It’s been strange to watch the world of fertility become increasingly political. Leading up to the election, IVF and broader reproductive rights have become a red-hot topic. If knowledge is power, then each of us should be empowered with reliable information. From Tim Walz’s IVF experience to Trump's promise of "IVF for all" — and everything in between — here’s a quick primer on how IVF is playing out in the political arena leading up to the election.
Disclaimer: this is a nonpartisan message which does not weigh in on any political ideology. Our intention is to provide trustworthy, relatable information — each person can decide what to do with it.
When did IVF become such a political hot topic?
It started two years ago when the Supreme Court reversed Roe v. Wade and determined that abortion rights were no longer constitutionally protected. Individual states now had the power to decide whether abortion should be legal – and if so – under what circumstances. At the time, many signaled that this would open the door for the limitation of other reproductive rights. They were right.
IVF came into the mix earlier this year, when Alabama’s Supreme Court ruled that frozen embryos were “unborn children” and anybody who discards them could be found liable for wrongful death. The high court's decision posed big problems for IVF, a medical procedure that is almost entirely predicated around creating embryos which are then tested in a lab. Embryos that are unhealthy or unlikely to result in a viable pregnancy or birth are generally discarded. The court's decisions stipulated major repercussions (wrongful death) for those who discard these embryos – a big problem for practitioners of IVF. In the immediate aftermath, many Alabama fertility clinics halted operations.
Tim Walz gets personal
After the Alabama Supreme Court’s decision resulted in the closure of several IVF clinics, fear spread that other states too would adapt similar measures to limit access to IVF care. In an effort to avoid states being able to pass legislation which could result in further clinic closures, Democratic senators introduced a bill which would protect IVF access at the federal level. When Republican senators blocked this bill, it became clear that IVF had cemented itself as a political battleground topic.
Regardless of where you stand on the issue, the political dialogue around reproductive rights became increasingly criticized due to so much of it being controlled by men who often had no personal connection to, and thus little understanding of, the subject at hand. That changed a bit when Tim Walz stepped onto the stage and in his first primetime appearance, spoke about IVF being personal for him: “When my wife and I decided to have children, we spent years going through infertility treatments. And I remember praying every night for a call for good news. The pit in my stomach when the phone rang, and the agony when we heard that the treatments hadn't worked. So this wasn't by chance that when we welcomed my daughter into the world, we named her Hope.”
But there was one big problem – Walz, and his wife Gwen, never went through IVF.
IUI vs. IVF - what’s all the noise about?
It wasn’t long before Walz’s comments – which spoke to the profound and highly personal nature of fertility treatments – were used against him. Political opponents correctly pointed out that the Walz family went through IUI (intrauterine insemination), not IVF (in vitro fertilization).
So what’s the difference, was Walz lying, and how big a deal was all of this?
First, let’s get clear on what IUI actually is – a fertility procedure in which male sperm is placed directly into a woman’s uterus. Unlike IVF, no eggs are extracted and no embryos are created, which makes it a generally less rigorous protocol. As a result, it’s often the first course of intervention a fertility doctor will recommend, though its success rates are considerably lower than IVF.
So yes, IUI is unquestionably a different protocol than IVF. But how big a snafu was it for Walz to refer to IUI as IVF? You should decide for yourself; here is some helpful context to help you do so.
-
The road to IUI or IVF is usually the same. For most, there is a long journey that precedes fertility treatment, generally involving a lengthy period of trying to conceive naturally. If you’ve been trying for 12+ months without success, you have met the technical definition of infertility – a place nobody wants to be. Whether your treatment journeys starts with IUI or IVF, you are often grappling with underlying infertility, which causes a lot of the heartache described by Walz.
-
Reliance and uncertainty. For anybody that is turning to IUI or IVF, there is a lot at stake. Without these interventions, millions would never be able to bring a child into the world – so the reliance here is huge. At the same time, most people going through either protocol describe a heavy dose of uncertainty regarding if, and when, the protocol will work. This can often contribute to staggering rates of depression and anxiety seen amongst women facing infertility – regardless of whether IUI or IVF is their prescribed medical protocol.
- IVF is often used as a catchall phrase. IVF is not the same thing as IUI. They are different medical protocols/procedures. But IVF is often used to refer to other types of fertility treatment which fall under the broader IVF bucket. As an example – egg freezing is often turned to as a means of fertility preservation. Though it is technically different from IVF, is often blanketed in as part of the broader fertility treatment conversation. IVF, IUI and egg-freezing are all different protocols, but in colloquial terms, IVF is often used as a catchall that encompasses all of these fertility treatments. So while you won’t get points on your SATs for answering that IUIs and IVF are the same thing, in everyday conversation (especially in a non-medical environment), it’s not uncommon to use the term IVF to refer to a broader spectrum of fertility treatments such as IUI.
Trump: Free IVF for all
The IVF conversation got even louder, when just a couple weeks ago, Trump declared a “free IVF for all” policy as part of his presidential promise. Interestingly, Trump’s position on reproductive rights has been hard to define. On the one hand, his appointment of three conservative Supreme Court justices had outsized influence on reversing Roe v. Wade and significantly reducing access to abortion care. At the same time, he has spoken out in support for IVF on more than one occasion. In the wake of Alabama Supreme Court’s finding that forced the closing of many IVF clinics, it was Trump that stepped in to help restore access to IVF when he leaned on Alabama’s lawmakers to pass legislation to protect IVF. They did, and several of the fertility clinics which had to halt operations, were back in business.
More recently, Trump doubled (or tripled) down on his support for IVF when declaring at an August rally that “Under the Trump administration your government will pay or your insurance company will be mandated to pay for all costs associated with I.V.F. treatment.”
First thought? This is amazing!! Second thought, can that even be done? Well, let’s break it down (again, with no political bias, just the facts).
The first thing that needs to be pointed out is that there’s one rather huge detail that was left a bit open-ended in Trump’s declaration: who’s footing the bill? The government? Or insurance companies? It's an important distinction; let’s take a look at both scenarios.
Route 1: Getting insurance companies to pay
There are two ways to get insurance companies to cover the cost: Congress passing new legislation or IVF being added to a list of women’s health services covered by the Affordable Care Act. Objectively, there are significant obstacles to either of these scenarios. The legislation route is challenging in that it would require Republicans, who just voted against a bill which would have nationally protected IVF, to now take proactive measures to mandate more access to IVF. It’s possible another Trump presidency could influence Republican lawmakers to get behind this legislation, but it’s far from a shoo-in given how many Republicans are on the record as being philosophically opposed.
The second route – folding IVF under the Affordable Care Act – also appears an uphill climb for a couple reasons. First, the Affordable Care Act is a Democratic (Obama-era) healthcare law that's viewed unfavorably by most Republicans. Trump himself has been outspoken about repealing and replacing the Affordable Care Act altogether. The idea that he’d now use this program as the vehicle to further this IVF policy, would mean not only keeping it intact, but to an extent, embracing it. It’s unclear how quickly Trump and other Republicans would be willing to do this.
Still, there's another potential hoop to jump through. It's not Trump nor even Congress that can decide whether IVF could be covered under the Affordable Care Act. Instead, it’s a panel of doctors which manage the benefit and decide which healthcare services should be free for all. Historically, the panel has approved services viewed to aid in disease prevention, such as mammograms which can detect breast cancer. The early consensus is that it would be unlikely (but not impossible) that this panel would include IVF as a preventative protocol which should be covered by the Affordable Care Act.
Route 2: Government Funding
If mandating insurance coverage proves unsuccessful, Trump did propose another possibility – government funding. So how realistic is this? The first problem here is that this would equate to a IVF-specific single payer system and there is well-documented opposition to anything that resembles a single-payer system. Separately, there’s also the issue of funds. Depending on who you ask, this could cost anywhere from $10B to $100B a year – not exactly chump change. If government wanted to fund this, it would require significant political maneuvering to set up a unique payer system and then appropriate billions of taxpayer dollars each year. With the amount of political gridlock that exists today, there’s no telling if a system like this with that kind of budget would actually find its way to fruition.
None of the above means Trump might not genuinely try to implement free IVF for all if elected, it just lays out how it could be done and the challenges that exist.
What would free IVF look like?
It’s worth pointing out that if IVF for all did get funded, there'd be a huge surge in demand, with unmatched supply, creating a whole other set of logistical issues that we won’t go into detail about here. But right now there are about 450 fertility clinics across the US and largely not enough specialized reproductive clinicians to service them. Opening the floodgates to millions more Americans that could now afford IVF would shock the system. Any new funding that vastly increased IVF access would need to be coupled with a comprehensive plan for how this medicine could be delivered to an exponentially larger patient population.
The Bottom Line
Political policy is super simple…said nobody ever. Everybody should make decisions for themselves but it’s important to do so based on reliable information. Today, that can be hard to find. We’ll stay out of the politics of it all but do our part to help educate where we can. As always, feel free to reach out if we can support in any way along your fertility (or education) journey.
