Provide insurance coverage for in vitro fertilization to all members of the U.S. military.
Declare I.V.F. to be an “Essential Health Benefit” — and extend coverage to the nearly 50 million Americans insured through the Affordable Care Act.
Push Congress to pass a law requiring private insurance companies to cover I.V.F. procedures for any person struggling with infertility.
Those are among the sweeping potential policy changes under discussion at the White House as aides prepare to release a highly anticipated report on combating infertility, according to two representatives in the fertility field who participated in the meetings.
Infertility doctors and other leaders in the industry, along with representatives of conservative policy groups skeptical of the procedure, have been shuttling in and out of the White House for months to meet with senior officials, including the chief of staff, Susie Wiles. The conversations have been both wide-ranging and highly specific, with aides signaling their interest in a variety of ideas that would make I.V.F. accessible to a far greater swath of the country, some participants said.
“They’ve called me over and over again,” said Kaylen Silverberg, a Texas doctor who runs a large fertility clinic in Austin and has been regularly advising the White House group overseeing the report. One of the aides leading the report, he added, called him at 10 o’clock one night last week, presenting a series of hypothetical actions the administration could take to expand I.V.F. access and asking for his input.
“She had very, very specific questions: What would the implications be if we did this? What are the pros and cons? What are we missing?” Dr. Silverberg said.
Dr. Silverberg described some of the specific proposals he and White House officials had been discussing, as did TJ Farnsworth, the founder and chief executive of a large chain of fertility clinics.
The White House process has also drawn criticism, with some experts in the field questioning why the country’s leading I.V.F. medical and advocacy group has not been invited to participate, even as aides solicit input from for-profit companies and conservative advocates.
That group, the American Society for Reproductive Medicine, sent numerous emails and letters to the White House aides overseeing the effort, according to Sean Tipton, the group’s chief advocacy and policy officer. It never received a response.
“It’s disappointing that they don’t want to tap into our expertise,” Mr. Tipton said. His group sets the guidelines for the field and has been pushing for increased I.V.F. access for decades. “We traffic in a currency that seems to be of little interest to the administration: expertise, experience and know-how.”
Even those who have met with White House officials say they are keeping their expectations in check, emphasizing that President Trump has yet to publicly make any concrete policy proposals. His February executive order calling for the fertility report directed aides to make recommendations for “aggressively reducing out-of-pocket and health plan costs for I.V.F. treatment.”
“The first executive order got people excited, but you read it, and it doesn’t mean anything specific,” said Mr. Farnsworth, who met with White House officials in March. Still, he added, “the idea that there is a U.S. president even talking about this, I think is a positive.”
A White House spokesman, Kush Desai, said expanding access to I.V.F. was a “key priority” for Mr. Trump.
“The administration’s close coordination with outside stakeholder groups across the political spectrum to inform our I.V.F. access plan reflects our commitment to delivering on this priority for the American people,” Mr. Desai said.
Mr. Trump began embracing infertility issues on the campaign trail in early 2024, after the Alabama Supreme Court ruled that frozen embryos used in I.V.F. should be considered children. The decision prompted intense backlash from both Democrats and Republicans across the country. Mr. Trump quickly distanced himself from the ruling, urging the Alabama legislature to protect access to the procedure and later promising to make it free, without providing details on how he would do so.
As the White House pushes for Americans to have more babies, with some concerned about the declining U.S. birthrate, many in the Trump administration are eager to combat infertility, which now affects roughly one in six women of reproductive age. But that goal is complicated by dueling interests within Mr. Trump’s base. Many Christian conservatives who oppose abortion also oppose I.V.F. because they are uncomfortable with the loss of embryos, which they consider people. Embryos are routinely discarded during I.V.F. because they fail to develop.
Many women who struggle to conceive eventually turn to I.V.F., a procedure in which the egg is fertilized outside of a woman’s body and that now accounts for approximately two percent of births in the United States. But the procedure is not covered by many insurance companies, and typically costs between $15,000 and $20,000 for a single cycle. Many women require more than one cycle before they are able to have a baby.
It’s not yet clear how the White House will address the issue in the report. Administration officials have said they intend to look at the issue of infertility “holistically” — a term often used by those skeptical of I.V.F. — while Mr. Trump has declared that he would become the “fertilization president.”
“We are going to have a holistic fertility policy,” Calley Means, a White House adviser, told Fox News in late April, adding that there had been a “mandate from the top” and that more details would be forthcoming.
A major expansion of I.V.F. access for the general public would likely require legislative action. Congress could compel insurance companies to cover I.V.F. and other forms of infertility care. But there are also some steps the administration could take on its own to expand coverage.
When Mr. Farnsworth met with White House officials, he told aides there was a lot the president could do “with a stroke of a pen.” He proposed providing I.V.F. coverage to veterans and active-duty troops, the majority of whom do not currently have access to infertility care.
“I walked away without any certainty about anything,” said Mr. Farnsworth, who leads the Fertility Providers Alliance, a trade group. “But I walked away at least encouraged to know that they’re showing curiosity around what the options are.”
Other advocates and businesses in the I.V.F. field are hoping the administration will bolster infertility care for federal workers and instruct all federal insurance plans to cover the procedure. That move could cut against the mission of Elon Musk’s Department of Government Efficiency, which has been looking for ways to reduce costs across the federal government.
“Federal employee health benefit plans could be expanded relatively easily,” said Allison Swartz, general counsel at Progyny, a fertility benefits company that has met with White House officials. “We definitely want to serve as many different folks as possible.”
Others in the field expect that the Trump administration may zero on in the high price of fertility medications, which usually cost thousands of dollars for each cycle. Earlier this week, the president signed an executive order calling for lower prescription drug prices. While cheaper, generic I.V.F. drugs are available in Europe, none have been approved in the United States.
As infertility clinics and benefits companies push for more insurance coverage for I.V.F., some conservatives have been advocating for alternative ideas more in line with the “Make America Healthy Again” movement led in part by Robert F. Kennedy Jr., the health and human services secretary.
The Heritage Foundation, for instance, has been pushing for an approach called restorative reproductive medicine. The idea involves examining what proponents call the root causes of infertility, which they say can include issues with diet and exercise, as well as reproductive health conditions like endometriosis. I.V.F., in this approach, is a last resort.
“Many people are becoming aware and understanding that infertility is a more complex diagnosis than they were originally led to believe,” said Emma Waters, a policy analyst at the foundation who recently published a report on the subject. “They’re realizing that there are more narrowly tailored treatments available.”
Ms. Waters has proposed directing the National Institutes of Health to expand their study of infertility and using government funds to promote programs that educate women on their menstrual cycles, such as classes on cycle-charting, a technique that some women also use to try to prevent pregnancy without using birth control.
The American Society for Reproductive Medicine has called this approach “political” and not based in science.
Groups like Heritage, Mr. Tipton said, “are trying to mask their opposition to I.V.F. because I.V.F. is incredibly popular.”
“If you have built a movement on the idea that a fertilized egg is the moral and constitutional equivalent of a born child, I.V.F. is a threat to you,” he added, referring to the antiabortion positions of conservative policy groups like Heritage.
“They saw that in Alabama and they’re reacting.”
Sarah Kliff contributed reporting.
Caroline Kitchener is a Times reporter, writing about the American family.
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