Access to Fertility Care: Findings from the 2024 KFF Women’s Health Survey

Key Takeaways

• One in eight (13%) reproductive age women say they or their partner have ever needed fertility services to help them become pregnant or prevent a miscarriage. Similar shares of women across party lines report needing fertility care at some point.
• However, a smaller share say they have actually received services. One in ten women ages 18 to 49 say they or their partner have received fertility assistance, but 3% of women say they were unable to get the fertility care they needed. Most reproductive age women (87%) say they have never needed fertility services.
• Cost is the leading reason why women say they could not obtain the fertility care they need. Higher shares of women with low incomes report cost as the main barrier compared to those with higher incomes.
• The fertility services that reproductive age women most commonly use are fertility advice, fertility testing, and medications to improve ovulation. Among women who say they or their partner ever needed fertility care, 14% report they received in-vitro fertilization (IVF), and 14% report they received artificial insemination (IUI), which translates to 2% of all reproductive age women who report ever receiving either service.
• One-third (32%) of reproductive age women say it is difficult to access infertility services in their state. Nearly half of women who have ever needed infertility services (48%) say it is difficult to get care in their state, compared to 30% of those who have never needed infertility services.

Fertility care, particularly in vitro fertilization (IVF), came into the spotlight earlier this year when the Alabama Supreme Court issued a ruling declaring that embryos created during the IVF process are “unborn children.” The decision sparked widespread outrage and attention over the role of fetal personhood policies in limiting care for a range of reproductive health care services beyond abortion, including some contraceptives and fertility assistance. IVF has also become an issue on the presidential campaign trail.

The 2024 KFF Women’s Health Survey provides new data on access to fertility care, including women’s opinions about access in their state, cost barriers, and the range of fertility services that women use. The survey was conducted from May 13 – June 18, 2024, online and by telephone among a nationally representative sample of 6,246 adults ages 18 to 64, including 3,901 women ages 18 to 49. This paper presents data among women ages 18 to 49.

Need for Fertility Care and Cost Barriers

One in eight (13%) women ages 18 to 49 say they or their partner needed fertility assistance services at some point. Nationally, 13% of reproductive age women report needing fertility services to become pregnant or prevent a miscarriage at some time in their lives (Figure 1). Higher shares of women ages 36 to 49 (18%) report ever needing fertility services at some point, compared to 4% of women ages 18 to 25 and 13% of those ages 26 to 35.

The need for fertility care is similar across most other demographic groups, except slightly lower among Black women (9%) compared to their White counterparts (14%). Similarly, 10% of women with lower incomes report needing fertility services, slightly less than women with higher incomes (15%). The survey finds that similar shares of women across party lines report needing fertility care at some point. Similar shares of lesbian/gay women (12%), bisexual women (12%), and non-LGB women (14%) report needing fertility services at some point to become pregnant or prevent a miscarriage. Compared to women who do not follow any religion in particular (11%), higher shares of those who identify as Protestants (16%) or some other religion (16%) report ever needing fertility assistance.

Among all reproductive age women, one in ten say they or their partner have received fertility services at some point. One in ten women have received fertility services, while 3% say they needed services but were not able to obtain it (Figure 2). While a relatively small share of women say they could not obtain fertility services, they may not be able to grow their families as desired because they could not get the care they needed. Most reproductive age women (87%) say they have never needed fertility services. This may include women who have not yet tried to become pregnant as well as women who do not want to have children.

The leading reason why women say they didn’t get needed fertility services is cost. This is more commonly reported among women with low incomes.

There are many obstacles to receiving fertility care, including costs, coverage, provider availability, and time constraints. However, cost is by far the single largest barrier. Among reproductive age women who reported needing fertility services at some point, 12% (2%of all reproductive age women) say they did not receive these services and cost was the primary reason (Figure 3). Not surprisingly, this is more common among women with lower incomes. Among women who said they ever needed fertility services, a quarter (24%) with lower incomes cite cost as the main reason they could not obtain fertility services, compared to 6% of women with higher incomes. Overall, this represents 2% of all reproductive age women with low incomes and less than 1% of those with higher incomes who say they did not obtain fertility services because of cost.

Coverage for fertility services is limited in both private insurance and Medicaid. The 2024 KFF Employer Health Benefits Survey finds that about a quarter (27%) of large firms that offer health benefits cover IVF services. Some states require state-regulated private insurers to cover some level of fertility services, but Medicaid, the health coverage program for people with lower incomes, rarely covers fertility services. In fact, federal law exempts state Medicaid programs from a requirement to cover fertility medications, which is different from most other outpatient prescription drugs which typically must be covered by the program.

There is a wide range of services that people may use for fertility assistance and the costs vary widely too, with the most expensive services exceeding thousands of dollars on average, which makes them out of reach for most people, particularly those with lower incomes and those with limited or no insurance coverage.

Types of Fertility Services

The leading fertility services that women report receiving are advice, testing, and drugs to improve ovulation.

Fertility assistance encompasses a broad array of services, including advice and counseling, medications, surgical procedures, diagnostic tests, imaging studies, cryopreservation, intrauterine insemination (IUI), in-vitro fertilization (IVF), and surrogacy. Depending on individual circumstances, people may use a variety of these services to become pregnant and/or to prevent miscarriages, particularly if they have a history of or are at higher risk for pregnancy loss. The costs of services also vary greatly.

Among the 13% of reproductive age women who ever needed fertility services, about half said they received advice (50%) or testing for themselves or their partner (45%), and more than a third (38%) received drugs (e.g. clomid, hormones, etc.) to improve ovulation (Figure 4). Just over one in ten (12%) women said they had a corrective surgery or drugs to address an issue such as fibroids or endometriosis. Among all reproductive age women, the shares who have used these services are smaller and presented in Figure 4 and Appendix Table 1.

Among the one in eight reproductive age women who said they or their partner ever needed fertility services, 14% report they received IVF, and 14% report they received artificial insemination, also known as IUI. This translates to 2% of all reproductive age women who report receiving IVF or IUI.

IVF is a medical procedure where a sperm and egg are combined in a lab setting to create an embryo, which is then placed in the uterus. While a relatively small share of people ever use IVF or IUI, many seek these services after trying a range of other services such as medications, acupuncture, and surgeries. The IVF process is complex and can involve several procedures, including egg freezing, which 7% of women who needed fertility services said they received. Costs for a single course of IVF average between $9,000 and $14,000, and many people require multiple rounds. Insurance coverage of IVF is limited in private insurance and nearly non-existent for those covered by Medicaid, making it unaffordable for many people. Some grant programs are available to help offset costs, but they are limited and only reach a relatively small portion of people in need of services.

Artificial insemination, also known as Intrauterine insemination (IUI) is another fertility procedure that involves injecting sperm into the uterus. It is less invasive and less expensive than IVF, and some people choose it for those reasons.

In the wake of public outrage at the Alabama court ruling, politicians across parties have said they want to promote greater access to IVF, including former President Donald Trump who has said that he would provide access to full coverage of IVF costs if elected President through a mandate on insurance companies and federal funding. At the same time, a federal proposal to guarantee a right to IVF access across the country failed to pass in the U.S. Senate twice in 2024, with opposition from nearly all Republican members, including Vice Presidential Nominee JD Vance during the first IVF vote in June.

Smaller shares of women with lower incomes report receiving fertility services.

Fertility services can be very costly, and women with lower incomes report using many services at lower rates compared to those with higher incomes (Figure 5). Among the 13% of reproductive age women who needed fertility services, one-third of women with lower incomes say they received advice, compared to nearly six in ten women with higher incomes (59%). About one in four women with lower incomes who needed fertility services say that have used drugs for ovulation (28%) and testing services for themselves or a partner (25%), which is lower than women with higher incomes (44%and 56% respectively). Eight percent of women with low incomes who have ever needed fertility services say they received IVF, compared to 17% of women with higher incomes. Similarly, smaller shares of women with low incomes who needed fertility services (4%) report receiving IUI compared to those with higher incomes (18%).

Women’s Perceptions on Access to Fertility Services

One-third of women ages 18 to 49 say it is difficult to access infertility services in their state.

One-third of women of reproductive age say it is difficult (32%) to access infertility services in their state. A smaller share say it is easy (19%), while almost half (48%) do not know, likely because 93% of this group (data not shown) say they have never needed such care. Notably, among women who say they have needed fertility care at some point, almost half (48%) characterize access as difficult (Figure 6).

Cost stands out as the single largest barrier to fertility care, and across the board, access to the range of fertility services is lower among people with lower incomes. There are no federal requirements to cover fertility services in insurance plans. Some states have enacted fertility coverage requirements, but their reach is limited and piecemeal. Former President Trump has said that if elected, his administration would require full coverage for the costs of IVF, but this would not be possible without Congress passing a law. This seems unlikely given the two failed attempts to pass a law recognizing the right to IVF services.