When President Trump stepped into the politically fraught debate over in-vitro fertilization on the campaign trail and then again on his return to office this year, he promised to safeguard access, ensure insurance coverage and even make the procedure “free.”

His initial pledge to address the very real problem of population decline came last year after an Alabama court ruling disrupted fertility treatments and fueled fears that IVF could become a victim of the broader fight over reproductive rights. In February, Mr. Trump even signed an executive order directing his policy team to explore ways to lower costs and expand access. 

While the order stopped short of mandating insurance coverage or guaranteeing public funding, the president branded himself as IVF’s most vocal defender and called the procedure a “miracle” for families struggling to have children.

Over the summer, however, Mr. Trump appeared to shift his posture. The White House acknowledged it had no plans to require insurers to cover fertility treatments or to create new federal subsidies, leaving many to scratch their heads. 

“Trump’s people should be very nervous about this topic, especially as he, following his immediate political instincts, came out so strongly for it and then has done zilch,” a Stanford law and biosciences professor, Hank Greely, tells the New York Sun.

Mr. Greely pointed to Mr. Trump’s February executive order, which called for a report on IVF policy within 90 days. By May, speculation swirled about what the findings might be, but silence followed. 

“My speculation is that he realized it was complicated and that the pro-life, anti-abortion, pro-embryo part of his coalition would be quite unhappy about expanding IVF,” Mr. Greely said. 

The sudden reversal reflects the new fault lines in post-Dobbs politics, where Republicans are under pressure to reconcile the demands of anti-abortion activists – who see embryos as children – with the concerns of millions of Americans who view IVF as their only hope of parenthood.

From Alabama Shockwaves to a National Flashpoint

The Alabama Supreme Court ignited a national debate last year by ruling that frozen embryos used for in-vitro fertilization are “children” under state law. This led fertility clinics to immediately stop services, fearing they could be sued for wrongful death when they disposed of surplus embryos. Many families were left in the middle of treatment without a clear path forward.

The chief advocacy and policy officer at the American Society for Reproductive Medicine, Sean Tipton, tells the Sun that “the outcry was so strong that the [Alabama] legislature, one of the most conservative in the country, quickly passed a law to restore IVF.”

“That shows how popular IVF is and how much pressure it creates for anti-abortion lawmakers,” Mr. Tipton said. 

Public opinion toward the procedure has been remarkably stable. A 2024 Pew Research Center survey showed that more than 70 percent of Americans, including a majority of Republicans and self-identified pro-life voters, view access to IVF as a good thing. 

Mr. Tipton observes that IVF was “far more visible during the 2024 elections than ever before,” with Democratic vice-presidential candidate Tim Waltz publicly discussing his own infertility journey and presidential hopefuls promising to protect the procedure.

The GOP’s Fertility Dilemma

Yet even as support for IVF has grown across party lines, the procedure appears caught in the crosscurrents of conservative politics.

Mr. Trump’s retreat spotlights a deeper fracture inside the Republican Party. For decades, social conservatives have championed “personhood” — the belief that life begins at conception, including in a lab dish. If enshrined into law, that principle makes IVF problematic, since the process often creates more embryos than are implanted, with some frozen indefinitely or destroyed.

The policy director at the American Association of Pro-Life Obstetricians and Gynecologists, Rebecca Weaver, applauds the Alabama court for recognizing “the personhood of embryonic human beings.” 

“Unfortunately, the backlash from that decision has led, in many instances, to an expansion of an already unregulated frontier in a misguided attempt to help more adults become parents,” she told the Sun. “The blind promotion of IVF regardless of the ethical and physical concerns for mothers and human embryos is concerning for all our patients.”

Ms. Weaver observed that any ethical framework must start from the position that “all human embryos deserve dignity and respect,” which means greater transparency, mandatory reporting on embryo use and outcomes, and “an end to the destruction of embryos.”

“Policies should primarily be geared towards addressing the root causes of infertility and treating those causes, as well as increasing regulatory oversight on the IVF industry, which currently profits from not addressing those root causes,” she continued.

Ms. Weaver hints that the IVF industry, which was valued globally at $34.7 billion in 2023 and projected to grow to $62.8 billion in just 10 years, profits by offering costly procedures rather than focusing on diagnosing or treating underlying medical issues that cause infertility. In her view, this creates a financial incentive to prioritize repeated IVF cycles over addressing patients’ root health problems.

A visiting fellow at the Ethics and Public Policy Center, Katelyn Shelton, makes a similar case. She contends that the administration’s retreat reflects recognition that IVF doesn’t resolve underlying health issues and instead creates new legal and ethical challenges. 

“There are an estimated 1.5 million embryos in cryostorage right now, and that number is growing every day,” Ms. Shelton told the Sun. “What do you do when a clinic accidentally destroys your embryos? Are they lawfully treated as property or persons? What happens when genetic testing is faulty, and your child develops a disease you screened out?”

Ms. Shelton pointed to Arkansas’s recent adoption of the RESTORE Act, developed by the Ethics and Public Policy Center, as a model. The law focuses on restorative reproductive medicine, which seeks to diagnose and treat the root causes of infertility rather than relying on embryo creation. 

Restorative reproductive medicine is an approach that seeks to diagnose and treat the underlying causes of infertility — such as hormonal imbalances, endometriosis, or ovulation disorders — rather than bypassing them through procedures like IVF. It uses medical, surgical, and lifestyle interventions to restore natural fertility to achieve conception through intercourse.

“Women are sick of being told that painful periods are normal, only to be diagnosed 10 years later with a condition that prevents her from getting pregnant,” Ms. Shelton said. “The answer isn’t a blank government check for IVF; the answer is fixing broken women’s healthcare.”

The Counterweight: IVF as Mainstream Medicine

Advocates for IVF, however, argue that restorative medicine cannot replace the procedure for millions of couples. In 2023, the number of IVF cycles performed at reporting clinics in the United States rose to 432,641 from 389,993 in 2022, with around 37.5% of assisted reproduction cycles resulting in a live birth. 

“For many infertile people, only IVF is going to work,” Mr. Greely said. 

While he acknowledges alternatives, he describes most of them as ineffective, noting that many patients already try fertility drugs or lifestyle changes before turning to IVF.

Mr. Tipton also argues that patients’ needs should drive policy. “Some may choose alternative treatments for religious reasons, and that’s fine. What’s not fine is trying to mandate that for everyone else,” he said. 

He notes that efforts to make the procedure more widely available have been most successful at the state level: New York, California, and several other states have passed mandates requiring insurance companies to cover IVF in recent years, while employers offer the procedure as a means to attract the best employees. 

“The cost of IVF is about the same as a C-section. But people don’t pay for C-sections out of pocket — insurance does,” Mr. Tipton said. “Insurance companies and employers make money by denying care, and most don’t cover IVF.”

What This Means for 2025 and Beyond

Mr. Trump’s step back from his sweeping IVF promises sheds light on the competing pressures at play. While he has long emphasized the importance of strengthening American families, making IVF free or universally covered would carry significant financial implications for the federal government and insurers. 

In the United States, a single IVF cycle costs an average of $15,000 to $25,000, among the highest prices in the world, and many couples require multiple rounds to succeed. Expanding coverage nationwide would demand tens of billions in new spending or mandates, a prospect that complicates an already polarized budget debate.

For Republicans, the political risks are equally significant. Democrats see an opportunity to cast themselves as defenders of reproductive medicine, while GOP leaders struggle to balance pro-life principles with the reality that IVF is broadly popular. 

Mr. Greely predicts Democrats will make “protecting IVF” a major campaign theme. Republicans, he suggests, will either echo support in vague terms or “try to change the subject.”

That tension is playing out within Mr. Trump’s own coalition. In the middle is a president who once promised IVF would be free but now faces the political cost of delivering on that pledge. The result is a policy paradox – a party urging Americans to have more children while wrestling with both the financial and ethical costs of how those children are conceived.

While Mr. Tipton emphasizes that most families “just want a child” and will do what it takes to bring that dream to life, others view the technological advancements very differently.

“Fertility treatment should not primarily be about creating copious amounts of embryos, the majority of which are either destroyed or frozen indefinitely,” Ms. Shelton said. “Fertility treatment should be about restoring fertility.”

The White House did not respond to a request for comment.