| As someone who writes a lot about reproductive health care, I've always taken it as gospel that in vitro fertilization is expensive. President Donald Trump's recent executive order directing his team to explore ways to lower the cost got me thinking, though. What exactly goes into making it so pricey? I hopped on a call with Sheeva Talebian, a reproductive endocrinologist and fertility specialist at CCRM Fertility in New York City, to learn more. The high cost is partly due to the sheer number of trained professionals needed throughout the process, which Talebian laid out during our chat. For a female patient, an IVF cycle starts with an initial consultation that may include a pelvic sonogram and follow-up blood work. There are specialty medications to be ordered (and administered), and once the patient starts treatment, she is coming to the office multiple times a week for blood work and ultrasounds. Then the eggs are retrieved in a surgical procedure and are fertilized in a lab. At some centers, like CCRM, fertilized embryos are checked for chromosomal abnormalities before being frozen and implanted later. All that adds up to dozens of people at work. "Just the number of actual bodies that it takes is exponentially higher than going to your doctor for an annual OB-GYN visit," Talebian says. One cycle can range from an estimated $10,000 to $20,000, Talebian says, with another $3,000 to $8,000 in medications. Patients may need multiple cycles before bringing home a baby, which increases the costs. One 2023 study found that 40-year-olds with unexplained infertility, for example, would have a 25% live birth rate after the first egg retrieval round. That adds up to some serious financial stress for prospective parents. Among people that pursued fertility treatment, 28% took on debt to cover health care costs and 46% said they received a surprise bill or paid more than expected, according to virtual health-care provider Maven Clinic, which recently surveyed 3,700 workers at large companies on the topic. One big way to cut costs for those grappling with infertility would be mandating that health insurance plans cover IVF, something the American Society for Reproductive Medicine, a trade group, says is a clear solution. It's a fix that Trump floated on the campaign trail when he promised to make such treatments free. (Insurance coverage of fertility treatments is limited in private plans and "nearly non-existent" for those covered by Medicaid, according to health policy research group KFF.) Trump's executive order didn't include language on such a change, and doesn't do anything to immediately lower those costs or expand access to such reproductive treatments. The administration said it will cut costs by "easing unnecessary statutory or regulatory burdens," according to the executive order, though it didn't go into detail on what those changes may look like. The White House didn't respond to emails seeking comment. There is little federal involvement in IVF beyond reporting statistics to the Centers for Disease Control and Prevention, so regulatory costs aren't a major cause of pricing, according to Talebian. But mandating insurance provider coverage, and reexamining rules around the development and sale of fertility drugs, which are available at cheaper prices in other countries, could lower patient costs. "You are saying that you want to improve access to IVF benefits," Talebian says. "Let's put the words to power and make it happen." — Kelsey Butler | 
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