Posted by Lucy Tu

https://www.theatlantic.com/health/archive/2025/07/infertility-ivf-trump-men/683379/?utm_source=feed

Donald Trump—who is, by his own accounting, “the fertilization president” and “the father of IVF”—wants to help Americans reproduce. During his 2024 campaign, he promised that the government or insurance companies would cover the cost of in vitro fertilization. In February, he issued an executive order promising a plan to expand access to the procedure and reduce its steep cost. (The administration has yet to release this plan, but the White House spokesperson Kush Desai told me that the president’s advisers have completed their recommendations.)

In its broader push to boost the U.S. birth rate, the Trump administration has increased the child tax credit, implemented a new $1,000 baby bonus, and, according to reporting by The New York Times, floated affirmative action for parents who apply to Fulbright scholarships. But Trump’s push to expand IVF exposes a fault line in modern conservatism’s approach to fertility treatments in particular: Some pronatalists view the procedure and other fertility technologies as essential tools to reverse declining birth rates, but others, including many anti-abortion activists, are pressing for legal protections for the embryos that might be discarded or damaged during IVF. The latter group has instead coalesced around alternative fertility treatments, which it claims will boost birth rates while prompting a broader reexamination of the U.S. fertility industry.

This debate poses an obstacle to any easy policy wins for the Trump administration on IVF. But the conversation also routinely overlooks a major part of the fertility equation: men. If the Trump administration is serious about boosting fertility without alienating either its pro- or anti-IVF constituents, expanding access to infertility treatments specifically for men could offer a meaningful—and perhaps politically viable—path forward.

For decades, reproductive care in the United States has been considered a women’s issue. Among heterosexual couples struggling to conceive, infertility is roughly as likely to stem from male factors as from female ones. Yet in up to 25 percent of infertility cases, the male partner is never evaluated. Male infertility can sometimes be treated with hormone therapy or surgical correction of physical blockages. But male-infertility care is less likely to be included in state insurance laws than female treatments such as IVF. Plus, in most cases, “you can bypass male-infertility problems by just treating the woman more aggressively, even if she doesn’t have fertility issues herself,” Peter Schlegel, a urologist and male-infertility specialist who runs New York Men’s Health Medical, told me. According to CDC data, approximately one in six IVF cycles is initiated solely due to male infertility.

That means women disproportionately bear the medical and emotional demands of fertility treatment. IVF typically requires women to undergo daily hormone injections and invasive procedures. Hormone treatments can cause nausea, mood swings, bloating, and bruising at the injection site. Egg retrieval typically involves anesthesia, at least 24 hours of rest after, and days of recovery for lingering symptoms. Most people who use IVF need multiple cycles to conceive, and recent research has raised concerns about possible long-term health consequences from repeated treatments, including elevated cancer risks.

It’s no wonder, then, that patients and policy makers have been looking for alternatives to IVF. The Heritage Foundation, an influential conservative think tank that opposes abortion and has described the American IVF industry as the “Wild West,” has called for the U.S. government to embrace restorative reproductive medicine, or RRM. This model, which originated in the 1970s as a natural family-planning method, focuses on identifying and treating what proponents call the “root causes” of infertility, including hormonal imbalances and diseases such as endometriosis; IVF is a last resort. Some vocal RRM proponents reject the procedure outright, arguing that it treats embryos as commodities and women as vessels, subjecting them to expensive, dehumanizing procedures.

The American Society for Reproductive Medicine, which opposes restrictions on both IVF and abortion, has dismissed RRM as a “rebranding of standard medical practice” designed to stop short of the full range of modern pregnancy care. “Instead of getting 21st-century treatment based on a Nobel Prize–winning technology, anti-abortion groups like the Heritage Foundation want patients to have medicine circa 1977,” Sean Tipton, ASRM’s chief advocacy and policy officer, told me. RRM supporters, in turn, argue that they’re simply making room for less invasive and lower-cost options. (A single cycle of IVF currently costs $15,000 to $20,000, and treatments are usually paid out of pocket.) “IVF is high-tech. What we do is more humdrum,” says Phil Boyle, the president of the International Institute for Restorative Reproductive Medicine and a contributor to the Heritage Foundation’s recent report on RRM. He also told me that RRM encourages careful evaluation of both partners, potentially reducing the burden of treatment on women.

[Read: The pro-baby coalition of the far right]

Even so, RRM often requires women to engage in meticulous cycle tracking and hormone monitoring, leaving them to shoulder the ongoing work of managing and measuring their biology in service of pregnancy. This emphasis on women’s bodies and behaviors is especially conspicuous amid a broader cultural preoccupation with male virility. Health Secretary Robert F. Kennedy Jr. has warned of the “existential problem” posed by declining testosterone levels and sperm counts in teenage boys. (He has offered dubious comparisons in the process, claiming that adolescent boys now have less testosterone than 68-year-old men.) Online, male-health influencers blame falling fertility on pesticides and plant-based diets, and advise their followers to eat more meat and avoid processed foods.

And yet, for all the public hand-wringing over male infertility, medical treatments for it remain absent from policy conversations. In the months since the White House issued its executive order on IVF access, it does not appear to have made any mention of improving access to male-infertility care. (When I asked Desai last month about male-fertility proposals, he declined to answer the question.) The Heritage Foundation has vigorously advocated for RRM, yet its policy papers and lobbying efforts do not prioritize male-specific treatments, including semen analysis, hormone testing, and surgeries that can correct some forms of severe male infertility. Its RRM report does make passing mention of interventions for men, such as improving diet and managing insulin resistance, but its recommendations are overwhelmingly directed at women. Fertility-related proposals from both sides of the aisle have likewise scarcely addressed male-specific infertility treatments, according to data from RESOLVE, a nonprofit advocacy organization that supports awareness of the full spectrum of infertility-treatment options.

Policy changes to improve male fertility are both feasible and potentially far-reaching. Access to reproductive urologists is deeply uneven across the U.S., which contributes to the chronic underdiagnosis of male-factor infertility. One 2010 study found that 13 states had no specialists for male infertility at all. To help close this gap, federal agencies could fund additional fellowship positions or loan-repayment programs for male-fertility specialists who commit to working in medically underserved areas. States could also revise telemedicine laws, which sometimes bar out-of-state providers from treating patients remotely. Lawmakers could mandate that insurance companies cover key services and invest in labs that are developing and testing new therapies, such as stem-cell-based sperm regeneration.

[Read: A less brutal alternative to IVF]

For the foreseeable future, IVF will remain irreplaceable for some families, including single parents, heterosexual couples whose future children are at high risk of genetic anomalies, and LGBTQ couples pursuing reciprocal IVF, in which one parent provides the egg and another carries the pregnancy. But advocates across the IVF debate agree that patients need more options, and right now, many don’t have them. Supporters and critics of IVF, including ASRM and the Heritage Foundation, told me they support greater insurance coverage for male-infertility care.

If coverage expands for IVF but not for other fertility treatments, more patients will be routed toward it, even when less invasive or more targeted options might work just as well. A more forward-looking fertility policy would mean not just increasing IVF access but also expanding whose bodies—and whose health—should be the focus of U.S. reproductive care.

https://www.theatlantic.com/health/archive/2025/07/infertility-ivf-trump-men/683379/?utm_source=feed