One year ago, President Trump enacted a presidential order that instructed the administration to create policy recommendations aimed at protecting access to in vitro fertilization (IVF), making it more available, and lowering costs for patients.
In October, new measures were revealed to help decrease the expenses associated with IVF and common fertility medications, while also looking into options like expanded employer benefits and a special benefit category for assisted reproductive technology. Despite these efforts to make this expensive treatment more accessible, the administration refrained from implementing widespread federal mandates for insurance coverage or direct governmental funding for IVF.
The investment of $20,000 or more for each IVF cycle might be better utilized in other financial incentives that encourage family growth, especially considering the achievement rate of only 25% to 30% for this procedure.
With the U.S. fertility rate falling below the replacement level, serious demographic and socio-economic challenges have gained political traction following the last election. As we stand in 2024, the U.S. birth rate is expected to reach an all-time low of 1.6 births per woman of childbearing age, significantly below the replacement rate of 2.1. This decline has been ongoing since the early 2000s and picked up speed after the 2008 recession.
President Trump has framed his endorsement of IVF as a means for the government to assist couples wishing to start or expand their families. While the administration hasn’t rolled out universally “free” IVF, its policy suggests a commitment to making IVF more accessible for Americans.
Why IVF Won’t Resolve the Birth Rate Issue
The notion that enhancing access to IVF could remedy the fertility crisis is, frankly, quite unrealistic.
To begin with, reaching a higher birth rate through government-funded IVF would be extraordinarily costly. The average IVF procedure can cost about $15,000 per cycle, on top of another $5,000 for medications.
Secondly, the success rates are often disappointing. A typical IVF cycle results in pregnancy for roughly 20% to 35% of women under 35, and that percentage drops as age increases.
IVF is generally offered to women struggling with infertility who can’t conceive naturally. However, although infertility is a real issue, it’s not the primary driver behind the declining birth rates.
A 2013 Gallup Poll showed that, on average, American adults wish to have two to three children, a sentiment that hasn’t changed since the 1970s. The 5% of adults who don’t want children is consistent with figures from 1990.
In many cases, medical factors are not the sole reasons for the inability of many Americans to have children. Economic considerations are the leading cause of our declining birthrate, with over three-quarters of individuals indicating financial constraints as their primary reason for not having more children.
If that’s the core issue, spending $20,000 or more per IVF cycle for a mere 25-30% success rate might be more effectively redirected towards other financial strategies to promote family growth among those who feel they cannot afford children.
We can and should discuss specific proposals, like child tax credits or support for stay-at-home parents—approaches that promise considerably better returns on investment when compared to IVF.
To genuinely encourage more births, it isn’t enough to just help with conception in a lab. We must focus on making it easier for Americans to support those children once they’re born.
Ethical Challenges of IVF
While IVF can assist couples in becoming parents, it carries significant ethical concerns.
Clinics often compete on the basis of success rates, which can lead to invasive egg retrieval procedures aimed at producing as many embryos as feasible (often exceeding the number of children the couple intends to have).
Frozen embryos are stored for later use; however, it’s unclear how many are currently cryopreserved, with estimates varying from 500,000 to several million.
Many embryos end up being neglected by their parents, who cease paying the annual storage fees that can range from $500 to $1,000, and often do not respond to clinics’ requests for guidance. Most parents are unwilling to allow the destruction of surplus embryos, highlighting a moral dilemma.
While some alternatives exist—such as adopting embryos or donating them for research—these options are hardly satisfactory. Many parents are understandably hesitant about these morally complex choices.
Those parents know very well what happens when those “clumps of cells” are placed into the womb. The ethical dilemma intensifies if they later decide they do not want to raise those children, leaving their embryos trapped in a “cryogenic nursery.”
It’s challenging to place all the blame on IVF clients. When faced with a range of morally ambiguous choices, most couples admit that they primarily focus on achieving pregnancy, often overlooking future implications for leftover embryos until later.
By generating numerous human embryos that are never implanted, we create a significant ethical problem. This scenario should compel a reconsideration of the practices that led us to this upsetting situation.
A More Effective Approach to Infertility
We ought to acknowledge the distress infertility causes couples struggling to conceive. Nonetheless, there are more beneficial options than IVF.
The egg retrieval process associated with IVF poses serious health risks. While long-term data is needed, evidence suggests increased risks for the children born from these procedures.
Research indicates children conceived this way may face a heightened likelihood of congenital anomalies, chronic diseases, cardiovascular issues, metabolic disorders, cognitive impairments, and even cancer—likely due to epigenetic changes initiated in the IVF process.
This points to a common-sense understanding that, when feasible, it’s generally better to conceive in a natural setting rather than in a laboratory environment.
Nevertheless, a heavy emphasis on IVF as a remedy for infertility—which often appears as the first line of defense for couples—might be hindering research and clinical focus on addressing the foundational causes of infertility.
Rather than concentrating on IVF, the Trump administration should champion medical measures that help couples who struggle to conceive naturally.
In numerous areas of contemporary medicine, we tend to prioritize invasive lab-based procedures instead of treatment strategies designed to address underlying issues.
Restorative reproductive medicine techniques, for example, encompass dietary adjustments, hormone balancing, and, in some instances, required medication or surgical procedures. These align with broader public health goals aimed at addressing chronic health crises, rather than merely providing quick and costly fixes.
Policy Considerations
Several hurdles exist in broadening access to these interventions, and effective policies could help tackle them.
Research funding is too limited, and currently, there’s a lack of adequate training for physicians in addressing and treating infertility’s root causes.
Endometriosis, a leading cause of infertility, poses challenges not only for achieving pregnancy but also leads to significant pain and other persistent symptoms if not treated appropriately.
However, many specialists lack training in the complex surgical approaches necessary for treating endometriosis and other similar issues.
A Better Way Forward
The administration’s effort to assist infertile couples in having children is commendable, but IVF isn’t the optimal solution.
Instead of putting all resources into one method, a broader strategy that focuses on understanding and addressing the fundamental causes of infertility would be far more beneficial. This respects human life at every step, circumvents unsolvable ethical dilemmas, and ultimately leads to more fulfilled parents and healthier children.
It’s a plan that, ideally, could garner support from all Americans.
