The issue
President Donald Trump signed an executive order last month to develop policies that promote access to in-vitro fertilization and “aggressively reduce” out-of-pocket and insurance costs related to treatment. The order directs the office that oversees domestic policy to submit a list of recommendations in 90 days.
More people have sought fertility treatment in the last decade, as more women delay having children and rely on medical interventions to help them get pregnant. Four in ten U.S. adults said in 2023 that they or someone they knew used fertility treatments – up from 33% from just five years earlier, according to a study from Pew Research Center.
Although fertility treatments are on the rise, there’s still a gap in accessibility. Roughly 2% of all U.S. babies were conceived using IVF, according to the U.S. Centers for Disease and Control Prevention. Yet about 16% of people globally experience infertility, according to the World Health Organization. Price can deter patients from getting treatment, with a single IVF cycle costing anywhere from $15,000 to $20,000 and up to $30,000 when a donor egg is involved, according to the U.S. Department of Health and Human Services.
Sparse insurance coverage and high costs have led fertility companies to crop up in the city to offer coverage outside traditional health plans. Those companies say the federal government’s focus on making IVF more accessible could drive policies that benefit the industry.
“It’s sort of a watershed moment,” said Dr. Neel Shah, chief medical officer of the Lower Manhattan-based fertility provider Maven, adding that fertility coverage has historically been decided by the states. “There’s no shortage of things that could be done.”
Fourteen states – including New York – require insurance companies to cover IVF in some capacity. New York’s law, which went into effect in 2020, requires that fully insured employers cover up to three IVF cycles for people diagnosed with infertility. The state also requires Medicaid to cover fertility drugs. But the requirements don’t apply to self-insured companies or people without a diagnosis of infertility, leading benefits companies to fill in the gaps.
The players
New York is home to some of the nation’s leading fertility companies, including Progyny, Maven and Kindbody. Local fertility executives say they’re optimistic about the financial impact federal policies could have on their industry.
“The spirit of that executive order is very positive relative to the industry itself and certainly relative to us,” Pete Anevsky, CEO of Progyny, told Crain’s. “Until there’s more detail about that I really can’t guess, but the direction is positive.”
Progyny, headquartered in Midtown, earned $1.2 billion in revenue last year, a 7% increase from 2023, according to a financial statement released last week. Though the company projected slower revenue growth in the coming year after losing Amazon as a major client, some analysts say federal policies could increase the company’s bottom line.
“While the executive order lacks detailed policy actions, President Trump’s advocacy for protecting and improving access to IVF coverage is broadly positive for the fertility space,” Allen Lutz, an equity research analyst at Bank of America, said in a recent research note. Federal legislation that preempts state law and mandates insurance coverage for IVF could increase demand for Progyny’s services, Lutz said, recommending investors purchase its stock and raising the target price from $25 to $30 per share.
The city is also home to privately funded fertility benefit companies. Maven – which provides both fertility treatment and pregnancy and menopause care – closed a $125 million Series F in October, bringing its total fundraising to $425 million, the firm said. Flatiron-based startup Kindbody, which struggled to raise money last year, may also stand to benefit.
Yeah, but…
Trump’s executive order does not outline specific policies to curtail IVF’s hefty price tag – including one of the president’s campaign promises to make the treatment free.
The city’s fertility industry can’t count on a windfall until policies are in writing. Although IVF access appears to be a bipartisan issue for now, Shah said future policies could resurface questions around fetal personhood and arguments that discarding embryos should be illegal. A court in Alabama ruled last year that frozen embryos had the same rights as a person, prompting the state to pass legislation to protect patients and providers from criminal liabilities. Discussions around personhood could bubble up amid conversations about access and affordability, according to Shah.
What’s next
The federal government has a May deadline to unveil recommendations on IVF policies. The policies could address two buckets: spotty access to insurance coverage and the high costs of care.
The primary way to target sparse insurance coverage is by mandating coverage. A federal mandate for IVF coverage for all federal employees is “low-hanging fruit,” according to Shah, who also noted that there are hundreds of thousands of government workers and an increasing number of people seeking treatment.
Targeting costs, however, would require the federal government to increase the supply of fertility treatments to meet the growing demand, Shah said. Currently there are approximately 1,200 reproductive endocrinologists – the physicians that provide IVF – in the U.S. Expanding the types of clinicians eligible to administer treatment, including general ob-gyns, could help offset high costs, he said.
Asked about the feasibility of Trump’s campaign promise to make IVF free, Shah said that no health care procedure comes without costs.
“Even having a baby in the U.S. is not free,” Shah said. “I think the question is more, how do we defray the costs.”
