If only the world were ideal, I would be passionately in favour of public funding for reproductive care. Given that the majority of people throughout the world define themselves and their lives in the context of family, a responsive body politic would emphatically insist that medical care that enables family building should be one of the highest priorities for health care coverage. Perhaps I would find myself as avidly supportive of this viewpoint were I living somewhere other than the United States. Alas, the world is not ideal, and I am privileged to live in the US where the burden of public funding for reproductive medicine would outweigh the advantages for both providers and patients.