BACKGROUND  Utilization of In Vitro Fertilization (IVF) to treat infertility is increasing, despite the high cost incurred, often resulting in multiple births with poor outcomes.  Physicians practicing in states with insurance mandates have been shown to transfer fewer embryos, resulting in fewer multiple births and improved outcomes.  OBJECTIVES: The objective of this study was to compare the impact of mandated IVF insurance coverage on the cost per live birth of healthy infants and infants born with disability. METHODS: A Markov model was developed to calculate the number of live births resulting from a maximum of six IVF cycles, and cumulative costs through initial hospital discharge.  Age-specific utilization rates, pregnancy rates, birth rates, multiple rates, and costs for states with and without insurance mandates were derived from the literature, insurances claims databases, and publicly available CDC data.   The model takes a societal perspective and reports results in 2010 US dollars. RESULTS: In hypothetical cohorts of 10,000, for women under the age of 35-years, the insurance strategy results in 42 fewer births with disability. The non-insurance strategy results in 31 additional healthy births but at a cost of $1,831,462 per healthy birth.  For women aged 35-37, the insurance strategy dominates the non-insurance strategy with 12 additional births with disability, and 282 additional healthy births.  For women aged 38-40, the insurance strategy dominates the non-insurance strategy with 0 additional births with disability, and 46 additional healthy births.  For women aged 41-42, the insurance strategy results in 23 fewer births with disability, and 1 fewer healthy birth.  The cost for each additional healthy birth is $244,903,064. CONCLUSIONS: This study shows insurance coverage for IVF is a “cost-effective”, and in some age groups a dominant strategy, even in the short time horizon from delivery through initial discharge and should be considered for inclusion as a standard insurance benefit.