CBS News
Fertility treatment costs are out of reach for many Americans, even with insurance
Mary Delgado’s first pregnancy went according to plan, but when she tried to get pregnant again seven years later, nothing happened. After 10 months, Delgado, now 34, and her partner, Joaquin Rodriguez, went to see an OB-GYN. Tests showed she had endometriosis, which was interfering with conception. Delgado’s only option, the doctor said, was in vitro fertilization.
“When she told me that, she broke me inside,” Delgado said, “because I knew it was so expensive.”
Delgado, who lives in New York City, is enrolled in Medicaid, the federal-state health program for low-income and disabled people. The roughly $20,000 price tag for a round of IVF would be a financial stretch for lots of people, but for someone on Medicaid — for which the maximum annual income for a two-person household in New York is just over $26,000 — the treatment can be unattainable.
Expansions of work-based insurance plans to cover fertility treatments, including free egg freezing and unlimited IVF cycles, are often touted by large companies as a boon for their employees. But people with lower incomes, often minorities, are more likely to be covered by Medicaid or skimpier commercial plans with no such coverage. That raises the question of whether medical assistance to create a family is only for the well-to-do or people with generous benefit packages.
“In American health care, they don’t want the poor people to reproduce,” Delgado said. She was caring full-time for their son, who was born with a rare genetic disorder that required several surgeries before he was 5. Her partner, who works for a company that maintains the city’s yellow cabs, has an individual plan through the state insurance marketplace, but it does not include fertility coverage.
Some medical experts whose patients have faced these issues say they can understand why people in Delgado’s situation think the system is stacked against them.
“It feels a little like that,” said Elizabeth Ginsburg, a professor of obstetrics and gynecology at Harvard Medical School who is president-elect of the American Society for Reproductive Medicine, a research and advocacy group.
Whether or not it’s intended, many say the inequity reflects poorly on the U.S.
“This is really sort of standing out as a sore thumb in a nation that would like to claim that it cares for the less fortunate and it seeks to do anything it can for them,” said Eli Adashi, a professor of medical science at Brown University and former president of the Society for Reproductive Endocrinologists.
Yet efforts to add coverage for fertility care to Medicaid face a lot of pushback, Ginsburg said.
Over the years, Barbara Collura, president and CEO of the advocacy group Resolve: The National Infertility Association, has heard many explanations for why it doesn’t make sense to cover fertility treatment for Medicaid recipients. Legislators have asked, “If they can’t pay for fertility treatment, do they have any idea how much it costs to raise a child?” she said.
“So right there, as a country we’re making judgments about who gets to have children,” Collura said.
The legacy of the eugenics movement of the early 20th century, when states passed laws that permitted poor, nonwhite, and disabled people to be sterilized against their will, lingers as well.
“As a reproductive justice person, I believe it’s a human right to have a child, and it’s a larger ethical issue to provide support,” said Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, an advocacy group.
Joaquin Rodriguez
But such coverage decisions — especially when the health care safety net is involved — sometimes require difficult choices, because resources are limited.
Even if state Medicaid programs wanted to cover fertility treatment, for instance, they would have to weigh the benefit against investing in other types of care, including maternity care, said Kate McEvoy, executive director of the National Association of Medicaid Directors. “There is a recognition about the primacy and urgency of maternity care,” she said.
Medicaid pays for about 40% of births in the United States. And since 2022, 46 states and the District of Columbia have elected to extend Medicaid postpartum coverage to 12 months, up from 60 days.
Fertility problems are relatively common, affecting roughly 10% of women and men of childbearing age, according to the National Institute of Child Health and Human Development.
Traditionally, a couple is considered infertile if they’ve been trying to get pregnant unsuccessfully for 12 months. Last year, the ASRM broadened the definition of infertility to incorporate would-be parents beyond heterosexual couples, including people who can’t get pregnant for medical, sexual, or other reasons, as well as those who need medical interventions such as donor eggs or sperm to get pregnant.
The World Health Organization defined infertility as a disease of the reproductive system characterized by failing to get pregnant after a year of unprotected intercourse. It terms the high cost of fertility treatment a major equity issue and has called for better policies and public financing to improve access.
No matter how the condition is defined, private health plans often decline to cover fertility treatments because they don’t consider them “medically necessary.” Twenty states and Washington, D.C., have laws requiring health plans to provide some fertility coverage, but those laws vary greatly and apply only to companies whose plans are regulated by the state.
In recent years, many companies have begun offering fertility treatment in a bid to recruit and retain top-notch talent. In 2023, 45% of companies with 500 or more workers covered IVF and/or drug therapy, according to the benefits consultant Mercer.
But that doesn’t help people on Medicaid. Only two states’ Medicaid programs provide any fertility treatment: New York covers some oral ovulation-enhancing medications, and Illinois covers costs for fertility preservation, to freeze the eggs or sperm of people who need medical treatment that will likely make them infertile, such as for cancer. Several other states also are considering adding fertility preservation services.
In Delgado’s case, Medicaid covered the tests to diagnose her endometriosis, but nothing more. She was searching the internet for fertility treatment options when she came upon a clinic group called CNY Fertility that seemed significantly less expensive than other clinics, and also offered in-house financing. Based in Syracuse, New York, the company has a handful of clinics in upstate New York cities and four other U.S. locations.
Though Delgado and her partner had to travel more than 300 miles round trip to Albany for the procedures, the savings made it worthwhile. They were able do an entire IVF cycle, including medications, egg retrieval, genetic testing, and transferring the egg to her uterus, for $14,000. To pay for it, they took $7,000 of the cash they’d been saving to buy a home and financed the other half through the fertility clinic.
She got pregnant on the first try, and their daughter, Emiliana, is now almost a year old.
Delgado doesn’t resent people with more resources or better insurance coverage, but she wishes the system were more equitable.
“I have a medical problem,” she said. “It’s not like I did IVF because I wanted to choose the gender.”
One reason CNY is less expensive than other clinics is simply that the privately owned company chooses to charge less, said William Kiltz, its vice president of marketing and business development. Since the company’s beginning in 1997, it has become a large practice with a large volume of IVF cycles, which helps keep prices low.
At this point, more than half its clients come from out of state, and many earn significantly less than a typical patient at another clinic. Twenty percent earn less than $50,000, and “we treat a good number who are on Medicaid,” Kiltz said.
Now that their son, Joaquin, is settled in a good school, Delgado has started working for an agency that provides home health services. After putting in 30 hours a week for 90 days, she’ll be eligible for health insurance.
One of the benefits: fertility coverage.
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Two undersea cables carrying internet data deep in the Baltic Sea have been damaged, European telecommunications companies have said, drawing warnings from European governments of possible Russian “hybrid warfare” targeting global communications infrastructure.
The foreign ministers of Finland and Germany said in a joint statement on Monday that a cable connecting the two countries had been cut and that the incidents had raised suspicion of possible sabotage.
“A thorough investigation is underway. Our European security is not only under threat from Russia’s war of aggression against Ukraine, but also from hybrid warfare by malicious actors,” the ministers said, without blaming any particular entity for the possible sabotage.
Stefan Sauer/picture alliance/Getty
The Finnish company Cinia confirmed Monday that its submarine cable between Finland and Germany was damaged. The cable is about 730 miles long and connects telecommunications networks in central Europe to Finland and other Nordic countries.
“The details of the fault are yet not known and are currently being investigated,” the company said in a statement on its website.
Swedish company Arelion confirmed to CBS News on Tuesday that one of its cables was also damaged.
“We can confirm that one of our subsea fiber cables — the one between Gotland, Sweden and Šventoji, Lithuania — is damaged. The issue was detected on November 17, and we currently do not know what caused it as we have not been able to examine the cable,” Arelion spokesperson Martin Sjögren told CBS News.
“Arelion is in contact with Swedish authorities and the Swedish Armed Forces regarding the incident. The cable will be repaired over the next few weeks depending on weather conditions,” he said.
Audrius Stasiulaitis, a spokesperson for the Swedish multinational telecom company Telia, which uses and operates the Arelion cable, said the firm believed the cable was physically damaged.
“We can only speculate on what has happened, but as far as we see, it is not affected by equipment failure and we presume it’s physical damage,” he told CBS News over the phone on Tuesday.
The damage to the cables comes after reports over the past year that Russia may be targeting key infrastructure connecting Nordic countries.
An April 2023 joint investigation by the public broadcasters of Sweden, Denmark, Norway and Finland found that Moscow was operating a fleet of suspected intelligence vessels in Nordic waters as part of a Kremlin campaign potentially aimed at targeting underwater cables and wind farms.
There have been attacks on European infrastructure since Russia launched its full-scale invasion of Ukraine 1,000 days ago.
In September 2022, the Nord Stream 1 and Nord Stream 2 pipelines, both designed to carry natural gas from Russia to Germany under the Baltic Sea, were damaged by explosions.
Both Ukraine and Russia denied any involvement in the explosions. In August, German media reported that prosecutors had issued an arrest warrant for a Ukrainian man over the pipeline attacks.
Sweden and Finland have both joined the NATO military alliance over the past two years, as the war in Ukraine fuels concern about Russia’s possible intentions, and just this week, both countries updated their war preparation guidance and published online booklets for citizens to prepare for the eventuality of a war or other crisis.
In the wake of former President Donald Trump’s re-election, Israel’s far-right minister of finance suggested the country would look to annex the occupied West Bank in 2025. Here’s what you need to know:
What is the West Bank?
The West Bank is an area of land on the west bank of the Jordan River, which is part of the former British-mandated territory of Palestine. It is surrounded by Israel on three sides — the north, west, and south — and it borders the country of Jordan on its east, across the river.
After the departure of British forces in 1948 when the modern state of Israel was created, Arab forces entered and retained the West Bank, and the city of Jerusalem was divided into two sectors: the Israeli west and the Jordanian east.
During the Six-Day War in 1967, Israel occupied the West Bank and established a military administration there. Israel claimed East Jerusalem as part of its own territory, but fighting between the Israelis and the region’s Palestinian inhabitants — who live with significant restrictions on their movement and other aspects of life under the decades-long occupation — has continued.
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Hamas, designated a terrorist organization by the United States and Israel, decisively won a 2006 West Bank parliamentary election over the Western-backed Fatah faction, led by Mahmoud Abbas, which had been administering the Palestinian Authority. The Hamas victory brought sanctions and boycotts by the U.S., the EU and Israel of the new, Hamas-led joint Palestinian leadership.
In 2007, Abbas dissolved the Hamas-led administration in the West Bank and created an emergency cabinet that favored Fatah. The power struggle between the two Palestinian factions led to a split between the West Bank and Gaza, with Western powers supporting the Fatah-administered West Bank diplomatically and economically, while blockading the Hamas-run Gaza Strip.
How could U.S. policy change during the second Trump administration?
The longstanding position of the United States has been support for a two-state solution to the conflict between Israelis and Palestinians, meaning the creation of an independent state of Palestine alongside the independent state of Israel. Most iterations of this policy envision a future Palestinian state made up of the West Bank and East Jerusalem, as well as Gaza.
Trump’s previous administration bucked tradition, but did not flat-out reject a two-state solution. Trump moved the U.S. embassy from Tel Aviv to Jerusalem and offered a plan that would have cemented Israeli control over the entire city. It also would have protected Israeli settlements in the West Bank, which are illegal under international law, while moving toward Palestinian self-rule.
President-elect Trump’s pick to serve as the next U.S. Ambassador to Israel, former Arkansas governor and Baptist preacher Mike Huckabee, has never supported a two-state solution.
In an interview with The Associated Press when he was running to be the Republican presidential nominee in 2015, Huckabee said that, if elected, his administration would formally recognize the West Bank as part of Israel.
“I feel that we have a responsibility to respect that this is land that has historically belonged to the Jews,” Huckabee told the AP.
In a podcast interview earlier this year, Huckabee said that there “isn’t such a thing” as Palestinians, describing himself as an “unapologetic, unreformed Zionist.” He voiced similar views during his campaign in 2008.
Israel “is an extraordinary oasis in a land of totalitarianism surrounded by tyranny,” he said on the podcast earlier this year.
Florida Sen. Marco Rubio, Trump’s pick for Secretary of State, has repeatedly voiced support for the Israeli government’s response to Hamas’ brutal Oct. 7, 2023 attack.
“Although the Biden-Harris Administration has publicly backed Israel’s right to defend itself, it has also undercut Israel’s maneuverability, leading to a schizophrenic policy towards the region,” Rubio said in a letter to current Secretary of State Antony Blinken in August.
Voicing his objection to U.S. sanctions against individuals alleged to be supporting “extremist settler violence” against Palestinians in the West Bank, Rubio wrote that, “Israel has consistently sought peace with the Palestinians. It is unfortunate that the Palestinians, whether it be the Palestinian Authority or FTOs such as Hamas, have rejected such overtures. Israelis rightfully living in their historic homeland are not the impediment to peace; the Palestinians are.”
Israel’s far-right government says it’s preparing for annexation of the West Bank
Some of those who do not support the creation of an independent Palestinian state do support Israel’s annexation of the West Bank, including members of the current far-right Israeli government led by Netanyahu.
Netanyahu’s Likud party is currently part of a coalition, formed to keep Netanyahu in power, with radical right-wing nationalist parties such as the Religious Zionist Party.
Netanyahu, who has spoken out against the creation of a Palestinian state, committed to pursuing the annexation of the West Bank in Likud’s coalition agreement with the Religious Zionist Party.
“The people of Israel have a natural right to the Land of Israel,” the agreement says. “In light of the belief in the aforementioned right, the Prime Minister will lead the formulation and promotion of a policy within the framework of which sovereignty will be applied in the West Bank, while choosing the timing and considering all national and international interests of the state of Israel.”
Bezalel Smotrich, the Israeli finance minister who’s a member of the Religious Zionist Party, said he believed Israel could work with the incoming Trump administration to promote annexation of the West Bank.
“I am convinced that we will be able to work closely together with President-elect Trump and all members of the incoming administration, to promote the common values and interests of the two countries, to strengthen the strength and security of the State of Israel, to expand the circle of peace and stability in the Middle East out of strength and faith and on the basis of recognition in the unquestionable historical belonging of the whole Land of Israel to the people of Israel,” Smotrich said on social media.
Israeli settlements and smaller outposts in the West Bank are illegal under international law. They’re also seen as a barrier to a potential two-state solution, because the more Israeli Jews live in the occupied territory, the less likely it seems that Israel would ever abandon control of the land for it to become part of a Palestinian state.
A Pew Research Center survey carried out in the summer found Israelis divided on the potential security risks and benefits of continued settlement expansion, with 40% of respondents saying they help make Israel more secure and 35% saying they hurt security. The survey found 21% of Israelis didn’t believe settlement expansion would have any significant impact on security.
Some Israeli activists believe their government is taking advantage of the country’s collective grief after the Oct. 7 attack to push an agenda in the West Bank that doesn’t have broad public backing.
“In Israel, there’s very little public criticism or any sort of public debate on what is going on in the West Bank,” Sarit Michaeli, international advocacy lead for the Jerusalem-based rights group B’Tselem, told CBS News of the situation post-Oct. 7 attack. “Israelis are furious. They’re angry. They’re hurt. They’re traumatized, and this collective trauma has been exploited by our government to push forward policies that most Israelis don’t necessarily agree with in the West Bank.”
In June, the Israeli body that governs the West Bank transferred many powers over the territory from Israeli military officials to civil ones, who work under Smotrich.
Since the Oct. 7 Hamas attack, the monitoring group Peace Now says it has documented at least 43 new illegal outposts in the West Bank, mostly on farmland. Dozens of new roads have been paved to facilitate the establishment of these outposts, the group said.
What would it mean if Israel does annex the West Bank?
In 2020, Tel Aviv University’s Institute for National Security Studies (INSS) analyzed what Israeli annexation of the West Bank could actually entail. They looked at three possible scenarios, with Israel either taking full security and administrative control of a portion of the Palestinian territory, or just preventing future evacuation of existing Israeli settlements.
In all three of the scenarios examined, Israeli sovereignty would not necessarily be applied in full to Palestinians in the area. If it were to be, Palestinians would live under the jurisdiction of the State of Israel and, under Israeli law, would be entitled to request citizenship.
Nasser Ishtayeh/SOPA Images/LightRocket/Getty
The INSS said annexing West Bank territory would make it harder for future Israeli governments to give up that land as part of any deal to create a Palestinian state.
“In actuality, annexation means tying the hands of future Israeli governments that would be willing to transfer territories for a political settlement,” the INSS report said.
One senior Palestinian politician in Gaza recently told CBS News that regardless of what changes Israel ushers in under the new leadership in Washington, it would not end the Palestinian people’s decades-long fight for a state of their own.
“We will struggle for our rights,” Mustafa Barghouti, a doctor in Gaza and the leader of the Palestinian National Initiative party, told CBS News. The Palestinian National Initiative party champions a unified democratic government for both the West Bank and Gaza.
“It will take time. We will suffer. We know that. But what’s the alternative? To cease to exist? It’s ethnic cleansing. We cannot accept that,” Barghouti said.
Authorities in Hawaii are warning residents who attended a local pet fair to watch for symptoms of avian influenza after a local flock of ducks and other birds tested positive for the H5N1 virus that has fueled a global outbreak of infections.
Officials suspect wild migrating birds are likely to blame for the first known infection of a flock in Hawaii, which had been the last state in the country with no reported cases in poultry or wild birds during the current outbreak.
Sequencing done by the U.S. Department of Agriculture’s national lab in Iowa confirmed the infection, federal officials announced Monday.
The specific genotype of the virus that infected the birds is known as A3, said Lyndsay Cole, a spokesperson for the federal Animal Plant Health Inspection Services.
This is different from the B3.13 genotype that has been fueling this year’s unprecedented outbreak on dairy and poultry farms and suggests the virus spilled over into the flock in Hawaii from migrating wild birds.
Investigators have not turned up any links so far between the flock and imported animals or travel, a spokesperson for Hawaii’s Agriculture Department said. The island has “strict importing regulations for birds and other animals,” the spokesperson said.
All the infected birds were housed at the same site, though investigations are ongoing to root out other potential cases. The birds were also not symptomatic until several days after the fair, the state Health Department said, lowering the risk to humans.
“As the birds were not showing signs of infection at the time of the fair, the likelihood of spreading H5N1 to humans is low. However, out of an abundance of caution, DOH recommends that individuals who attended the fair and touched a duck or goose monitor for influenza-like illness (ILI) and conjunctivitis,” the state said in a release.
A quarantine order was issued for the property where the birds lived and all will be required to be “depopulated and the premises cleaned and disinfected,” the state Agriculture Department said. An order was also issued to prevent any animals from being moved in or out of the site.
At least 10 birds, which included ducks, a goose and a zebra dove, had been reported dead at the property on Nov. 12. Samples from the dead birds were sent to be tested for the virus.
Closely watching for human cases
Confirmation of the infected flock in Hawaii follows a detection of the virus in the area from wastewater samples collected by the state earlier this month.
Health officials around the country have been closely watching for signs of H5N1 spreading in their communities amid mounting cases in humans across North America.
At least 53 cases have been confirmed across seven states so far this year, the federal Centers for Disease Control and Prevention (CDC) says. Most are linked to the B3.13 version of the virus that has been infecting workers at dairy farms and nearby poultry farms in recent months. None of them are known to have been severely ill.
Health officials in Canada announced this month that they had detected a case of H5N1 bird flu in a critically ill hospitalized teenager. That patient had been infected by the D1.1 genotype of H5N1, which is related to another ongoing poultry outbreak in British Columbia, the Canadian province where they lived.
Experts say the virus that infected the teenager does appear to have some worrying mutations, which might explain why the case was more severe.
“The preliminary sequence from the H5N1 human case in British Columbia has been posted and it is not good news,” Scott Hensley, a professor of microbiology at the University of Pennsylvania, posted on Nov. 16.
Genetic sequencing data from human cases so far in the U.S. have not found any signs of the virus mutating to spread more efficiently between humans or to be significantly more dangerous, the CDC says.
But the agency also recently found evidence that several cases had been asymptomatic and gone undetected during the outbreak so far, prompting stepped up testing recommendations.
Orono H.S. senior identified as driver in Minnetonka fatal crash
Undersea cables cut or damaged, and European governments hint at possible Russian sabotage
Trump win fuels discussion of Israel annexing the West Bank. Here’s what that means.
Orono H.S. senior identified as driver in Minnetonka fatal crash
Undersea cables cut or damaged, and European governments hint at possible Russian sabotage