Despite Trump’s Big Executive Order to Expand Access, IVF Is in a Really Weird Place

It seems like a lifetime ago, but maybe you recall: On February 18, 2025, nearly a month after being inaugurated, President Trump issued an executive order to “expand IVF access”—the first for any U.S. president. He asked a group within his administration to propose ideas that could make IVF more affordable and accessible. Trump, who famously called himself the “father of IVF” during his presidential campaign, wanted a full report in 90 days.

In May, the group (the Domestic Policy Council) presented their ideas. Now, five months later, the Trump administration finally announced its plan. The policy includes a recommendation for private companies to offer an “employer benefit option” for infertility coverage—think vision or dental coverage but for IVF—per The New York Times, as well as a steep cost reduction of some IVF medications, Reuters reports. All that means the process will remain expensive and inaccessible to many Americans.

Because the administration’s policy is a recommendation and not a requirement, Insurance companies don’t actually have to follow through and incorporate IVF benefits into their health care plans. And when it comes to prices for fertility drugs, that’s just one line item of IVF’s steep costs. One cycle can run up to $30,000—with this recommendation, officials said the cuts would only save about $2,200 per cycle. The policy also doesn’t include Medicaid plans or explicitly mention what care will be included, like tests and labs, fertility preservation, or fertility health care counseling.

For many, these promises falling flat aren’t surprising from the leader of a party that’s decidedly anti-choice. During Trump’s 2024 presidential campaign just a year earlier, anti-choice rhetoric allowed the Alabama Supreme Court to rule that embryos were people. After that, clinics across the state paused IVF procedures indefinitely—with some even closing completely—concerned about potential lawsuits if an embryo was accidentally destroyed during the IVF process.

Within a week, Alabama’s governor signed a bipartisan bill shielding IVF providers and patients from being attacked in court, and Alabama IVF clinics reopened. Still, given the uncertainty, physicians who perform IVF procedures, as well as patients, continued to flee the state.

Some hypothesize Trump used these events as an opportunity to separate himself from the wildly unpopular ruling and ultimately capture voters who were put off by it. We can’t say for sure that was the plan, but if that was the case, it's not hard to see why pro-IVF policies might be back-burnered for the time being (particularly since other initiatives by the Trump administration and his political allies could wind up making it more difficult than ever to undergo IVF—more on that below).

All this to say, while IVF is technically still widely available, the future of the procedure is still being determined. In order to get a better grasp on everything that’s truly happening with IVF, we tapped reproductive rights experts and advocates. Below, they share the five biggest things you should know about the overall state of IVF.

On his first day in office, President Trump issued a blatantly anti-trans executive order requiring federal agencies to only recognize two genders, male and female. The order defines female as “a person belonging, at conception, to the sex that produces the large reproductive cell.”

Those “person” and “at conception” mentions all but codify the concept of embryos as people into the federal system, says Kimya Forouzan, a state policy advisor at the Guttmacher Institute, a reproductive rights research and policy organization. In other words, it takes the Alabama logic national. States could interpret this as giving embryos “personhood” status and limit IVF access accordingly.

“Fetal personhood laws” categorize embryos and fetuses as people and grant them the same rights as you and I, says Kulsoom Ijaz, a senior policy counsel at Pregnancy Justice, a nonprofit organization that advocates for pregnant people. Anti-abortion advocates justify this under the 14th Amendment, which guarantees citizenship and equal protection under the law to “all persons born or naturalized in the United States.”

Fourteen states already have personhood language that’s broad and vague enough to potentially be applied to embryos in state constitutional amendments, civil laws (like wrongful death statutes), and criminal laws (such as fetal homicide laws), says Ijaz.

For example, in 2024, Pennsylvania issued a ruling that extends “equal protection” to the “unborn” on “every relevant civil or criminal proceeding in which it is possible to do so without violating the Federal Constitution.” Depending on how you define “unborn,” this could, in theory, make discarding embryos murder.

Ijaz is most concerned about states that have the same combination of laws as Alabama (wrongful death laws and broad personhood laws), and those states include Utah, Missouri, and Louisiana, which already requires IVF clinics to ship embryos out of state for destruction. (You can visit Pregnancy Justice to see where the rest of the country stands with these laws).

“If they had the appetite, if they’re hostile enough, they could do the same thing that they did in Alabama,” says Ijaz. In states with a similar set of personhood laws, courts could decide to hold health care providers criminally or civilly liable if an embryo is accidentally destroyed during the IVF process, making that care obsolete.

In September 2024 following the Alabama ruling, Republican Senators Ted Cruz and Katie Britt, of Texas and Alabama, respectively, proposed a bill that they touted would “protect both IVF and life”—or what some would call “ethical IVF.”

Labeling any practice as ethical sounds like a good thing, but it’s a misnomer when it comes to IVF. Proponents of “ethical IVF,” who believe that embryos deserve rights, want laws to limit the destruction of those embryos. But for many reasons, those embryos can often be discarded, mostly because those created in the process of IVF sometimes aren’t viable due to genetic issues.

These kinds of restrictions can increase the health risks of an already-risky procedure. For example, the Heritage Foundation, the conservative group that created Project 2025, suggests that the U.S. should “limit the number of embryos that can be created per woman” and “prohibit the use of preimplantation genetic testing.” But if fewer embryos can be created and none of them can be genetically tested before they’re used, each retrieval becomes a gamble.

In South Carolina, for example, a proposed amendment to the state’s Human Life Protection Act wants only one embryo produced from IVF to be implanted at a time. That means most people would likely have to undergo multiple procedures, each time using a single embryo, in order to get pregnant—making the procedure even more costly, time-consuming, and mentally and emotionally draining than it already is.

These “ethics laws” would force all but the wealthiest to give up, says Karla Torres, senior human rights lawyer at the Center for Reproductive Rights. In the end, groups including LGBTQIA+ couples, single parents, and people statistically at higher risk of infertility (like older women and Black women) would be hit hardest.

One of the few good things to come from that 2024 Alabama decision is that it drove the public and politicians to champion IVF, says Barbara Collura, a patient advocate, IVF expert, and founder of Vital Voices Consulting, which works to advance equity and access in reproductive health care. Public protest against the Alabama ruling quickly led 11 other states to introduce bills protecting IVF providers and patients or specifying that embryos outside the body are not legally human beings.

Elsewhere, other protections were already in place before all that went down. After the Supreme Court overruled Roe v. Wade in 2022, eight states created laws protecting IVF. These include:

• Delaware
• Georgia
• Illinois
• Maryland
• Minnesota
• New Jersey
• Tennessee
• Colorado

Three other states have proposed bills protecting IVF, including North Carolina, South Carolina, and Ohio.

Frustratingly, some of the very same states protecting IVF are also passing personhood laws—this might seem contradictory and it is. “Policy makers sometimes don’t understand how regulating abortion through personhood laws could impact the practice of IVF," says Danielle Melfi, the CEO of RESOLVE.

Obviously, the best solution would be a comprehensive federal right to reproductive autonomy, says Ijaz. Without that, “geography could determine whether you can start a family,” she adds.

The New York Times recently reported that some conservatives and MAHA (Make America Healthy Again) advocates are pushing for more “restorative reproductive medicine” (RRM) to treat infertility. The American College of Obstetricians and Gynecologists (ACOG) calls this a “nonmedical approach” to treating infertility, per a statement, since RRM mostly focuses on the female sources of infertility—mainly endometriosis—and treats other sources of infertility with lifestyle changes.

“When provided as the primary or only option, RRM can expose patients to needless, painful surgical interventions, limit their access to the full range of evidence-based fertility care interventions, and delay time to pregnancy while potentially increasing overall costs,” ACOG writes.

Naturally, Republican lawmakers have already proposed bills in the House and Senate that would expand access to restorative reproductive medicine. Those bills would also protect providers who don’t offer IVF, essentially punishing those who do.

Though nothing has been passed yet, the president’s nominee for Surgeon General, the position that shapes public health initiatives and campaigns including for reproductive health, is a big fan of prioritizing restorative reproductive medicine over other science-backed options, like IVF.

We know. This can all sound demoralizing. But for now, IVF is still an mostly available and a safe option for conceiving. This news is always developing, so we’ll be sure to update this story when more info is released.

Colleen de Bellefonds

Colleen de Bellefonds is a freelance journalist and editor who covers science, health and parenting. Her reporting and writing regularly appears in Well + Good, US News & World Report, Women's Health, The Bump, What To Expect, SELF and many other publications. She lives in Paris, France with her husband and two kids. See more of her work at colleendbellefonds.com, or follow her on X @colleencync and Insta @colleendebellefonds.