(OSV News) -- President Donald Trump's Feb. 18 executive order on in vitro fertilization is the president's first step toward fulfilling a campaign trail promise to expand IVF -- an action the Catholic Church and other experts warn will fuel large-scale destruction of embryonic human life, while doing little to increase the nation's overall birth rate.
Trump's executive order "directs policy recommendations to protect IVF access and aggressively reduce out-of-pocket and health plan costs for such treatments," according to a statement issued that same day by the White House. It quoted Trump as saying, "We want more babies, to put it very nicely."
But the actual outcome, as Bishop Michael F. Burbidge of Arlington, Virginia, pointed out in a statement Feb. 19, is likely to be much different.
"'Expanding access' to IVF as described in this executive order is likely to unjustly promote IVF in a way that will result in the abandonment or death of millions of embryonic human persons, involve all taxpayers with a serious moral injustice, provide federal subsidies for already lucrative IVF businesses, and ignore the risks to parents and children of America's broadly unregulated IVF industry," he said.
IVF treatments -- which fertilize an egg outside the body in a laboratory dish -- are opposed by the Catholic Church because they frequently involve the destruction of human embryos, in addition to other ethical and moral issues.
"In my experience, I have observed that many Catholics have only a vague notion of what the church teaches about IVF, since they have usually not received significant formation on the issue," noted Father Tad Pacholczyk, director of education and a senior ethicist at the National Catholic Bioethics Center.
"The typical Catholic is often unable to explain why IVF is wrong," he told OSV News.
Out of more than 413,000 artificial reproductive technology cycles recorded in 2021, only 112,088 resulted in pregnancy. Of those, only 97,128 babies were successfully born, according to U.S. Centers for Disease Control and Prevention data.
Multiple embryos are typically created for use in an IVF cycle, so the number of human embryos currently created each year by IVF in the U.S. runs into the hundreds of thousands with the majority typically lost through what fertility clinics on their websites explain as "IVF attrition."
In one example provided by an IVF clinic, 10 harvested mature eggs may yield eight human embryos through IVF; of these embryos, just three to four may develop into embryos viable for transfer after cryopreservation. Typically one embryo -- or two in some cases -- is then implanted in each attempted transfer. CDC data shows 45% of embryo transfers on average result in a single live birth for women under 35, and the average diminishes to 23% for women under 40.
"Donum Vitae" ("The Gift of Life") -- issued in 1987 by the Vatican's Congregation (now Dicastery) for the Doctrine of the Faith -- equates IVF with abortion, saying it comes out of the "abortion mentality" and "can lead to a system of radical eugenics."
"Development of the practice of in vitro fertilization has required innumerable fertilizations and destructions of human embryos," it stated, explaining that "through these procedures, with apparently contrary purposes, life and death are subjected to the decision of man, who thus sets himself up as the giver of life and death by decree."
In "Dignitas Personae" ("Dignity of a Person") -- issued by the doctrinal congregation in 2008 -- the church recognized couples who can't conceive do suffer, but counseled that "the desire for a child cannot justify the 'production' of offspring."
The Catechism of the Catholic Church states, "Techniques involving only the married couple (homologous artificial insemination and fertilization) ... remain morally unacceptable." It adds, "The act which brings the child into existence is no longer an act by which two persons give themselves to one another, but one that entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person."
Father Pacholczyk amplified these official teachings.
"IVF substitutes an act of laboratory manipulation for an act of bodily union between spouses," he said. "It turns procreation into production. IVF is really the flip-side of contraception: rather than trying to have sex without babies, we now try to have babies without sex."
The commodification of offspring -- even if the end result is the gift of life -- is a critical moral concern for the church.
"By doing IVF, we act against the human dignity of our children by setting up a subclass of those who originate in petri dishes and test tubes rather than in the intimacy of the one-flesh union of spouses," said Father Pacholczyk, while emphasizing "the problem with IVF is never with the child."
"Humans are meant to be loved into being through that mutual spousal self-gift of the marital act," he said, "rather than produced through manufacturing methods and laboratory protocols."
Prior to the Feb. 18 executive order, Trump publicly professed his backing for IVF multiple times on the campaign trail and called himself "a leader on IVF." At an Aug. 29 campaign stop in Potterville, Michigan, Trump pledged that "your government will pay for -- or your insurance company will be mandated to pay for -- all costs associated with IVF treatment. Because we want more babies, to put it nicely."
What Trump's executive order on IVF leads to precisely remains to be seen. But experts previously noted the IVF mandate Trump proposed on the campaign trail would not increase fertility while saddling taxpayers and premium payers with costly IVF bills.
Whatever the finer points of an IVF policy might be, Lyman Stone, senior fellow and director of the Pronatalism Initiative at the Institute for Family Studies, told OSV News, "there's not going to be an IVF baby boom."
"That's just not how IVF works," he said.
IVF procedures are, Stone clarified, "very disproportionately composed of first births to older women." While that still sounds like increased fertility, "the other thing that happens is when you have more reproductive technology options, people have a tendency to delay fertility," explained Stone. "So you freeze your eggs when you're 31, and you say, 'Well, I don't need to be in any particular rush, because at the end of the day, I've got all the time in the world.'"
But given some of the inherent difficulties in births to older mothers, that's not always true.
"These two factors more or less cancel out. So the net result is that there are no extra babies," Stone said. "That's why we say this policy won't work -- the delay effects offset the other possible effects."
"We see this from many actual cases where places have actually implemented these policies," added Stone. "We can see what happens. And the answer is, that there's no big change in fertility."
Patrick T. Brown, a fellow at the Ethics and Public Policy Center in Washington, has crunched the numbers.
"According to the Department of Health and Human Services, the cost per successful IVF outcome ranges somewhere around $61,000, and over 90,000 babies were born via IVF in 2022 (2.5% of all births nationwide)," Brown shared. "If we just take those numbers and assume a second Trump term would cover them with taxpayer money, that would be somewhere around $55 billion over 10 years."
Two other factors complicate projections; Brown said an insurance mandate could mean "very large increases" in premiums, while increased IVF availability could also translate to increased demand -- "making $55 billion over 10 years a very, very conservative estimate."
"Whether it's paid for by insurance premiums or by public money," Stone noted, "there's a transfer involved here. Older, less fertile, and LGBT couples are receiving a benefit -- a benefit they're likely to use -- and younger people with natural fertility are paying for it," he emphasized.
A host of coverage questions also arise, noted Timothy P. Carney, senior fellow at the Washington-based American Enterprise Institute: At what age and for how long? Is IVF only for married couples? Would surrogacy -- where another woman is impregnated with IVF-conceived embryos and carries the child (or children) to term for the intended parents -- be included?
"All of those questions are wide open -- and it's not easy to draw lines. Would it be discrimination if you said, 'No, we only cover married couples,' or what about not-married couples? What about cohabitating couples?" he asked. "Can you imagine that Congress or Health and Human Services has the bandwidth -- the wisdom, the prudence -- to make these finer distinctions?"
While Carney's rhetorical question seems to answer itself, he predicted thorny deliberations. "All of those things are totally unexplored -- and it would be a really difficult debate. It would raise all sorts of issues," Carney concluded.
Conscience issues must also be considered if the Trump administration ever moves to some type of IVF mandate.
"Such a mandate would be immoral," Father Pacholczyk observed -- echoing arguments heard in 2011 when the Obama administration attempted to compel the Little Sisters of the Poor to include abortifacient coverage in their employee health coverage -- "since insurers and employers would presumably be forced, and therefore complicit in, financially subsidizing in vitro fertilization procedures for their employees."
It would, Father Pacholczyk added, "constitute an intrusion into the religious works and governance of the church and represent a federally mandated violation of her members' consciences."
Ultimately, Trump's embrace of IVF complicates his relationship even further with the American pro-life voting bloc, and particularly with Catholics.
"The reality is," Stone said, "it's a thing many Catholics and other people who believe life begins at conception may have problems with -- that is also unlikely to do anything demographically."
Bishop Burbidge's statement underscored the point: "In practice and principle, IVF is incompatible with the president's evident support for the good of human life and his desire to encourage family formation."
He proposed "life-affirming and positive actions" that President Trump and federal and state lawmakers take instead: "Consider concrete ways to encourage earlier marriage and family formation, establish programs to address direct pregnancy and childbirth-related expenses that may act as a barrier to the growth of families, and expand coverage for life-affirming and restorative fertility care."
"We must work for building up families," he said, "in ways which do not entail the destruction of human life."
