In April 2023, the World Health Organization released a statistic that should have rewritten the public conversation about fertility: roughly 17.5% of adults, or about 1 in 6 of us, will experience infertility in our lifetimes. The figure was nearly identical in high-income countries (17.8%) and in low- and middle-income countries (16.5%).
Infertility is, statistically, one of the most common medical experiences a human can have. Access to its treatment is one of the most unevenly distributed.
This is what the fertility access map looks like in 2026. A person in Tel Aviv can walk into a clinic and access publicly funded IVF for as many cycles as it takes to bring home up to two children. A person in Calgary, just over an hour from a clinic in another province with public coverage, pays for everything out of pocket: testing, treatment, medication, storage. A person in Sacramento can use new state-mandated insurance coverage that took effect in January. A person across the state line in Reno cannot. The medicine is the same in all four cases. The map is what changes.
What follows is a look at three things: how big the global gap actually is, why North America in particular is tangled up in geographic and political inequities, and what's beginning to move.
The Global Picture
The headline finding from the WHO's 2023 report is the prevalence: 1 in 6 people, regardless of where they live or how rich their country is. The disparity isn't in who experiences infertility. It's in who gets help.
The WHO factsheet is blunt: assisted reproduction is "still largely unavailable, inaccessible and unaffordable in many parts of the world." Direct medical costs for a single IVF cycle in low- and middle-income countries can exceed the average annual income, which means treatment can pull a family into financial hardship even when it works. A systematic review of socioeconomic and cultural barriers published in 2025 identified the consistent obstacles: financial constraints, lack of insurance, low fertility literacy, and social stigma, each one heavier in rural and lower-income settings.
Stigma in particular is not just a private burden. The WHO notes that women experiencing infertility frequently face violence, divorce, social ostracism, and depression, and that the cause of infertility is often blamed on the woman regardless of who carries the underlying medical factor. In some countries, this is the difference between a hard medical experience and a life-altering one.
The picture in higher-income countries is less catastrophic but not as different as we might hope. Almost everywhere, most fertility care is paid out of pocket. The WHO has been recommending universal coverage of fertility treatment for years. Most countries, including most of North America, haven't taken them up on it.
The North American Paradox
If you'd told someone twenty years ago that the United States and Canada would, in 2026, still have wildly inconsistent access to a treatment first used successfully in 1978, they probably wouldn't have believed you. This is the wealthiest region in the world. It contains some of the most advanced reproductive medicine on the planet. And it is, by any measure, one of the harder places to actually receive that care if your insurance and your geography aren't lined up correctly.
There is no national fertility benefit in the U.S. There is no national fertility benefit in Canada. What exists in both countries is a patchwork.
The U.S. Patchwork
In the United States, fertility coverage is decided state by state. As of early 2026, 25 states have laws requiring some level of fertility coverage from insurers, but the quality and scope of those laws vary dramatically. Some require IVF coverage outright. Some require only diagnostic testing. Some carve out so many exemptions that the mandate functionally doesn't reach most workers.
In January 2026, California's landmark mandate took effect, extending IVF coverage to an estimated 9 to 10 million Californians who didn't have it before. It was, in real terms, the single biggest expansion of fertility access in American history. Virginia followed with legislation requiring up to three lifetime IVF cycles in its essential health benefits plan beginning in 2028. Arizona and Hawaii moved on iatrogenic infertility coverage for cancer patients. After years of inaction, the momentum has been real.
But the gaps are also real. Roughly half the country still has no mandate. Even where mandates exist, only 41% of self-insured employers in mandate states actually provide full IVF coverage to their employees, because federal ERISA law allows them to opt out. A typical IVF cycle in the U.S. now runs $15,000 to $30,000 including medications. Most patients need more than one.
In February 2025, President Trump signed an executive order directing the administration to develop policy recommendations on expanding IVF access and reducing costs. The order itself didn't change anything about insurance coverage; it asked for a list of ideas. The administration unveiled its first follow-up policies in October 2025, with three initiatives focused on cost. Whether any of it produces durable policy is still being written.
For now, the answer to "do you have IVF coverage" in the U.S. depends on three things: which state you live in, who your employer is, and whether your employer is self-insured. Those three variables shouldn't determine whether you can become a parent. They do.
Canada's Province Lottery
Canada has the same problem with a different shape. There is no federal IVF program. Coverage is set provincially, and the differences between provinces are stark.
Quebec covers one IVF cycle per lifetime for women up to 41, including medications and one year of embryo storage. Ontario funds one IVF cycle per eligible patient up to age 43, with no age cap on IUI, and announced a $100 million expansion for fiscal year 2026/27 to reduce wait times. New Brunswick, P.E.I., Manitoba, and Nova Scotia each offer some form of public reimbursement or grant. British Columbia's program launched in April 2025, finally adding the country's third-largest province to the list of jurisdictions with public coverage.
That leaves Alberta and Saskatchewan, plus the territories. According to the Vanier Institute of the Family's 2025 report on fertility treatment in Canada, residents of provinces without coverage frequently travel out of province to access treatment, which adds flights, accommodation, and time off work to an already-expensive process. Geography compounds cost.
Alberta is, as of mid-2026, the last province in Canada without a fertility funding program or an announced plan to introduce one. Fertility Alberta, a patient-led non-profit advocacy organization, estimates that more than 250,000 Albertans are affected by infertility, and points out that they bear 100% of the cost of testing, treatment, and medication unless their employer offers fertility benefits.
Fertility Alberta describes itself as "the province's only nonprofit dedicated solely to fertility care access." It was founded by current and former patients in 2023 and won Fertility Matters Canada's National Change Maker award in 2024 for its work pushing for public funding. The organization has been a steady, public voice arguing that Alberta's standing as the last province without a fertility program is not just a healthcare gap but a fairness one. A patient in Edmonton and a patient in Toronto are dealing with the same medicine and the same biology. One has a publicly funded cycle on the table. The other has a credit card.
What Universal Coverage Actually Looks Like
It's worth knowing that universal-or-near-universal fertility coverage is not theoretical. It exists. The WHO's 2023 recommendation for universal coverage of fertility treatments points to several countries already doing it.
Israel covers IVF cycles until a patient has up to two children with their current partner. France covers IVF up to four attempts for women up to 43, including medications. Belgium covers six IVF cycles per lifetime. Denmark and the Netherlands have similar models. These countries have not seen their healthcare systems collapse under the cost. Several have higher fertility utilization rates and broader access for single parents and same-sex couples than most of North America offers.
The argument against universal coverage usually rests on cost. A 2024 economic analysis cited by Fertility Alberta and others argues that public IVF funding can actually save the healthcare system money over the long term, in part because it reduces the medical and economic costs associated with the multiple-birth pregnancies that often follow self-funded cycles, where patients transfer more embryos to maximize their odds with limited resources. You can disagree with that math. It's harder to argue that the current map is fair.
The People Pushing the Map
The story of fertility access right now is partly about policy and partly about people who are tired of waiting for it. In Canada, the Vanier Institute released its first comprehensive report on fertility treatment access in March 2025, supported in part by Fertility Alberta. The report has become a reference point in conversations about provincial coverage gaps.
In the United States, RESOLVE: The National Infertility Association tracks state mandate progress, mobilizes patients to lobby state legislatures, and has been instrumental in advancing many of the recent state mandates. Fertility Matters Canada plays a similar role nationally, while Fertility Alberta works the provincial conversation.
These are not abstract advocacy organizations. They are largely patient-run, often started by people who went through a fertility journey, looked at the system, and decided not to leave it the way they found it. If you're reading this from a part of the world where coverage doesn't exist, that work matters in concrete ways. It's how the map starts to change.
What You Can Do Right Now
1. Find out exactly what your insurance does and doesn't cover. Ask for the policy language in writing, including any IVF-specific exclusions, lifetime maximums, and pre-authorization requirements. Many people discover they have more partial coverage than they realized; others discover the opposite. Either way, you need to know.
2. Look outside your immediate geography. This is the focus of our companion piece on going abroad for IVF, but it applies domestically too. A patient in Alberta may save money traveling to Quebec or Ontario for a cycle. A patient in a non-mandate U.S. state may find the math works out differently across state lines.
3. Check whether your employer offers benefits separate from your insurance plan. Companies like Carrot, Progyny, and Maven now provide fertility benefits to a growing number of employees, often outside of standard health coverage. Employees of mid-size companies sometimes have access without realizing it.
4. Find your local advocacy organization. Fertility Alberta, Fertility Matters Canada, and RESOLVE all maintain resource libraries, peer support networks, and updates on legislation. Many have specific advocacy actions you can take from home in fifteen minutes.
5. Get a fertility lawyer if donor or surrogacy is involved. Cross-border parental recognition is a real risk that varies by jurisdiction and is changing rapidly. Don't assume the rules are intuitive.
6. Document your costs. Many tax credits and reimbursement programs require detailed records, and most patients underestimate what's deductible or claimable until they're filing.
Where This Goes Next
The conversation about fertility access in North America has been quieter than it should have been for a long time. That is finally changing. California's mandate, BC's program, Ontario's investment, Virginia's legislation, the Vanier Institute report, and the visible, persistent work of organizations like Fertility Alberta have moved the topic from a private grief to a policy question.
What it would take to close the gap is not a mystery. The countries that have done it have done it with public funding, regulatory consistency, and a willingness to treat infertility as a medical condition rather than a personal misfortune. Whether the rest of us get there depends on what the next several years of policy actually produce, and on how loud the people most affected are willing to be.
If you are in the middle of this right now, your access is shaped by a system, and the system is shifting. That doesn't fix today. But it's worth knowing that the map you are navigating is not the map the next generation will navigate, if enough of us keep pushing.
Resources
WHO: 1 in 6 People Globally Affected by Infertility (2023) — The foundational global prevalence report and the basis for the universal-coverage recommendation.
Vanier Institute of the Family: Fertility Treatment in Canada (2025) — Comprehensive overview of provincial coverage and access patterns, supported by Fertility Alberta.
Fertility Alberta — Patient-led non-profit advocacy organization working to expand fertility care access in Alberta.
Fertility Matters Canada — National non-profit for patient education, peer support, and federal advocacy.
RESOLVE: The National Infertility Association — U.S. state mandate tracker, peer support, and legislative advocacy.
MultiState: 2026 State Fertility Coverage Mandates — Current overview of U.S. state legislation and mandate trends.
