In the summer of 2024, amid his characteristically mean-spirited presidential campaign versus Kamala Harris, Donald Trump made a refreshingly generous promise that buoyed the hopes of parents across the country who had struggled to conceive a child. “We are going to be, under the Trump administration, we are going to be paying for that treatment,” Trump said, referring to in vitro fertilization, “or we’re going to be mandating that the insurance company pay.” A few weeks before the election, he even went so far as declare himself the “father of IVF.” “We want fertilization, and it’s all the way, and the Democrats tried to attack us on it, and we’re out there on IVF, even more than them,” he said during a town hall hosted by Fox News.
Once back in office, though, Trump was more like a deadbeat dad. Yes, in February he issued an executive order to increase access to IVF while lowering its cost, which in his eyes made him the “fertilization president.” But it was mostly hot air. Trump did strike a deal in October with a subsidiary of German pharmaceutical company Merck KGaA to slash prices for IVF drugs in exchange for tariff relief, but IVF advocates said the estimated $2,200 savings wouldn’t do much to help couples afford a treatment that costs as much as $25,000 for a single round. The promised free coverage for IVF never came to pass, and in many ways the IVF landscape has gotten notably worse thanks to Republicans in Washington and in state houses across the country. And that’s a big opportunity for the Democrats in a critical election year.
In April 2025, budget cuts killed the Centers for Disease Control and Prevention’s Assisted Reproductive Technology Surveillance team, a panel that tracked how well IVF works in the United States. Then in December, and again a few weeks ago, Republicans in Congress killed a provision to expand the military’s coverage of IVF, despite having voted for such coverage in the past. Trump, who is notorious for letting Capitol Hill lawmakers know when they have displeased him, said nothing. Meanwhile, there’s a nascent movement in red states to regulate IVF and providers, leading to fears that anti-IVF forces will slowly chip away at access to fertility technology much as anti-abortion groups eroded access to abortion in the years leading up to the Supreme Court’s Dobbs ruling.
This is a dramatic shift from 2024, when the Alabama Supreme Court ruled that embryos created through IVF are considered “unborn children,” leading local clinics to pause treatment out of fear of criminal prosecution and civil liabilities. The nationwide backlash pressured the Alabama legislature to move quickly to assure the legality of IVF, and Republicans across the country scrambled to assure voters that they supported the procedure.
“Already in 2024, the Democratic plan was to make reproductive policy issues as big a deal as they could,” said Sean Tipton, chief advocacy and policy officer for the American Society for Reproductive Medicine. “President Trump, being the extremely talented politician that he is, saw that and decided that being against IVF was going to be really bad. So he was going to be for it. I think if he had not done that, I don’t think we would have heard any pro-IVF things out of most Republicans.
“So Republicans had to thread that needle,” Tipton added. “What they have chosen to do is campaign as if they’re pro-IVF and govern as if they’re not.”
Danielle Melfi, CEO of the national infertility association RESOLVE, said there’s a “big gap ... between promises and reality.” “Every politician was really forced to go on the record to say, hey, we support IVF, we support people being able to have families if they’ve experienced infertility,” she said. “But where the difference is coming up is, how do we make real-world access available to people?”
Trump seemed sincere about supporting IVF, and has been vocal about wanting more native-born babies in America. As recently as May, in an Oval Office event, he announced a proposed rule that would allow employers to offer IVF coverage as a stand-alone benefit, much like vision or dental care. Still, that rule wouldn’t require employers to cover fertility treatments. “No president has done more to help Americans struggling to start families than President Trump, whose administration has created a new fertility benefit option and slashed the cost of fertility drugs,” White House spokesman Kush Desai said in a statement to The New Republic. “The Administration will continue to explore additional policies to build on these historic successes.”
IVF was a politically polarizing issue even before the 1978 birth of Briton Louise Brown, dubbed the first “test tube baby” by the media. Some believed that IVF, which includes freezing and sometimes destroying unused embryos, was tantamount to abortion. Others “didn’t like IVF because it would enable people who were single, unmarried, and people who were in same-sex relationships to all have children, too—and also, enable people to prioritize a career and education,” said Mary Ziegler, a professor at UC Davis School of Law who is at work on a book on the history of IVF. “All of these things were not something conservatives approved of.”
IVF is enormously popular now, with a 2024 Pew Research poll showing that seven in ten Americans think it’s a good thing; eight percent think it’s a bad thing, and 22 percent don’t know. But determined opposition remains from religious and social conservatives. That’s apparent not just in Congress, where GOP House Speaker Mike Johnson, an evangelical Christian, has quietly scuttled efforts to expand access to IVF, but in the reaction to last weekend’s announcement by Democratic Representative Alexandra Ocasio-Cortez that she is freezing her eggs.
Prominent blogger Matt Walsh called the decision “totally backwards and ridiculous,” writing, “She’ll turn 37 in a couple months. If she got pregnant now, it would technically be a geriatric pregnancy. Instead she’s freezing her eggs. This desire to start having children late in life is completely baffling to me.” Mollie Hemingway, the editor in chief of The Federalist, wrote, “Ladies, get married to a good man as young as you’re able and have your babies and do it naturally. This is a very sad public performance/display of unnecessarily unwise decision making.” (“Naturally” is right-wing code for getting pregnant through sex and not using birth control, condoms, or other forms of contraception.)
The White House, however, sees this is a losing issue. “We most certainly want to encourage more women and families to have children, period,” a senior White House official told Axios. “That’s a diplomatic way of saying, ‘Yes, the Matt Walsh messaging is not helpful.’” Another Trump adviser told the outlet, noting the upcoming midterm elections, “This isn’t really a winner for Republicans.”
Democrats haven’t made IVF a front-burner issue in the midterms, as they did in the 2024 general election, after the Alabama court ruling. But it’s starting to pick up: In announcing the reintroduction of the Right to IVF Act in July, Senator Tammy Duckworth, a Wisconsin Democrat who had both of her children via IVF, slammed Trump for dropping the fertility ball. “Almost two years after promising free IVF for all Americans if he were elected, Donald Trump has still failed to deliver,” she said. And Ocasio-Cortez, making her egg-freezing announcement, noted that she was doing so in part because of the “political environment where this administration is denying reproductive care to women across the country, from abortion rights to the ability to carry out a healthy pregnancy.”
With Congress at a standstill on the issue, action is moving to the states. And there, IVF advocates say, is the real threat. RESOLVE monitored 181 bills across 39 states this year and found that 41 threatened IVF access.
Proposals range from mandatory tracking of embryos (as South Dakota considered and rejected this year) to Targeted Restrictions of IVF Providers, known as “TRIP” laws, which would impose reporting and other regulations on clinics, as Tennessee considered and rejected last year. That measure also would have prohibited genetic testing and imposed an embryo creation limit of four times the number of children the patient hopes to have. (Since not all embryos are viable, providers try for as many as they can create—typically eight for women under 35, and four to five for patients 35-40.)
Embryonic “personhood” laws and bills (considered but not passed this year in South Carolina, Oklahoma, and Minnesota) are a constant threat to IVF, advocates say, citing the Alabama Supreme Court ruling. In Louisiana, embryos are considered “juridical persons” under the law, and it is illegal to intentionally destroy a viable embryo. People who have embryos created have to keep them frozen in the Bayou State or ship them elsewhere.
Such tactics, reproductive rights advocates say, are similar to the strategy used to weaken abortion rights, state by state, when an outright ban was out of reach. “We see a lot of parallels between the efforts to restrict or ban abortion and what we’re seeing now in the states to restrict IVF,” said Karla Torres, senior human rights counsel for the Center for Reproductive Rights. “Conservatives or anti-abortion advocates who are now targeting IVF know they cannot outright ban it. What they are looking for [are ways] to restrict access to it or undermine the standard of care for IVF.”
Ziegler agrees. “It’s parallel to the playbook that took down Roe,” she said.
Arkansas, meanwhile, last year became the first state to enact the RESTORE Act, which requires insurance companies to cover what is called Restorative Reproductive Medicine, or RRM. The controversial approach—which critics deride as “blame and shame”—aims to identify and treat physical issues and lifestyle choices that allegedly interfere with fertility. The problem, IVF proponents say, is that precious time can be wasted finding the “root cause” of infertility—and then it may be too late for IVF.
Emma Waters, senior policy analyst in the Center for Technology and the Human Person at The Heritage Foundation, rejects the notion that RRM is not as effective. “To treat infertility, one must treat the underlying causes. IVF, in and of itself, doesn’t do that,” said Waters, the co-author of the Heritage paper that has become a template for state legislation pushing RRM.
Torres said she expects other states to follow suit in promoting the “restorative” care at the expense of IVF. In Texas, the state GOP recently approved a party platform opposing IVF and promoting “natural procreative technology,” an element of RRM, as an alternative to IVF. (While Texas law requires insurers to offer IVF coverage, employers don’t have to sign up for it. Further, with a few exceptions, the couple must have been infertile for five years, and only the husband’s sperm can be used.)
Another new battleground in the IVF wars is surrogacy, Torres said. Florida recently enacted a law banning gestational surrogacy contracts if any of the parties is a citizen or resident of a State Department-designated “foreign country of concern.” While the law appears aimed at birthright citizenship, it has the effect of limiting IVF, Torres said.
The movement in red states to limit IVF is picking up steam, Tipton said. And since state legislatures tend to move more quickly than Congress, they could change IVF access quickly. “Legislation is like sperm,” Tipton said. “There’s a lot of it. Most of it’s not going to amount to anything. But if you’re not taking appropriate precautions, there’s going to be hell to pay.”
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