Challenges of Access to Fertility Preservation in the US

In an interview with Targeted Oncology, Katherine McDaniel, MD, reproductive endocrinologist at the University of Southern California and HRC Fertility, discusses the barriers to fertility preservation access for patients diagnosed with cancer.

In the fertility care landscape, access to treatment remains one of the most significant barriers for patients. Many of the advanced medical interventions required to address infertility—such as in vitro fertilization (IVF), intrauterine insemination (IUI), and fertility preservation techniques—are often not covered by insurance plans. As a result, the high out-of-pocket costs make these treatments prohibitively expensive for a large number of individuals and families.

The extent of this financial burden varies dramatically depending on where a patient lives. In the United States, insurance coverage for fertility treatments is heavily influenced by state laws, creating a patchwork system of access. Some states have enacted mandates requiring insurers to cover certain fertility services, while others offer no such protections.

For example, California has been a leader in improving fertility care access. In 2019, the state passed Senate Bill 600, which mandated insurance coverage for fertility preservation for patients undergoing medical treatments (such as chemotherapy or radiation) that could jeopardize their future fertility. This was a crucial step forward, particularly for cancer patients and others facing medically necessary procedures that might impact their reproductive health.

However, not all states have followed suit. Currently, only about 20 states have some form of fertility coverage mandate, and even among those, the requirements vary widely. Some states mandate coverage for diagnostic testing only, while others include IVF or egg freezing. In states without any mandates, patients often face tens of thousands of dollars in expenses for a single IVF cycle, putting treatment out of reach for many.

This disparity in access creates a significant inequity in reproductive health care. Patients in states without coverage mandates may delay treatment, seek lower-cost (but less effective) options, or forgo care altogether due to financial constraints.

Looking ahead, the issue of affordability and insurance coverage will remain a critical challenge in fertility care. Advocacy efforts continue to push for federal policies and expanded state mandates to ensure that all patients, regardless of where they live, have equitable access to the treatments they need. Until then, the financial burden of fertility care will remain a major barrier for countless individuals hoping to build their families.