To compare IVF utilization rates and IVF outcomes in states with and without mandates for male infertility coverage. In 2020, 43 states recorded their lowest fertility rate in 3 decades. In-vitro fertilization (IVF) is an important treatment for couples affected by infertility, including 50% of couples with male factor infertility as a contributing cause. As of 2020, 12 states had passed laws mandating insurance coverage for IVF; only 7 of those states also mandated coverage for male infertility care.

We obtained nationwide claims data from over 91 million insured US individuals from 2003 to 2020 in Optum’s de-identified Clinformatics Data Mart Database. States were categorized into 3 groups: states mandating IVF and male infertility care coverage, states mandating only IVF coverage, and all remaining states. We calculated IVF utilization rates and pregnancy, live, multiple, and preterm birth rates following IVF.

IVF utilization was 6-fold higher in states with mandated male infertility coverage compared to states without any mandated coverage. Pregnancy and birth rates after IVF were similar across groups. The absolute number of births from IVF per 100,000 women was highest in states with insurance coverage mandates that included male infertility care.

IVF utilization rates and absolute number of live births from IVF were highest in states with an insurance mandate that included male infertility care. In the setting of declining fertility rates, policymakers drafting new legislation for infertility coverage should consider including coverage for male infertility care to promote family-building.