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Why the “IVF is too expensive” rhetoric hurts us
Earlier this month, NPR did a short blurb about the cost of IVF and asked readers to reach out to share their stories. While we are happy to see attention paid to IVF, we are also disheartened that this rhetoric about the cost of IVF always seems to miss the mark.
Yes, IVF is costly.
This is a known entity and has been for a long time. However, the infertility community needs to stop describing IVF as “expensive” as though it exists outside the normal bounds of American healthcare. IVF is not uniquely costly. It is priced similarly to many other complex medical procedures. What makes it inaccessible is not its cost—it’s the lack of insurance coverage.
When people say IVF is expensive, what they usually mean is that it’s expensive to pay for out of pocket. But that distinction really matters. Nearly all healthcare in the United States is prohibitively expensive without insurance. That’s precisely why insurance exists.
A knee replacement costs, on average, $30,000–$50,000 before insurance. A caesarean routinely exceeds $20,000. These are not rare or exotic procedures. They are all a part of what makes up standard medical care. And they are covered—not because they are cheap, but because we recognize that no individual should be expected to pay for them alone.
Imagine if insurance companies refused to cover knee replacements or a C-section. That scenario would be unthinkable. Yet this is exactly what infertility patients are told every day. Labeling IVF as “expensive” subtly reinforces the false idea that it is optional, indulgent, or a luxury. It is not. It is evidence-based medical care for a diagnosed medical condition, infertility. It is evidence-based medical care for a medical need.
Insurance coverage—or the lack of it—is the single biggest barrier preventing people from growing the families they dream of. Paying out of pocket for a fertility treatment is impossible for many patients, just as it would be impossible for most Americans to pay cash for a C-section or joint replacement. This isn’t a personal failure or a budgeting problem. It’s a policy failure.
Furthermore, insurance companies can negotiate prices. Individual patients do not have that leverage. Without insurance, patients are exposed to the full sticker price of care—just as they would be for any uncovered medical procedure. IVF isn’t the problem. The way we’ve decided whose healthcare deserves coverage is. Fertility care is an outlier in insurance coverage—or lack thereof—and puts the onus on families. It lets insurance companies off the hook. Americans want to build strong, loving families and should have the freedom to access fertility insurance coverage.
If we wouldn’t expect someone to pay cash for a knee replacement, we shouldn’t expect people to pay cash to build their family.
FEMM: Know your acronyms
Are you tired of acronyms yet? Well, here comes another one to keep you on your toes: Fertility Education and Medical Management (FEMM). Now, this was a term we only found out about recently but it has actually been around for a number of years, first in the guise of the FEMM Foundation, which is funded by parties who are said to oppose birth control and abortion. Interestingly, they have even given a written brief to the United Nations on FEMM, stating, “Fertility awareness education empowers women and girls by teaching them how their bodies work. This means learning about the reproductive system, which launches conversations about how menstruation fits into a woman’s ovulation cycle.”
Now, so far, yes, we agree that it is vital that young women learn about how their reproductive systems work, including how it relates to things like menstrual cycles.
Then, however, it goes on to talk about biomarkers like cervical mucus patterns that, “empowers [women] for life to recognize the normal and abnormal signs of their bodies.” It all careens off the cliff when it talks about tracking menstrual cycles on apps, which is a huge red flag. Obviously women need to know as much as they can about their cycles but using apps to track their periods all gets a bit dystopian. It is coded as empowerment but serves judgement that it’s women’s bodies that are at fault if they are unable to conceive.
A report that came out last year from the University of Cambridge found that menstrual cycle tracking apps are presented as empowering women and addressing the gender health gap. However, according to Dr. Stefanie Felsberger, lead author of the report, “the business model behind their services rests on commercial use, selling user data and insights to third parties for profit.” This has played out in the United States where data about menstrual cycles has been collected by officials in an attempt to undermine abortion access. “Menstrual tracking data is being used to control people’s reproductive lives,” said Dr. Felsberger. “It should not be left in the hands of private companies.”
From how we read the tea leaves, FEMM—which My Catholic Doctor states is another type of RRM— is really just the rhythm method, polished up with a fancy new name but putting the responsibility for fertility squarely and solely on the shoulders of women. Meanwhile, of course, male factor infertility contributes to roughly 40% to 50% of all infertility cases in couples worldwide, with males being solely responsible for about 20–30% of these cases. If you can’t get pregnant, it’s your fault—it’s all very antiquated.
And there are rumblings that this is how the US will now be framing foreign assistance for reproductive health as well. That $10 million of birth control sitting in Belgium—which the U.S. government has said has been destroyed but the Belgians say it hasn’t—is just the tip of the reproductive iceberg.
Cue, again, Restorative Reproductive Medicine (RRM), something we wrote about back in our May 2025 newsletter.
First, as a reminder, RRM is defined as being a “comprehensive approach” that focuses on “identifying and correcting the underlying causes” versus “simply treating symptoms.” It claims to use a holistic approach that includes emphasis on natural menstrual cycles and addressing things like inflammation and lifestyle factors. Part of that is helping women “understand” their reproductive cycles and helping women identify “optimal times” for conception.
However what RRM really does is:
Exposes Patients to More Trauma & Cost: RRM can subject patients to unnecessary and painful surgical interventions. In the U.S., most infertility care is not covered by insurance and must be paid out of pocket. This situation drives patients toward the unfounded path of RRM, increasing financial barriers and forcing many to choose between essential needs.
Puts Patients at Risk: RRM may delay or deny access to effective fertility treatments. Since fertility care is highly time-sensitive, these delays can significantly reduce a patient’s chances of achieving pregnancy.
Preying on the Vulnerable: The stress and anxiety of infertility is exacerbated by the creation and promotion of RRM to serve a political agenda, exploiting the vulnerability and opening the door for scammers selling ineffective treatments and gadgets.
Lots to unpack here, but suffice to say, RRM very much coincides with a lot of the MAHA policies against medical interventions. As the New York Times recently wrote, “Today, an approach long confined to the medical fringe has unified Christian conservatives and proponents of Robert F. Kennedy Jr.’s Make America Healthy Again movement — and is suddenly at the forefront of the fertility conversation in the Trump administration and the broader Republican Party.”
According to an editorial in The Hill by Dr. Elizabeth Ginsburg, president of the American Society for Reproductive Medicine and the fellowship director of Reproductive Endocrinology and Infertility at Harvard University, “Those who oppose IVF for political, religious or ideological reasons and would like to see it eliminated as an option have selectively chosen parts of legitimate medical practice in fertility care that they call Restorative Reproductive Medicine.” She goes on to add those “incorrectly touting the practice as something separate from standard-of-care infertility management” are doing it based on political or religious ideologies.
Which is exactly like policy from the anti-abortion playbook that was used by the Right for years in terms of working on overturning Roe. It’s just reconfiguring it and repackaging it for fertility healthcare, especially IVF. According to an opinion piece in The Hill from 2024: “For decades following the 1973 Roe v. Wade decision, anti-abortion advocates were successful in incrementally advancing their agenda, enacting new laws that made abortion harder to get and highly stigmatized. Public support for abortion’s legality has remained consistent. But the sheer number and scope of state-level abortion restrictions — such as forced waiting periods, bans on insurance coverage and unnecessary clinic requirements — combined with a well-funded strategy to build conservative power at the state and local levels, ensured that abortion became technically legal but inaccessible for many, even with Roe in place.”
Now, just replace the word abortion with IVF…and you see they are using the same tried and tested tactics. We need to stop debating the rather nonsensical nature of things like RRM and FEMM and focus on what is really happening here: the slow but meticulous stripping away of access to IVF across the United States, especially to certain socio-economic and minority groups.
Just one more justification for why we fight the good fight at State Strong.
South Carolina’s scary new proposed legislation
Below is from Ashley Lidow, Chief Strategy Officer at South Carolina’s WREN: Women’s Rights & Empowerment Network. WREN is on the frontlines of South Carolina’s attack on women’s health.
Here’s what happened during the hearings for H. 4760 and H. 3537
H. 4760 (Attack on Abortion Medication), which attacks access to abortion medication by falsely reclassifying it as a Schedule IV drug.
After two hours of testimony, 700 written statements, and 80 phone calls, the subcommittee voted 3–2 to move H. 4760 forward to the full House Judiciary Committee. The bill could be heard as early as next week.
OPPOSE H. 4760
H. 3537 (Death Penalty Bill), which would charge people with homicide for getting an abortion, providing abortion care, or anything else deemed to "harm" a fertilized egg.
H. 3537 did not receive a vote and will require another subcommittee hearing to move forward. We will keep you updated if this moves forward.
OPPOSE H. 3537
At WREN, we believe everyone deserves the freedom to make decisions about their health and family without government interference. These bills threaten that freedom, and we must stay vigilant.
Here’s how you can take action right now:
Continue to contact your legislators and urge them to vote OPPOSE H. 4760 & H. 3537.
Stay signed up for WREN alerts to receive updates.
Share this update with friends, family, and community members.
WREN will continue to monitor both bills closely and share updates via their newsletter (so sign up!) as soon as new information becomes available. Your voice is making a difference, and we’re grateful to have you in this fight.
Share Your Story in a National Study on Fertility Insurance Coverage
The Women’s Health Research & Action Center (WHRAC), a 501(c)(3) nonprofit, is leading a national research study called The Social and Financial Impacts of Inadequate Insurance Coverage for Fertility Treatment (COST-FiT). The study explores how gaps in fertility insurance coverage shape out-of-pocket costs, work and financial decisions, and family-building timelines.
COST-FiT is led by WHRAC in collaboration with researchers from Stanford School of Medicine, the University of North Carolina at Chapel Hill, and Johns Hopkins University. The study is IRB-approved.
You may be eligible to participate if:
You are currently experiencing infertility and/or undergoing fertility treatment to build your family
You have experienced infertility and/or sought fertility treatment within the past 24 months.
Participation involves completing a secure, anonymous online survey that takes approximately 30 minutes to complete. Participants who complete the survey will receive a $10 Amazon e-gift card as a thank-you for their time.
Findings from this study will be published in peer-reviewed journals and shared through policy-relevant reports and educational forums to help inform efforts to improve access to fertility care.
To help protect data quality and prevent fraudulent responses, we kindly ask that this survey not be shared on public social media platforms or open forums (e.g., Reddit). You are welcome to share the survey with trusted friends, family members, or colleagues who may be eligible. All broader survey distribution is carefully managed by WHRAC.
Access the survey here.
If you have questions or concerns about the study, please contact the study’s Principal Investigator, Dr. Leah Chapman, PhD, MPH, at leah@whrac.org.
Hey, journalists, don’t be a stranger!
We have seen a load lot of stories lately out there about IVF, infertility, surrogacy and reproductive healthcare. And while we are (mostly) glad to see these issues getting attention and discussion, they are incredibly nuanced, and different perspectives would be useful and helpful.
State Strong is here as a resource for you—from putting you in touch with our members, who have years of experience with advocacy around these topics, to pinpointing who and what are good resources in individual states working on these issues.
Part of what we do is media outreach and we can be that expert you are looking for on a plethora of stories. So don’t be a stranger: reach out, say hello and get to know a bit more about what we do.