IVF Under Attack: Anti-Reproductive Freedom Fertility Doctrines

In vitro fertilization (IVF) is the most commonly used method of assisted reproductive technology (ART) in the United States, and has helped millions of people build their families.

However, there are emerging threats to fertility care that undermine reproductive freedoms. They purport to increase access to IVF but would actually undermine its accessibility and effectiveness and compromise pregnant people’s rights and bodily autonomy.

This fact sheet aims to explain some of these concerning proposals, including their anticipated harmful impacts.

In Vitro Fertilization

IVF is a widely used method of assisted reproductive technology in which an egg is combined with sperm in a lab to help create an embryo.

IVF can be done using donated gametes (egg and/or sperm) and may involve a surrogate who carries the pregnancy. To date, IVF has helped millions of people build their families since the late 1970s. In 2023, IVF accounted for over 95,000 births in the United States (approximately 2.6% of all births in the country).

There are well-researched best medical practices that give patients the best odds of becoming pregnant through IVF. These practices account for each individual’s or couple’s reason for pursuing IVF, including:

• Female or male infertility factors,
• People who do not have the necessary gametes (egg and/or sperm) to become pregnant, and
• Those who face an increased risk of transmitting a serious, inheritable genetic or chromosomal condition to a child.

After nearly 50 years of being developed, practiced, and refined based on the best available research and evidence, standard IVF protocols today require creating multiple embryos per cycle. That is because only about 70% of retrieved mature eggs end up fertilizing, and of those that do fertilize, only half go on to develop into an embryo. After an embryo is transferred into a person’s uterus, it may or may not implant in the uterine lining.

Given these odds, creating as many embryos as possible per cycle is critical to giving patients the best chance of becoming pregnant and having a baby. It is best medical practice to transfer a single embryo into the uterus at a time to avoid a multiples pregnancy. And since it is common for people to have multiple embryos at the end of an IVF cycle, they may decide to cryopreserve (freeze) the remaining embryos and in the future decide to use, donate, or discard them.

Anti-Reproductive Freedom Fertility Approaches

There are multiple policy proposals targeting IVF that have been put forth by anti-reproductive freedom policymakers and organizations. These proposals would jeopardize patients’ rights, disregard best practices, and discriminate against LGBTQ+ families and single and unmarried people. These proposals frame infertility as a personal failure and could result in people losing their right to use their own frozen embryos and even being forced to transfer possession of their embryos to strangers.

Restricted IVF

Restricted IVF is an anti-reproductive freedom, sub-standard approach to IVF that prioritizes ideology over science and disregards best medical practices.

Referred to as “ethical IVF” by its proponents, this approach is anything but. It is premised on the idea that embryos should have legal rights that trump the rights of pregnant people, resulting in restrictions that require patients to take on more physical, emotional, and financial burdens—and make an already daunting process not only more expensive but also less effective.

Elements of Restricted IVF will likely include:

• Limiting the number of embryos created per cycle, e.g. permitting only one embryo per cycle,
• Prohibiting embryo cryopreservation (freezing embryos),
• Prohibiting genetic screening of embryos,
• Requiring patients to put their embryos up for “adoption,” and/or
• Limiting IVF access to straight married couples who have the necessary gametes.

Laws and policies that advance Restricted IVF would:

• Undermine IVF’s medical standard of care, which is to create as many embryos as possible per cycle to give patients the best chance of becoming pregnant and having a baby,
• Force patients to undergo more cycles, unnecessarily putting their bodies through an already arduous regimen,
• Push IVF further out of reach because of its already high out-of-pocket costs. By making IVF less effective, Restricted IVF would likely require patients to incur higher out-of-pocket costs from needing additional cycles to become pregnant and have a live birth. A single cycle of IVF can cost upwards of $30,000 if a patient does not have insurance coverage,
• Potentially require patients to transfer all embryos created at once—which could lead to a multiples pregnancy—or put excess embryos “up for adoption,” and
• Exclude single people, unmarried couples, same-sex couples, and patients who use donor gametes, donor embryos, or work with a surrogate.

Blame-and-Shame Fertility

Blame-and-Shame Fertility is an anti-reproductive freedom doctrine that assumes infertility is the pregnant person’s fault—based on their diet, lifestyle, age, etc.—and that using modern assisted reproductive technology, like IVF, is a personal failure. Dubbed “restorative reproductive medicine” by its proponents, this fertility approach casts IVF as part of “methods that are inherently suppressive, circumventive, or destructive to natural human functions.” 

While many people’s fertility journeys already incorporate holistic care, including ovulation tracking and homeopathic treatments, Blame-and-Shame Fertility positions these methods against IVF, rather than as complimentary, and disparages those who use modern reproductive technologies to become pregnant.

Elements of Blame-and-Shame Fertility include:

• Blaming women for their infertility and promising to “fix” it and “restore” their bodies to become pregnant by encouraging only “natural” reproductive technologies, including:
  • Body temperature tracking,
  • Menstrual cycle tracking, and
  • Cervical mucus monitoring.
• Framing infertility as a woman-only issue disregarding the fact that that male-factor infertility accounts for or contributes to 20-40% of infertility diagnoses in heterosexual couples in the U.S., and 
• Presuming that only heterosexual people and couples need access to fertility health care.

Laws and policies that advance Blame-and-Shame Fertility would:

• Place the burden of infertility solely on the shoulders of women and further stigmatize them for struggling to become pregnant or carry a pregnancy to term,
• Promote a narrow vision of family—both what it looks like and how it’s created—and do nothing to promote access to fertility health care for single and/or unmarried individuals and LGBTQ+ couples for whom IVF is a critical method of family building,
• Delay people’s access to IVF by either pushing Blame-and-Shame Fertility as an equivalent alternative or requiring that people pursue it as a prerequisite to receiving IVF coverage, and
• Siphon funding from public health programs if they are required to incorporate Blame-and-Shame Fertility into their family planning programs.

This ideology is already appearing in law. For example, Arkansas introduced and enacted House Bill 1142 during their 2025 legislative session called the Reproductive Empowerment and Support Through Optimal Restoration (RESTORE) Act. Among other things, under it:

• Title X facilities in the state are required to integrate Blame-and-Shame Fertility into its existing public health programs and to allocate funding to cover its implementation, syphoning money from other care,
• Providers at publicly funded entities in the state are allowed to refuse to train in, provide, or in any way facilitate ARTs, like IVF, based on their “sincerely held religious beliefs or moral convictions” without guaranteeing a patient’s access to care, and
• Private insurers mandated to provide IVF coverage are required to also cover Blame-and-Shame Fertility programming and services.

Targeted Restrictions of IVF Providers (TRIP) Bills

Anti-reproductive freedom lawmakers and groups are also now repurposing their anti-abortion tactics to undermine IVF access. This session, for the first time, bills were introduced to limit IVF, using the same structure and intent of Targeted Restrictions of Abortion Providers (TRAP) laws.

TRIP bills single out IVF and contribute to stigma around infertility, fertility care, and individuals and families who use IVF to start or grow their families. If enacted, they would:

• Make it physically or financially more difficult—and even impossible—for ART/IVF providers and clinics to provide evidence-based, patient-centered care to their patients,
• Allow lawmakers, not ART/IVF providers, to determine the standard of care, and
• Compel ART/IVF providers to provide less effective, more expensive care to patients who often are already unable to afford the IVF’s high out-of-pocket costs.

In its 2025 legislative session, for example, Tennessee legislators considered a bill that not only singled out ART/IVF providers for licensing schemes and reporting requirements but also included a prohibition on genetic testing and prohibited providers from fertilizing more eggs than four times the number of children the patient hopes to have, thereby incorporating Restricted IVF provisions.