On the campaign trail this week, former President Donald Trump pledged to make in-vitro fertilization free if elected in November. Trump spoke about his plan during a rally.

“I’ve been looking at it and what we’re going to do is, for people that are using IVF – which is fertilization – the government is going to pay for it or mandate your insurance company to pay for it, which is going to be great,” Trump said.

Infertility rates are rising around the world and the cost of IVF in the U.S. can be a huge barrier to treatment. The American Society for Reproductive Medicine estimates that fewer than a quarter of infertile couples have sufficient access to infertility care. 

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The cost of a single cycle in the U.S. can run $20,000-$25,000, and many families need multiple cycles to achieve a live birth. Studies show an IVF cycle in the U.S. is 271% more expensive than the mean cost in 25 other countries. 

“We want to produce babies in this country, right?” Trump said.

The U.S. fertility rate has been at or below replacement levels for more than 50 years. The official replacement rate is 2.1 births per woman. The U.S. currently sits at less than 1.7 births per woman.

And this story is not unique. All but one developed nation struggles with low birth rates. The main concern is this will eventually put a major strain on economies as fewer working-age people will be around to contribute. 

That is why this campaign season, candidates are talking more about policies like free IVF and baby bonuses, and the U.S. is far behind on this train.

The vast majority of European countries offer public funding for IVF. For instance, in France, the national health plan covers up to four IVF cycles per child.

In China, where the birth rate is even more dismal than in the U.S., the government agreed in 2023 to offer free fertility treatments.

And in the one developed country in the world where fertility is robust, IVF is free there too.

“It’s an unlimited number of treatments, up to the second child, so long as the mother is below age 45,” Alex Weinreb, a demographer and Research Director at the Taub Center for Social Policy Studies in Israel, said. “It’s quite generous.”

Israel’s fertility rate is the envy of developed countries at 2.9 births per woman. But because its birth rate is already so high, Weinreb said free IVF has less effect. 

“If Israel’s fertility was low, then the effect would be larger, but as of now, about 5% or so of births in Israel in any given year, they stem from IVF,” Weinreb said.

So why pay for the program at all? Weinreb said it is all about what the program communicates.

“I think the more important thing in Israel, or in the Israeli context, is it sends a message that the state is supporting women and men’s desire to have children,” Weinreb said.

Trump quickly took his message of free IVF to the campaign trail but with little detail on how he would pay for universal fertility treatments or force insurance companies to cover the cost.