IVF, Federal Power, and State Autonomy in 2025: Where We Stand Now
With Donald Trump now back in office following his 2024 re-election, the legal and political landscape surrounding reproductive healthcare remains intensely contested. Among the most pressing issues is the question of federal protection for in-vitro fertilization (IVF) and other assisted reproductive technologies (ART).
This debate was reignited earlier this year following the Alabama Supreme Court’s February 2024 decision, which held that frozen embryos created through IVF should be considered children under the state’s wrongful death law. That ruling caused temporary disruptions to IVF services in Alabama and prompted a nationwide outcry. In response, a bipartisan chorus of lawmakers called for federal action to protect IVF access. However, despite this momentum, the Right to IVF Act, initially introduced in mid-2024, has since stalled in Congress.
While the bill has not advanced significantly under the new Republican-led Congress and White House, the broader issue of IVF rights remains deeply relevant, especially in light of increasing legal uncertainty at the state level.
Can Congress Federally Protect IVF? A Constitutional Examination
The legal path to federal protection of IVF services is fraught with constitutional complexity. Central to the debate is the Commerce Clause (Article I, Section 8, Clause 3 of the U.S. Constitution), which gives Congress the authority to regulate interstate commerce. Proponents argue that IVF and ART services clearly impact interstate commerce—patients often cross state lines for care, medications are shipped nationwide, and fertility clinics operate across multiple jurisdictions. This creates a strong legal basis for Congress to legislate on the matter.
However, opponents may invoke the Tenth Amendment, which reserves powers not delegated to the federal government to the states. Traditionally, states have had primary authority over medical practice and public health, including regulation of reproductive healthcare. In the post-Dobbs v. Jackson Women’s Health Organization era (see Ruling), states have adopted widely varying policies on reproductive rights, and some lawmakers now argue that IVF regulation—like abortion—should be left to the states.
Equal Protection and Unequal Access
Legal scholars also point to the Equal Protection Clause of the Fourteenth Amendment as a justification for federal IVF protections. Because access to IVF now varies dramatically from one state to another, federal legislation could help eliminate those disparities, ensuring more equitable access to reproductive healthcare regardless of geography. The argument is that people in more restrictive states should not face insurmountable barriers to forming families simply due to their zip code. We always support getting a firsthand understanding of the fundamental laws surrounding important topics, and so we recommend you read the Equal Protection Clause if you are not yet familiar with it.
Insurance Coverage and Federal Labor Law
Another key provision of the stalled Right to IVF Act involves requiring insurance coverage for IVF. This intersects with the Employee Retirement Income Security Act (ERISA), a federal law that regulates employer-sponsored health insurance (codified at 29 U.S.C. § 1001 et seq.). Any new IVF mandate would likely require amending or clarifying ERISA to ensure private insurers—including large self-funded employer plans—must comply. Without such amendments, federal IVF guarantees could remain toothless for many workers. Learn more about ERISA regulations.
The Road Ahead
While the Right to IVF Act has faded from the legislative spotlight, the broader movement for federal IVF protection is far from over. Several Democratic lawmakers continue to advocate for updated legislation, though its chances remain slim under current congressional leadership. Meanwhile, some traditionally conservative states have taken steps to insulate IVF from future legal challenges, suggesting there may be room for bipartisan compromise—even if a sweeping federal guarantee remains elusive for now.
Why IVF Still Matters
The status of IVF access raises profound questions about medical autonomy, federalism, and equal rights. As reproductive technologies become more advanced and a greater consideration for Americans wishing to build families, the legal framework surrounding IVF will only grow in importance.
For now, IVF remains legal in all 50 states—but there are differences in accessibility, affordability, and it being secure. As litigation continues and state legislatures consider new policies, 2025 is likely to be a pivotal year in shaping the future of reproductive healthcare in the United States.