40 Years Later, In Vitro Fertilization is Still for Rich People

America’s birth rate is declining and yet one of the most successful fertilization treatments remains out of reach for many Americans. That isn’t good for the country.

The first baby conceived via in vitro fertilization was born 40 years ago. Since that time, the International Committee Monitoring Assisted Reproductive Technologies estimates that there have been 8 million babies born worldwide thanks to the IVF procedure. That’s an impressive number, to be sure, but the more astounding figure is the dollar amount attached to all those babies. When you consider for a moment that an average round of IVF and associated medication can cost at least $20,000 in today’s dollars, it becomes very clear that those 8 billion babies emerged not only from their happy-if-uncomfortable mothers but also from a reproductive technology industrial complex buoyed by significant private spending. IVF treatments still aren’t covered by most health insurance plans, which means that the down payment on kids conceived in Petri dishes remains troublingly high.

According to the Centers for Disease Control, the birth rate is lower now than it has been since the mid-1980s. That might make sense in perspective of the Great Recession, but the odd thing about the prolonged decade of declining birth rates is that those rates generally rebound with the economy. That hasn’t been the case this time around, despite an economy that appears to be on an indefatigable upward trend.

Why does it matter? Well, it hasn’t in the United States — so far. That’s because a decline in population is offset by immigrants. But should immigration be curtailed, which seems likely in the context of the Trump administration, a low birth rate could lead to labor shortages, a declining tax base, and less income for social programs to protect those most in need like the disabled, poor, and elderly. We know this because that’s the contemporary struggle in Japan. America needs babies. Many Americans can’t afford to have them. (Yes, adoption and foster parenting are both options, but not all couples wish to go that route.)

Some of the declines in the birth rate are certainly linked to younger adults consciously putting off having children because of financial insecurity or fear of responsibility. This leads to complications when they get around to it late. Many will join the massive and growing population struggling with fertility issues. Male infertility, in particular, has been increasing globally. So much so that a recent study suggested men are about half as fertile as they were in the 1970s. We are not in the midst of a crisis, but it’s not unreasonable to surmise that one might be coming — especially if government programs continue to penalize parents.

So here we are facing a bizarre conundrum: The American birth rate is in decline. Adding to population worries, the current administration is curtailing immigration. And, finally, thanks to an increase in infertility, there are millions of Americans who can’t become parents despite their desire to have kids. The answer, it would seem, would be IVF, which can be successful up to 70 percent of the time. But IVF isn’t covered by the ACA in most states (Massachusetts gets to be smug on this one) and the ACA is looking shaky either way. This lack of national support has allowed for a lack of institutional support. IVF assistance funds are a fairly common perk at exceptionally competitive businesses, but quite rare overall.

Even when coverage is available, IVF can be inordinately expensive. One mother who recently wrote about her successful IVF birth on Romper estimated the total cost at nearly $40K. In fact, she and her husband had to take out loans against his 401K in order to raise the funds. It’s no small wonder that many prospective parents tap out.

Still, it’s highly unlikely that things will change until the crisis is at our door. After all, the current administration and Congress would rather remove insurer coverage mandates than add them. Guaranteed fertility coverage would be a family-first policy solution, but it’s unlikely in the current atmosphere given that universal access to IVF would likely lead to the birth of children to poorer, non-white parents unlikely to raise young Republicans.

IVF has been around for 40 years. It’s increasingly successful and efficient. It’s a medical gift. But the gift is only available to rich people. That’s both a choice and a shame. If our leaders are pro-family, they should put their money where their mouths are.