Why Promoting IVF Will Not Reverse the Birth Dearth
“We want more babies,” said candidate Donald Trump in August 2024.1 He was not wrong. Birth rates in developed nations, including the U.S., have been declining for almost two decades. According to the U.S. Centers for Disease Control, 3.6 million babies were born in 2025, the fewest since 1979 when the country had fewer potential parents.2 While demographers say a stable population would require 2.1 children born to each woman in that age group, we are now at 1.6 and declining. And as each generation has fewer people of reproductive age, the problem will accelerate. Some analysts speak of developed nations as self-eradicating in a few generations.3
This reality is said to have enormous economic and social consequences: A rapidly aging population, with fewer young adults working to support their parents and grandparents; a potential collapse of Social Security, retirement pensions, and the nation’s health care system; declining creativity and innovation in science, technology, and commerce; and so on.4 This “birth dearth” is a public crisis, deserving government’s attention.
So President Trump is right as far as this goes. But he has proposed that his Administration solve this problem by promoting in vitro fertilization (IVF), such as by mandating its coverage in health insurance and/or subsidizing it with tax dollars.5 He has solicited plans for implementing this policy, and several bills have been introduced in the current Congress to do so.6
This effort has rightly been criticized on moral grounds, especially due to the very large number of newly conceived embryos discarded or frozen in the IVF process. Concerns are also raised about the eugenic selection of children, and how the procedure facilitates the buying and selling of children through “surrogate motherhood.” But on practical grounds alone, efforts to address the birth dearth by maximizing use of IVF ignores three important facts.
IVF Failures and Problems
First, among all treatments for infertility, IVF is the most exotic, expensive, and wasteful—wasteful of resources as well as of nascent human lives. Its problems have been well documented.7 It fails far more often than it succeeds in producing a live-born child. The U.S. Centers for Disease Control report that IVF clinics presided over 435,426 reproductive “cycles” in 2022, of which only 22% led to a live-birth delivery. Writing in 2018 to “celebrate” 40 years of IVF, two British medical experts said its effectiveness remains “limited” and asked rhetorically, “can you imagine any other branch of medicine or surgery accepting and working with a 70% failure rate?” Countries where the government subsidizes up to three cycles of IVF have found that about two-thirds of patients abandon the effort to have a child this way before the third attempt.
The surviving children are also more likely than naturally conceived children (or those conceived after other treatments) to have significant health problems. And women undergoing IVF are more likely to have complications in giving birth, and are at risk of serious harm (including, ironically, infertility) from the superovulatory drugs stimulating production of several ova at a time for IVF attempts. Reports of “mixups” in which women give birth to an unrelated couple’s child, of scandals in which fertility doctors secretly use their own genetic material to father multiple children, and of lawsuits against IVF clinics that negligently allow large numbers of frozen embryos to thaw and die, have been prominent in news media.
President Trump may think IVF is an effective response to infertility because former advisor Elon Musk reportedly used it to engender at least twelve children with three different women.8 But these women, one of whom was a professional colleague, did not have fertility problems. They resorted to IVF in order to have a child with the genes of a brilliant entrepreneur. This was about eugenics, not medical treatment.
IVF Coverage Mandates: No Solution
A second inconvenient fact: IVF’s irrelevance to birth rates has been demonstrated by experience with statewide insurance policies. The Centers for Disease Control report that the birth rate has been declining fairly steadily since 2007—with an historic low of “53.1 births per 1,000 females ages 15-44” in 2025, 1% lower than in 2024.9 CNN has published a breakdown by state for the 2024 figures, making it possible to compare birth rates with the presence or absence of an IVF coverage mandate.10
The ten states with the highest birth rates in 2024, beginning with the high-est, are: South Dakota (66.7), Nebraska (62.9), Alaska (60.8), North Dakota (60.4), Kentucky (60.3), Utah (59.9), Texas (59.3), Indiana (59.1), and Iowa and Arkansas (tied at 58.8).
Only one of these states, Arkansas (tied for 9th highest birth rate), had a broad IVF coverage mandate in 2024. Kentucky required coverage only of “fertility preservation” efforts, preserving the gametes of people whose medical treatment has caused or is expected to cause infertility (e.g., cancer treatment). Texas has a mandate with many limitations: Insurers must offer the coverage but employers can choose not to purchase it; the procedure must in-volve only the policyholder and policyholder’s spouse; the fertility problem must have existed for five years or be due to specified medical conditions; and other treatments must have been tried first. Utah had a pilot project for public employees, but it expired in 2024.11
The ten states with the lowest birth rates, beginning with the very lowest, are: Vermont (41.7), Rhode Island (45.0), New Hampshire (45.9), Oregon (46.1), Maine (46.3), Massachusetts (46.8), Connecticut (48.9), Illinois (49.7), California (49.8), and Nevada (50.1).
Seven of these ten states had broad IVF coverage mandates in 2024. One might guess that a low birth rate was perhaps a state’s reason for establishing the mandate, but most of these mandates existed for years or decades before 2024, with no apparent effect. Massachusetts enacted its policy in 1987; Rhode Island in 1989, with amendments in 2006 and 2017; Illinois in 1997; Connecticut in 2005, with amendments in 2017; New Hampshire in 2020. Mandates in Maine and California began in 2024, but experience in the other states provides no reason to believe they will significantly affect the birth rate. CNN remarks that these differences are chiefly regional, with Northeastern and West Coast states having the lowest fertility and Southern and Midwest states having the highest. One might also compare CNN’s map of birth rates with a map identifying “blue” and “red” states—or with estimates of attendance at religious services, often seen by demographers as a factor in family size. Clearly access to “free” IVF is not a major factor.
Misreading the Underlying Problem
The third fact is that the current “birth dearth” does not even have much to do with infertility. Once again, federal data tell the tale.
In 2013, the National Survey of Family Growth showed that from 1982 to 2010, infertility among married women of reproductive age in the U.S. had declined from 8.5% of these women to 6.0%, at the same time that a previously robust national birth rate had begun its slide toward the current crisis.12 By 2019 infertility had risen again, but only to about the same level as in 1982.13 Trends on infertility and on low birth rates do not correlate at all.
To understand this we must cite the government survey’s definition of in-fertility as “a lack of pregnancy in the 12 months before the survey, despite having had unprotected vaginal intercourse in each of those months with the same husband or cohabiting partner.” It covers only people who we can assume, based on their actions, are willing and trying to have a child. What has drastically changed nationwide is not the ability but the willingness.
In short, this is a problem that will not be solved by technology. It is a social, cultural, and yes, a spiritual problem.
What Can Government Do to Help?
It might start by ceasing to do things that make the problem worse. Surely it is no coincidence that the states with the lowest birthrates also have some of the most expansive laws for allowing and funding abortion. For example, despite the federal ban on Medicaid funding of elective abortions, eight of the ten states with the lowest birth rates (all but Rhode Island and New Hampshire) subsidize them with state funds. Of the ten states with high birth rates, only Alaska does so, under court order. Withholding federal funds from Planned Parenthood, which performs abortions on 97% of its pregnant clients, would be a step in the right direction.14 If you want more live births, stop encouraging women to eliminate their offspring before birth.
Some conservatives may not welcome a mention of immigration policy in this context. But until recently, immigration was the only thing preventing the U.S. from joining European countries in sinking below replacement level. Immigration has brought in more people, including people whose culture welcomes larger families. Whatever else it does, deporting millions of these residents will make the problem worse.15
A third factor is economic pressure. Funds saved by defunding the abortion industry can be channeled toward pregnancy aid centers empowering women to accept their unborn children, a larger and refundable child tax credit, affordable housing, and other forms of support. More generally, a faltering and unstable economy evoking fears of a recession can make many young people hesitate before bringing a child into the world.
But the fundamental problem lies deeper. Sociologist Robert Bellah and philosopher Charles Taylor told us a long time ago that the dominant view of the human person in Western industrial nations has become one of “expressive individualism.” Each individual presents as an isolated bearer of aspirations for self-aggrandizement, even self-definition. Relationships with others are contractual and inherently changeable, depending on whether they advance one’s personal goals—even romantic bonds are “situationships.” The sexual revolution has reflected and magnified that view, as freeing sex from procreation tends to free it from mutual respect and commitment. How this view of the person distorts attitudes toward assisted reproduction and abortion has also been analyzed.16 Lasting vows to spend life with a spouse, and the willingness to sacrifice time and resources for years to raise a dependent child, simply make little sense in this view. Secularization has added fuel to the trend, as it is often by religious faith that people readily accept, and find profound meaning in, such sacrifice for the sake of others.
Ironically, IVF is the perfect reproductive technology for accommodating this model of the person. All the people involved may be strangers. Sperm and egg “donors” (or vendors), contracting couple, and woman hired as a “surrogate womb” need never have met each other. An ad for the Colorado IVF mandate, the “Building Families Act,” emphasized its benefit for same-sex couples and “unpartnered individuals.”17 For that matter, IVF works equally well (or badly) if both genetic parents have died, provided that their gametes were frozen beforehand.
If this view of the person is the fundamental problem, our current president—who has been called, fairly or not, “the president of expressive individualism”—may not be in the best position to lead us in solving it.18 But then, government in general is not well equipped for healing this kind of cultural wound, which requires a revived appreciation for family, community, and values that transcend politics. At any rate, it should be clear that promoting IVF is, at best, irrelevant to the problem.
NOTES
1. Ryan King, “Donald Trump promises to expand IVF access during rally, town hall: ‘We want more babies’,” New York Post, August 29, 2024, available at https://nypost.com/2024/08/29/us-news/ donald-trump-promises-to-expand-ivf-access-we-want-more-babies/
2. Brady E. Hamilton et al., “Births: Provisional Dara for 2025,” Vital Statistics Rapid Release, Report No. 43, National Vital Statistics System, April 2026, available at https://www.cdc.gov/nchs/ data/vsrr/vsrr043.pdf
3. Solène Tadié, “Demographic Crisis Poses a Greater Threat to the West Than Ever Before, Scholar Warns,” National Catholic Register, March 11, 2025, available at https://www.ncregister. com/interview/tadie-mads-larsen-demographic-crisis-threat-to-west
4. Sarah Lee, “The Impact of Population Decline,” NumberAnalytics, May 25, 2025, available at https://www.numberanalytics.com/blog/impact-of-population-decline
5. Executive Order 14216, “Expanding Access to In Vitro Fertilization,” 90 Fed. Reg. 35 (Feb. 24, 2025) at 10451, available at https://www.govinfo.gov/content/pkg/FR-2025-02-24/pdf/2025-03064.pdf
6. See H.R. 1878 (“IVF Access and Affordability Act”), S. 2035 (“Protect IVF Act”), and H.R. 3480 (“Health Coverage for IVF Act of 2025”), available at congress.gov
7. See USCCB Secretariat of Pro-Life Activities, In Vitro Fertilization: The Human Cost (March 2025) for citations, available at https://www.usccb.org/resources/IVF_Human_Cost_2025.pdf
8. Matthew Schmitz, “Elon’s Family Values,” First Things, April 2025, pp. 11-13, available at https://firstthings.com/elons-family-values/
9. Hamilton et al., note 2 supra.
10. Alex Leeds Matthews et al., “The US average fertility rate ticked down again: See where your state ranks,” CNN, April 16, 2026, available at https://www.todaynews.blog/en/news/2026/04/16/us-states-births-fertility-rates-dg
11. “Insurance Coverage by State,” RESOLVE (2026), available at https://resolve.org/learn/ financial-resources/insurance-coverage/insurance-coverage-by-state/
12. Anjani Chandra et al., “Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth,” National Health Statistics Reports, Number 67 (August 14, 2013), available at https://www.cdc.gov/nchs/data/nhsr/nhsr067.pdf
13. Colleen Nugent and Anjani Chandra, “Infertility and Impaired Fecundity in Women and Men in the United States, 2015–2019,” National Health Statistics Reports, Number 202 (April 24, 2024), available at https://www.cdc.gov/nchs/data/nhsr/nhsr202.pdf
14. USCCB Secretariat of Pro-Life Activities, Planned Parenthood: Setting the Record Straight (April 2021), available at https://www.usccb.org/issues-and-action/human-life-and-dignity/abortion/upload/ Planned-Parenthood-fact-sheet.pdf
15. Shannon McDonagh, “US Population Projections Drop Due to Lower Birth Rates, Less Immigration,” Newsweek, January 15, 2025, available at https://www.newsweek.com/us-population-decline-birth-rates-immigration-cbo-2025-2015619; News release, U.S. Census Bureau, “U.S. Population Growth Slows Due to Historic Decline in Net International Migration,” January 27, 2026, available at https://www.census.gov/newsroom/press-releases/2026/population-growth-slows.html
16. See O. Carter Snead, What It Means To Be Human: The Case for the Body in Public Bioethics (Harvard University Press 2020), pp. 5-6 (explaining the concept) and 279 (citing sources by Bellah and Taylor).
17. “Colorado Insurance Law,” RESOLVE (2026), available at https://resolve.org/learn/financial-resources/insurance-coverage/colorado-insurance-law/
18. Ronald E. Osborn, “Donald Trump: The President of Expressive Individualism,” America, January 21, 2019, pp. 18-25, available at https://www.americamagazine.org/politics-society/2018/10/31/ donald-trump-president-expressive-individualism/
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Original Bio:
Richard M. Doerflinger is retired from 36 years working for the U.S. Conference of Catholic Bishops, where he directed public policy efforts for its Secretariat of Pro-Life Activities. He is a public policy fellow at Notre Dame University’s Center for Ethics and Culture and an associate scholar at the Charlotte Lozier Institute.
