The looming showdown over IVF, explained

President Donald Trump says he wants Americans to have more babies, and his administration is willing to try almost anything, from cash bonuses to transportation grants. 

However, there is one method for conceiving children that thousands of people use every year, but that has divided the Trump White House and the larger MAGA coalition: in vitro fertilization (IVF). 

Trump has repeatedly emphasized his support for IVF, even going so far as to call himself “the fertilization president” and “the father of IVF.” But some social conservatives, including high-profile groups that have been critical to the MAGA coalition and Trump’s unlikely alliance with evangelical Christians, oppose IVF on religious grounds. They have backed restrictions on the procedure as well as unproven alternatives like “restorative reproductive medicine.”

Now the two camps are headed for a showdown over the Pregnant Workers Fairness Act, which President Joe Biden signed in 2023. The law requires most employers to offer reasonable accommodations for workers’ needs arising from pregnancy, childbirth, or related conditions. A regulation implementing the law, issued by the Equal Employment Opportunity Commission in 2024, clarifies that those related conditions include miscarriage, abortion, lactation, and fertility treatments.

Andrea Lucas, the Trump-appointed chair of the EEOC, has signaled that she wants to revisit the Biden-era regulation. Workers’ rights advocates fear the EEOC could revise the rule to exclude accommodations related to IVF, like being allowed to take time off for appointments, potentially forcing people to choose between keeping their jobs and getting pregnant. 

“Employers frequently balk at IVF appointments, seeing them as elective and not as necessary,” Inimai Chettiar, president of the workplace justice nonprofit A Better Balance, told me. The protections of the Pregnant Workers Fairness Act “are really critical when it comes to IVF,” Chettiar said.

When Trump announced an agreement in October that could lower some fertility drug prices, some patients and doctors were optimistic that he would make good on his promises around IVF. But now, some experts fear his administration is moving to restrict IVF access and creating an environment in which fertility treatment, like abortion, becomes ever more stigmatized and difficult to access. 

Social conservatives won a big victory in the Supreme Court decision Dobbs v. Jackson Women’s Health Organization, and it’s increasingly clear they won’t stop there. “My bigger fear really is that we’re going to move to the right in terms of access to reproductive medicine, reproductive care — that restricting access to abortion really was just the first step,” said Karen Guzzo, a family demographer and director of the Carolina Population Center at the University of North Carolina at Chapel Hill.

The challenge of balancing work and IVF

For workers going through IVF, flexibility is not a luxury but a necessity. Because such treatments are often timed to a patient’s menstrual cycle, scheduling can be unpredictable. “They’ll suddenly call you and say, ‘Tomorrow is your retrieval,’ and then you have to be out the full day,” Chettiar, who became a parent through IVF, told me. Missing an appointment can mean missing a precious chance at a successful pregnancy.

The Pregnant Workers Fairness Act aims to protect workers from discrimination or even losing their job by requiring employers to grant time off for medical appointments and other accommodations like water breaks or an excuse from tasks that require heavy lifting. The accommodations workers need are often “very basic,” Chettiar said — but before the law passed, they were too often denied. A 2013 study estimated that 250,000 women per year had their requests for reasonable accommodations rejected.

Workers without access to sick leave and those with physically demanding jobs are especially in need of the protections the law provides, said Gaylynn Burroughs, vice president of education and workplace justice at the nonprofit National Women’s Law Center. So are patients of color and older patients, who may need more cycles of IVF than younger, white patients to achieve a pregnancy, Chettiar told me.

“I’ve talked to many women, especially in the health care industry, who had to stop IVF because they weren’t able to get the time off of work,” Chettiar said. 

Some workers say they’ve faced retaliation for pursuing fertility treatments. One woman, a manager at an Illinois Buffalo Wild Wings, filed suit earlier this year alleging that when she asked for sick leave for an IVF appointment, she was fired.

Although the Pregnant Workers Fairness Act is only a few years old, “we’re already seeing really tremendous impacts,” Sharita Gruberg, vice president for economic justice at the nonprofit National Partnership for Women & Families, told me. One recent study found a 9.6 percent reduction in pregnancy loss in states newly covered by the law, likely due to safer work conditions.

“We have increased birth rates from this law,” Gruberg said. “Turns out, when you create the conditions for folks to have their families and be supported and not jeopardize their livelihood in the process, lo and behold, you get babies.”

The future of IVF protections under Trump

However, Lucas, the Trump-appointed EEOC chair, has long argued that the regulation implementing the Pregnant Workers Fairness Act is too broad. In a 2024 statement, she wrote that the rule “fundamentally errs in conflating pregnancy and childbirth accommodation with accommodation of the female sex, that is, female biology and reproduction.” 

Regarding fertility treatment specifically, she writes, “the Commission paradoxically interprets a statute requiring employers to accommodate a worker’s pregnancy and childbirth into a provision that also requires accommodation of a worker’s inability to become pregnant.”

In 2024, Democrats held a majority on the five-member EEOC, and Lucas was outvoted. But after his inauguration, Trump fired two Democratic commissioners and named Lucas acting chair. The October confirmation of Brittany Panuccio, a Republican, solidified conservative control and set the stage for bigger moves.

Many work-life balance and gender justice advocates fear that the agency will take this opportunity to revisit the Pregnant Workers Fairness Act, issuing a new rule that could exclude patients undergoing IVF. Patients receiving or recovering from an abortion have already been excluded by a federal court decision last May. (The Trump administration declined to appeal that ruling.)

A narrowing of the regulation is “something that we should be worried about, given the statement that Andrea Lucas put out,” Burroughs said. “She provided basically a road map for what she would like to change about the rule.”

Removing protections for IVF would be devastating for patients, advocates say. With more than 90,000 babies born by IVF in the US every year, thousands of workers have already begun fertility treatments with those protections in place. “It’s really heartbreaking to think of a worker who’s planning things out, trying to figure out how to make this work, and then has the rug pulled out from underneath them mid-process,” Gruberg said.

What an IVF showdown means for pronatalism

The anticipated changes at the EEOC come at a contentious time for the Trump administration’s reproductive health and family policy.

The second Trump administration has been animated by pronatalism: the idea that birth rates are too low and that society should work to boost fertility. Vice President JD Vance, Trump ally and onetime DOGE head Elon Musk, and House Speaker Mike Johnson have all expressed concerns about America’s possible population decline. Pronatalist advocates were reportedly meeting with White House staff and submitting policy suggestions this spring.

However, there’s always been a split among conservative pronatalists over the role of IVF in building families. One side, loosely affiliated with the “tech right,” embraces fertility treatments as a way of boosting birth rates and even screening for IQ and other traits. On the other side are anti-abortion groups and religious conservatives who oppose IVF because human embryos are sometimes destroyed in the process. 

By allowing people to have children later in life, the procedure also cuts against the cultural ideals of some conservative groups, which support earlier marriage and parenthood as an antidote to what they see as an excessively careerist and individualistic society. IVF “gives women the option of waiting longer and they would prefer people not wait longer,” Guzzo told me.

Trump himself has often touted his support for IVF, promising on the campaign trail that “under the Trump administration, your government will pay for, or your insurance company will be mandated to pay for, all costs associated with IVF treatment.” A plan unveiled by the White House in October, however, fell far short of that goal, merely offering federal guidance around employer-based IVF coverage and a deal to sell IVF medications at a discount on the forthcoming prescription portal TrumpRx.gov.

“We are very curious to see how the EEOC is going to tackle this, because there are so many different opinions on the right around IVF,” Chettiar said. “I don’t know where they’re going to land.”

Whatever the EEOC decides, advocates say any rollback of IVF protections would undermine the Trump administration’s stated commitment to improving fertility care — and the country’s birth rate.

“You can say we’re going to improve insurance coverage, and we’re going to do all these things, and then I can’t leave work to go to my doctor’s appointment,” Gruberg said. “We’re looking at a future where workers under this administration would not have the actual right to access IVF.”