OBJECTIVE: Financial constraints limit many patients from being able to access infertility care, especially assisted reproductive technologies (ART) such as in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). We sought to determine the impact of state insurance mandates for infertility coverage on the utilization of IVF within each state.DESIGN: Retrospective analysis of publicly available data. MATERIALS AND METHODS: All IVF centers in the United States in 2017, their zip code, and number of cycles performed were extracted from CDC data. Using US census data, the median salaries for zip code and state were extracted. The number of IVF centers and number of IVF cycles between states with and without infertility coverage insurance mandates were compared. The association between geographic region, income and the number of IVF cycles was evaluated. IVF centers in mandate and non-mandate states were sequentially sorted by the median household income of the zip code they are located in and grouped into successive increments of $10,000 of median household income. Total number of cycles per successive $10,000 income bracket were compared in mandate and non-mandate states. Paired and unpaired Student's T-tests were performed for continuous variables.RESULTS: Fifteen states mandate some degree of infertility coverage. States with insurance mandates for infertility coverage had a greater number of yearly IVF cycles per 100,000 residents compared to states without infertility coverage mandates (104 cycles vs 57 cycles per 100,000 p¼0.029). However, there was no difference between the number of IVF centers per person between states with and without infertility coverage mandates (0.16 vs 0.13 per 100,000 residents, p¼0.058). On average, IVF centers were located in zip codes with greater median incomes than their respective states