Despite the acknowledgment of infertility as a “disease of the reproductive system,” infertility remains an unmet need in the United States. Though there have been significant advances in assisted reproductive technology (ART), there remain significant barriers to accessing care, most significantly being the cost of infertility services. Furthermore, remarkable racial and ethnic disparities have been consistently identified when evaluating outcomes of ART treatment in the United States. Race has been identified as an independent predictor of live birth and cumulative live birth rates following in vitro fertilization (IVF). Over the past 30 years, state insurance mandates for IVF coverage have been proposed and accepted in many states to help reduce the burden of cost as a barrier to accessing infertility treatment. Currently, 21 states have insurance mandates for some infertility coverage, though the scope of coverage varies widely between states. While insurance mandates have been found to increase rates of infertility treatment across racial and ethnic groups, the increase in usage has not been enough to eliminate health disparities as a function of race indicating that there is still further work to be done to address racial and ethnic disparities in infertility treatment in the United States.