By now, you’ve likely seen the headlines announcing Costco Wholesale’s launch of a nationwide fertility access program to decouple infertility treatment from traditional insurance pathways and reassemble it into a vertically coordinated cash-pay ecosystem. Costco members (and even non-members) will soon have access to a direct-to-consumer cash-pay telehealth platform through Sesame Health, access to a robust fertility clinic network through IVI RMA North America clinics, and medication fulfillment at discounted prices through Costco Pharmacy.
No, you won’t get Kirkland brand IVF medications. Yes, you will get discounts.
Overview of Costco’s Fertility Program
Costco’s model operates on two parallel economic layers: (1) Program access and (2) Treatment costs.
A monthly fee (~$99/month for members and ~$119/month for non-members) covers telehealth fertility consultations, care coordination, diagnostic test ordering, and case navigation through IVF and other assisted reproductive technology (ART) treatments. This subscription fee does not cover the cost of diagnostic testing, IVF procedures or ART procedures, which will be paid for separately by patients. The subscription fee does include Costco’s negotiation of exclusive IVF drug pricing for members. This two prong approach increases access to reproductive care, decreases the waiting period for meaningful testing and fertility care coordination, and decreases out-of-pocket costs for patients by reducing the cost of IVF medications.
Meaningful Discounts and Access to Care
Looking into the financials it appears Costco will be able to deliver on their promise to provide meaningful discounts on fertility care. A typical self-pay patient can expect to spend $3,000-$6,000 for IVF medications, compared with Costco’s program offering $1,640-$2,296 for the same medications. Combine this financial benefit with the fact that that over 85% of IVI RMA clinics are within 25 miles of every Costco address, you can see how Costco’s program is aimed at improving access to fertility care and not only on reduced out-of-pocket costs. Let’s look at each step more in depth:
Step 1 — Digital intake
Patients begin through Sesame telehealth clinicians, who collect reproductive history, order labs, coordinate imaging, and assess infertility etiologies. This decreases the typical 3-6 month wait for initial consultations with reproductive endocrinologists. Fertility patients know that waiting to move forward with fertility treatment can be frustrating as delays are associated with decreased fertility rates and less than optimal outcomes. Through Costco’s program, by the time patients meet with their IVF physician they can provide a comprehensive medical history to better determine a reproductive treatment plan on a truncated timeline.
Step 2 — Diagnostics
Some of the most common diagnostic testing ordered by Sesame telehealth clinicians include: semen analysis, AMH testing, day-3 FSH/E2, AFC ultrasounds, hysterosalpingography (HSG), TSH/prolactin levels, and endocrine panels. While Sesame clinicians coordinate each patient’s workup, they do not perform the testing and procedures. Once a patient completes all testing diagnostics ordered by their Sesame telehealth physician, they will be referred to a nearby IVF Clinic to meet with a reproductive endocrinologist as may be necessary.
Step 3 — Referral to IVF clinic
Patients requiring ART in order to have a child are referred to a nearby IVF Clinic through IVI RMA North America. Approximately 85% of IVI RMA clinics operate within a 25 mile radius of a Costco store. All IVI RMA clinics perform IVF cycles, IUI procedures, egg freezing, fertility preservation, and other assisted reproductive treatments. For patients requiring the assistance of an egg donor, sperm donor, or gestational surrogate, such arrangements will be coordinated in collaboration with their IVF Clinic.
Step 4 — Fertility Treatment and IVF Medication
When the IVF Clinic has determined the best treatment care plan for the patient, Costco will negotiate prices for the required fertility medications. While only a few medications were publicly identified, the IVF medication bundle through Costco is expected to include drugs in the following categories: (1) gonadotropins (Follistim, Gonal-f, Menopur); (2) GnRH antagonists (Ganirelix, Cetrotide); (3) Trigger medications (Ovidrel, Pregnyl); and (4) Luteal phase support (Progesterone). Costco’s speciality pharmacy infrastructure already distribuerts many of these medications through its Member Prescription Program.
The Economics of IVF
Average U.S. costs for each phase of the IVF cycle are as follows:
| Component | Approximate cost |
|---|---|
| Consultation + monitoring | $2k–$4k |
| Medications | $3k–$6k |
| Egg retrieval | $6k–$10k |
| Embryology lab | $3k–$6k |
| Embryo transfer | $3k–$5k |
Total cycle cost often reaches $15k–$30k out-of-pocket.. Costco’s program estimates a savings of anywhere from $5,500-$10,000 per IVF cycle due to reduction in medication prices, negotiated clinic discounts, and elimination of insurance and administrative overhead.
This program potentially disrupts specialty fertility pharmacies, insurance-dependent fertility clinics, and wait times for reproductive endocrinologists. Costco’s program undercuts pricing of exiting speciality fertility pharmacies, reduces diagnostic delays associated with meeting with a reproductive endocrinologist, and may frustrate insurance providers presently providing coverage for specific fertility treatments.
Regulatory and Insurance Context
It’s important to state that Costco’s program is not insurance and does not bill insurers. This program is a cash-pay healthcare marketplace. Sesame intentionally avoids insurance to maintain transparent pricing. Costco pharmacies operate under state pharmacy licensing requirements and regulations and within the federal rules governing prescription dispensing. IVF drugs will continue to remain prescription only and dispensed following the order of a reproductive endocrinologist. Discount programs typically cannot be used with federal programs due to anti-kickback statues.
Structural Restraints and Criticisms
Though Costco’s program is overwhelmingly encouraging, we would be remiss not to address a few potential constraints and drawbacks. Since patients in the program will ultimately be referred to IVI RMA clinics only, this may exclude patients who are already in the care of other reproductive endocrinologists and clinics outside RMA’s network. Though out-of-pocket costs for medications will be reduced, the out-of-pocket costs for procedures including egg retrievals, embryo transfers, lab services, cryopreservation of embryos, and genetic testing will remain high. Additionally, physicians may be tempted to change medical protocols if pricing bundles incentivize certain medications.
Public Policy and American Politics
Costco’s announcement of a discounted fertility treatment program amid increasing politicization of reproductive rights and political focus on access to fertility care is no accident. Costco is stepping into a space where market innovation, gaps in public policy, and political interest intersect. Given Costco’s ~125 million members globally, the company may become one of the largest fertility-care referral pipelines in the United States.
Fertility care in the United States has long been characterized by inequity in access, high out-of-pocket costs, and limited insurance coverage. A single IVF cycle can cost between $12,000 and $25,000, often requiring multiple attempts, placing treatment out of reach for many hopeful parents. Even for insured patients, substantial cost-sharing remains the norm. This structural reality has made fertility treatment a compelling target for both policymakers and private-sector disruptors.
The scale of infertility underscores the growing urgency of the issue. The World Health Organization estimates that 1 in 6 people globally experience infertility, a figure echoed in U.S. data and widely cited by policymakers and industry leaders alike. Compounding this, the United States is experiencing historically low fertility rates, dropping below 1.6 births per woman in 2024, raising broader economic and demographic concerns about population aging, labor force contraction, and long-term growth.
It is against this backdrop that fertility care has become increasingly politicized. The 2025 Executive Order on IVF marked a notable moment in federal engagement, directing policymakers to explore ways to expand access and reduce costs. While the order signaled strong rhetorical support for fertility treatment, its practical impact has been insignificant. Subsequent policy proposals emphasized cost reductions and employer-based coverage incentives but stopped short of mandating insurance coverage or allocating federal funding. The gap between political messaging and policy implementation leaves room for private actors to shape access to care.
Costco’s program can be read, in part, as a response to that gap. Leaders involved in the initiative explicitly referenced the executive order as a “call to action,” framing the partnership as aligned with national policy priorities. The dynamic of corporations operationalizing policy goals that our government does not fully fund or mandate reflects a broader trend in American healthcare, where access is often mediated through employer benefits, private networks, and consumer-facing platforms rather than universal public programs.
Yet the politicization of IVF extends beyond cost and access. Legal and ethical debates (particularly following state-level rulings on embryo status) have placed fertility treatment within the broader conflict over reproductive rights. IVF, once largely insulated from abortion politics, is now often entangled in questions about personhood, regulation, reproductive rights, and the limits of state intervention. In 2026 we are living within a cultural paradox: fertility treatment is simultaneously promoted as a pro-family policy priority and contested as part of a larger ideological struggle over reproductive autonomy.
Costco’s fertility program launch signals how access to reproductive technology may evolve. By leveraging scale, negotiated pricing, and direct-to-consumer healthcare models, the company is helping to normalize fertility treatment as a consumer service – something that can be shopped for, compared, and bundled alongside other health offerings in the future. This market-driven approach raises important policy questions. If access to IVF increasingly depends on membership models, employer benefits, or private partnerships, disparities in equitable access may continue to persist along lines of income, employment, and geography. Public policy has yet to resolve whether fertility care should be treated as an essential health benefit, a subsidized social good, or a largely private responsibility.
The launch of Costco’s fertility program reveals where we as Americans are at this critical moment in time in a convergence of politics, religion, medical technology, economics, and demographics. Should access to fertility care be driven by government policy, private innovation, medical technology, or some hybrid of the three? The answer to this question will not only shape how reproductive healthcare is defined in the United States, but will also impact which Americans will be able to build a family in the face of infertility.
