President Trump will have to navigate a delicate tightrope when he comes out with a promised plan to expand access to in vitro fertilization.
The complex balancing act will require the president to appease two portions of his base. On one side are pro-life advocates who say the IVF industry is an unregulated “wild west” akin to abortion because the embryos created during the process are often discarded. On the other side are conservatives, led by potential MAGA heir Vice President J.D. Vance, who say it’s a solution to the long-term economic problems caused by America’s record-low birth rate.
In February, Mr. Trump directed his Domestic Policy Council to develop ways to make IVF more accessible and affordable to Americans struggling with fertility. Those proposals could come within days.
The White House has closely guarded its plans. White House spokesman Kush Desai said it was still “premature” to discuss the yet-to-be-finalized recommendations.
The president is expected to sidestep one of the thorniest issues surrounding the IVF debate: What happens to embryos that are not transferred to the uterus for implantation or are no longer needed for reproductive purposes? It is widely expected that the recommendations will address access, but not what should be done with the embryos. Many pro-life advocates have condemned their use in genetic testing or their destruction, arguing that the embryos are life.
“Please stop and study the IVF industry, which is disturbing as it preys on desperate families, kills humans in the embryonic stage, and promotes eugenics,” Students for Life of America President Kristan Hawkins posted on X shortly after Mr. Trump released his executive order.
Nevertheless, if the recommendations significantly improve access to IVF, the burgeoning industry is set to explode. In 2023, the number of babies born from IVF increased to 95,860 from 91,771 in the previous year, a nearly 5% increase and accounting for 2.6% of births in the U.S.
The industry is currently valued at $5.7 trillion, and it could swell to $8 trillion depending on the recommendations.
Critics warn it would be misguided and dangerous to expand access to an industry that isn’t governed by the same stringent regulations as other medical procedures.
“The fertility industry today is by and large an underregulated, unaccountable industry with very few federal or state laws governing what takes place,” said Emma Waters, a policy analyst specializing in reproductive medicine at the Heritage Foundation. “It is very unique as compared to other major medical procedures because it is primarily self-regulated by major societies such as the American Society for Reproductive Medicine and Resolve,” she said. “These organizations are setting the guidelines that clinics are supposed to follow but have no legal bearing. They are also financially motivated to see an increase in the fertility industry because, as the fertility industry increases, so does the power of these organizations.”
The American Society for Reproductive Medicine and Resolve: The National Infertility Association both declined to comment.
A spate of recent lawsuits ranges from a White couple suing for getting the wrong embryo and giving birth to a Black baby to people suing when they lost eggs or embryos when a clinic’s storage lab imploded.
Minimal regulations are split among federal, state and professional organizations. The U.S. Centers for Disease Control and Prevention offers some oversight by auditing and inspecting a small percentage of the nearly 450 U.S. clinics each year. Their reviews are largely to validate data.
Mr. Trump last month eliminated the CDC’s Assisted Reproductive Technology Surveillance team, which tracked IVF effectiveness data as part of his mass federal government layoffs.
While most states require hospitals and medical facilities to report serious or avoidable medical errors, those requirements don’t apply to IVF Clinics. Blood banks are more regulated than the IVF industry.
Instead, the industry self-policies with many of the accredited organizations that advocate for increased IVF access, such as the American Society for Reproductive Medicine (ASRM), monitoring embryology clinics.
There is no requirement that clinics must report mishaps to the government, monitoring organizations, the public or patients. That means it’s unclear how many accidents and errors take place each year.
Dr. Roger Shedlin, president and CEO of WINFertility, an infertility benefits management company, said there is robust oversight of the industry. He cited a 1992 federal law that requires clinics to report IVF success rates to the CDC and certified embryo laboratories. However, the law does not require labs to report how many embryos they’ve created or whether they’ve been discarded, donated to research or frozen.
In 2024, about 90% of fertility clinics participated because there is no penalty for noncompliance, according to CDC data.
The 1992 law, combined with supervision provided by reproductive organizations such as ASRM and the Society for Assisted Reproductive Medicine (SART), and insurers who cover IVF benefits, creates three layers of industry oversight, he said. Those layers, Dr. Shedlin said, allow for oversight down to cycle level, which is all the steps involved in the IVF process.
“When you consider the oversight provided by government regulators, including mandated clinical outcome reporting through the CDC, professional societies like ASRM and SART, and benefit managers, I am confident about the external oversight of the fertility industry today.”
However, Dr. Shedlin acknowledged there is some room for improvement in industry transparency, noting that some publicly available data can have a lag time of as long as two years.
Another needle the Trump administration will have to thread is whether for-profit organizations can exempt themselves from covering IVF procedures for religious or moral objections. It’s an issue the administration hasn’t addressed.
During the 2024 campaign, Mr. Trump said, “Your government will pay for or your insurance company will be mandated to pay for all costs associated with the IVF treatment.” That raised some alarms that it could be on par with President Obama’s controversial mandate requiring businesses to cover employees’ contraception methods, including the morning-after pill.
Republicans howled over the mandate, and the Supreme Court concluded that for-profit entities could bow out under religious exemptions.
“It would really be an overstep on the part of a Republican administration,” a GOP strategist privately told The Washington Times. “There is almost a hypocrisy here if they support a government mandate for IVF. You’ll see [the Obama lawsuits] all over again.”
About half of employers with more than 500 workers (47%) covered IVF last year, up from 45% in 2023, and about 70% of employers with more than 20,000 workers, up from 62% in 2003, according to a survey by Mercer, a financial services company.
Currently, 22 states have passed legislation requiring insurers to cover at least some fertility care, with 15 of those requiring coverage for IVF. However, who and what gets covered differ drastically from state to state, largely because of the high price of treatments.
Dr. Shedlin said those state mandates have both improved access and care, along with reducing costs because insurers are picking up the cost, which can be as high as $20,000. He noted that recent polls show the procedure is overwhelmingly popular with the American people.
An April survey by Pew Research Center found that 70% of Americans said increased IVF access is a good thing, compared to 8% who said it was a bad thing and 22% who said they were unsure.
“A national statutorily mandated fertility benefit would help improve access and control costs,” Dr. Shedlin said. “A federal fertility policy could be a way for the Trump administration to support patients seeking these services in states that don’t currently provide mandated coverage.”
Those alarmed about America’s declining birth rate, such as Mr. Vance, who routinely addressed the issue on the campaign trail, have touted IVF as a miracle solution to the problem.
More than 3.6 million babies were born in the U.S. last year, a meager 1% rise from the record-setting low in 2023. The U.S. fertility rate is roughly 1.6 births per woman over her lifetime, well below the 2.1 births needed for the U.S. to maintain its population through births alone.
That could create economic havoc in the U.S in less than a generation because it will lead to fewer Americans paying taxes and reducing the labor force.
There are other methods than IVF to increase births. Some healthcare advocates have pushed for addressing the root causes of infertility through what’s known as restorative reproductive medicine (RRM). That method focuses on treating a woman’s underlying health problems.
A 2024 study of Irish RRM clinics found that they had a success rate of 40% compared to 24% per treatment cycle at IVF clinics.
“I think we do a disservice to women and men if we don’t first take time to understand what’s contributing to the diagnosis of infertility and seek treatment that actually addresses the root cause. It might take a couple of months or a year to really treat those conditions, but it’s a far cheaper process, and the success rates are comparable or slightly higher than they are for IVF,” Ms. Waters said.
Dr. Shedlin says there is room for both types of fertility treatments.
“As technology advances, our definition of assisted reproductive technologies can evolve to include not just traditional interventions like IVF, but also newer innovations that support fertility preservation and address the underlying causes of infertility,” he said.
