Today, the image of what a family can look like has many possibilities, but the science that helps create families has not caught up.
In the final panel before lunch on the first day of the 2025 Boston Globe Summit, titled “IVF and Inequality: Barriers and Solutions,” fertility experts considered these barriers to access of fertility treatments and potential solutions to expand equitable access.
“When we speak about infertility, we begin with the fundamental truth that the ability to build a family is a basic human right,” said Dr. Mark D. Hornstein, the director of the Reproductive Endocrinology Division at Mass General Brigham, in opening remarks on behalf of the healthcare giant, which was also a sponsor of the Summit.
Panelists included Sen. Julian Cyr, Dr. Alan Penzias, the medical director at Boston IVF, and Libby Horne, the Senior Vice President of U.S. Fertility and HIV/Endocrinology at EMD Serono. Jessica Bartlett, a medical reporter at the Boston Globe, moderated the discussion.
“At Mass General Brigham, you see that one of the most significant barriers in fertility care isn’t just cost, it’s understanding how to access coverage,” Hornstein said, explaining that this information barrier includes when patients don’t know what their benefits are or where to go for help.
Massachusetts has a mandate, originally issued in 1987, that requires insurance providers to cover all non-experimental infertility procedures. Last year, a new fertility preservation law expanded these services to include sperm and egg freezing for those facing medical diagnoses or treatments that may cause infertility.
However, only about one-third of the patients who live in Massachusetts are actually covered by the mandate, according to Penzias. This is a result of about 56% of patients working for self-insured companies, according to the 2024 Massachusetts Employer Survey. The Employee Retirement Income Security Act nullifies state insurance mandates, so the insurance provided by the employers supersedes the mandate.
47% of large employers in the U.S. cover fertility treatment, according to the 2024 Mercer Report, but this gap still exists for employees in over 50% of these companies.
Cyr proposed legislation that aims to fill some of these gaps by expanding coverage for Medicaid, which the mandate does not include protections for. This legislation also focuses on making changes that expand access for LGBTQ families—changing the definition of infertility to expand beyond just medical causes would allow same-sex couples to access infertility treatments.
In the most recent data by The Boston Foundation, 9.1% of Massachusetts adults between 2020-2022 identified as LGBTQ, an increase from previous years.
“We’ve got to have some cultural competence here, and we have to understand how people are building families in 2025,” Cyr said. “We need to be responsible to their needs as [LGBTQ] folks become adults and as they seek to build families.”
But overcoming access is just the precursor for overcoming the high costs of fertility treatment.
Horne discussed the recent agreements made between EMD Serono, a leading manufacturer of fertility medications, and the Trump administration last month. This agreement aims to extend drug availability by lowering their costs. Horne said she thinks this move from the Trump administration is a “game-changing” short-term solution to decrease medication costs for patients who pay out-of-pocket.
“This new pathway allows us to come together with others and those exact stakeholders and build a better solution for pricing for patients,” Horne said. She said that price listings that are direct-to-consumer would help patients navigate the financial challenges related to drug costs, but there is still more support and innovation needed in the field.
One of the final major barriers to fertility treatments that the panelists discussed was the geographical challenges. Bartlett noted that many fertility clinics in Massachusetts are located in higher-income areas and questioned panelists on whether this created access barriers. Dr. Penzias suggested telehealth appointments as a solution to this barrier.
“For those who can’t travel because their jobs won’t let them, it’s been absolutely life-changing for them,” he said.
Before concluding the panel, Bartlett asked the panelists to reflect on what they would change to make fertility treatment access more equitable and affordable. Dr. Penzias emphasized the need for universal, equitable insurance that will provide access for queer families, military, federal employees, and anyone else who wants to have a child.
“We have the science to be able to help build families. Now we need the policies to match,” Dr. Penzias said.
Horne said expanding access can also start with updating the definitions of the ERISA and Affordable Care Act to establish categories for maternal and newborn care and prescription drug medicines.
Cyr simply answered, “Pass my bill,” and expressed concerns about the Trump administration’s attacks on LGBTQ people, despite its moves to help with IVF medication access.
“This is the most openly hateful administration we’ve seen on the national level [in] targeting those people. So, even more reason why Massachusetts [should] double down, protecting our residents, [and] defending our values here,” Cyr said.
Dr. Hornstein appeared back on stage for closing remarks, reflecting on the clinical, pharmaceutical, and legislative challenges discussed related to fertility treatment.
“I think the path forward is variable, but it’s clear. Access to fertility care is critical to the well-being of our society,” Dr. Hornstein said. “The challenges remain, and those of us who are committed need to move forward with this agenda.”