President Donald Trump on Thursday announced two moves that could lower the cost of fertility treatments for some Americans but fell well short of his campaign promise to make in vitro fertilization (IVF) available to all Americans at no cost.

Employers will now be able to offer standalone insurance to cover infertility treatments, but those plans will have loose requirements about what they are required to cover, Trump said in a White House address. Trump also announced that one major drugmaker, EMD Serono, will offer discounts on the list price for drugs used in IVF. 

The White House told reporters that the government would not provide incentives for employers to offer fertility benefits. A White House fact sheet did not offer any details about how any such plans would be regulated. 

Employers already could offer fertility benefits if they chose, said Alina Salganicoff, senior vice president and director of women’s health policy at KFF, a nonpartisan health policy organization. “There’s nothing stopping any employer right now, other than the cost of such a benefit could be prohibitive,” she said. 

Creating a new fertility insurance option altogether is a cumbersome process, she added. It requires companies to build out insurance offerings and companies to choose to offer it. And there are other key questions surrounding the Trump announcement, she said, including whether employers are allowed to put other stipulations on who qualifies for benefits, such as being married or being in a heterosexual relationship.

“I don’t know how this will all be operationalized,” she said. “The details are all very important.”

Heidi Overton, deputy director of the White House Domestic Policy Council, said Thursday that the insurance plans could also cover other fertility options beyond IVF. In fact, it’s not clear that these plans will be required to cover IVF, which is typically the most expensive infertility treatment but also the most effective.

“This new benefit option simultaneously represents the greatest opportunity to expand coverage of IVF that the federal government has ever taken, while also improving the care delivered additionally and very importantly, it gives employers maximum flexibility to design benefits that are consistent with their values,” Overton said.

It’s a reversal from remarks that Trump made on the campaign trail, when he said the Trump administration would “be mandating that the insurance company pay” for IVF.

While drug prices can make IVF significantly more expensive, they are not the main source of costs. IVF can cost between $12,000 and $17,000 without including pharmaceutical expenses, according to the National Council of State Legislatures; including medications, it is closer to $25,000. The Department of Health and Human Services has estimated a cycle of IVF can cost between $15,000 and $20,000 for a single cycle — more if donor eggs are involved. In its own fact sheet, the White House estimated that the fertility drug discounts would save patients about $2,200 per cycle. Those discounts will be available through the drug-purchasing portal TrumpRx.com, per the White House fact sheet.

Americans generally approve of IVF access and either want elected officials to protect access or not make rules, according to polling from The 19th and SurveyMonkey. About half, 48 percent, say they want officials to protect access and just 10 percent say they want them to restrict use. Restrictions are slightly more popular with Republicans; 16 percent say they want officials to restrict use of IVF. 

The fertility regimen has drawn the ire of abortion opponents, who oppose the practice because IVF generally involves retrieving eggs from inside a body, developing multiple embryos in a lab and testing them for viability before implanting a healthy one in a uterus. Because the egg retrieval process is involved, and not all will yield healthy embryos, medical professionals make extra, ultimately discarding those that are not used. 

“While it could have been worse, it’s still a reflection that they aren’t totally on board,” Kristan Hawkins, the head of the anti-abortion group Students for Life, posted on the social media platform X. “I’m thankful there’s no new healthcare mandate forcing coverage for the destructive IVF industry, but IVF, as it’s practiced, still destroys countless humans in the embryonic stage.”

Asked at the news conference about religious objections to IVF from anti-abortion groups, Trump said he was unaware of them. 

“I’m just looking to do something because, you know, pro-life,” he said. “I think this is very pro-life. You can’t get more pro-life than this.”

While some states have laws mandating that private health insurance pay for at least a few rounds of IVF, those benefits are sparse in much of the country. It is largely not covered for people covered by Medicaid, the federal-state insurance program for low-income Americans.

Abortion opponents have encouraged Trump to promote alternatives to IVF, including what some call “restorative reproductive medicine,” which they say treats the root causes of infertility. 

Many reproductive endocrinologists have voiced criticism of that alternative — which relies on tracking fertility through one’s menstrual cycle, along with emphasizing nutrition and exercise — saying it is unreliable and lacking a strong evidence base and that many patients with infertility are already taking those steps.

Restorative reproductive medicine providers have met with Health and Human Services officials, encouraging the government to have insurance cover restorative reproductive medicine, said Linda Ruf, who runs the Vitae Clinic, one such health center in Texas.

Overton suggested that employers could choose to emphasize this option in any fertility benefit they choose to offer.

“Employers are going to be able to decide how to cover the root causes of infertility, things like obesity, metabolic health and other things that are impacting infertility,” she said. “And also, if they want to encourage their employer, their employees, to see certain types of doctors, and they can work with providers that are identifying the highest quality fertility providers.”

Any truly comprehensive fertility insurance offering must include IVF, said Salganicoff of KFF, noting that even in cases where physicians know the root cause of someone’s infertility, that treatment regimen can be the only realistic option.

RESOLVE: The National Infertility Association said the White House’s announcement underscored the importance of IVF. 

“It makes important progress in two areas for Americans facing infertility: reducing IVF drug costs and encouraging companies to offer increased family-building benefits,” said Danielle Melfi, RESOLVE chief executive. “We believe this is an important step forward on the road to ensuring all Americans can access the care they need to build the families of their dreams.”

Access to fertility health care, including IVF, is difficult for all Americans, said Polly Crozier, director of family advocacy at GLAD Law, and the costs are prohibitive for many couples.

“I’ve heard of families who have put off being able to buy a house or put off making substantial payments on their student loans,” she said. “They are difficult financial choices that people have to make in order to build their families.”

For LGBTQ+ families, these struggles are multiplied, Crozier said. LGBTQ+ couples often have to jump through more hoops to prove that they need access to infertility treatments in the first place. Insurance companies are more likely to deny them coverage or to demand that they prove their infertility struggles than cisgender, heterosexual couples. In Hawaii, Texas and Arkansas, gay couples are effectively excluded from state mandates for infertility treatment. And overall, LGBTQ+ people face more discrimination at the doctor’s office: They are more likely to be refused medical care and blamed for their health problems. 

Despite those barriers, many LGBTQ+ couples and singles are determined to grow their families. Restrictions or bans on IVF care disproportionately affect LGBTQ+ people trying to have children, Crozier said. That’s because many LGBTQ+ couples can only have children through assisted reproductive technology or fertility treatments, whether that looks like surrogacy or using donor egg or sperm. 

“LGBTQ+ people want to have kids. I think more and more of them are wanting to have kids as the years go by,” she said. 

That includes Kerrie King and her wife, Kristi Ihrig. They’ve been trying to have a child for over two years, which includes paying $9,000 for multiple rounds of intrauterine insemination (IUI). That cost doesn’t include the two-hour drive from their rural town to Madison, Mississippi, which has the only local LGBTQ-friendly fertility clinic that they could find. They’ve paid for several hotel stays in order to make the commute more manageable, and since appointments can require multiple visits in the same day. Their insurance, Ambetter Health, doesn’t cover their fertility treatments because of their same-sex relationship. 

When King and Ihrig first saw Trump’s executive order on expanding IVF accessibility in February, they took a break from trying to have a child out of fear that the administration would exclude or target them for their LGBTQ+ identity. 

“Safety is our main concern,” King told The 19th in May, during that pause. “With Trump’s presidency targeting LGBTQ+ Americans and the trans people, it just really worries me.” 

As months went by without any news from the White House, they started their journey again. King researched other options to determine if the couple should try another IUI cycle or attempt INVOcell, a form of IVF recently cleared by the Food and Drug Administration for expanded use. At a recent OB-GYN appointment in September, she told her doctor that she was ready to try fertility treatments again. As King and her wife raise Max — her stepson — they still dream of growing their family. 

“I am adopted, and so is my wife. My family was really broken growing up,” King said. “I want to be able to have a child and show them what unconditional love is, and for them to not know what a broken family is.”