Republicans Are Selling “Ethical IVF.” It’s a Scam.

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While the government is shut down, Republicans are debating another budget issue: whether a military appropriations bill should include coverage for in vitro fertilization for military personnel^[2]. At the moment, military members have coverage only for service-related infertility^[3]. Democrats battled to ensure that the House version of the bill, which passed last month^[4], would expand access to cover all causes of infertility. With the IVF measure now under discussion in closed-door Senate meetings, the provision’s Democratic sponsors are hoping that President Donald Trump and the GOP members of Congress won’t scupper the proposal—as House Speaker Mike Johnson did with a previous IVF proposal^[5]—and take credit for a popular political win, one consistent with the president’s previous political promises^[6]. That hope seems mistaken. At the moment, the IVF proposal looks likely to die again^[7]. Its fate will put on display a new anti-IVF strategy that conservatives will use to wage war on the procedure across the country.

Republicans are mobilizing against the provision by arguing that IVF, a technology that accounted for nearly 3 percent of all births in the United States in 2023^[8], not only harms rights-holding embryos but is also ineffective^[9]. They spotlight an alternative they call restorative reproductive medicine, a series of treatments, including fertility tracking, medication, and surgery, that they argue can treat the root causes of infertility^[10]. These treatments may sound familiar to anyone with a loved one who has faced infertility. That’s because they’re part of the standard individualized plan in fertility clinics. What makes RRM different is that it excludes IVF and other treatments that some conservative Christians deem unethical because of their potential impact on embryos.

For some people, the treatments associated with RRM might be helpful. After all, some infertility patients can achieve a healthy pregnancy without turning to IVF or other more advanced techniques. The problem, argue the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, is that RRM assumes that the same treatments will work for everyone—and that RRM will stigmatize IVF as unethical and ripe for regulation or prohibition (RRM is sometimes marketed quite literally as “ethical IVF”). ACOG, for example, argues that 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.” What’s more, RRM tends to focus on female-factor infertility, which accounts for only about a third of the issues facing those trying to conceive (about a third of cases involve male-factor infertility, and about a third involve both gamete donors or undetermined causes). Promoting RRM may reinforce the sense of shame or inadequacy experienced by women who are unable to conceive. And RRM wouldn’t help same-sex couples or those who are single by choice, for whom IVF may be necessary to conceive a genetic child.^{[11][12][13][14][15][16][17][18]}

RRM is as much a political lifeline for abortion opponents and Republicans as it is a medical treatment. Last year, when the Alabama Supreme Court issued a ruling declaring IVF embryos to be children for the purposes of the state’s wrongful death of a minor law^[20], a nightmare began for the GOP. The Alabama decision was deeply unpopular: Polls showed that a staggering majority of Americans supported IVF^[21], and politicians across the ideological spectrum, including Trump, rushed to declare their support. At the same time, the anti-abortion movement celebrated the ruling for recognizing the personhood of the unborn.^[22] Groups like the Heritage Foundation^[23] and Students for Life^[24] rolled out plans and talking points endorsing IVF restrictions. Republicans were torn between pleasing conservative Christians opposed to IVF and catering to the vast majority of voters who favored it.

To make matters more complicated, IVF access appealed to some of the increasingly influential pronatalists in the GOP coalition, who believed that making access more affordable could lead to the birth of more babies each year^[25]. Pronatalism has waxed and waned in influence. In the Reagan years, for example, the American Enterprise Institute promoted fears about a baby bust that could bankrupt Medicare and Social Security and dilute the influence of Western values across the world^[26]. Conservative Christians, like televangelist and former presidential candidate Pat Robertson^[27], took pronatalist positions too.

But until recently, pronatalists made limited progress in the political arena. Oscillations in the birth rate sometimes made anxieties about a “baby bust” seem overstated. Liberals and independents sometimes argued that a lower birth rate wouldn’t be all bad, especially since that tended to follow higher rates of education for women^[28]. Some pronatalists recognized that immigration could make up for a “birth dearth” among Americans born in the United States^[29].

Now, finding an effective pronatalist solution seems even harder for Republicans. Calling for higher immigration to make up for lower birth rates is a nonstarter when the Trump administration has made record-setting deportations a key talking point^[30]. Policies or stipends to encourage people to have more children^[31] may run counter to the cost-cutting ambitions of small government conservatives; paid family leave or child care contradict conservative Christians’ arguments that more women should stay at home, at least when their children are young^[32].

RRM strategies seem tailor-made to create common ground between conservatives who identify as pronatalist. It appeals to both MAHA and the Christian Right by assigning responsibility for infertility to women, assuming that families should involve a married heterosexual couple, and suggesting that families have been denied information about their bodies and fertility by a greedy industry that sounds strikingly like what abortion opponents for years have called “Big Abortion.” The tagline some Republican members of Congress have used for RRM even echoes a long-standing anti-abortion talking point: Women deserve better^[33].

And RRM promises families struggling with infertility that they can avoid the cost and political firestorm now surrounding IVF. Abortion opponents worked for years to encourage Americans to question the morality of abortion. Now, by branding RRM an ethical alternative, the anti-abortion movement seems set to do the same with IVF.

There are real concerns with IVF in America, even for those who do not belong to the movement for embryonic personhood. IVF is often financially out of reach for many struggling with infertility. There are not always remedies for IVF families who deal with negligence or reproductive loss. There are ethical questions about the treatment of surrogates and gamete donors and the fate of embryos when couples break up. RRM-based strategies seem designed less to address these issues than to stigmatize IVF and open the door to legal restrictions on it—or at least to defeat measures that make IVF more affordable.

IVF coverage is almost certainly going to be excised from the defense funding bill. But the reasons conservatives give for that are a preview of a war on IVF that is just beginning.

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