AN EXECUTIVE ORDER BY PRESIDENT TRUMP ABOUT EXPANDING ACCESS TO IVF - and the balancing act between federal and state reproductive policies and their possible impact on IVF
David H Barad, MD, MS, is Director of Clinical IVF and Research and a Senior Scientist at the CHR. He can be reached through the editorial office of The Reproductive Times
In the very first weeks of the new administration, President Trump has passed executive orders that will impact reproductive issues (1, 2, 3). At times encouraged by often inflammatory comments in the media, some patients have become fearful that these or future rulings could affect their access to infertility services, - especially in vitro fertilization (IVF). We here, therefore, briefly reviewed what steps the Federal and State Governments in reality have taken and how, if at all, they might affect fertility care.
To start, it must be clearly stated that, currently, there exists no Federal policy that restricts access to fertility care for members of the general public. Following the Supreme Court’s 2022 Dobbs decision overturning Roe v. Wade, the Biden administration issued Executive Orders 14076 and 14079 which actually expanded access to reproductive healthcare services, including contraception, maternal healthcare, emergency pregnancy and miscarriage care, and abortions. Interestingly, fertility services were, however, not included in these protections.
Upon reassuming office, on January 24, 2025, President Donald Trump signed Executive Order 14182, titled "Enforcing the Hyde Amendment," revoking the Biden administration’s previous Executive Orders 14076 and 14079, thereby announcing a clear shift in federal reproductive health care policy, potentially reducing certain protections and access to all above-named services. But – again noteworthy - fertility services, once again, were not included (1).
The restrictions announced by the Trump administration, thus, will undoubtedly impact general Ob/Gyn practices, but do not in any way directly affect infertility care. There is, however, one exception affecting only members of the armed forces: As of January 31, 2025, the Department of Defense no longer reimburses service members for out-of-state travel to obtain reproductive healthcare services that are not covered by TRICARE (health insurance of active service members and their families) —including in vitro fertilization (IVF). This policy reversal rescinds a directive from October 2022 that previously allowed such reimbursements (4).
It is also important to note that – like other federally-funded health programs including Medicare and Medicaid, TRICARE never covered IVF, except in cases where an individual’s infertility was military service- connected, as – for example – if it was caused by a combat injury. This change, however, clearly increases for all other service members seeking IVF the overall financial burden by adding related travel expenses. On a side note, – because TRICARE never covered most fertility services, the Center for Human Reproduction (CHR) for many years has offered active-duty members of all branches of the U.S. military significant discounts for all fertility treatment-related costs.
The 2022 Dobbs decision overturning Roe v. Wade, of course, returned all regulations regarding abortion services back to the States. This to a rather unconventional ruling of the Alabama Supreme Court, in February 2024, - suggesting that frozen embryos under the state's wrongful death statute must be considered "minor children" (5).
Considering the potential legal consequences from such a bizarre ruling, several clinics, including the University of Alabama at Birmingham Health System, unsurprisingly in their responses immediately ceased all IVF-related operations (6). Prompted by concerns over access to fertility treatments, former President Donald Trump publicly urged Alabama lawmakers to protect IVF services, emphasizing his strong support for their availability. To address these legal concerns, the Alabama legislature swiftly passed a law granting full civil and criminal immunity to IVF providers for the loss or destruction of embryos during standard procedures. Following the enactment of this law in March 2024, all Alabama clinics resumed their IVF services.
Alabama is, however, not alone in having potentially IVF-restricting laws on the books. Louisiana, for example, has long-standing laws granting personhood rights to embryos, which have placed specific restrictions on in vitro fertilization (IVF) practices within the state. Since 1986, Louisiana law has recognized a viable in vitro fertilized human ovum as a "juridical person," affording it certain legal rights and protections (see below) (7).
Consequently, patients and fertility clinics in Louisiana are unable to dispose of surplus embryos locally. Patients who choose not to retain their excess embryos must transfer them to facilities in other states where disposal is legally permitted.
Due to opposition from the state’s powerful anti-abortion lobby, in May 2024, legislation aimed at ensuring the continued legality of IVF treatments in Louisiana was shelved (8). Anti-abortion lawmakers, who hold majority control in the Louisiana legislature, refused to remove language defining embryos as "human beings" from the bill. Louisiana Right to Life, the state’s largest anti-abortion organization, indicated it would likely oppose the bill without this language.
The concept of "fetal personhood" is a legal doctrine, from the moment of conception granting embryos the same rights as living individuals. The President’s recent executive order stating that federal agencies recognize only two sexes—male and female—as determined at conception and asserting that these sexes are immutable - has by some been interpreted as support for the concept of “fetal personhood” (9).
Given President Trump's strong support for the widespread availability of in vitro fertilization (IVF)—even suggesting it should be available "for free"—it is likely that he does not endorse interpretations that would restrict IVF practices. This is also supported by the just released Executive Order on February 18, 2025, with the title, Expanding Access to In Vitro Fertilization,” which stated the following:
“Today, many hopeful couples dream of starting a family, but as many as one in seven are
unable to conceive a child. Despite their hopes and efforts, infertility struggles can make
conception difficult, turning what should be a joyful experience into an emotional and
financial struggle. My Administration recognizes the importance of family formation, and as a
Nation, our public policy must make it easier for loving and longing mothers and fathers to
have children.
In vitro fertilization (IVF) offers hope to men and women experiencing fertility
challenges. Americans need reliable access to IVF and more affordable treatment options, as
the cost per cycle can range from $12,000 to $25,000. Providing support, awareness, and
access to affordable fertility treatments can help these families navigate their path to
parenthood with hope and confidence.
Therefore, to support American families, it is the policy of my Administration to ensure
reliable access to IVF treatment, including by easing unnecessary statutory or regulatory
burdens to make IVF treatment drastically more affordable.
Within 90 days of the date of this order, the Assistant to the President for Domestic Policy shall submit to the President a list of policy recommendations on protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment.”
However, the debate over when an embryo attains human status lies at the intersection of abortion issues and IVF. Some anti-abortion advocates argue that life begins at conception, the moment of fertilization, and therefore, embryos should be granted legal protections and the rights of minor children from that point onward.
From a scientific standpoint this is, however, an untenable argument since natural conception also involves the “wastage” of a large majority of embryos. The best evidence is that even at peak fertility in the mid-20s, couples do not conceive every month they attempt to. It, indeed, takes on average of about 3.4 months to conceive, even though a young couple at peak fertility can be expected to produce on average one embryo every month. In other words, even at peak fertility, over two-thirds of human embryos do not lead to implantation and pregnancy. How can they then be considered to deserve the rights of children?
If all embryos were to be legally regraded as persons, freezing, or failing to implant them could then, of course, be considered neglect, abuse, or even wrongful death. Fetal personhood laws, therefore, could criminalize standard IVF practices.
Project 2025 is a conservative policy agenda developed by the Heritage Foundation and allied organizations prior to the last election campaign. Despite denials by President Trump during the campaign of any association with this document, his administration has already implemented many policies that align with the Project 2025 agenda. Many executive actions, indeed, even closely mirror Project 2025's proposals, with some containing almost identical language (10). Unfortunately Project 2025’s agenda also includes strong advocacy for fetal personhood (11) and, therefore, potentially contradicts President Trump’s own pronouncements in favor of expanded IVF utilization in the country as well as his recent Executive Order of February 18, 2025.3
During his 2024 presidential campaign, former President Donald Trump expressed strong support for in vitro fertilization (IVF), suggesting that the federal government or insurance companies could cover the associated costs. Interestingly this was also the solution Sean Tipton, MD, Chief Advocacy and Policy officer of the ASRM, expressed in an official response of the ASRM to the Executive Order when stating: “There is a fix to this problem: Require health insurance plans to cover IVF for patients who need it (12).
At an August 29, 2024, town hall event in La Crosse, Wisconsin, he stated, "We want to produce babies in this country, right?" and emphasized his commitment to making IVF treatments accessible (13, 14). At the March for Life rally on January 24, 2025, President Trump, basically reaffirmed his administration's pro-life stance when reaffirming that, - "we will again stand proudly for families and for life," (14) suggesting that he considers a pro-IVF position aligned with a pro-life position.
His advocacy for accessible IVF treatments, therefore, suggests he may – in contrast - not be fully aligned with the view that life starts at fertilization, as standard IVF procedures usually involve the creation and potential disposal of multiple embryos. This nuanced stance, however, well reflects his administration's emphasis on "common sense solutions" in reproductive health policy.
This conflicting stance between supporting IVF access and – at least to a degree the anti-abortion movement—highlights a fundamental tension in reproductive policy. While promoting IVF funding could expand fertility options, enshrining fetal personhood in law at state level could simultaneously restrict or criminalize standard IVF practices. This, of course, creates uncertainty for patients, providers, and policymakers alike.
Which brings us to the so-called Dickey–Wicker Amendment also the subject of a future article in The Reproductive Times. It is the name of an appropriation bill rider attached to a bill passed by United States Congress in 1995, and signed by former President Bill Clinton, which prohibits the United States Department of Health and Human Services (HHS) from using appropriated funds for the creation of human embryos for research purposes or for research in which human embryos are destroyed (15). The Amendment is a rider and attaches since its initial passage in 1996 automatically annually to the Labor, Health and Human Services, and Education appropriations bills and, therefore, automatically renews without debate (16).
As a result of complete lack of government funding for IVF research, advancements in IVF have largely relied on private funding and patient contributions. This reliance on non- federal sources has, of course, limited the scope and scale of potential advancements in IVF research.
As the future article specifically argues, if the Trump administration indeed wants to be supportive of IVF, it could finally terminate the Dickey–Wicker Amendment to make federal funds available for research that could advance IVF procedures. This would, of course, require an act of Congress.
References
1. Executive Order 14182—Enforcing the Hyde Amendment. (2025, January 24). Federal Register, 90(20), 8751-8752. https://www.federalregister.gov/documents/2025/01/31/2025-02175/enforcing-the-hyde-amendment
2. Trump reinstates 'Mexico City policy' ban on funding international abortions. (2025, January 24). Catholic News Agency. https://www.catholicnewsagency.com/news/261809/trump-reinstates-mexico-city-policy- ban-on-funding-international-abortions
3. Executive Order Expanding Access for In Vitro Fertilization. https://www.whitehouse.gov/presidential-actions/2025/02/expanding-access-to-in-vitro-fertilization/
4. Associated Press. (2025, January 31). Pentagon strips travel reimbursement for troops seeking abortions, fertility treatment. AP News. https://apnews.com/article/a18ce5dc08b654bfbcc147a4965ec470
5. Associated Press. (2024, February 16). Alabama Supreme Court rules frozen embryos are children. AP News. https://apnews.com/article/alabama-supreme-court-frozen-embryos-children-161390f0758b04a7638e2ddea20df7ca
6. Ginod, P., & Dahan, M. H. (2024). Embryos as unborn children: The Alabama Supreme Court's ruling and its possible impact for legal rulings in other states. Journal of Law and the Biosciences, 11(1), lsad001. https://doi.org/10.1093/jlb/lsad001
7. Louisiana State Legislature. (1986). Destruction of in vitro fertilized human ovum. Louisiana Revised Statutes, Title 9, §129. https://legis.la.gov/legis/Law.aspx?d=108446
8. O'Donoghue, J. (2024, May 29). Louisiana lawmaker shelves IVF protection bill, leaving questions about legal challenges. WWNO - New Orleans Public Radio. https://www.wwno.org/politics/2024-05-29/louisiana-lawmaker-shelves-ivf-protection-bill-leaving-questions-about-legal-challenges
9. Hogue, I. (2025, January 23). Trump's Executive Order on Gender Attacks Abortion Rights. https://time.com/7210539/trumps-executive-order-gender-abortion-rights/
10. Popli, N. (2025, January 24). Trump's early actions mirror Project 2025, the blueprint he once dismissed. Time https://time.com/7209901/donald-trump-executive-actions-project-2025/
11. The Heritage Foundation. (2023). Mandate for Leadership: The Conservative Promise. Washington, D.C.: The Heritage Foundation. Retrieved from https://www.heritage.org/mandate
12. Tipton S. The ASRM. February 18, 2025. https://www.asrm.org/news-and-events/asrm-news/press-releasesbulletins/asrm-responds-to-trump-executive-order-on-ivf/
13. Reuters. (2024, August 29). Trump says IVF costs would be covered if he is elected. Reuters. https://www.reuters.com/world/us/trump-says-ivf-costs-would-be-covered-if-he-is-elected-2024-08-29/
14. National Public Radio. (2024, August 30). Trump says he'll support free IVF treatments in a second term. NPR. https://www.npr.org/2024/08/30/nx-s1-5094454/trump-tells-town-hall-crowd-that-he-supports- free-ivf-treatments
15. Trump, D. J. (2025, January 24). Remarks by President Trump at the 52nd Annual March for Life. The White House. https://www.whitehouse.gov/briefings-statements/remarks-president-trump-52nd-annual-march-life/
16. National Institutes of Health Revitalization Act of 1993, Pub. L. No. 103-43, § 121, 107 Stat. 122 (1993) Retrieved from https://www.congress.gov/bill/103rd-congress/senate-bill/1/text