Mandating insurance coverage for IVF will not boost fertility

Lyman Stone

September 10, 2024 9 Reactions

More recent cases

For what it’s worth, it’s easy to see that these policies simply cannot have big effects. The studies above all predate 2018, when Delaware implemented a comprehensive IVF coverage law, so Delaware is not included in their sample of states with IVF coverage. What happened to fertility in Delaware before and after IVF coverage?

Well, we can look at age-specific fertility rates in Delaware from 2016-2018 vs. 2019-2022, and see how they changed compared to nearby states, Pennsylvania, Maryland, and New Jersey.

As the figure shows, the effects are extremely small. Birth rates for women under age 35 fell in Delaware and nearby states, but ever-so-slightly more in Delaware during these time periods. Birth rates rose among women over age 35 in both areas, but by slightly more in Delaware. On net, Delaware’s IVF law may have possibly increased fertility by, at most, 0.005 children on average. Not 0.5 children: 0.005.

We can verify these small effects because Delaware reports the number of children born as a result of IVF. Estimated total fertility rates before age 35 fell 0.002 children more for women under 35 excluding IVF than it did including IVF, and children born after age 35 rose by 0.003 children, meaning the increase in IVF is associated with a 0.005-child increase in Delaware’s fertility. Two different methods yield the same result: free IVF boosted fertility by such a small amount it is virtually undetectable.

We can look at another case: Quebec. In 2011, Quebec dramatically increased the public subsidy available for IVF, with the result that IVF usage almost tripled. We can compare birth rates by age in Quebec from 2007-2009 to those in 2011-2013, and see what they would have been if they had shown a similar trend as the rest of Canada, and how much of that gap can be explained by live births from IVF.

Quebec’s births for women under age 35 declined much more than might have been guessed from the wider Canadian trend, even as likely births from IVF cycles under age 35 rose by around 400 births. Meanwhile, Quebec’s births for women over age 35 also rose by much more than might have been expected: but again, only about 400 births came from IVF.

If we assume that none of those likely IVF births replaced counterfactual non-IVF births, Quebec’s increase in IVF subsidies boosted fertility by just 0.005 children per woman, similar to Delaware. Of course, that’s assuming that the entire increase due to IVF subsidies involves extra births that would not have occurred otherwise, which may not be the case.

Conclusion

If the goal is to boost births, subsidies for IVF are a peculiar kind of policy. They disproportionately go to people unlikely to have additional births beyond the first birth, and only subsidise very specific subsets of individuals and families with specific values (i.e. people without ethical objections to IVF), and they may incentivise fertility delay among younger couples. 

On the one hand, it’s not surprising that IVF subsidies are gaining popularity: infertility is a legitimate medical condition worth treating. Politicians who fear that the public won’t stomach direct support for family life may gamble that the public will support fertility subsidies masquerading as health interventions.

Moreover, couples struggling with infertility garner obvious and well-deserved sympathy, and academic research shows that infertility has significant mental health costs. And since the fertility industry is increasingly attracting investment from Silicon Valley into pricey procedures, including eugenic embryo selection via IVF, there is no shortage of lobbyists willing to encourage politicians to support these policies.

But IVF subsidies are essentially a form of Potemkin pronatalism: they may sound pronatal but the supposed benefits do not really exist. The main effect of IVF subsidies is just a transfer of money away from some types of families (especially people who marry young, who tend to be lower income) to other types of families (especially those who marry late and tend to be higher income, or LGBT couples with a wide range of incomes), without any net effect on overall fertility, and perhaps an intensification of fertility delay.

Subsidies for IVF may be justifiable for health reasons, or on the basis of supporting couples who can’t have kids any other way, or they may be unjustifiable on moral or ethical grounds, or because they subsidise wealthier families more, but these questions are outside the bailiwick of pronatalism. However, on the simple question of “Will subsidising IVF increase fertility?” the simple answer is “no.”

What do you think of this analysis? Leave a comment below.

This article has been republished with permission from the Institute for Family Studies.

Lyman Stone is a senior fellow and director of the Pronatalism Initiative at the Institute for Family Studies. He is also the chief information officer of the consulting firm Demographic Intelligence.

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