In the wake of President-elect Donald Trump’s victory, women and birthing people have been left to wonder how his return to power will impact their reproductive rights. Though his political record demonstrates an unwillingness to recognize key reproductive freedoms, including abortion, his avowed support for in vitro fertilization (IVF) breaks ranks with many Republican Party politicians who oppose the procedure. Trump, in an effort to appeal to the majority of U.S. voters who support IVF, even proclaimed himself the “father of IVF,” despite requiring Senator Katie Britt (R-Ala.) to explain the procedure to him earlier this year.
While Democrats and Republicans debate the future of IVF, around 22% of U.S. adults remain unsure if they support the procedure, possibly owing to a lack of knowledge about what IVF actually entails. Moreover, cultural taboo contributes to misconceptions about the treatment — for example, the Catholic Church condemns IVF, decrying that it disassociates marriage from procreation. So, putting politics and culture aside, what is the science behind IVF?
The journey from lab to life begins when a person seeks to become pregnant. There are many reasons someone might seek the help of assisted reproductive technology: 1 in 8 U.S. couples struggle with infertility, same-sex partners can use IVF to start a family and cancer patients may freeze their eggs to protect their fertility from chemotherapy-induced damage. Regardless, the first step in IVF is an evaluation of the male and female partners’ eggs and sperm, ensuring that at least some of their reproductive cells, called gametes, are healthy. Then, the female partner receives hormone injections for 10 to 12 days, which allows multiple eggs to mature inside the ovary.
The next step in IVF is egg retrieval, which occurs while the patient is under anesthesia. With the guidance of an ultrasound machine, a doctor inserts a thin needle through the vagina into the ovary and extracts 10 to 20 eggs. The doctor then places the eggs in a dish with sperm isolated from the male partner’s semen.
The fertilized eggs grow in an incubator until they reach the blastocyst stage of development, typically after 3 to 7 days. This incubation period — during which growth occurs in an artificial environment instead of in a live organism — explains why the procedure is called “in vitro.” What characterizes a blastocyst embryo are two layers of cells: one that becomes the fetus and one that becomes the placenta.
Finally, doctors either freeze the blastocyst embryos for future use or transfer one or more of them into the patient’s uterus. Herein lies the main point of contention for IVF’s opponents: If frozen embryos are accidentally destroyed, does that constitute murder? That is, should embryos enjoy the same rights as people?
In February 2024, many in the United States reacted with shock and dismay at the Alabama Supreme Court’s answer to these questions. The court ruled that the accidental destruction of human embryos at IVF clinics constitutes child murder, spurring fertility clinics to cease operations. Though state lawmakers responded with a measure that protects IVF providers from wrongful death lawsuits, many clinicians remained worried that the court’s ruling could expose them to legal repercussions.
Their legal concerns stem from the fact that it is common for fertilized eggs not to survive: 45% of lab-grown IVF embryos die before becoming blastocysts, and plenty of others die in the female body even when naturally conceived. Furthermore, when couples are left with extra embryos after a successful round of IVF, it is common practice for clinics to destroy them or donate them to research.
Given that IVF enjoys widespread support throughout the United States, it is unlikely that concerns about fetal personhood will lead to significant bans, especially as the GOP remains split on the issue. However, fertility experts worry that increasing the legal risk of IVF could impose restrictions on the use of embryos, rendering the process more inefficient and requiring couples to undergo more cycles. IVF is already quite cost prohibitive, with one cycle costing up to $24,000 and lacking insurance coverage in 31 U.S. states.
In the United States, the debate about IVF is far from settled — as recently as September 2024, Senate Republicans blocked a bill that would have enacted federal protections for IVF, contradicting Trump’s assertion that he wants to expand access to the treatment. Nevertheless, the science underpinning the safety and efficacy of IVF remains steadfast, as does the fact that thousands of families could not have exercised their right to bear children in its absence.
