5 Things President Trump's Executive Order on IVF Gets Wrong

President Donald Trump’s recent executive order on IVF is a worrying sign of things to come. Titled “Expanding Access to In Vitro Fertilization”, it does not do anything to immediately expand access to IVF or to lower prices. Essentially, the order is a referral to committee and a request for proposals. But the goals are badly out of sync with the most pressing needs of American families. 

In an accompanying fact sheet, President Trump stated he wants to lower costs and pare back regulations, so that IVF is accessible to more families and in order to boost fertility nationwide. But the Trump administration is making five key mistakes. 

1. IVF Is Not Currently Overregulated

The United States is a global outlier when it comes to our practice of IVF. We collect almost no data about how IVF clinics operate—they report neither how many embryos they create and destroy, nor their (accurate) success rate in helping parents carry to term. While other nations have adopted regulations to minimize the number of “extra” embryos created, the United States essentially allows clinics to chart their own course. 

When clinics make big mistakes, they push for more exemptions from basic legal liability and threaten to close clinics in states that hold them to account. The Alabama Supreme Court never “banned” IVF—they ruled that clinics that negligently destroyed embryos could be sued for the deaths of these children by their bereaved parents. Clinics responded by closing their doors unless they were given broad immunity to make mistakes with the children they created. 

There are many places where parents are burdened by overbroad regulations. The Trump administration would be better off overhauling car seat rules, child care staffing ratios, or family-unfriendly zoning to meet parents in their need. 

2. IVF Does Not Boost Fertility

Without question, IVF has helped many infertile parents have the children they longed and prayed for. Children conceived through IVF now represent 2% of American births. But it is a mistake to conclude IVF is therefore raising the birth rate. Studies of the effect of state-level subsidies to IVF suggest instead that it is changing when and which children are born, as Lyman Stone has pointed out in this space. 

Expanding IVF tends to slightly increase births to women over 35 while decreasing births for younger women. There is no reason the government should put its thumb on the scale to specifically incentivize later births rather than expanding paid leave or other programs that might help more women feel comfortable trying for children earlier.

3. IVF Doesn’t Fix The Real Barrier to Family Formation

Infertility is a heavy burden to carry. Delayed marriage and family formation exacerbates this problem. Much of America’s decrease in fertility is actually a decrease in marriage rates. Married fertility remains relatively stable, but fewer men and women are achieving the marriages they desire. Rather than play catch-up by expanding IVF, we need to help men and women meet and marry earlier, when they will find it easier to have children and will be able to treasure them for much more of their lives. 

4. IVF Costs Can Only Be Redistributed

IVF is expensive. The process of preparing and harvesting eggs and then fertilizing and evaluating them requires costly drugs and staff time. Potential mothers and their doctors need to plan their whole month around retrieval timing. The executive order is very unlikely to result in basic scientific breakthroughs that lower the cost of stimulating and retrieving eggs. The question is how the costs will be redistributed. 

The budget is tight, and it is unlikely that IVF costs will be covered by the federal government through new deficit spending or by finding a corresponding pay-for. IVF is not preventative care, like vaccination, where the cost of “free” care can be offset by diseases avoided down the line. If the costs are going to be lowered, it will be through cross-subsidy, where insurers lower the sticker price to IVF but raise everyone’s premiums to compensate. This will make insurance harder to afford for working families and raise barriers to all medical care, not just infertility treatments.

5. IVF Forces Parents into a Sophie’s Choice

Ultimately, all advocacy to increase take-up of IVF is advocacy for some children at the expense of others. That conundrum was on full display in the SBA Pro-Life America statement in response to the IVF executive order. SBA asked for regulation and consequences for practioners who “negligently destroy human embryos desired by infertile couples.” 

But, of course, most of the embryos created and destroyed by IVF are not accidentally unfrozen and ruined as they were in Alabama. They are destroyed deliberately, not negligently, and with the permission of the parents because the extra children are not desired. Some are destroyed because their parents preferred boys over girls (or vice versa). Some are destroyed because parents, mindful of the uncertainty of IVF, made more embryos than they planned to use. Some are destroyed by court order, when parents divorce, disagree about their children, and one parent prevails in demanding they be discarded along with the marriage.

The federal government can and should support family formation and help parents have the freedom to care for their children. Whether the goal is raising the overall fertility rate or helping poorer parents access care, expanding IVF is not the best way to achieve either of these goals. IVF costs too much and does too little to justify the government trying to increase uptake. Ultimately, IVF necessarily relies on dehumanizing some children, which makes it a bad fit for creating a culture that welcomes all children. 

Leah Libresco Sargeant is the author of Building the Benedict Option and runs Other Feminisms, a substack community.