Four years have passed since the Supreme Court delivered its decision in Dobbs v. Jackson Women’s Health. This ruling, which aimed to overturn the constitutional right to abortion and nearly five decades of legal precedent, has brought significant implications for reproductive justice that extend beyond abortion itself. One significant area impacted is in vitro fertilization (IVF), accounting for nearly 3% of births annually.
The public strongly backs access to IVF. During his campaign, President Trump announced intentions to mandate coverage for the full costs of IVF treatment. In May, he introduced a rule facilitating easier employer coverage of fertility care, highlighting its perceived importance. However, treating IVF differently from abortion presents difficulties since both involve personal decisions about family creation and control over prenatal life.
IVF procedures are costly, typically ranging from $15,000 to $20,000 per cycle. To maximize efficiency and cut costs, excess embryos are often created. Prospective parents traditionally have had the freedom to control unused embryos, choosing whether to discard, donate, or preserve them. Estimates put the number of frozen embryos in the U.S. at over one million.
The production of excess embryos poses challenges in states with abortion bans aimed at protecting unborn children. The Dobbs ruling stated that states could safeguard “prenatal life … at all stages of development,” pushing them to adopt embryo-protective measures. Consequently, many states restrict IVF by treating embryos outside the womb differently from those in utero. This presents complications as equating embryos with people could lead to IVF bans or limitations that diminish its effectiveness.
For instance, in 2004, Italy enacted a law allowing the fertilization of only three eggs and banning embryo freezing. This required immediate embryo transfer. In the five years this law was active, IVF success rates declined, and the incidence of multiples (twins, triplets, etc.) increased, posing health risks to women and children. Women also faced the physical strain of repeated hormonal stimulations.
Despite the complexities, four years following Dobbs, there is ongoing debate about balancing embryo protection with maintaining the popular IVF. The Trump administration issued documents concerning “embryo adoption,” labeling embryos as children needing families, while supporting IVF. Concurrently, discussions in the Texas Republican Party question whether IVF should be banned to protect prenatal life. Two years ago, the Southern Baptist Convention declared that embryos are people, urging the use of infertility treatments respecting embryo dignity. In Alabama, a court verdict in a negligence case involving embryo destruction recognized embryos as persons for wrongful death claims, leading to IVF cessation until legislature-provided immunity for IVF providers.
Despite these tensions, IVF likely remains protected in many states. Fertility patients, often older, married, non-Hispanic white or Asian, and wealthier, are more inclined to vote in favor of their interests. The process of creating life through IVF could justify continued patient control over embryos. However, a scenario allowing IVF while banning abortion could worsen societal inequities, affecting those with less privilege who already face abortion access challenges. Abortion seekers often include low-income, 20-year-old women of color, and unmarried individuals with fewer means to overcome abortion prohibitions. The high cost of IVF further limits accessibility to underserved populations.
The American Society for Reproductive Medicine regards both IVF and abortion as integral reproductive healthcare. The ability to access either is crucial for reproductive justice, highlighting the right to have or not have children and to raise them with dignity. States implementing abortion prohibitions since Dobbs have compromised these rights, affecting the most disadvantaged, as seen in increased pregnancy-related and infant mortality rates in abortion-ban states.
In a post-Dobbs world, preserving the ability to create families through IVF must remain a priority for reproductive justice. Guarding reproductive justice and equity requires not banning IVF or abortion, both being facets of the same reproductive issue.
Sonia Suter, a law professor at The George Washington University Law School and the founding director of the Health Law Initiative, highlights these issues. All rights to this content are reserved by Nexstar Media Inc., 2026.