The World Health Organization recently released its first-ever global guidelines to prevent, diagnose and treat infertility.
Globally, approximately 1 in 6 people of reproductive age will experience infertility at some point in their lifetimes — 13.4% of U.S. women aged 15 to 49 grapple with the issue, according to estimates from the CDC’s National Center for Health Statistics — and fertility rates are falling worldwide.
At the same time, access to needed care and support is hard to come by, especially for women of color and those with a lack of health insurance coverage or the ability to pay for the expensive fertility services out-of-pocket.
What the WHO Guidelines Do And Do Not Address
The WHO defines infertility as the failure to achieve pregnancy after 12 months or more of regular unprotected sexual intercourse. The guidelines, which address both policies and health systems to help those wishing to become pregnant, are substantive, but the WHO asserts that they do not cover all aspects of infertility. They were developed by a multidisciplinary group of global experts and underwent peer review, covering ways to manage, prevent and diagnose infertility, among other topics. Some notable aspects of the guidelines cover:
- Providing information about fertility and infertility to those of reproductive age, using low-cost strategies;
- Listening to individuals and couples, respecting their preferences, being sure not to omit psychological and social or peer support if needed;
- Consideration of cost-effective treatment; and
- Routinely informing couples and individuals about the risks associated with sexually transmitted infections and the link to infertility.
The guidelines fall short of making recommendations on managing personal risk factors outside of smoking and sexually transmitted infections, and the need for workplace supports such as coverage in employer-sponsored health insurance plans and supportive paid leave policies.
The WHO does affirm that addressing infertility is central to human rights, acknowledging its relevance to gender equality, the right to health, equitable access to health care and financial protection, given the large out-of-pocket costs associated with fertility care. In a U.S. context, it’s important to unpack social issues like bias and affordability because of the racial disparities seen in infertility among women.
Racial Disparities in Infertility
Black women in the U.S. experience disproportionately high rates of infertility, according to the National Women’s Law Center. They’re nearly twice as likely as their white counterparts to face infertility.
Other reproductive health concerns largely faced by Black women can affect their ability to conceive, such as uterine fibroids, pelvic inflammatory disease and endometriosis. Toxic stress caused by racism and bias can also perpetuate higher rates of infertility among Black women. Access to fertility treatment also varies along racial lines, with barriers in health insurance coverage and affordability challenges cited as key contributors.
A network of support and a sense of community, rooted in reproductive justice, is vital to expel shame from the experience of infertility and give Black women hope. Advocacy tools such as those seen on the platform The Broken Brown Egg, which exists primarily to empower and inform the experience of infertility, are breaking ground by demystifying infertility among Black women and other marginalized groups.
Affordability and Insurance Coverage
Fertility treatment is extremely cost-prohibitive. A single cycle of in vitro fertilization can cost on average between $15,000 and $30,000, and many women need to go through multiple cycles to conceive. The expenses do not end there; purchasing sperm or eggs, genetic tests, medication and other health care-related fees can also add up. This makes health insurance coverage of fertility care essential for most women in the U.S.
Such coverage varies widely across the country. The comprehensive nature, or lack thereof, of insurance plans depends on design, policy terms and whether your state mandates this type of coverage. Some states mandate coverage of infertility diagnosis and treatment, including IVF. Still, coverage limitations and high out-of-pocket costs make fertility care out of reach for many Americans.
On October 16, President Donald Trump announced actions to lower costs and expand access to IVF and high-quality fertility care. Trump’s plan includes a drug-pricing agreement with a leading fertility treatment manufacturer, expedited FDA review of a lower-cost fertility medication, and creation of a new benefit option for employers to offer fertility benefits directly to their employees. The drug-pricing agreement applies to a small subset of medications within the IVF regimen, with potential savings estimated at around $2,200 per treatment cycle. This would provide some relief in terms of affordability, yet drugs alone can cost tens of thousands of dollars per cycle, according to the American Society for Reproductive Medicine. The fertility benefits under Trump’s new option would sit outside of health insurance plans and would not be subject to the federal statutes that typically regulate health insurance. The option is also just that – not a required benefit that employers must offer. This arrangement would continue to leave fertility care out of reach for too many Americans, including women in low-wage jobs, Black women, and other women of color. Trump’s plan does not replace the need for comprehensive insurance coverage of fertility care. There is currently no federal mandate to cover fertility care in U.S. health insurance plans.
Better Coverage of Fertility Care Needed to Advance Equity
KFF asserts that gains in health insurance coverage have been realized among most racial and ethnic groups, despite a period of rising uninsured rates during President Trump’s first term. Still, Black women have higher rates of uninsurance than white women — 2023 estimates show that 9.8% of Black women were uninsured compared to 6.8% among white women.
Black women are also more likely to be covered by Medicaid and ACA Marketplace plans, whereas employer-sponsored insurance is less common among them. And with insurance premiums set to skyrocket in the new year, along with changes under President Trump’s One Big Beautiful Bill Act going into effect, coverage of fertility care could become even further out of reach for millions of women in the U.S.
The patchwork of fertility coverage across states and health insurance plans also stifles access to fertility care. And while it will take all U.S. women several decades to reach pay parity with men working the same jobs, it is particularly grim for women of color. Black women experience grave pay inequities, and it will take them 200 years to reach parity with white men. This puts them in a difficult position when trying to tackle increasing health care expenses. They are also less likely to have access to the paid leave required to take time away from work for fertility treatment.
These are all important social factors that affect a woman’s ability to afford and access fertility care.
