,000. This estimate assumes, however, that potential beneficiaries won’t change their behavior in light of new incentives.
But behavioral changes are in fact likely, so a static estimate understates long-term program costs. For instance, most IVF patients currently pay for the treatment themselves, which naturally limits its use. Government-funded IVF could induce some couples to delay childbearing or engage in elective fertility preservation (such as freezing eggs or sperm), leading to growing use and reliance on fertility treatments rather than conventional conception over time. This would mean even more cost growth for the “free” IVF program.
Fewer Births?
Although program costs are an issue, the proposal’s potentially perverse influence on births is perhaps even more concerning. New incentives created by a “free IVF” policy could inadvertently depress fertility, leading to more babies born via IVF but fewer babies born overall.
The false sense of security produced by the promise of a government-funded fertility insurance policy could influence would-be parents to delay having children, only to realize that childbearing is impossible or impossibly challenging, even with reproductive technology’s help. That outcome is quite likely, given that both IVF patients and the general public are unrealistically optimistic about IVF success rates.
Research finds that most people are not fully aware of IVF’s limitations: In a 2022 study, the average IVF patient expected a 59% success rate, whereas doctors’ average prospective estimate of patient success was nearly half that, at 30%. Another study similarly found that women’s estimates of IVF success indicated “vast” overoptimism.
Unrealistic expectations combined with “free” IVF could mean that couples encounter greater challenges when they finally begin to try expanding their families. It is an unfortunate biological reality that fertility problems increase with age, especially in women: CDC data indicate that about 15% of women age 15–29, 27% of women age 30–39 and 43% of women over 40 find it difficult or impossible to carry a pregnancy to term.
Older women are not only more likely to run into fertility challenges, but also less able to resolve those issues even with the help of reproductive technology. IVF success declines dramatically with patient age: According to data from the Society for Assisted Reproductive Technology, IVF procedures result in a baby about 50% of the time for women younger than 35, but less than 8% of the time for women older than 40.
Unfortunately, even when individuals can resolve fertility issues via reproductive technology, the solution frequently requires trial and error over multiple rounds of testing and treatment, which can take years. For some women who delay childbearing due to the proposed policy, the biological window may not allow enough time for the treatment to succeed before it closes for good. In one large study, 65% of women who had undergone six rounds of treatment had a successful pregnancy, leaving 35% still unsuccessful at that point.
While an IVF subsidy or mandate may reduce short-term financial concerns for patients, the average personal cost of pursuing treatment grows over time. Fertility treatment is well known to be mentally, emotionally and physically taxing. In cases where personal costs are high and outcomes are especially uncertain, some patients will no doubt opt out rather than press forward with indefinite rounds of treatment.
Given that Trump’s IVF proposal is motivated by pro-natal sentiment (“We want more babies, to put it very nicely,” he stated), delayed childbearing resulting in greater fertility challenges and an overall decline in births would be a counterproductive outcome indeed.
Practical Probabilities
Trump’s IVF proposal is likely to result in negative consequences for both America’s finances and its fertility rates—if the proposed policy ever materializes. In a campaign season where both sides’ economic proposals convey an increasing sense of desperation and economic illiteracy, how much talk is simply bluster?
Given congressional Republicans’ recent legislative activity and informal reactions, it seems unlikely that they would pass anything like Trump’s IVF proposal. But Senate Democrats and two Senate Republicans attempted to advance the Right to IVF Act again in late September—a bill that sounds remarkably similar to Trump’s plan, in that it would require private insurers to pay for IVF.
The Right to IVF Act is currently cosponsored by 48 Senate Democrats, and a future Democratic-controlled Congress, with the right White House ally, would be well positioned to realize such a plan with substantial support. Though Kamala Harris has not provided her own view on an IVF subsidy or mandate, her endorsement of such a plan does not seem outside the realm of possibility. Perhaps the most likely path to realization is under a Harris administration rather than a Trump one.
But regardless of whether such a policy is ever enacted, Trump’s IVF proposal highlights a simple truth about policymaking: Greater spending does not guarantee the outcome you desire. That goes double when it comes to fertility decisions, which are difficult to influence meaningfully via public policy. Before creating a “free IVF” policy that throws money at the problem of declining fertility, policymakers should seriously consider whether such a program would actually work.
