In vitro fertilization (IVF) is a medical procedure in which an egg is fertilized outside the body before being placed inside a womb. Some countries have chosen to cover IVF through public spending, but there is usually a limit to the number of cycles being publicly covered. Ultimately, the willingness to public IVF-coverage will depend on its cost-effectiveness. Several attempts have been made to provide cost-effectiveness analyses (CEA) of IVF, a surprisingly difficult task. The aim of this article is to examine the theoretical underpinnings for CEA of IVF-treatment. I argue that at least two theoretical questions must be answered. First, what is the desired outcome of an IVF? It could be to cure biological infertility, or to cure unwanted childlessness. The former may imply the latter, but not vice versa. Curing unwanted childlessness can be achieved by other means than IVF. However, curing biological infertility is also problematic, as many of those who require IVF to become parents do not have infertility issues. Other reasons, such as sexuality or not having a partner, can also be a driving force behind IVF. Depending on how we understand the desired outcomes of IVF, it may lead to different CEA-results. Second, who is the IVF treatment for? IVF treatment is quite different from the majority of medical treatments, given that it entails two lives rather than one. While the IVF-procedure concerns an existing individual or couple, the aim of the procedure is to procreate a new individual. Therefore, one needs to take a stance on whether the benefits of IVF-treatment belong to the pregnant woman, the procreated child– or both. Finally, I show that there is a high elasticity in the chosen philosophical assumptions behind any CEA of IVF-treatment.