JULY2026
The United States may be on the verge of introducing one of the most significant changes to employer-sponsored fertility benefits in recent years. In May 2026, the U.S. Departments of Treasury, Labor and Health & Human Services published a proposal that would create a completely new category of “Excepted Fertility Benefits.”
The proposal follows President Donald Trump’s Executive Order aimed at expanding access to IVF while reducing costs for American families. However, while the ambition has been widely welcomed, the proposal has also triggered substantial debate across the fertility sector. The American Society for Reproductive Medicine (ASRM), representing nearly 8,000 reproductive medicine professionals, has submitted detailed comments questioning whether the proposal will actually achieve its intended goals.
So what is being proposed—and why is it controversial?
Why is this proposal significant?
Unlike many European countries, fertility treatment coverage in the United States largely depends on employers. Today:
• many employers offer no fertility benefits at all,
• coverage varies enormously between companies,
• self-funded employer plans are generally not required to follow state infertility insurance mandates,
• patients frequently pay tens of thousands of dollars themselves.
The proposal seeks to make it easier for employers to voluntarily offer fertility benefits through a separate benefit package that would be exempt from many existing health insurance regulations.
The underlying political objective is straightforward: Make fertility treatment more available while reducing regulatory complexity for employers.
What are “Excepted Fertility Benefits”?
Instead of integrating fertility care into standard health insurance, employers could establish a separate fertility benefit. The proposal would allow benefits covering:
• fertility investigations
• infertility diagnosis
• fertility counselling
• treatment of reproductive disorders
• fertility medications
• surgery
• IUI
• IVF
• other assisted reproductive technologies
• medically appropriate treatment of underlying infertility conditions provided the benefits are primarily directed toward diagnosing, mitigating or treating infertility.
The proposal also introduces a maximum lifetime benefit of USD 120,000 per participant, indexed for medical inflation.
Why does the U.S. Government believe this could work?
The proposal argues that fertility benefits resemble other specialised healthcare benefits already treated separately, such as dental or vision plans. By reducing regulatory requirements, policymakers hope more employers will decide to offer fertility benefits voluntarily.
The proposal also highlights several important demographic realities:
• U.S. reproduction remain below replacement level.
• Around one in five Americans experience infertility.
• IVF treatment can easily exceed USD 40,000 before a successful pregnancy is achieved.
• Employer fertility benefits remain unavailable to many American workers.
ASRM welcomes the ambition but questions the solution
While ASRM strongly supports expanding fertility care, its response is critical of the proposed mechanism. Its overall conclusion is that unless substantially revised, the proposed rule should be withdrawn.
Five major concerns raised by ASRM:
- No employer is actually required to provide fertility benefits
Perhaps the largest criticism is that the proposal does not mandate coverage.
Employers remain free to offer nothing.
ASRM argues this falls well short of the administration’s earlier commitment to make IVF broadly affordable through insurance coverage.
- Employers might reduce existing fertility benefits
Ironically, employers currently providing generous fertility coverage could decide to replace those benefits with the new limited “excepted” package.
Rather than expanding access, some employees could ultimately receive less comprehensive coverage.
- A lifetime dollar cap may influence medical decisions
ASRM questions whether a fixed lifetime benefit encourages patients to make financial rather than clinical decisions.
For example:
Patients approaching the benefit limit may choose multiple embryo transfers instead of evidence-based single embryo transfer to maximise pregnancy chances before their benefits are exhausted.
This could increase maternal and neonatal risks while ultimately increasing healthcare costs.
ASRM instead recommends limiting coverage by completed IVF cycles rather than by total dollars.
- Lack of a clear infertility definition
The proposal deliberately leaves infertility broadly defined.
ASRM argues this creates uncertainty regarding:
• patient eligibility,
• covered services,
• consistency across employers,
• potential discrimination.
The organisation recommends adopting ASRM’s internationally recognised medical definition of infertility.
- Less regulatory protection
Because these plans would qualify as “excepted benefits,” they would not necessarily be subject to many Affordable Care Act and HIPAA requirements.
ASRM expresses concern about:
• inconsistent coverage standards,
• reduced consumer protections,
• privacy implications,
• employer insight into sensitive reproductive healthcare decisions.
What does this mean for fertility clinics?
Should the proposal be finalised, clinics may increasingly interact with dedicated fertility benefit providers rather than traditional insurers. This could create:
• new referral pathways,
• new reimbursement models,
• increased employer partnerships,
• greater demand for documented treatment outcomes,
• additional administrative complexity.
How employers ultimately design these benefit packages will largely determine whether access genuinely improves.
A global perspective
The discussion unfolding in the United States reflects a broader international challenge. Across many developed countries:
• birth rates continue to decline,
• infertility affects growing numbers of individuals,
• governments increasingly recognise fertility treatment as part of broader demographic policy,
• employers are becoming important contributors to family-building support.
The U.S. proposal demonstrates that expanding access is no longer only a healthcare issue as it has become part of labour policy, economic policy and population strategy.
Our perspective
From our perspective, any initiative that raises awareness of infertility and encourages more employers to support fertility treatment should be welcomed. However, meaningful progress ultimately depends on whether patients receive equitable, evidence-based and affordable access to appropriate treatment. The proposal represents an important step in recognising fertility care as a legitimate employee benefit. Whether it becomes a transformative policy or simply another optional benefit available only to some employees will depend on the final regulations adopted after public consultation.
One thing is already clear:
The debate around fertility benefits is moving beyond reproductive medicine. It is increasingly becoming a discussion about workforce wellbeing, employer attractiveness, demographic sustainability and how societies choose to support individuals and couples wishing to build a family.