Cheaper IVF Means More Babies, Yet the Industry Is Investing in Everything Else

Sunfish CEO Angela Rastegar on the $70,000 baby, shrinking employer benefits, and why affordability, not the embryology lab, determines who becomes a parent.

Every fertility clinic in America can tell you the price of a cycle. Almost none will tell you the price of actually having the baby.

The gap between those two numbers is where Angela Rastegar built Sunfish.

A cycle runs about $25,000, she says, but with roughly two thirds of cycles failing, "we estimate the average cost of having an IVF baby is actually closer to $70,000."

Research presented at the European Society of Human Reproduction and Embryology's 42nd Annual Meeting in early July analyzed ART registry, economic and demographic data from 22 countries and regions, covering more than 95% of global ART activity between 2021 and 2023. The finding: halving patient out-of-pocket costs was associated with a 2.67-fold increase in births through assisted reproduction.

The researchers built a "cost-to-baby" metric, the estimated cost of achieving one live birth, and found it ranged from 66% of median household income in Israel to 833% in parts of Africa.

Countries that keep treatment under affordability thresholds post the highest utilization: 11.8% of all births in South Korea come through ART, 11.7% in Spain, 9.3% in Japan. The study, led by Dr. Stephanie Kuku of Conceivable Life Sciences, was presented with its abstract published in Human Reproduction; the full peer-reviewed paper has not yet been published.

For scale, 2024 was the first year the United States recorded more than 100,000 IVF births, per SART data released by ASRM in March. By CDC's count, ART accounts for roughly 2.6% of American infants. South Korea is at 11.8%.

The constraint on IVF births is not the science. It is the invoice.

Sunfish sells fixed-price IVF and egg freezing memberships it calls success programs, underwritten against a patient's own biology. The company reviews blood work, sperm health where relevant, and uterine ultrasounds alongside the standard fertility workup, then quotes one price covering the journey through to a baby, financing included if needed. The pricing absorbs the variables that blow up patient budgets.

A cycle quoted at $25,000 can land anywhere from $20,000 to $40,000 once additional embryo transfers, at $4,000 to $5,000 each, medications and genetic testing accumulate.

The guarantee is the novel part.

"If you are not ultimately successful with us, we actually put our money where our mouth is."

Failed IVF patients receive a partial refund toward another attempt. Egg freezing patients who miss their target egg count get a second cycle paid in full. The egg freezing version of the program launched in April; the IVF version has run for about two years.

Rastegar built the product after living the problem herself. Before Sunfish, she ran a startup with no fertility benefits and froze her eggs on her own, spending more than $50,000 of her own money across four retrievals.

"Even with all the knowledge that I have and all of the experience that I have, it was still very draining, very stressful. It's one of the hardest things I've ever done," she said.

She counts the emotional toll, not the physical one, as the second biggest reason patients quit treatment. Cost is the first.

Sunfish reports that 71% of its patients achieve pregnancy and graduate to an OB/GYN. The endpoint stops short of live birth, so the figure is not comparable to registry statistics from SART, which track deliveries and stratify heavily by age. The company told The Luteal its predictive model was back-tested across 10,000 historical patient simulations and forecast total treatment costs and outcomes with 97% accuracy, though back-testing is not prospective validation.

Per its 2024 through June 2026 cohort, 77% of patients who fail a retrieval stay in treatment. In a market where the second largest dropout driver is emotional attrition, retention after failure is the business model. None of these figures have been independently audited.

Rastegar estimates about 40% of Americans have some form of fertility coverage, and says the majority of Sunfish's own patients arrive without full coverage. The direction of travel, in her telling, has reversed.

"A lot of companies that used to cover $20,000 of benefits now only cover 10."

Against a $70,000 average cost per baby, a $10,000 benefit is a gesture. The debt follows. "When you look at the different types of household debt Americans are taking on, fertility is now the fourth largest type of debt after buying a home, student loans, and buying a car," Rastegar said, a ranking standard household debt series do not break out and The Luteal could not independently confirm.

California's SB 729 took effect for large-group plans issued or renewed on or after January 1, requiring coverage of up to three egg retrievals and unlimited embryo transfers, and Massachusetts has long had among the strongest mandates in the country.

"Even in states where there's great mandates, we still see about 50% of people needing help," Rastegar said. The leakage is partly structural: SB 729 exempts self-funded employer plans, small-group plans and religious organizations, which leaves out a large share of the insured workforce before anyone reads the fine print.

Rastegar's list of who falls through runs from the self-employed, to families excluded by older mandates' medical definitions of infertility, to per-cycle caps, to a newer phenomenon she is watching in California: clinics walking away from insurance altogether. "Just like in mental health, where not all therapists will accept insurance, I'm seeing some clinics not accept fertility insurance, just given the economics and the reimbursement rate."

Rastegar watches the capital from both sides of the table, investing in early-stage health tech alongside running Sunfish. "Women's health in general has historically been underfunded by venture capital dollars, but I've been really excited this year to see a lot more funding go into health tech in general, including women's health," she said. "Most of that has focused on AI and kind of software innovation, but I think there's some really interesting opportunities to grow this market when it comes to lab work, robotics, and the harder science."

"Hyperpersonalized care is what I'm most excited about, especially in women's health, where a lot of solutions have been treated almost like one-size-fits-all historically," she said. "More investment in women's health, more data in women's health, and improved AI and analytics in women's health is allowing us to be a lot more specific about what each person needs for her body to have success, whether it's in fertility or other areas of women's health."

Her ambition for Sunfish runs through the data it accumulates with every cycle it prices.

"Our number one goal is to be the fertility intelligence layer," she said, a system that reads a patient's biology before treatment starts and prices the path to a baby the way a lender prices a mortgage. The framing is deliberate. "A lot of women kind of act as the CFO of their households. So we want to support women on that journey with better data and analytics."

The fertility market is splitting in two. One side is making IVF work better. The other is making it affordable. Most of this year's funding went to the first.

By the study's own models, affordability alone explained 77% to 84% of the variation in how much countries use IVF. It is the largest cost-access correlation the field has ever recorded.

The evidence has picked a side. The money hasn't.