Since in vitro fertilization was invented nearly 50 years ago, at least 10 million children who would not otherwise exist have been brought into the world. New constellations of families — older moms, same-sex parents, single dads — have flourished. This is one of the major scientific success stories of modern life. But despite these advances, I.V.F. in the United States today is far from a sure path to parenthood. Fertility care is still so unevenly available that it feels almost like entering a lottery, in which the state you call home, the company that employs you or your relationship status determines whether you become a parent.
Access to fertility care is not a niche problem. The ranks of the infertile, already estimated at one in six people of reproductive age globally, are poised to grow: One recent study estimated that as more women worldwide age and delay childbearing, infertility cases among women over 35 will increase by nearly 50 percent by 2036.
In the United States the rising number of births to women over 40 masks the fact that many others in the same cohort fail to get pregnant — and that delaying parenthood is often a downstream effect of the greater time and effort it now takes to establish middle-class stability. Queer and single people, also growing demographics, need assistance getting pregnant, too. As more people seek fertility treatment, this necessary care remains out of reach for a significant share of the population.
The choice to become a parent is profoundly personal. All people, not just couples who are heterosexual and fertile, should have the ability to make this decision for themselves. So what if we thought of starting a family as a fundamental human experience that should be available to all? What if we extended the ability to have a family — one that many possess as a matter of good fortune — into a basic human right?
The desire for a child comes from somewhere deep and unfathomable. Many people will risk upending their lives for the chance to try to have a baby, and success is nowhere near guaranteed. They seek out strangers online for sperm donation. They max out credit cards, start GoFundMe campaigns or take out loans through fertility lenders like Future Family, which has extended upward of $200 million in credit since 2016. People apply for baby scholarships or grants from charities to help pay for fertility care. They give away half their eggs in exchange for the chance to freeze some of their own for free. They wait for years to adopt. They go to countries where fertility treatment is one-third to half the American cost. I traveled to Europe twice to freeze my eggs and a third time for I.V.F., all for less than the price of a single I.V.F. cycle in New York City.
“People scrimp and save; sometimes they take second mortgages out, go into I.R.A.s, all sorts of things like that,” Dr. Jonathan Van Blerkom, who helped invent a simplified I.V.F. system designed to lower costs, told me. “And if they don’t get pregnant, which many don’t even in the best programs, they don’t have the baby — but they still have the debt.”
There is increasing institutional and political recognition that more people need help to build their families. In 2023 the American Society for Reproductive Medicine expanded its definition of infertility to acknowledge same-sex couples and single people. This year, at least five states have introduced bills requiring insurance plans serving large employers to cover I.V.F. If passed, they would add to the 25 states that currently require insurance plans to provide at least some level of fertility care and the 15 that require coverage of I.V.F.
