Earlier this year, conservatives in the Tennessee House staged an eleventh-hour skirmish over an IVF protection bill introduced by two of their Republican colleagues. The bill eventually passed, becoming one of the first in the nation to explicitly protect access to IVF. But some lawmakers who voted for it have signaled their willingness to revisit the issue.
In Georgia, a Republican-sponsored bill to codify the right to IVF into law sailed through the legislature, even as fellow conservative lawmakers introduced their own anti-abortion bill that opponents warned would undermine the IVF protections in the new law.
In statehouses around the nation, IVF has emerged as a dividing line running through the Republican Party. Particularly in states where abortion is banned, lawmakers who unite under the “pro-life” banner disagree over whether the popular treatment gives life or destroys it.
People who believe embryos are children oppose IVF because it can involve the discarding of some embryos, which they say is akin to abortion.
“The popularity of IVF creates a dilemma for Republican politicians who have had anti-choice organizations as a key part of their constituency for their whole careers,” said Sean Tipton, chief advocacy and policy officer at the American Society for Reproductive Medicine.
After the Alabama Supreme Court ruled last year that embryos are people, fertility clinics around the state temporarily halted their services, sparking nationwide outrage.
Republicans and Democrats rushed to pledge their support for fertility treatments such as IVF and announce their plans to protect it.
On the campaign trail last year, Trump promised to make insurers cover IVF so that it would be free for patients. After taking office, he signed an executive order giving White House officials 90 days to assemble a list of policy recommendations on protecting IVF access and reducing costs.
In March, he called himself “the fertilization president.”
But a week later, his administration eliminated the team of experts at the federal Centers for Disease Control and Prevention responsible for tracking IVF outcomes across the United States. The team had, among other things, operated a database allowing consumers to look up an individual fertility clinic’s success rates. Earlier this month, The Washington Post reported that the White House doesn’t plan to require insurers to cover IVF services, though administration officials told the newspaper that IVF access remains a priority.
Meanwhile, conservative groups that oppose abortion have begun pushing an obscure alternative treatment for infertility called “restorative reproductive medicine,” or RRM. Advocates have urged the White House and federal and state legislators to back RRM, which is based on the idea that the underlying causes of infertility can be treated through lifestyle changes and improving a person’s overall health.
Arkansas recently became the first to pass a pro-RRM law. Others might follow suit in upcoming legislative sessions.
Cole Muzio, founder and president of the Georgia conservative Christian nonprofit Frontline Policy Council, said he doesn’t expect to see legislators try to ban IVF outright, despite preemptive efforts by legislators in his state and others to protect it.
“Republicans are intrinsically pro-family, and the idea of supporting those who want to have a family is a conservative, noble, positive thing,” he said.
“At the same time, IVF discards an overwhelming number of human lives. We’ve got a lot of work to do to educate people.”
This spring, the Tennessee bill protecting IVF passed unanimously in the state Senate. But by the time it hit the House floor in April, many of its Republican supporters sat silently while a few of their GOP colleagues tried to derail it.
The bill’s sponsor, Republican state Rep. Iris Rudder, told the Tennessee Lookout that she hadn’t expected disagreement over the bill to “mushroom the way it did.”
It eventually passed. But 11 Tennessee House Republicans sent a letter to GOP Gov. Bill Lee urging him to veto it and calling it “a Trojan horse that could potentially undermine Tennessee’s strong and righteous stance on the protection of innocent human life.”
Lee signed it in April.
The following day, Tennessee Senate Majority Leader Jack Johnson — who voted for the bill and said he supports IVF and contraceptives — told constituents during a legislative forum that he’d had “lots of conversations” about it and expects the legislature to revisit the issue again in the next session.
“I think we’ll be back next year to take another stab at it,” he said.
In Georgia, the state’s most powerful Republicans made a bill to codify the right to IVF a major priority this year. It was signed into law in May.
“Thanks to a lot of bipartisan support and hard work, Georgians who want to grow their families will never have to worry about whether or not they can access this vital treatment,” the bill’s sponsor, Republican state Rep. Lehman Franklin, posted to X after it passed through the legislature. Franklin and his wife conceived through IVF, a story he has shared publicly as he promoted the measure.
“At the end of the day, being pro-family means being pro-IVF,” he wrote.
Muzio, of the Frontline Policy Council, believes the IVF debate represents not so much a split in the Republican Party as it does a lack of education about what the treatment really means to people who believe human life begins as soon as an egg is fertilized.
“Hopefully you’ll see [legislation] put in place that either backs different fertility treatments that are more pro-life or guardrails put in place to restrict the discarding of human life for the purposes of IVF,” he said.
For conservatives who see IVF as akin to abortion, restorative reproductive medicine has emerged politically as an option for addressing infertility without explicitly supporting IVF, which remains overwhelmingly popular among Americans.
RRM was a relatively obscure idea until anti-abortion groups such as The Heritage Foundation began elevating it over the past year as an alternative to IVF. With RRM, a practitioner might help patients analyze their diet, chart their menstrual cycle to look for conditions that can impact fertility, or treat reproductive disorders like endometriosis or thyroid dysfunction.
Supporters argue that a more holistic approach is a better way to treat infertility, and that RRM methods are much less expensive than IVF, which can cost tens of thousands of dollars.
But RRM has been criticized in mainstream medical circles. The American College of Obstetricians and Gynecologists calls RRM a “nonmedical approach” and an “unproven concept” that can delay time to pregnancy and expose patients to needless and painful surgical interventions, such as procedures to treat polycystic ovarian syndrome. It says the approach overwhelmingly puts the onus on women, ignoring that infertility causes are just as common in men.
Some experts worry that patients spending months or years on RRM treatments will lose precious time when IVF could have helped them get pregnant.
And OB-GYNs warn RRM is closely tied to the anti-abortion “personhood” movement, which attempts to grant fertilized eggs the same legal status as people — potentially leading to a loss of rights for pregnant patients and more severe restrictions on birth control and other reproductive health care.
Tipton, of the American Society for Reproductive Medicine, believes RRM is more “ideology” than medical practice.
“[RRM] got legs thanks to the work of really influential right-wing and anti-choice groups,” he said. “They put their considerable resources into asking, ‘How do we blunt the momentum IVF is getting without saying we’re opposed to IVF?’”
But as RRM gains mainstream attention, it’s also found supporters in the Make America Healthy Again (MAHA) movement promoted by Robert F. Kennedy Jr., secretary of the U.S. Department of Health and Human Services. Some consumers remain skeptical of the fertility industry, where some clinics have ties to private equity firms and other large corporations.
In March, Arkansas Republican state Rep. Alyssa Brown told fellow legislators that RRM “prioritizes women’s health over the profits of Big Pharma and Big Fertility.”
Brown sponsored a first-of-its-kind bill in Arkansas — which passed in April and was signed into law — that requires state insurance companies to cover RRM treatments.
Brown promised during a hearing that it wouldn’t limit access to IVF. Arkansas was one of the earliest states, in 1991, to require insurance companies to cover IVF.
A similar bill with the same title, the RESTORE Act, was introduced in Congress again this year, after failing last year. It includes recommendations from The Heritage Foundation and the conservative, anti-abortion Ethics and Public Policy Center.
Arkansas’ new law also requires programs funded through Title X, which provides birth control and other reproductive care to low-income families, to use fertility awareness-based methods, mirroring a similar effort at the federal level. Under Kennedy, HHS has indicated plans to use Title X funding to open an “infertility training center.” Part of the center’s focus, according to its grant announcement, is to “educate on the root causes of infertility and the broad range of holistic infertility treatments” available to patients.
Meanwhile, state legislators around the country this year attempted to require health insurance to cover IVF, including in Montana, North Carolina, Rhode Island, Vermont and West Virginia.
Nevada’s Democratic-controlled legislature passed a bill in June establishing the right to fertility treatments, including IVF, but it was swiftly vetoed by Republican Gov. Joe Lombardo.
In May, Virginia Republican Gov. Glenn Youngkin signed a bill into law requiring a state insurance commission to consider coverage for procedures like IVF, a move that sets the stage for requiring health insurance companies to cover it. Before signing, Youngkin tried to insert a provision allowing private plans to opt out of coverage for religious or ethical beliefs, but the legislature rejected the change.
Although he signed the measure, Youngkin said his exemption idea needed to be taken up if the state eventually mandates coverage of fertility treatments.
This story was produced by Stateline and reviewed and distributed by Stacker.