I 
118TH CONGRESS 
1ST SESSION H. R. 4731 
To require health insurance coverage for the treatment of infertility. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 19, 2023 
Ms. DELAURO (for herself, Mr. CLEAVER, Ms. JACOBS, Ms. CHU, Ms. MENG, 
Mr. CONNOLLY, Mr. POCAN, Ms. PINGREE, Ms. ROSS, and Mr. NADLER) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Education and 
the Workforce, Ways and Means, Oversight and Accountability, Veterans’ 
Affairs, and Armed Services, for a period to be subsequently determined 
by the Speaker, in each case for consideration of such provisions as fall 
within the jurisdiction of the committee concerned 
A BILL 
To require health insurance coverage for the treatment of 
infertility. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Access to Infertility 
Treatment and Care Act’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
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(1) Infertility is a medical disease recognized by 
the World Health Organization, the American Soci-
ety for Reproductive Medicine, and the American 
Medical Association that affects men and women 
equally. 
(2) According to the Centers for Disease Con-
trol and Prevention, 1 in 8 couples have difficulty 
getting pregnant or sustaining a pregnancy. 
(3) Infertility affects a broad spectrum of pro-
spective parents. No matter what race, religion, sex-
ual orientation, or economic status one is, infertility 
does not discriminate. 
(4) According to the Centers for Disease Con-
trol and Prevention, 11 percent of women in the 
United States between the ages of 15 and 44 have 
difficulty getting pregnant or staying pregnant. 
Similarly, 9 percent of men in the United States be-
tween the ages of 15 and 44 experience infertility. 
(5) Infertility disproportionately affects individ-
uals with particular health complications. For cancer 
patients and others who must undergo treatments 
such as chemotherapy, radiation therapy, hormone 
therapy, or surgery that are likely to harm the re-
productive system and organs, fertility preservation 
becomes necessary. 
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(6) Leading causes of infertility include chronic 
conditions and diseases of the endocrine or metabolic 
systems, such as primary ovarian insufficiency, poly-
cystic ovarian syndrome, endometriosis, thyroid dis-
orders, menstrual cycle defects, autoimmune dis-
orders, hormonal imbalances, testicular disorders, 
and urological health issues. Other causes include 
structural problems or blockages within the repro-
ductive system, exposure to infectious diseases, occu-
pational or environmental hazards, or genetic influ-
ences. 
(7) Recent improvements in therapy and 
cryopreservation make pregnancy possible for more 
people than in past years. 
(8) Like all other diseases, infertility and its 
treatments should be covered by health insurance. 
(9) A 2017 national survey of employer-spon-
sored health plans found that 44 percent of employ-
ers with at least 500 employees did not cover infer-
tility services, and 25 percent of companies with 
20,000 or more employees did not cover infertility 
services. 
(10) Coverage for infertility services under 
State Medicaid programs is limited. The Medicaid 
programs of only 5 States provide diagnostic testing 
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for women and men in all of their program eligibility 
pathways; the Medicaid program of only one State 
provides coverage for certain medications for women 
experiencing infertility; and no State Medicaid pro-
grams cover intrauterine insemination or in vitro 
fertilization. 
(11) States that do not require private insur-
ance coverage of assisted reproductive technology 
have higher rates of multiple births. 
(12) The ability to have a family should not be 
denied to anyone on account of a lack of insurance 
coverage for medically necessary treatment. 
SEC. 3. STANDARDS RELATING TO BENEFITS FOR TREAT-
MENT OF INFERTILITY AND PREVENTION OF 
IATROGENIC INFERTILITY. 
(a) IN GENERAL.— 
(1) PHSA.—Part D of title XXVII of the Pub-
lic Health Service Act (42 U.S.C. 300gg–111 et 
seq.) is amended by adding at the end the following: 
‘‘SEC. 2799A–11. STANDARDS RELATING TO BENEFITS FOR 
TREATMENT OF INFERTILITY AND PREVEN-
TION OF IATROGENIC INFERTILITY. 
‘‘(a) IN GENERAL.—A group health plan or a health 
insurance issuer offering group or individual health insur-
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