The executive orders from President Donald Trump over the past few weeks have been fast and furious, and, for those of us in the reproductive space, sometimes terrifying. (Is birthright citizenship under the Fourteenth Amendment really on its way out?) Still, yesterday’s executive order promising an expansion of access to IVF protection is … cautiously exciting. But before we declare a stopped clock right even once, there are some serious issues that need addressing.
Unaffordable Care. Access to, and affordability of, standard-of-care fertility treatments has long been an issue in the United States. While a few states have passed IVF insurance mandates requiring health insurance plans to include fertility treatments like IVF — just as it would treatments for any other medical issues — a majority of Americans remain without insurance coverage for IVF. This leads hopeful parents-to-be to take desperate measures, like setting up crowdsourcing accounts to afford the high out-of-pocket costs for treatment, or even working a second job at Starbucks for the IVF insurance coverage.
Insurmountable IVF Obstacles. A year ago, in February 2024, we saw a major threat to IVF access, when the Alabama Supreme Court issued its ruling in LePage v. Center for Reproductive Medicine. There, the state’s high court determined that cryopreserved embryos are legally minor children, and that the destruction of embryos equated to the causing the death of children. In reaction, fertility clinics in Alabama immediately shut down all IVF services. So even those people lucky enough to be able to afford IVF lost access to treatment, as well as control over their own genetic material and embryos. After the ruling, even then-candidate Trump remarked on his support for IVF. And fortunately for Alabamans, the state legislature acted swiftly, and passed a bill to shield IVF providers from liability.
On its face, the new Trump executive order promises the protection of IVF, as well as increasing affordable access — great things, in the abstract. But is this real? Many questions are still open.
Federal IVF Protection. Trump and Vice President JD Vance have both spoken about their interest in Americans having more kids. Assuming those interests are in good faith, passing federal legislation protecting access to IVF would be a great start for the “more babies” goal. Maybe Congress could pass something like the Access to Family Building Act, which was previously introduced, but failed along partisan lines. With the leader of the Republican Party now vocally in support, it should be unanimous for federal legislators to support a statutorily enshrined nationwide legal right for patients to access IVF and other assisted-reproductive technology services, and for doctors to provide IVF treatment in line with medical standards.
Give Veterans Access To Fertility Care. What about at least giving veterans fertility services? Currently, veterans have access to VA-covered treatment if their need for fertility treatment was directly and specifically caused by injuries suffered by their service. But, of course, such a clear cause is only present in a small number of cases. For many others, the cause of infertility is unknown. Passing comprehensive legislation to require full coverage for those that served our country seems only fair.
Affordable Care For All. While we are at it, let’s give everyone else insurance-covered access to fertility treatment as well! Congress could pass something like the previously introduced Access to Infertility Treatment and Care Act. In his executive order, Trump acknowledged the extreme expense of IVF — $12,000 to $25,000 per IVF cycle. If insurance plans were required to cover treatment for infertility and fertility preservation services, everyone, regardless of financial resources, could access the care they need to grow their families. Let’s require all Affordable Care Act policies, as well as Medicaid, to include IVF!
Of course, these are all acts of the legislative branch, not the Executive Branch. But given that equivalent pieces of legislation previously failed on party lines, with Republicans unified in opposition, vocal support of the leader of the Republican Party should be all that Congress needs to get these passed handily. Right?
The building blocks are there. So it seems like it’s time to build something we can all agree on — access to affordable medical care to grow families. As they say, even a stopped clock is right twice a day.
Ellen Trachman is the Managing Attorney of Trachman Law Center, LLC, a Denver-based law firm specializing in assisted reproductive technology law, and co-host of the podcast I Want To Put A Baby In You. You can reach her at [email protected].
