The National Center for Health Statistics reported that fertility rates across the country have declined from 2015 to 2020, with 43 states recording the lowest fertility rate they’ve seen in the last 30 years.
Most research and discussions around fertility care typically focus on the woman, with not much being examined in regards to helping men who are struggling with the same issue.
But now new research may help to improve that.
In the journal Urology, researchers found that having insurance companies cover male fertility procedures, alongside female ones, is associated with more in vitro fertilization, or IVF, use and a higher number of babies born from IVF.
Not only did states with both female and male fertility coverage see more births, but they also saw significantly better rates of couples using IVF.
“We’ve known that fertility rates have been dropping for decades,” explained Amelia Aynaz Khoei, M.D., M.P.H., lead author of the study.
“Advocating for improved coverage for men could help families to meet desired familial goals,” said Khoei, also a fourth-year urology resident at Michigan Medicine.
These research findings could also help guide President Donald Trump’s interest in greatly expanding IVF coverage to more couples in the United States.
Examining male-related fertility data
With 15% of couples impacted by infertility and many families unable to cover the costly associated expenses, Khoei felt examining the male side of the issue could help reveal some useful information.
In vitro fertilization, on average, costs more than $12,000, and a lack of health insurance coverage for IVF forces couples to pay the full cost themselves, the paper notes.
The IVF procedure combines a man’s sperm and a woman’s egg to produce an embryo, which, if successful, creates an embryo that’s then implanted into a woman’s uterus.
When different-sex couples seek fertility treatment, society often assumes it’s the woman experiencing reproductive issues.
But research has come to show otherwise: up to half of the time, fertility issues may stem from the male in the relationship.
“Examining a lack of mandated insurance coverage for male infertility care is key given that male factor is the sole cause of infertility in one third of infertility cases, with an additional 20% of cases having a male factor as a contributing cause,” said Khoei.
The study was done by comparing IVF use and IVF outcomes in states with and without insurance mandates that cover male infertility treatments.
Procedures covered included IVF and embryo transfers, varicocele repair, sperm retrieval and vasectomy reversals.
The group reviewed claims data from over 91 million insured individuals in the United States from 2003 to 2020.
States were split into three groups: states that mandated IVF and male infertility care coverage, states that mandated only IVF coverage, and all remaining states which had no mandates for infertility care coverage.
From there, the research team calculated the use of IVF along with pregnancies that resulted in live births.
They found that IVF utilization was six times higher in the states that required both male and female infertility care be covered by insurance compared to states without such mandates.
Additionally, the absolute number of births from IVF per 100,000 women was highest in states with insurance coverage mandates that included male infertility care.
The research team also found that IVF use and the number of babies born from IVF were higher in states that mandated coverage for both IVF and male infertility care than in states that only mandated insurance coverage for IVF alone.
“These findings suggest providing insurance coverage to help men seek infertility care allows more couples do IVF and have more babies that just covering IVF alone,” explained James M. Dupree, M.D., M.P.H., Professor of Urology and Obstetrics & Gynecology and the senior author of the study.
“Covering male infertility care seems to help the couple as a whole,” said Dupree.
Expanding male infertility care in future insurance coverage
With declining fertility rates on the rise, Khoei urges policymakers drafting new legislation around this issue to heavily consider including men’s fertility care to help promote family building.
Patients need help with overcoming structural barriers and financial vulnerability, and therein lies a world of opportunity for new legislation, says Khoei.
“Plenty of research shows that birth outcomes improve after male infertility is addressed. We’re at a crucial point of change; policymakers interested in improving fertility rates and increasing the number of healthy babies born across the country should consider including insurance coverage for males in order to promote access to care and safe deliveries,” said Khoei.
“Partnering with physicians and researchers can help guide those future changes.”
Additional authors: Phyllis Yan, Rodney L. Dunn, David Suh, Marissa S. Weiss, Kristian Black, Erica E. Marsh, Edward C. Norton, Vanessa K. Dalton andJames M. Dupree.
Paper cited: “In Vitro Fertilization Utilization Rates and Outcomes in States with and without Insurance Coverage Mandates for Male Infertility Care,” Urology. DOI: 10.1016/j.urology.2026.01.034
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Previously Published on michiganmedicine.org with Creative Commons License
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