An emotional debate has attended the question of whether health insura
nce should cover the cost of in vitro fertilization (IVF) for infertil
e couples. Some private health plans have opted to cover IVF, although
most have not. Ten states have mandated that it be included or offere
d as a standard benefit for private health insurance plans. This artic
le analyzes several key issues in the debate: the impact of insurance
coverage; the cost-effectiveness of IVF; valuing the benefit of IVF; a
nd adoption as an alternative. It recommends policy action in several
areas: more efficiently allocating resources for IVF (by giving priori
ty to couples with better chances of success, and by making more exten
sive use of facilities with higher success rates); ensuring that clear
and reliable information about the effectiveness of IVF is available;
and leveling the playing field between IVF and adoption.