Trump’s IVF order: one small step for the U.S., one giant leap for the GOP
Advisors have until May to come up with recommendations to support access to IVF
A couple weeks ago, U.S. President Donald Trump released an Executive Order on “expanding access to IVF.” In a separate fact sheet, Trump explained in his trademark style that “we want more babies, to put it very nicely.”
White House Press Secretary Karoline Leavitt announced the order on X in allcaps saying: “PROMISES MADE. PROMISES KEPT.” As of now, it’s too early to say whether Trump’s groundbreaking campaign promises in favor of protecting and reimbursing IVF will be kept: the terse document is too short on specifics.
In the Order, Trump affirms that “infertility struggles can make conception difficult, turning what should be a joyful experience into an emotional and financial struggle.” He also states: “My Administration recognizes the importance of family formation, and as a Nation, our public policy must make it easier for loving and longing mothers and fathers to have children.”
The Order signals America’s pivot to political pronatalism. While nations like France and Israel have long histories of official pronatalism, this is a fairly novel development for the U.S., which for the longest time could rely on natural population growth, with large families driven by factors like by cheap land and lively religious communities.
The Order pledges to take action to make IVF accessible:
Americans need reliable access to IVF and more affordable treatment options, as the cost per cycle can range from $12,000 to $25,000. Providing support, awareness, and access to affordable fertility treatments can help these families navigate their path to parenthood with hope and confidence. Therefore, to support American families, it is the policy of my Administration to ensure reliable access to IVF treatment, including by easing unnecessary statutory or regulatory burdens to make IVF treatment drastically more affordable.
The order instructs the Assistant to the President for Domestic Policy (that would Vince Haley) to present within 90 days “a list of policy recommendations on protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment.”
And that’s about it. While one can be disappointed that the Order at this stage is largely symbolic, taking some time to formulate policy is certainly not a bad thing on any important issue, so as to avoid erratic and purely slogan-driven decision-making, to which populist governments in particular are often prone.
Symbolically, the Order is quite a big deal for a U.S. president, let alone a Republican one. The National Infertility Association RESOLVE reacted to the Order saying: “In our decades of advocacy, we have never seen an administration prioritize IVF as an issue impacting millions of Americans. For this we are grateful.”
The American Society for Reproductive Medicine (ASRM) said it was “gratified to see today’s Executive Order” and called on Trump to “demonstrate his commitment to IVF access for all Americans by immediately ensuring that all federal employees, civilian and military, have access to IVF.”
IVF has significant potential to increase U.S. fertility. Whereas only 2% of births in the U.S. are enabled via IVF, in Israel—where the procedure is paid for by the government—IVF-enabled births had risen to 5.8% by 2021 (and are probably even higher now). Supporting IVF can make a meaningful contribution to getting the U.S. back to replacement-level fertility. IVF can also enable access to monogenic testing of embryos to weed out genetic diseases from future generations.
While the U.S. almost certainly has the most advanced IVF and genetic testing services in the world, these are costly and often inaccessible. With Democrats having long supported IVF, Trump’s backing signals a rare opportunity for bipartisanship in our hyper-polarized times. Both Republicans and Democrats can potentially support IVF as a cause important both for fulfilling Americans’ hopes of building families and for the country’s demographic dynamism.
Republican politicians have tended to not be so supportive of IVF given that religious conservatives within the GOP coalition have opposed technologies destroying human embryos (such as stem cell research and IVF insofar as it produces excess embryos). In addition, as detailed in a recent podcast from the Claremont Institute (a Trump-friendly think-tank), religious conservatives may oppose IVF’s capacity to support nontraditional family structures (e.g., motherless families if a gay couple chooses to use IVF via a surrogate) and genetic selection.
As noted back in December by Pete Shanks of the egalitarian bioconservative Center for Genetics and Society (CGS), Trump’s team is “serving two masters” when it comes to reproductive politics: the GOP’s traditional base of religious bioconservatives and Silicon Valley techno-natalists like Elon Musk who are open to novel family structures and using reprogenetic technology for enhancement. Shanks argues these gaps in the new GOP coalition offer opportunities for left-wing bioconservatives who oppose genetic enhancement as a new form of “eugenics”:
[W]hat happens, for example, when Musk-style, techno-enhanced pronatalism runs up against the conservative campaign for embryonic personhood? . . . As activists trying to promote a humane, generous, fair society, we clearly have huge tasks ahead of us. But perhaps contradictions on reproductive rights and technologies within the relatively loose coalitions around the incoming President may open up spaces in which we can work.
So far, the Trump Administration has continued to balance appeals to the religious base—witness Vice President J. D. Vance’s debut speech at the March for Life Rally and actions against financing pro-abortion NGOs abroad—with support for IVF and ambivalent positions on state-led abortion restrictions, mindful of not wanting to alienate broader American opinion.
Probably, a lot depends on simply who has the ear of President Trump and that isn’t necessarily going to be the traditional pro-lifers of Conservatism, Inc. So far, President Trump has developed a remarkably close partnership with Musk, empowering his Department of Government Efficiency (DOGE) to pursue an extraordinary agenda of reforming—really, tearing down for eventual reconstruction, as he did with Twitter—whole swathes of the federal government. While Richard Hanania thinks the Trump-Musk bromance is built to last, I am not sure anything is so predictable in Trumpworld.
The upcoming recommendations on IVF to be presented in mid-May and how these are leveraged, both by the Administration and by Congress if legislative action is needed, will be important indications of things to come: both on how the Trump team balances the elements of their coalition and for the prospects of greater reproductive freedom and the growth of techno-natalism in America.