Trump delves into thorny IVF recommendations that threaten to split Republicans

President Trump must navigate a delicate tightrope when he proposes a 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 Vice President J.D. Vance, who say IVF is a solution to the long-term economic problems caused by America’s record-low birth rate.

In February, Mr. Trump directed the Domestic Policy Council to develop ways to make IVF more accessible and affordable to Americans struggling with fertility. Those proposals could be announced within days.

The White House has closely guarded its plans. Spokesman Kush Desai said it was premature to discuss the unfinalized recommendations.

The president is expected to sidestep one of the thorniest issues of the IVF debate: What happens to embryos that are not transferred to the uterus for implantation or are no longer needed for reproductive purposes? The recommendations are widely expected to address access but not what should be done with the embryos. Many pro-life advocates have condemned genetic testing or the destruction of embryos. They argue 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.

If the recommendations significantly improve access to IVF, the burgeoning industry is set to explode. From 2022 to 2023, the number of babies born through IVF increased from 91,771 to 95,860, nearly 5%, accounting for 2.6% of births in the U.S.

The industry is valued at $5.7 trillion. Depending on the recommendations, it could swell to $8 trillion.

Critics warn that expanding access to an industry that isn’t governed by the stringent regulations of other medical procedures would be misguided and dangerous.

“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 declined to comment.

Among a spate of lawsuits, a White couple is suing over getting the wrong embryo and giving birth to a Black baby. Others have lost eggs or embryos to the implosion of a clinic’s storage lab.

Minimal regulations are divided among federal, state and professional organizations. The 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.

Last month, as part of his mass federal government layoffs, Mr. Trump eliminated the CDC’s Assisted Reproductive Technology Surveillance team, which tracked IVF effectiveness data.

Although most states require hospitals and other medical facilities to report severe or avoidable medical errors, those mandates don’t apply to IVF clinics. Blood banks are more regulated than the IVF industry.

Instead, the industry self-regulates. Accredited organizations that advocate for increased IVF access include the American Society for Reproductive Medicine, which monitors embryology clinics.

Clinics are not required to report mishaps to the government, monitoring organizations, the public or patients, which obscures the number of accidents and errors each year.

Dr. Roger Shedlin, president and CEO of WINFertility, an infertility benefits management company, said the industry has robust supervision.

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 have created or whether the embryos have been discarded, donated to research or frozen.

According to CDC data, about 90% of fertility clinics participated in 2024. There is no penalty for noncompliance.

The 1992 law, combined with supervision from organizations such as the American Society for Reproductive Medicine and the Society for Assisted Reproductive Medicine, and insurers that 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 room for improvement in industry transparency. He said some publicly available data can have lag times of two years.

The Trump administration must also determine whether for-profit organizations can exempt themselves from covering IVF procedures because of religious or moral objections. The administration has yet to address this issue.

During his 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 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 Republican Party 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.”

A survey by Mercer, a financial services company, found that 47% of employers with more than 500 workers covered IVF last year, up from 45% in 2023. About 70% of employers with more than 20,000 workers covered the procedure, up from 62%.

Twenty-two states have enacted laws requiring insurers to cover at least some fertility care, and 15 require IVF coverage. Who and what is covered differ drastically from state to state, largely because of the high prices of treatments.

Dr. Shedlin said those state mandates have improved access and care and reduced costs because insurers are picking up the cost, which can be as high as $20,000. He noted that polls show the procedure is overwhelmingly popular with Americans.

An April survey by the Pew Research Center found that 70% of Americans said increased IVF access is a good thing and 8% said it was a bad thing. Another 22% 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 by America’s declining birth rate have touted IVF as a miracle solution. That includes Mr. Vance, who routinely addressed the issue on the campaign trail.

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 fewer Americans will pay taxes, reducing the labor force.

Methods other than IVF can increase births. Some health care advocates have pushed for addressing the root causes of infertility through restorative reproductive medicine, which focuses on treating a woman’s underlying health problems.

A 2024 study of Irish restorative reproductive medicine clinics found a success rate of 40% per treatment cycle, compared with 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 said both types of fertility treatments have room for improvement.

“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.