How IVF Care Differs Between Israel and the United States

Someone close to me went through IVF. I mostly watched from the outside: the injections, the blood draws, the stretches of waiting for a phone call that could go either way. I’m not going to pretend I understand what that felt like from the inside. But it’s changed how I read every fertility policy story that crosses my desk since, because I know now that behind the numbers is somebody sitting by a phone.

That’s part of why I’ve spent time looking closely at how Israel and the United States actually treat infertility. Not as an abstract insurance question, but as two very different answers to the same basic problem: what happens when your body won’t do the thing you want it to do.

Since the 1990s, Israeli law has entitled every Israeli woman, regardless of marital status or sexual orientation, to state-funded IVF, with essentially unlimited cycles, until she has two children with her current partner. Researchers who study the policy describe Israel as the world’s most intensive per-capita consumer of IVF, and it’s not hard to see why given the funding structure. The premise underneath all of it is that infertility is a medical condition, one the state has decided is worth treating the same way it treats a fracture.

That doesn’t mean the system is problem-free. In 2017, Israel shifted a share of IVF activity from private clinics to the public system to cut wait times. A more recent analysis of that shift, using data from one of the country’s largest health funds, found live birth rates dipped afterward, especially for women over 40. And because the policy places so few limits on how many cycles a woman can try, some pursue treatment for a decade or longer, well past the point where the odds are realistically in their favor. Doctors there have raised real concerns about what that does to older patients, physically and emotionally.

The U.S. doesn’t operate from anything close to that premise. A single IVF cycle typically runs somewhere between $15,000 and $25,000 once medications and monitoring are added in, and most patients need more than one. Insurance coverage is a genuine patchwork. Roughly a third of states have some kind of fertility mandate, and even among those, what’s actually covered varies a lot: some require full IVF coverage, others just a diagnostic workup. Self-funded employer plans, which cover most Americans with job-based insurance, are often exempt from state law entirely.

There’s been movement at the federal level. In February 2025, the Trump administration signed an executive order directing agencies to find ways to lower IVF costs and expand access, though the order itself created no new coverage requirement. The first concrete follow-through came that October: a deal with the drugmaker EMD Serono to discount several common IVF medications through a new federal platform, TrumpRx.gov, which began rolling out in early 2026. It’s real money for some patients; medication can run up to a fifth of a cycle’s cost, but it doesn’t touch the much bigger expense of the procedure itself, and it depends on which drugs you’re prescribed and whether your employer opts in to related benefit changes. Advocacy groups tracking the rollout have been careful to call it a start, not a fix.

The practical result is that American patients often spend nearly as much energy fighting for access as they spend on treatment itself, an idea I’ve seen laid out well elsewhere. A diagnosis alone doesn’t tell you whether you’ll get treated in America. Your zip code and your employer’s benefits package matter just as much, sometimes more.

Doctors who’ve trained in both systems tend to notice this gap immediately. Dr. Eliran Mor, an Israeli-trained reproductive endocrinologist now practicing in the Los Angeles area, is one example of a physician whose career spans exactly that divide: Israel’s essentially open-ended public funding on one side, America’s insurance patchwork on the other.

The gap isn’t only financial. Israel is an unusually pronatalist society, and that shapes how openly people talk about fertility treatment. Plenty of Israeli women have gone through multiple IVF cycles, and it’s rarely something anyone hides. American fertility culture still carries more silence, even as public awareness has grown. Cost and stigma feed each other here, and a lot of patients go through treatment quietly, without the kind of informal support network that’s more common in Israel.

There’s an economic angle too, one that’s easy to miss. Economists who’ve studied Israel’s system argue that heavily subsidized IVF doesn’t just change who gets access; it changes incentives in the marriage and family-formation market itself, since the state absorbs nearly all the cost and risk. In the U.S., cost works as a filter in the opposite direction: it delays or blocks family-building for people who’d otherwise be strong candidates for treatment, purely because they can’t afford it. A study following English-speaking women who moved to Israel and used the local fertility system captured that shift well. Several described something close to disbelief at no longer having to weigh a baby against a bank balance.

Worth noting, too: Israel’s fertility rate, still among the highest in the industrialized world at around 2.9 children per woman as of 2025, has been essentially flat to slightly declining the past couple of years. Generous funding clearly hasn’t hurt, but it isn’t a guarantee of anything either.

Neither system is a clean model to copy wholesale. Israel’s openness raises real ethical questions about treating patients well past the point where success is likely. The American system, for all its dysfunction, allows for a kind of clinical flexibility and innovation that a more centralized model doesn’t always leave room for. Physicians like Dr. Eliran Mor, who trained in one system and now practices in the other, end up straddling both instincts at once: the Israeli assumption that treatment shouldn’t be rationed by cost, and the American reality that it often is. But having watched this up close, I don’t think it’s only a policy debate. It’s a question of what a country decides infertility actually is. Israel decided a long time ago that it’s a medical condition worth treating without a financial gate attached. The U.S., for the most part, still hasn’t made that call, including executive orders and drug discounts.

Family building is hard enough as a medical matter. It shouldn’t be this much harder as an administrative one.