Don't celebrate Trump's IVF order yet – here's why

On 18 February, President Trump signed an executive order – the directive changes neither the law nor policy – aimed at expanding access to IVF (see BioNews 1278). This was hailed by the White House as the president fulfilling yet another campaign promise, as he stated last summer that the government or insurance companies would cover the cost of IVF 'for all Americans that need it' (see BioNews 1254 and 1258). He also, strangely asserted that he was 'the father of IVF', which was both untrue and lacked any detail of what he was implying by that statement.

Much of this rhetoric came on the heels of the ruling by the Alabama Supreme Court in February 2024 that frozen embryos in clinics should be considered children (see BioNews 1228 and 1229). This, rightly, sent shivers down the backs of both patients and their doctors over the fate of fertility treatments. Those treatments can cost $25,000 a go and are not often covered by insurance, and according to the Independent, the White House has said that only about a quarter of employers offer coverage for IVF for employees.

Since this executive order, I've been inundated with questions from friends asking if they should 'hurrah' this moment, potentially a bright light in what many see as dark times that have set in because of this new administration. My strong caution to them has been that we need to wait and see, as there are some concerning aspects that need to be teased out.

First, this statement, 'Our nation's public policy must make it easier for loving and longing mothers and fathers to have children,' on the White House fact sheet, raises concern. This seems to imply that it would just be for heterosexual couples, and possibly not inclusive of single people and same sex couples who wish to build families. When I was single, I underwent IVF and had a miscarriage at seven weeks. Would this therefore not apply to others who were like me and haven't found – or don't want – a partner to raise a child with? And will same sex couples not be allowed the same rights to whatever this new equitable access will be? Lest we forget, the new Treasury Secretary Scott Bessent is a gay dad – twice over – through IVF and surrogacy. Could this exclude even members of Trump's own cabinet?

The second concern is over who exactly Trump's assistant for domestic policy will be speaking with over the next 90 days to 'reduce out-of-pocket and health plan costs for IVF treatment'. There is no mention of who will be advising his policy people – will it be bipartisan groups who work on issues concerning IVF and fertility? Will IVF patients be asked for their opinions? Will clinicians and fertility advocates be asked to give their recommendations? In other words, will all stakeholders be included in these conversations?

Republicans don't exactly have a good track record when it comes to supporting IVF legislation, a shining example being just last year when the US Senate voted – twice – against the Right to IVF bill that would have ensured federal protections for IVF (see BioNews 1243 and 1257). One senator who voted against the legislation was then Ohio senator JD Vance, who is now vice president. This law would have protected and guaranteed IVF access nationwide and addressed affordability by requiring insurance companies to offer coverage – exactly what the infertility and family-building community has been demanding. Instead of supporting it, Republicans voted against it and instead introduced a bogus messaging bill tied to Medicaid.

Giving an example on the state level, last year in Michigan not a single House Republican voted for the Michigan Family Protection Act, which in part created protections for children born in the state through assisted reproduction. Furthermore, only two Republican senators voted to pass the law, which will go into effect on 1 April).

Third, how would this, in practice, all be achieved? According to the New York Times, it would mean creating a single payer health care system for a single condition and would therefore, 'require Congress to fund a new division of a federal government to oversee the programme.' What would Elon Musk's Department of Government Efficiency think about that then? (Musk has a number of children born via IVF). Getting insurance companies to cover treatments could also be an uphill battle, possibly requiring the passing of new federal laws.

And lastly, this order focuses a great deal on bringing down costs versus access to coverage. Could this actually be more of a way to regulate IVF – a far-right wolf in sheep's clothing? The Heritage Foundation, for example, has made no secret of wanting to control who has access to fertility treatments. This is another red flag for me.

As always, the devil is in the details so I'll hold my 'hurrahs' until mid-May on this one. Trump's executive order might sound good in a headline, but the fine print matters. Until we see real protections – not just political posturing – any celebration is premature.