The Future Of Fertility In 2026

0:00Support for NPR and the following message come from the William and Flora Hewlett Foundation, investing in creative thinkers and problem solvers who help people, communities, and the planet flourish. More information is available at hewlett.org.

0:21Millions of people in the U.S. struggle with fertility. In 2024, fertility rates reached a new low. That's according to CDC data. Women are also waiting longer to have kids, while a growing number are deciding to opt out entirely. The Trump administration is pushing for a baby boom and promising to make in vitro fertilization or IVF treatments more accessible. Earlier this month, the administration's new prescription drug website, TrumpRx, went live. It offers several fertility medications, which President Trump says are being made available at a fraction of the cost. We're also delivering historic discounts for couples struggling with infertility as EMD Serrano will dramatically cut the cost of its most common IVF drugs.

1:07For example, a single dose of the most common IVF drug in the country, Gonal F, will plummet from the highest price in the developed world that we paid. The United States was subsidizing everybody. We paid the highest to the lowest price in the world. But fertility treatments continue to be prohibitively expensive for many. The average cost of a single IVF cycle can cost between$10 ,000 and$14 ,000 and can go up to$30 ,000 or more, with many paying a significant amount out of pocket. That's according to Forbes. Beyond the eye-popping price tag, the journey into fertility treatments can be emotionally taxing.

1:46It can also be confusing to navigate the many doctor's appointments and the endless medical jargon to figure out what's best for you. I'm Jen White. You're listening to the 1A Podcast. After this short break, we'll talk through the latest infertility treatments, debunk some fertility myths, and answer your questions. Stay with us.

2:09Support for NPR and the following message come from the William and Flora Hewlett Foundation, investing in creative thinkers and problem solvers who help people, communities, and the planet flourish. More information is available at Hewlett.org. Let's get into the conversation and meet our guests. Dr. Lucky Seacon joins us from the NPR studio in New York City. She's a double board certified OBGYN and reproductive endocrinologist at RMA of New York. And she's the author of the nationally bestselling book, The Lucky Egg. Dr. Lucky, thanks for joining us. Thank you for having me. Also with us is Sean Tipton.

2:46He's the Chief Advocacy and Policy Officer at the American Society for Reproductive Medicine. That's a nonprofit that works to advance care, infertility, and reproductive health through education, research, and advocacy. Sean, welcome to the program. Thank you. Happy to be here. So let's start with some recent news. Earlier this month, the TrumpRx site launched, as we said, with an emphasis on medication designed to address infertility. Four out of the 43 medications available on the website are for IVF treatment. The administration is pushing to make these treatments more accessible. But before winning a second term election, Trump actually promised to make IVF free.

3:21As part of our efforts to help working families, I'm announcing today in a major statement that under the Trump administration, your government will pay for or your insurance company will be mandated to pay for all costs associated with IVF treatment fertilization for women. IVF treatment. Because we want more babies, to put it very nicely. Sean, what has President Trump said and done about making IVF free? Well, he has said a lot and done only a bit. So as the clip you just paid indicated, he promised both during the campaign and in the early days of the administration that they would take steps to ensure that everybody in America had access to the infertility treatments they may need.

4:13What he has accomplished is a discount on a piece of it. So it is, you know, I don't want to take away from what will be some legitimate savings, but they're not extensive. So it is, you know, a 10 or 20 % savings on 10 or 20 % of the total cost. So it's something, but it is very, very far removed from the promises that he has made. And who's able to access these medications on the TrumpRx site? Well, as I understand it, any American can access the medications if you get a prescription from your physician that says you need these drugs. And, you know, then the way it works is you take the prescription, you go to the TrumpRx site, you see the pharmaceutical product you need.

4:56And essentially, they print you out sort of like a coupon that you can then take to take to your local drugstore if they're taking. And, you know, many pharmacy pharmacies have announced they're going to match the prices that are available on TrumpRx. You know, I think one of the challenges from a macro policy point of view is the pricing of pharmaceutical products, what consumers pay, what patients pay, is incredibly idiosyncratic. That is, you know, what you pay depends on do you have insurance? Does your insurance cover? Does it cover this specific medication? What dose do you need? So when people ask how much are these savings available for Trump Rx, it's almost an impossible question to answer broadly.

5:36It's going to depend on your specific circumstances. Dr. Lucky, what are you telling your patients about the new offerings through TrumpRx?

5:43Joshua Johnson:Well, I think it really can be advantageous, particularly for patients that don't have insurance coverage for medications. I think, you know, if you're paying out of pocket, there can be significant savings. It's not going to cover all of the medications that we use for various treatments. But there are three key medications that are often used as part of ovarian stimulation before an egg retrieval, whether you're freezing eggs or doing IVF. and there can be upwards of 60 % to 80 % reduction in price if you're paying out of pocket. But some people have insurance coverage, in which case this isn't going to be much of an advantage anyway.

6:18Joshua Johnson:And there are also external discount programs that you may be eligible for. So I think it's really about kind of price shopping or comparing and really understanding what your situation is to understand if it's an advantage and something that you should rely on. Well, we got this message from a member of our tax club. My daughter is 21 and has had issues since the start with her cycle. We are considering freezing her eggs for her future. I checked into it, and given the costs here in the U.S., we will try to have it done in Europe. She's a dual citizen. If low birth rates are such a concern, maybe more affordability would help.

6:53It's prohibitive for an average earner. Now, freeze.health is a website that helps women find prices for clinics around the world. And according to the site, a single cycle of egg freezing can cost$12 ,000 to$13 ,000 on average. And as we mentioned earlier, the cumulative cost for fertility treatment can reach into the tens of thousands of dollars. Sean, why is this treatment so expensive? Well, I think it's important to understand that medical treatments cost money. And one of the reasons IVF has this reputation as being expensive is because we have allowed the insurance industry and the employers who pay for them to somehow decide we're not going to cover this particular disease.

7:31We wouldn't allow them to say, you know what, I'm sorry to hear you broke your femur, but we're not going to cover that. But we let them do this for infertility. And I think it's immoral and unjust and the greed from these companies. And it shouldn't be allowed. And that's why we were so happy to hear candidate Trump and President Trump say he was going to address this with mandatory insurance. That has not happened. We're hoping it will. We think next month, we're going to see an introduction of a bipartisan bill in Congress to force insurance companies to do the right thing and actually cover people who have a disease.

8:03Well, at the beginning of January, many insurers in California must start covering fertility treatments, including IVF. So describe the landscape of state mandates for us, Sean, when it comes to insurance coverage for fertility treatments, because there are some states that require that coverage. Yeah, it's important. Yes, there are about 15 states who have some kind of mandatory insurance. However, it's important to understand that that doesn't cover everybody. Number one, it's not going to cover people who don't have insurance or who rely on, for example, most Medicaid plans don't cover anything.

8:36And there is a federal law that regulates large multi-state employers' insurance plans. Those are exempt from all these state mandates. And all the state mandates include an exemption for small employers, religious employers, et cetera. So the state mandates are important. That California mandate is going to bring tremendous increases in the availability of coverage for people in California, but it's not going to cover everybody yet. Dr. Lucky, what do you tell your patients about how to consider the financial costs of their fertility treatment journey? Because for some people, that journey is a long one.

9:14Joshua Johnson:Yes, and this is why I work in a multidisciplinary fashion. I have a team that specifically are experts in interpreting the fine print of an insurance policy. I have a financial coordinator where they're meeting with my patient after our consultation. And that way, the patient is really clear up front and understands the costs of the treatments that are being proposed in a transparent way. Sometimes certain policies will dictate the medicine, which is something we're seeing slowly going away, which is something I'm encouraged by. But it is a frustrating problem that when we're presenting patients with various treatment options, some plans may say, well, you have to do three or four rounds, maybe up to six rounds of this more laid back treatment option before we'll consider covering IVF.

10:09Joshua Johnson:and they'll have patients do things in a stepwise fashion, even if we as the doctor are really saying, no, this patient needs to go straight to IVF given their family building goals or their diagnosis. And we spend a lot of our time outside of clinical care talking directly with insurance companies and talking with their medical directors and trying to advocate for our patients and appeal their decision to deny treatment. Very briefly, Dr. Luckey, people use the term IVF to commonly refer to fertility treatment. But help us be a little bit more specific with our language. When we're talking about treatment to aid in pregnancy, what could fit under that umbrella?

10:47Joshua Johnson:So there's really two buckets of treatment when you think about various ways to try to overcome the many different causes of infertility. One of the biggest causes of infertility when patients come to us is what I like to call the inefficiency of human reproduction. We know that when you ovulate one egg, it's kind of a long shot. And it is possible to, before IVF, say, I'm going to just help you ovulate regularly. I'm going to boost your ovulation. So maybe you ovulate more than one egg. And we put sperm closer to where the eggs are being ovulated. That's called medicated IUI or intrauterine insemination.

11:21Joshua Johnson:It has a lower efficacy. It takes longer to get people pregnant. But it's a more laid back approach that's cheaper when considering out-of-pocket costs and comparing them to IVF. Well, let's pause for just a quick moment for a break. and then we'll talk about what's in that second bucket of treatment. And we'll also be joined by an embryologist to answer your questions about egg freezing, IVF, and more. That's just ahead.

11:48Let's get back to our conversation and bring in a new voice. Joining us from North Carolina is Elise Barnes. She's an embryologist with a background in genetics. Elise, welcome to the program. Hi, thank you for having me. Dr. Lucky, I want you to finish your thought about these two buckets of treatment for infertility. And you started with what you call the more laid-back approach, which includes intrauterine insemination. What's in that second bucket?

12:13Joshua Johnson:Yes. So medicated IUI is kind of like speed dating for your reproductive tract. More eggs, more sperm. You're hoping for a meeting to take place that's successful. IVF is akin to an arranged marriage. You're trying to control many more aspects to the process. So it starts with a egg retrieval cycle, and that's where you're taking shots, medications that mimic the natural signal your brain sends to your ovary to get you to mature and ovulate one egg, but at a higher level. So we're trying to capture a bunch of other eggs that happen to be available in that cycle. They're transient. They would be thrown away if you didn't remove them anyway.

12:47Joshua Johnson:And we're salvaging them, and we're removing them in a very minimally invasive procedure that takes 10 minutes or less under sedation. and we take the eggs outside the body and then we fertilize them outside the body. That's what in vitro fertilization means. We can turn them into embryos. We can grow them for up to a week. We can at that point transfer it into a woman's uterus. We can choose to freeze them and not transfer them until later. We can genetically test them at that point and then freeze the embryos and wait for the results to come back. And we do that by biopsying and removing a small part of the outer part of the embryo.

13:23Joshua Johnson:And then we put an embryo in the uterus, and you're basically bypassing if there's blockages in the fallopian tubes, if there's a low sperm count. It can be a very direct way to overcome very specific issues, but it's also very helpful, especially in older women where we know that there can be an accumulation of genetic errors in the embryos because we are able to screen those out and maximize the chance of an embryo implanting and lower the risk of miscarriage. Well, Elise, I want to turn to your work because many people may not be familiar with what an embryologist does. What does your work entail?

13:56Yeah, so some of the things that Dr. Seacon mentioned, you know, when they're performing that egg retrieval, we are the ones on the other side of the wall looking for those eggs in that follicular fluid. We are the ones culturing embryos out that entire week. We perform the embryo freezing, the embryo thaw, and the embryo biopsy that is then used for genetic testing. So we're doing a lot of the lab work behind the scenes in collaboration with providers. And what goes into the decision about whether an embryo is suitable for implantation, Elise? So we really want to see it reach a certain stage of development.

14:34We want to see it reach that blastocyst stage if we're doing a day five transfer. And then we're looking at the grade. So oftentimes we're grading embryos based on the different components. We're able to see which parts of the embryo will become the placenta and which parts will become the fetus. And we give those a grade based on visuals, but that's not the end-all be-all. It doesn't give us all the information we would need to say for sure whether an embryo is going to make a baby. So while we're doing the best that we can to choose the best embryo for transfer, it doesn't guarantee that that embryo will actually implant and create a healthy pregnancy.

15:12Dr. Lucky, according to reporting from Axios and data from the CDC, see more new moms are having kids alone in their 40s. And rates of unmarried women, 40 and over, have doubled since 2007. So how are you seeing the demographics of your patients shift?

15:28Joshua Johnson:Yes, I'm definitely seeing a lot more patients come in as single women and they say, you know, I've achieved the pinnacle of my career. I haven't found the person that I may want to settle down with, you know, on the relationship front. But I know I want to be a mother and I'm ready to have that conversation now. And I'm open to exploring doing so with donor sperm, whether it be a known donor, a friend, someone in their life that they want to have screened as a donor, or if they want to go through a sperm bank. And that is definitely something we're seeing a lot more of. I will say over the years, a higher proportion of my practice has become helping women freeze eggs or helping couples freeze embryos or single women freeze embryos using donor sperm.

16:13Joshua Johnson:You know, sometimes I joke with my team, my clinical team, like, does anyone want to get pregnant anymore? Because sometimes my entire schedule is filled with people that aren't really ready right now, but are wanting to plan for the future. And I think that's definitely a function of where I live, you know, where my office is located, and there's a lot of young professionals. But it is something that we're seeing a lot more of now because there is more comfort around the idea of egg freezing. The label calling it experimental was lifted by the ASRM in 2013. And since then, we've had many live births and our experience and our comfort level around this is improving.

16:54Joshua Johnson:And, you know, as it becomes more and more successful, which is also a function of people knowing about it and doing it at a younger age and therefore getting more eggs that tend to be healthier. I think, you know, there is going to be, I think the interest around this is just going to continue to grow. I want to talk a little bit more about egg freezing, but first we got this email from John who says, when my wife and I were in our late 30s, we began looking into infertility treatments. She went through several rounds of various treatments before the physical and emotional toll were too much.

17:24After a break and many conversations, we decided to adopt. We are in our early 40s now and have had almost two years with the thin four-year-old who found us. We couldn't be happier. We also got this from Ron in Dallas, who emails, IVF is an elective procedure and it is perfectly reasonable for insurance to decline to cover it. If it does, should insurance also cover any costs associated with adoption? Sean, I'd love your response to that. Often patients needing IVF are there because they're suffering from the disease of infertility, I have this naive view that health insurance is designed to cover people's health problems.

18:00So yes, you are not going to drop dead if you don't have a child, but I think there's no more basic human function than reproducing. And if you've got a disease that prevents that from happening, of course health insurance should provide for that. Well, and Dr. Lucky, just explain a bit more about some of the underlying causes for infertility, knowing that that varies from patient to patient?

18:24Joshua Johnson:Yes, there can be male factor, meaning problems with sperm quality, whether there's not enough sperm being produced or they can't swim in a forward direction. 50 % of couples with infertility have a male component to it. The other 50 % has a female component, and that can be stemming from problems with egg quality. This may be age-related because we all have a biological clock. There can be blockages in the fallopian tubes where there is no other option other than IVF to bypass those blockages. If there is a low sperm count, one of the ways we work around that is by fertilizing the eggs directly with one sperm cell at a time.

19:01Joshua Johnson:And then there are also people that have known genetic predispositions to miscarriages. These are called translocations in their chromosomes. Or maybe they carry a genetic disease that they want to stop. They want to stop the propagation of that into future generations. So there's many different reasons why people go through IVF, but those are some of the high-level causes. I also think PCOS and endometriosis are very common gynecologic disorders that are highly prevalent and underdiagnosed, and those are often a major component in our patients' infertility cases. So, Elise, when people turn to egg freezing, and again, this is something that's on the rise, walk us through that procedure.

19:42Yeah. So after stimulation, a week and a half or so of injectable hormonal medication, they're then put under anesthesia to have a physician remove the eggs from the ovary. And then they're sent to us in the lab. So then we're looking through that follicular fluid to find the eggs. We are then cleaning them up and preparing them for the egg freezing process. And then we actually walk them through a stepwise approach of different types of media. And then they are frozen rapidly in liquid nitrogen and can be stored in that liquid nitrogen basically for the foreseeable future. And Dr. Lucky, when you talk about egg freezing with a patient, what do you share with them about the length of time that those eggs can remain frozen but still viable?

20:34Joshua Johnson:Well, I tell them what the data shows, which is the duration of time that the eggs remain frozen and stored has no bearing on their ability to thaw successfully or turn into an embryo or to result in a pregnancy. There have been pregnancies from donated eggs that were frozen over 20 years ago. The technology has shifted. And in the past, you know, 10 to 15 years, we are using a much better approach called vitrification, which is flash freezing. It has allowed for less formation of ice crystals, which were damaging to egg cells. They're single cells and they're very fragile. And so that has really improved the survival rates and pregnancy rates.

21:18Joshua Johnson:But, you know, it's a great technology, but it's not perfect. And I think a huge part of the conversation I have with patients is not just describing the procedure and how it could potentially help them extend their window of opportunity to have children later down the line. And also the fact that their uterus doesn't age, right? So their ability to have an embryo implant isn't really as dependent on their age as, you know, the issue of egg quality is. But it's really important for them to realize that human reproduction is inefficient. And when you go through this high-tech process, no matter how much effort and expense goes into it, you're still working within the confines of this very inefficient system.

21:55Joshua Johnson:And not every egg is capable of thawing and turning into a healthy embryo. So it's important to talk about those numbers and give them a realistic outlook. And they need to be able to accept some of the unknowns that come along with the egg freezing process because it's inherent to this procedure. And, Sean, what does insurance coverage look like when it comes to egg freezing, but also the storage that has to take place once those eggs are retrieved? Insurance is very, very limited for gamete preservation, whether egg freezing or sperm freezing, for example, for men who undergo testicular cancer treatments.

22:30It's unfortunate. I mean, look, we are struggling to get appropriate coverage for people with a very clear disease of infertility. So I think getting this kind of coverage for gamete preservation or embryo preservation is going to take a while longer. Well, that's Sean Tipton. He's the Chief Advocacy and Policy Officer at the American Society for Reproductive Medicine. Sean, thanks for speaking with us. Happy to be here. Now let's go to a voicemail we got from one of you. Hi, my name is Chrissy. I live in Raleigh. I was diagnosed with breast cancer at age 33. And one of the first questions they asked me was if I wanted more children.

23:13and we knew we did and so before starting chemo I did the fertility treatments and was able to retrieve 15 viable eggs that we froze and ultimately used one of them to have our baby daughter and it has been such a joy to be able to experience having another baby after having such a difficult time with cancer. I'm so grateful that we were able to do that. We also heard from Robert in Tennessee who says, I was dealing with prostate cancer in 2025. My urologist suggested that prior to having the removal of surgery that causes a man to become sterile, I may want to freeze some sperm for future use.