Editing In vitro fertilisation (section)

==Availability and utilisation==

=== Cost ===
Costs of IVF can be broken down into direct and indirect costs. Direct costs include the medical treatments themselves, including doctor consultations, medications, ultrasound scanning, laboratory tests, the actual IVF procedure, and any associated hospital charges and administrative costs. Indirect costs includes the cost of addressing any complications with treatments, compensation for the [[Gestational surrogacy|gestational surrogate]], patients' travel costs, and lost hours of productivity.<ref>{{cite report |url=https://www.gov.ie/en/publication/af2460-health-research-board-report-assisted-reproductive-technologies-inte/?referrer=/blog/publications/health-research-board-report-assisted-reproductive-technologies-international-approaches-to-public-funding-mechanisms-and-criteria-an-evidence-review/ |title=Assisted reproductive technologies: international approaches to public funding mechanisms and criteria. An evidence review. |date=2017 |publisher=Health Research Board |location=Dublin |vauthors=Keane M, Long J, O'Nolan G, Faragher L}}</ref> These costs can be exaggerated by the increasing age of the woman undergoing IVF treatment (particularly those over the age of 40), and the increase costs associated with multiple births. For instance, a pregnancy with twins can cost up to three times that of a singleton pregnancy.<ref name="Chambers_2013">{{cite journal |vauthors=Chambers GM, Adamson GD, Eijkemans MJ |date=August 2013 |title=Acceptable cost for the patient and society |journal=Fertility and Sterility |volume=100 |issue=2 |pages=319–27 |doi=10.1016/j.fertnstert.2013.06.017 |pmid=23905708|doi-access=free }}</ref> While some insurances cover one cycle of IVF, it takes multiple cycles of IVF to have a successful outcome.<ref name="kff2022">{{Cite web |date=15 September 2020 |title=Coverage and Use of Fertility Services in the U.S. |url=https://www.kff.org/womens-health-policy/issue-brief/coverage-and-use-of-fertility-services-in-the-u-s/ |access-date=30 November 2022 |website=KFF |language=en-US |vauthors=Weigel G, Ranji U, Long M}}</ref> A study completed in Northern California reveals that the IVF procedure alone that results in a successful outcome costs $61,377, and this can be more costly with the use of a donor egg.<ref name="kff2022" />

The cost of IVF rather reflects the costliness of the underlying healthcare system than the regulatory or funding environment,<ref name="fs">{{cite journal |vauthors=Chambers GM, Sullivan EA, Ishihara O, Chapman MG, Adamson GD |date=June 2009 |title=The economic impact of assisted reproductive technology: a review of selected developed countries |journal=Fertility and Sterility |volume=91 |issue=6 |pages=2281–2294 |doi=10.1016/j.fertnstert.2009.04.029 |pmid=19481642 |doi-access=free}}</ref> and ranges, on average for a standard IVF cycle and in 2006 United States dollars, between $12,500 in the United States to $4,000 in Japan.<ref name="fs" /> In Ireland, IVF costs around €4,000, with fertility drugs, if required, costing up to €3,000.<ref>{{cite web |date=23 September 2009 |title=Call for infertility care awareness |url=http://www.rte.ie/news/2009/0923/fertility.html |work=RTÉ News}}</ref> The cost per live birth is highest in the United States ($41,000<ref name="fs" />) and United Kingdom ($40,000<ref name="fs" />) and lowest in Scandinavia and Japan (both around $24,500<ref name="fs" />).

The high cost of IVF is also a barrier to access for disabled individuals, who typically have lower incomes, face higher health care costs, and seek health care services more often than non-disabled individuals.<ref name="ncd.gov">{{Cite web |date=3 August 2015 |title=Chapter 11: Assisted Reproductive Technologies |url=https://ncd.gov/publications/2012/Sep272012/Ch11 |access-date=7 December 2021 |website=ncd.gov |language=en |archive-date=25 November 2021 |archive-url=https://web.archive.org/web/20211125233111/https://ncd.gov/publications/2012/Sep272012/Ch11/ |url-status=dead }}</ref>

Navigating insurance coverage for transgender expectant parents presents a unique challenge. Insurance plans are designed to cater towards a specific population, meaning that some plans can provide adequate coverage for gender-affirming care but fail to provide fertility services for transgender patients.<ref name="Learmonth2018">{{cite journal |vauthors=Learmonth C, Viloria R, Lambert C, Goldhammer H, Keuroghlian AS |date=September 2018 |title=Barriers to insurance coverage for transgender patients |journal=American Journal of Obstetrics and Gynecology |volume=219 |issue=3 |pages=272.e1–272.e4 |doi=10.1016/j.ajog.2018.04.046 |pmid=29733842 |s2cid=205373980}}</ref> Additionally, insurance coverage is constructed around a person's legally recognised sex and not their anatomy; thus, transgender people may not get coverage for the services they need, including transgender men for fertility services.<ref name="Learmonth2018" />

=== Use by LGBT individuals ===

==== Same-sex couples ====
In larger urban centres, studies have noted that lesbian, gay, bisexual, transgender and queer (LGBTQ+) populations are among the fastest-growing users of fertility care.<ref>{{cite journal |vauthors=Kirubarajan A, Patel P, Leung S, Park B, Sierra S |date=May 2021 |title=Cultural competence in fertility care for lesbian, gay, bisexual, transgender, and queer people: a systematic review of patient and provider perspectives |journal=Fertility and Sterility |language=English |volume=115 |issue=5 |pages=1294–1301 |doi=10.1016/j.fertnstert.2020.12.002 |pmid=33610322 |s2cid=231990647 |doi-access=free}}</ref> IVF is increasingly being used to allow lesbian and other LGBT couples to share in the reproductive process through a technique called [[reciprocal IVF]].<ref>{{Cite news |date=14 February 2018 |title=Shared motherhood: The amazing way lesbian couples are having babies |work=Cosmopolitan |url=https://www.cosmopolitan.com/uk/love-sex/relationships/a17851346/how-lesbian-couples-have-babies/ |access-date=21 March 2018}}</ref> The eggs of one partner are used to create embryos which the other partner carries through pregnancy. For gay male couples, many elect to use IVF through gestational surrogacy, where one partner's sperm is used to fertilise a donor ovum, and the resulting embryo is transplanted into a surrogate carrier's womb.<ref>{{Citation |title=Gay Men and Surrogacy |date=2020 |url=https://doi.org/10.1007/978-3-030-35610-1_8 |work=LGBTQ-Parent Families: Innovations in Research and Implications for Practice |pages=143–160 |access-date=30 November 2022 |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-030-35610-1_8 |isbn=978-3-030-35610-1 |vauthors=Berkowitz D |veditors=Goldberg AE, Allen KR}}</ref> There are various IVF options available for same-sex couples including, but not limited to, IVF with donor sperm, IVF with a partner's oocytes, reciprocal IVF, IVF with donor eggs, and IVF with gestational surrogate. IVF with donor sperm can be considered traditional IVF for lesbian couples, but reciprocal IVF or using a partner's oocytes are other options for lesbian couples trying to conceive to include both partners in the biological process. Using a partner's oocytes is an option for partners who are unsuccessful in conceiving with their own, and reciprocal IVF involves undergoing reproduction with a donor egg and sperm that is then transferred to a partner who will gestate. Donor IVF involves conceiving with a third party's eggs. Typically, for gay male couples hoping to use IVF, the common techniques are using IVF with donor eggs and gestational surrogates.<ref name="Bayer2017">{{Cite book |url=https://www.taylorfrancis.com/books/edit/10.4324/9781351241496/boston-ivf-handbook-infertility-steven-bayer |title=A Practical Guide for Practitioners Who Care for Infertile Couples, Fourth Edition |vauthors=Bayer SR |year=2017 |publisher=CRC Press |isbn=9781351241496 |veditors=Bayer SR, Alper MM, Penzias AS |doi=10.4324/9781351241496}}</ref>

==== Transgender parents ====
Many LGBT communities centre their support around cisgender gay, lesbian and bisexual people and neglect to include proper support for transgender people.<ref>{{cite journal |vauthors=Hoffkling A, Obedin-Maliver J, Sevelius J |date=November 2017 |title=From erasure to opportunity: a qualitative study of the experiences of transgender men around pregnancy and recommendations for providers |journal=BMC Pregnancy and Childbirth |volume=17 |issue=Suppl 2 |pages=332 |doi=10.1186/s12884-017-1491-5 |pmc=5688401 |pmid=29143629 |doi-access=free }}</ref> The same 2020 literature review analyses the social, emotional and physical experiences of pregnant transgender men.<ref name="Besse2020" /> A common obstacle faced by pregnant transgender men is the possibility of [[gender dysphoria]]. Literature shows that transgender men report uncomfortable procedures and interactions during their pregnancies as well as feeling misgendered due to gendered terminology used by healthcare providers. Outside of the healthcare system, pregnant transgender men may experience gender dysphoria due to cultural assumptions that all pregnant people are cisgender women.<ref name="Besse2020" /> These people use three common approaches to navigating their pregnancy: passing as a cisgender woman, hiding their pregnancy, or being out and visibly pregnant as a transgender man.<ref name="Besse2020" /> Some transgender and gender diverse patients describe their experience in seeking gynaecological and reproductive health care as isolating and discriminatory, as the strictly binary healthcare system often leads to denial of healthcare coverage or unnecessary revelation of their transgender status to their employer.<ref>{{Cite journal |display-authors=6 |vauthors=Ghofranian A, Aharon D, Friedenthal J, Hanley WJ, Lee JA, Daneyko M, Rodriguez Z, Safer JD, Copperman AB |date=2 September 2022 |title=Family Building in Transgender Patients: Modern Strategies with Assisted Reproductive Technology Treatment |journal=Transgender Health |volume=9 |issue=1 |pages=76–82 |doi=10.1089/trgh.2021.0210 |pmid=38312448 |pmc=10835155 |issn=2688-4887 |s2cid=252136338}}</ref>

Many transgender people retain their original sex organs and choose to have children through biological reproduction. Advances in assisted reproductive technology and fertility preservation have broadened the options transgender people have to conceive a child using their own gametes or a donor's. Transgender men and women may opt for fertility preservation before any gender affirming surgery, but it is not required for future biological reproduction.<ref name="Besse2020" /><ref>{{cite journal |vauthors=Maxwell S, Noyes N, Keefe D, Berkeley AS, Goldman KN |date=June 2017 |title=Pregnancy Outcomes After Fertility Preservation in Transgender Men |journal=Obstetrics and Gynecology |volume=129 |issue=6 |pages=1031–1034 |doi=10.1097/AOG.0000000000002036 |pmid=28486372}}</ref> It is also recommended that fertility preservation is conducted before any hormone therapy.<ref name="Bayer2017" /> Additionally, while fertility specialists often suggest that transgender men discontinue their testosterone hormones prior to pregnancy, research on this topic is still inconclusive.<ref name="Obedin-Maliver2016">{{cite journal |first1=Juno |last1=Obedin-Maliver |first2=Harvey J |last2=Makadon | title = Transgender men and pregnancy | journal = Obstetric Medicine | volume = 9 | issue = 1 | pages = 4–8 | date = March 2016 | pmid = 27030799 | pmc = 4790470 | doi = 10.1177/1753495X15612658}}</ref><ref name="Besse2020" /> However, a 2019 study found that transgender male patients seeking oocyte retrieval via assisted reproductive technology (including IVF) were able to undergo treatment four months after stopping testosterone treatment, on average.<ref name="Leung2019">{{cite journal |vauthors=Leung A, Sakkas D, Pang S, Thornton K, Resetkova N |date=November 2019 |title=Assisted reproductive technology outcomes in female-to-male transgender patients compared with cisgender patients: a new frontier in reproductive medicine |journal=Fertility and Sterility |language=English |volume=112 |issue=5 |pages=858–865 |doi=10.1016/j.fertnstert.2019.07.014 |pmid=31594633 |s2cid=203983887 |doi-access=free}}</ref> All patients experienced menses and normal AMH, FSH and E<sub>2</sub> levels and antral follicle counts after coming off testosterone, which allowed for successful oocyte retrieval.<ref name="Leung2019" /> Despite assumptions that the long-term androgen treatment negatively impacts fertility, oocyte retrieval, an integral part of the IVF process, does not appear to be affected.

Biological reproductive options available to transgender women include, but are not limited to, IVF and IUI with the trans woman's sperm and a donor or a partner's eggs and uterus. Fertility treatment options for transgender men include, but are not limited to, IUI or IVF using his own eggs with a donor's sperm and/or donor's eggs, his uterus, or a different uterus, whether that is a partner's or a surrogate's.<ref>{{Cite web |last=ColoCRM |title=Transgender Pregnancy Options for Men and Women |url=https://www.ccrmivf.com/transgender-pregnancy-options/ |access-date=7 December 2021 |website=CCRM Fertility |language=en-US}}</ref>

=== Use by disabled individuals ===
People with disabilities who wish to have children are equally or more likely than the non-disabled population to experience infertility,<ref name="ncd.gov" /> yet disabled individuals are much less likely to have access to fertility treatment such as IVF. There are many extraneous factors that hinder disabled individuals access to IVF, such as assumptions about decision-making capacity, sexual interests and abilities, heritability of a disability, and beliefs about parenting ability.<ref name="Silvers 430–437">{{cite journal |vauthors=Silvers A, Francis L, Badesch B |date=April 2016 |title=Reproductive Rights and Access to Reproductive Services for Women with Disabilities |journal=AMA Journal of Ethics |volume=18 |issue=4 |pages=430–437 |doi=10.1001/journalofethics.2016.18.4.msoc1-1604 |pmid=27099193 |doi-access=free}}</ref><ref>{{cite journal |vauthors=Acharya K, Lantos JD |date=April 2016 |title=Considering Decision-Making and Sexuality in Menstrual Suppression of Teens and Young Adults with Intellectual Disabilities |journal=AMA Journal of Ethics |volume=18 |issue=4 |pages=365–372 |doi=10.1001/journalofethics.2016.18.4.ecas2-1604 |pmid=27099185 |doi-access=free}}</ref> These same misconceptions about people with disabilities that once led health care providers to sterilise thousands of women with disabilities now lead them to provide or deny reproductive care on the basis of stereotypes concerning people with disabilities and their sexuality.<ref name="ncd.gov" />

Not only do misconceptions about disabled individuals parenting ability, sexuality, and health restrict and hinder access to fertility treatment such as IVF, structural barriers such as providers uneducated in disability healthcare and inaccessible clinics severely hinder disabled individuals access to receiving IVF.<ref name="ncd.gov" />

=== By country ===

==== Australia ====
In Australia, the average age of women undergoing ART treatment is 35.5 years among those using their own eggs (one in four being 40 or older) and 40.5 years among those using [[donated eggs]].<ref>{{cite web | url = http://www.theaustralian.news.com.au/story/0,25197,26117922-12377,00.html | title = More IVF babies but less multiple births | archive-url = https://web.archive.org/web/20090924235447/http://www.theaustralian.news.com.au/story/0,25197,26117922-12377,00.html | archive-date=24 September 2009 | work = The Australian | date = 24 September 2009 }}</ref> While IVF is available in Australia, Australians using IVF are unable to choose their baby's gender.<ref>{{cite journal | vauthors = Kippen R, Evans A, Gray E | title = Australian attitudes toward sex-selection technology | journal = Fertility and Sterility | volume = 95 | issue = 5 | pages = 1824–1826 | date = April 2011 | pmid = 21163475 | doi = 10.1016/j.fertnstert.2010.11.050 | doi-access = free }}</ref>

==== Cameroon ====
[[Ernestine Gwet Bell]] supervised the first Cameroonian child born by IVF in 1998.<ref name="Jr.Akyeampong2012">{{cite book| vauthors = Gates Jr HL, Akyeampong E, Niven SJ |title=Dictionary of African Biography|url={{Google books|39JMAgAAQBAJ|page=PR25|plainurl=yes}}|date=2 February 2012|publisher=OUP USA|isbn=978-0-19-538207-5|pages=25–}}</ref>

==== Canada ====
In Canada, one cycle of IVF treatment can cost between $7,750 to $12,250 CAD, and medications alone can cost between $2,500 to over $7,000 CAD.<ref>{{cite web | work = Health Research Board | date = 2017 | url = https://www.gov.ie/en/publication/af2460-health-research-board-report-assisted-reproductive-technologies-inte/?referrer=/blog/publications/health-research-board-report-assisted-reproductive-technologies-international-approaches-to-public-funding-mechanisms-and-criteria-an-evidence-review/ | title = Assisted reproductive technologies: International approaches to public funding mechanisms and criteria. | access-date = 30 November 2019 }}</ref> The funding mechanisms that influence accessibility in Canada vary by province and territory, with some provinces providing full, partial or no coverage.

[[New Brunswick]] provides partial funding through their Infertility Special Assistance Fund – a one time grant of up to $5,000. Patients may only claim up to 50% of treatment costs or $5,000 (whichever is less) occurred after April 2014. Eligible patients must be a full-time New Brunswick resident with a valid Medicare card<ref>{{cite web | url = https://www2.gnb.ca/content/gnb/en/departments/health/MedicarePrescriptionDrugPlan.html | title = Medicare and Drug Plans | work = Government of New Brunswick | date = 19 April 2013 | access-date = 30 November 2019 | archive-date = 5 December 2019 | archive-url = https://web.archive.org/web/20191205062414/https://www2.gnb.ca/content/gnb/en/departments/health/MedicarePrescriptionDrugPlan.html | url-status = dead }}</ref> and have an official medical infertility diagnosis by a physician.<ref>{{cite web | work = Service New Brunswick | date = 2018 | url = https://www.pxw1.snb.ca/snb7001/e/1000/infoTe.asp | title = Infertility Treatment – Special Assistance Fund | access-date = 30 November 2019 }}</ref>

In December 2015, the [[Ontario]] provincial government enacted the Ontario Fertility Program for patients with medical and non-medical infertility, regardless of sexual orientation, gender or family composition. Eligible patients for IVF treatment must be Ontario residents under the age of 43 and have a valid [[Ontario Health Insurance Plan]] card and have not already undergone any IVF cycles. Coverage is extensive, but not universal. Coverage extends to certain blood and urine tests, physician/nurse counselling and consultations, certain ultrasounds, up to two cycle monitorings, embryo thawing, freezing and culture, fertilisation and embryology services, single transfers of all embryos, and one surgical sperm retrieval using certain techniques only if necessary. Drugs and medications are not covered under this Program, along with psychologist or social worker counselling, storage and shipping of eggs, sperm or embryos, and the purchase of donor sperm or eggs.<ref>{{cite web | work = TRIO Fertility | date = 2016 | url = http://www.ontariofertility.ca/ | title = Ontario Fertility: Funding Explained | access-date = 30 November 2019 }}</ref>

==== China ====
IVF is expensive in China and not generally accessible to unmarried women.<ref name="ReutersChina2022">{{Cite web |date=16 August 2022 |title=China to discourage abortions to boost low birth rate |website=[[Reuters]] |url=https://www.reuters.com/world/china/china-discourage-abortions-boost-low-birth-rate-2022-08-16/ |access-date=16 August 2022 |archive-date=16 August 2022 |archive-url=https://web.archive.org/web/20220816224630/https://www.reuters.com/world/china/china-discourage-abortions-boost-low-birth-rate-2022-08-16/ |url-status=bot: unknown }}</ref> In August 2022, China's National Health Authority announced that it will take steps to make assisted reproductive technology more accessible, including by guiding local governments to include such technology in its national medical system.<ref name="ReutersChina2022" />

'''Croatia'''

No egg or sperm donations take place in Croatia, however using donated sperm or egg in [[Assisted reproductive technology|ART]] and IUI is allowed. With donated eggs, sperm or embryo, a heterosexual couple and single women have legal access to IVF. Male or female couples do not have access to ART as a form of reproduction. The minimum age for males and females to access ART in Croatia is 18 there is no maximum age. Donor anonymity applies, but the born child can be given access to the donor's identity at a certain age<ref>{{Cite journal |last1=De Geyter |first1=C |last2=Calhaz-Jorge |first2=C |last3=Kupka |first3=M S |last4=Wyns |first4=C |last5=Mocanu |first5=E |last6=Motrenko |first6=T |last7=Scaravelli |first7=G |last8=Smeenk |first8=J |last9=Vidakovic |first9=S |last10=Goossens |first10=V |date=2020 |title=Corrigendum. ART in Europe, 2015: results generated from European registries by ESHRE |url=http://dx.doi.org/10.1093/hropen/hoaa038 |journal=Human Reproduction Open |volume=2020 |issue=3 |pages=hoaa038 |doi=10.1093/hropen/hoaa038 |pmid=32995563 |pmc=7508022 |issn=2399-3529}}</ref>

==== India ====
The penetration of the IVF market in [[India]] is quite low, with only 2,800 cycles per million infertile people in the reproductive age group (20–44 years), as compared to China, which has 6,500 cycles. The key challenges are lack of awareness, affordability and accessibility.<ref>{{Cite news|url=http://businessworld.in/article/IVF-Fertile-Ground/08-08-2016-104172/|title=IVF: Fertile Ground| vauthors = Chatterjee P |work=BW Businessworld|access-date=8 July 2017}}</ref> Since 2018, however, India has become a destination for fertility tourism, because of lower costs than in the Western world. In December 2021, the [[Lok Sabha]] passed the Assisted Reproductive Technology (Regulation) Bill 2020, to regulate ART services including IVF centres, sperm and egg banks.<ref>{{Cite news|url=https://www.hindustantimes.com/india-news/parliament-winter-session-lok-sabha-passes-assisted-reproductive-technology-bill-to-regulate-ivf-clinics-101638384736526.html#:~:text=Kaul%2C%20New%20Delhi-,The%20Lok%20Sabha%20on%20Wednesday%20passed%20the%20Assisted%20Reproductive%20Technology,have%20mushroomed%20across%20the%20country/|title=Assisted Reproductive Technology (Regulation) Bill, 2020|access-date=2 December 2021}}</ref>

==== Israel ====
Israel has the highest rate of IVF in the world, with 1,657 procedures performed per million people per year.<ref>{{Cite book |last=Mancini |first=Susanna |title=Constitutional Secularism in an Age of Religious Revival |date=2014 |publisher=Oxford University Press, Incorporated |others=Michel Rosenfeld |isbn=978-0-19-102516-7 |location=Oxford |pages=238}}</ref> Couples without children can receive funding for IVF for up to two children. The same funding is available for people without children who will raise up to two children in a [[single parent]] home. IVF is available for people aged 18 to 45.<ref>{{Cite web|url=https://www.health.gov.il/English/Topics/fertility/Pages/ivf.aspx|title=In Vitro Fertilization |website=health.gov.il|access-date=1 August 2019}}</ref> The Israeli Health Ministry says it spends roughly $3450 per procedure.{{citation needed|date=March 2021}}

==== Sweden ====
One, two or three IVF treatments are government subsidised for people who are younger than 40 and have no children. The rules for how many treatments are subsidised, and the upper age limit for the people, vary between different [[County councils of Sweden|county councils]].<ref>{{Cite web|url=https://sahlgrenska.gu.se/english/research/news-events/news-article//three-ivf-attempts-double-chances.cid902435|title=Three IVF attempts double chances |date=14 May 2024 }}</ref> Single people are treated, and embryo adoption is allowed. There are also private clinics that offer the treatment for a fee.<ref>{{Cite web|url=https://www.1177.se/Fakta-och-rad/Behandlingar/IVF-provrorsbefruktning/ |title=IVF, provrörsbefruktning |website=1177.se |language=sv |access-date=23 February 2019}}</ref>

==== United Kingdom ====
Availability of IVF in England is determined by [[Clinical Commissioning Group]]s (CCGs). The [[National Institute for Health and Care Excellence]] (NICE) recommends up to 3 cycles of treatment for people under 40 years old with minimal success conceiving after 2 years of unprotected sex. Cycles will not be continued for people who are older than 40 years.<ref>{{Cite web|url=https://www.nice.org.uk/guidance/cg156/chapter/Recommendations#access-criteria-for-ivf|title=Fertility problems: assessment and treatment |date=20 February 2013 }}</ref> CCGs in [[Healthcare in Essex|Essex]], [[Healthcare in Bedfordshire|Bedfordshire]] and [[Healthcare in Somerset|Somerset]] have reduced funding to one cycle, or none, and it is expected that reductions will become more widespread. Funding may be available in "exceptional circumstances" – for example if a male partner has a transmittable infection or one partner is affected by cancer treatment.  According to the campaign group Fertility Fairness "at the end of 2014 every CCG in England was funding at least one cycle of IVF".<ref>{{cite news|title=RIP IVF? NHS cuts to fertility treatment 'will deny thousands parenthood'|url=https://www.independent.co.uk/life-style/health-and-families/health-news/rip-ivf-nhs-cuts-to-fertility-treatment-will-deny-thousands-parenthood-a6717326.html|access-date=2 November 2015|newspaper=Independent|date=2 November 2015}}</ref>  Prices paid by the [[National Health Service (England)|NHS]] in England varied between under £3,000 to more than £6,000 in 2014/5.<ref>{{cite news|title=IVF costs to NHS 'must be capped', says fertility expert|url=https://www.bbc.co.uk/news/health-34658354|access-date=30 October 2015|work=BBC News|date=29 October 2015}}</ref> In February 2013, the cost of implementing the NICE guidelines for IVF along with other treatments for infertility was projected to be £236,000 per year per 100,000 members of the population.<ref name="NICE-costing">{{Cite report|title=Fertility: assessment and treatment for people with fertility problems|date=February 2013|publisher=National Institute for Health and Clinical Excellence|edition=2016 update|page=7|url=https://www.nice.org.uk/guidance/cg156/resources/costing-report-188496685|access-date=17 February 2017|archive-date=17 February 2017|archive-url=https://web.archive.org/web/20170217143455/https://www.nice.org.uk/guidance/cg156/resources/costing-report-188496685|url-status=dead}}</ref>

IVF increasingly appears on [[NHS treatments blacklist]]s.<ref>{{cite news|title=NHS access to IVF being cut in England|url=https://www.bbc.co.uk/news/health-40848097|access-date=5 September 2017|work=BBC News|date=7 August 2017}}</ref>  In August 2017 five of the 208 CCGs had stopped funding IVF completely and others were considering doing so.<ref>{{cite news|title=CCGs propose range of new rationing cuts to fill deficit|url=http://healthcareleadernews.com/article/ccgs-propose-range-new-rationing-cuts-fill-deficit|access-date=5 October 2017|publisher=Healthcare Leader|date=16 August 2017|archive-date=6 October 2017|archive-url=https://web.archive.org/web/20171006112013/http://healthcareleadernews.com/article/ccgs-propose-range-new-rationing-cuts-fill-deficit|url-status=dead}}</ref>  By October 2017 only 25 CCGs were delivering the three recommended NHS IVF cycles to eligible people under 40.<ref>{{cite news|title=Number of CCGs offering recommended cycles of IVF drops 50% in 4 years|url=http://healthcareleadernews.com/article/number-ccgs-offering-recommended-cycles-ivf-drops-50-4-years|access-date=24 December 2017|publisher=Healthcare Leader|date=30 October 2017|archive-date=26 December 2017|archive-url=https://web.archive.org/web/20171226020718/http://healthcareleadernews.com/article/number-ccgs-offering-recommended-cycles-ivf-drops-50-4-years|url-status=dead}}</ref>  Policies could fall foul of [[Equality Act 2010|discrimination laws]] if they treat same sex couples differently from heterosexual ones.<ref>{{cite news|title=CCGs warned policies could break discrimination laws|url=https://www.hsj.co.uk/commissioning/ccgs-warned-policies-could-break-discrimination-laws/7020989.article|access-date=26 December 2017|publisher=Health Service Journal|date=9 November 2017}}</ref>  In July 2019 [[Jackie Doyle-Price]] said that women were registering with surgeries further away from their own home in order to get around CCG rationing policies.{{citation needed|date=August 2023}}

The [[Human Fertilisation and Embryology Authority]] said in September 2018 that parents who are limited to one cycle of IVF, or have to fund it themselves, are more likely choose to implant multiple embryos in the hope it increases the chances of pregnancy.  This significantly increases the chance of multiple births and the associated poor outcomes, which would increase NHS costs.  The president of the [[Royal College of Obstetricians and Gynaecologists]] said that funding 3 cycles was  "the most important factor in maintaining low rates of multiple pregnancies and reduce(s) associated complications".<ref>{{cite news |title=Regulator says IVF cuts put mothers and babies at risk |url=https://www.hsj.co.uk/commissioning/exclusive-regulator-says-ivf-cuts-put-mothers-and-babies-at-risk/7023274.article |access-date=8 October 2018 |publisher=Health Service Journal |date=4 September 2018}}</ref>

==== United States ====
In the United States, overall availability of IVF in 2005 was 2.5 IVF physicians per 100,000 population, and utilisation was 236 IVF cycles per 100,000.<ref name=hammoud>{{cite journal | vauthors = Hammoud AO, Gibson M, Stanford J, White G, Carrell DT, Peterson M | title = In vitro fertilization availability and utilization in the United States: a study of demographic, social, and economic factors | journal = Fertility and Sterility | volume = 91 | issue = 5 | pages = 1630–1635 | date = May 2009 | pmid = 18539275 | doi = 10.1016/j.fertnstert.2007.10.038 | doi-access = free }}</ref> 126 procedures are performed per million people per year. Utilisation highly increases with availability and IVF insurance coverage, and to a significant extent also with percentage of single persons and median income.<ref name=hammoud/>  In the US, an average cycle, from egg retrieval to embryo implantation, costs $12,400, and insurance companies that do cover treatment, even partially, usually cap the number of cycles they pay for.<ref>{{cite web | vauthors = Kraft D | date = 17 July 2011 | url =  https://www.nytimes.com/2011/07/18/world/middleeast/18israel.html | title = Where Families Are Prized, Help Is Free | work = The New York Times }}</ref> As of 2015, more than 1 million babies had been born utilising IVF technologies.<ref name="CDC-2015"/>

In the US, as of September 2023, 21 states and the [[District of Columbia]] had passed laws for fertility insurance coverage. In 15 of those jurisdictions, some level of IVF coverage is included, and in 17, some fertility preservation services are included.  Eleven states require coverage for both fertility preservation and IVF: Colorado, Connecticut, Delaware, Maryland, Maine, New Hampshire, New Jersey, New York, Rhode Island, Utah, and Washington D.C.<ref name="Maven">{{cite web |title=In what states is IVF covered by insurance?: A comprehensive guide for HR leaders |url=https://www.mavenclinic.com/post/in-what-states-is-ivf-covered-by-insurance |website=www.mavenclinic.com |access-date=2 October 2024 |language=en}}</ref> The states that have infertility coverage laws are Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, Utah, and West Virginia.<ref name="resolve2024">{{Cite web |date=June 17, 2024 |title=RESOLVE: Insurance Coverage by State |url=https://resolve.org/what-are-my-options/insurance-coverage/infertility-coverage-state/ |access-date=2 Oct 2024 |website=RESOLVE: The National Infertility Association |language=en-US}}</ref> As of July 2023, New York was reportedly the only state Medicaid program to cover IVF.<ref name="Henderson" />  These laws differ by state but many require an egg be fertilised with sperm from a spouse and that in order to be covered you must show you cannot become pregnant through penile-vaginal sex.<ref name="resolve2024"/> These requirements are not possible for a same-sex couple to meet.<ref name="Henderson">{{cite news |last1=Henderson |first1=Tim |title=Fertility health coverage is still hard to come by in many states • Washington State Standard |url=https://washingtonstatestandard.com/2023/07/29/fertility-health-coverage-is-still-hard-to-come-by-in-many-states/ |access-date=2 October 2024 |work=Washington State Standard |date=29 July 2023}}</ref>

Many fertility clinics in the United States limit the upper age at which people are eligible for IVF to 50 or 55 years.<ref name="Motherhood: Is It Ever Too Late">{{cite web | vauthors = Appel JS | date = 15 July 2009 | url = https://www.nytimes.com/2009/07/16/theater/theaterspecial/16tony.html | title = Motherhood: Is It Ever Too Late? | work = New York Times }}</ref> These cut-offs make it difficult for people older than fifty-five to utilise the procedure.<ref name="Motherhood: Is It Ever Too Late"/>