Across California’s IVF insurance divide, many are priced out of parenthood

In February, when 40-year-old Nicole Torres visited her OB-GYN at Cedars-Sinai Medical Center in Los Angeles to discuss why the recent nine-week ultrasound of her pregnancy had shown no heartbeat, she felt relieved to at least have clear next steps. Her doctor had given her a referral for an infertility specialist.

Torres was hopeful about the timing, too. She had learned about a new law requiring insurance companies to cover infertility diagnoses and treatment, specifically in vitro fertilization (IVF). Considered by fertility doctors to be the most effective medical intervention — in which eggs are surgically removed and combined with sperm inside a lab to create embryos that are transferred to the uterus — IVF is also the most expensive. A single cycle including medication costs about $25,000 in Los Angeles, and many people need multiple rounds to bring home a baby.

Yet after making an appointment, Torres, who lives in Ontario, received a message in her patient portal that made her heart sink. “The requested service is being denied because there is no covered benefit,” it read. Confused, she did a quick search and read the fine print of California SB 729: The long-awaited legislation only applied to employers with 100 or more workers. Torres, an accountant who was working for a small brewery, didn’t qualify.

“Why do some people get this benefit when other people don’t?” Torres asked. “We’re all struggling with the same infertility, the same heartache.”

Now she’s trying to find a way to afford IVF while feeling the pressure of time. So when she was laid off in April, she started looking for jobs with employers that offer coverage.

“I’m 40. I don’t want to go six more months and ‘keep trying,’ ” she says.

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For most of its 50-year history, IVF was widely regarded as something only the rich could afford. That’s despite the fact that nearly 1 in 6 people globally are estimated to experience infertility. It was especially out of reach for minorities; one study analyzing U.S. birth data from 2011 to 2019 found that Black and Latino women were 70% less likely to receive infertility treatments than white women.

Slowly, over the last two decades, more people received insurance coverage to pay for medical help to have a baby. A surge of large companies started offering infertility benefits to attract top talent, and states passed legislation making insurance mandatory. The result: The United States reached a new record of more than 100,000 IVF babies born in 2024.

In January 2026, California became the 15th state to mandate insurance companies pay for IVF. When Gov. Gavin Newsom signed the bill, he authorized what many advocates considered the most inclusive legislation in the country. It not only covered more services than other states, including three egg retrievals and unlimited embryo transfers, it covered them for more people. That meant LGBTQ+ and single people who historically had been shut out by definitions of infertility as a failure to conceive after six to 12 months of unprotected heterosexual intercourse.

What was once a story of inaccessibility had become one of hope.

There was just one hitch: The law applied only to employees of fully insured large companies plus CalPERS — potentially reaching roughly 9 million Californians, including workers, spouses and dependents, according to a legislative analysis.

SB 729 didn’t apply to employees of small businesses, those in individual or marketplace plans, Medi-Cal, the military, the uninsured or people in self-funded employer plans. Employees in CalPERS, the state system that provides health insurance to California public workers and retirees, become eligible in July of next year.

That meant millions have been left out — paying hefty bills on their own, trying to decipher if they might have coverage or postponing treatment to game a bewildering set of state and federal initiatives that may result in coverage in the next few years.

“I see people in my clinic who don’t understand they don’t have insurance coverage,” said fertility doctor Marc Kalan, co-founder of Los Angeles Reproductive Center in Encino. “Or they are in limbo, and they say, ‘I certainly don’t want to pay for it out of pocket if I’m going to have coverage in the future. I want to delay this.’ But that’s a bit of a gamble because time is just never on anyone’s side.”

Those people weren’t intentionally left out, explains infertility advocate Barbara Collura, former president of the infertility patient advocacy group RESOLVE that was at the forefront of the four-year push to pass a mandate in California. “The legislation is just what California could legally do,” she says, because other programs fall under federal jurisdiction.

There are other initiatives to expand access, including another bill Newsom signed last year that would include infertility coverage for individual and small group health insurance markets under the Affordable Care Act. However, such changes to these types of plans require federal approval. Yet, no new changes to California’s benchmark plans have been posted on the Centers for Medicare & Medicaid Services website.

And on the federal level, the Trump administration proposed a rule that would allow employers to voluntarily offer separate fertility coverage beginning next year — akin to offering dental or vision coverage — yet it has not been finalized.

A clinical embryologist carries out an egg freezing procedure at a private IVF clinic in Athens.

(Thanassis Stavrakis / Associated Press)

Physicians at five fertility clinics in the Los Angeles area agreed that in the nine months since the law went into effect, they’ve seen patient numbers go up — about 20% on average — and include patients who had postponed IVF for financial reasons.

Still, doctors say the rollout has been chaotic — some employers just introduced plans this summer — and patients often arrive at the office of Nina Vyas, a reproductive endocrinologist at Pinnacle Fertility in Los Angeles, with little idea about what their policies cover or what kind of deductibles or out-of-network restrictions apply. There are costly gaps in coverage: Insurers must cover the medical care involving donor eggs, sperm, embryos or a gestational carrier, but the mandate stops short of covering donor compensation, agency or legal fees or a carrier’s pregnancy — potentially adding tens of thousands to patients’ overall treatment bills.

Also, insurers might not approve genetic testing or procedures that inject sperm directly into an egg, or they require patients to undergo less costly but less effective procedures, such an intrauterine insemination, first before approving IVF.

In Loree Johnson’s therapy sessions, she’s heard stories of people who don’t have insurance using credit cards or pulling equity from their homes or 401(k)s if they don’t have enough money saved up for IVF treatment. They’re sharing or selling unused medications through online groups. They’re “clinic shopping” in search of providers offering discounts or traveling to foreign countries, where IVF is cheaper. Or like Torres, they’re job hunting in search of companies offering infertility coverage. “Sometimes people are taking jobs that aren’t really the best fit for them professionally or personally, but they’re making that sacrifice because of the financial support,” says Johnson, a reproductive mental health counselor based in Hermosa Beach.

To understand the effect of insurance coverage, consider Michele Metz, a 34-year-old nurse from Murrieta who spent nearly $100,000 for unsuccessful IVF treatments four years ago after a history of multiple miscarriages and endometriosis. “It’s heartbreaking to hear you need IVF to begin with. Then you have to find the money,” she says, explaining that she and her husband cobbled together a combination of loans and gifts from friends and family. They’re still making monthly $600 payments.

Then she learned at the end of last year that her husband’s company would be included in the mandate. “I was over the moon. It meant we had more chances,” she says. “You can only borrow that kind of money once in a lifetime.” Worried about the quality of her own eggs due to endometriosis, she’s undergoing IVF using donor eggs. “The insurance made it 100% possible. Without it, I don’t know if I would have had to make peace without kids,” she says.

This article was produced as a project for the USC Annenberg Center for Health Journalism’s 2026 California Health Equity Fellowship.