In-vitro fertilization has become the latest front in the political battle over reproductive rights, and it's left some Republicans grappling with how to square their support for IVF with their past stances on reproductive rights.
In the weeks since the Alabama Supreme Court ruled that embryos are children under the law, threatening access to IVF in the state, Congressional Republicans have lined up to voice their support for the procedure.
Republicans have tried to send a clear and unified message. The Senate GOP campaign arm advised those running for office to "clearly state [their] support for IVF" and "publicly oppose any efforts to restrict access" to the treatment in a memo to candidates obtained by NPR. In her Republican response to President Biden's State of the Union, Alabama Sen. Katie Britt said "we strongly support continued nationwide access to in-vitro fertilization."
But many GOP lawmakers have spent years arguing that life begins at conception – the same basic premise that upheld the Alabama decision, which threw fertility clinics and patients in the state into limbo.
Since the Alabama ruling, Republicans have struggled to articulate what distinguishes their views from the court's.
Kansas Sen. Roger Marshall, a practicing obstetrician, said he welcomes "every day 200 babies that are born because of in-vitro fertilization in this country.
"There's nothing more pro-family than supporting the birth of babies."
He's also one of the senators who co-sponsored the Life at Conception Act, a bill that would have granted constitutional protection to embryos at "the moment of fertilization," without any carve outs for IVF. If enacted, that legislation could have threatened access to IVF, during which embryos are often discarded or stored for years.
Asked if he saw any tension between those two stances, Marshall said: "I've wrestled with this for over 25 years as a practicing obstetrician. And when I talked to the spiritual experts, they can't agree on this particular issue. But I am absolutely certain that in vitro fertilization is a great thing, that God has given us this technology and we should use it."
Many Republicans have rallied around the message that IVF is "pro-life."
"As a pro-life guy, I think that IVF is pro-life," said Sen. Josh Hawley, R-Mo. "It helps people start their family or add to their family if they want to."
Hawley also co-sponsored the Life at Conception Act. When he was asked about the destruction of embryos through the process, he reiterated: "Having a baby is a pro-life thing. So I'm in favor of it."
Past support for "Life At Conception Act" causes strife
The Life at Conception Act bill had more than 160 republican cosponsors in the House before the Supreme Court struck down the right to an abortion.
Republican congressman Don Bacon was one of those early co-sponsors. But he didn't sign onto the bill in 2023, over concerns that the language would be used to challenge IVF.
"I just think in principle, on a normal pregnancy, we want to respect that that is a - it's human. It's alive," Bacon said. "I want to help mom and dads become mom and dads. That's my goal."
Congresswoman Michelle Steel faced criticism for signing onto the Life at Conception Act after publicly discussing her experience using IVF. She has been an active supporter for IVF treatment access.
She recently became the first lawmaker to take her name off the bill since Alabama's court ruling, citing "confusion" about her stance
"Nothing is more pro life than helping families with children, and I do not support federal restrictions on IVF," she said on the House floor on March 7.
Florida Sen. Marco Rubio acknowledged the tension facing conservatives.
"The ethical dilemma that this poses is, in order to create life, you have to destroy life because you'll create embryos that are not going to be used," Rubio said. "And it's a very difficult bioethical issue, and it's one that the practitioners themselves confront."
"That's what makes it complex," Rubio added. "And it's a balancing act that as a society we're going to have to make."
Emma Waters, a religion, life and bioethics associate at the conservative think tank The Heritage Foundation, said the group has been having discussions with members of Congress about what a "pro-life vision for IVF" would look like.
To Waters, that means not destroying embryos in the process of IVF for any reason. She suggested the U.S. could adopt policies limiting the number of embryos created during treatment or requiring that all embryos get implanted.
"I think a lot of Republican lawmakers in particular feel like they're forced into this strict binary where either they have to say, 'I'm fully in support of IVF, do whatever that entails, no limitations, no regulation, and just like I'm in support, go for it,'" Waters said. "Or they're going to have or they're going to be painted as being totally in opposition to IVF and not caring about women, not caring about children."
Fertility groups say regulations on embroy storage, like the ones Waters proposes, would threaten IVF access, decrease effectiveness and increase risks.
Barbara Collura – the CEO and president of RESOLVE: The National Infertility Foundation – said in a statement that "any changes to the clinical guidelines for IVF that try to regulate the creation of embryos will cause an incredible burden to the patient."
"Doing so would add cost, interfere with the patient and provider relationship, and have disastrous pregnancy outcomes," Collura continued.
How Congress might and might not respond
The Alabama legislature has resolved the issue there – for now. Lawmakers passed a bill in March to shield IVF providers from legal liability. But the law doesn't address the larger, underlying questions posed by the court decision.
Democrats in Congress have introduced legislation to protect IVF nationally. Rep. Susan Wild, D-PA., and Sens. Tammy Duckworth, D-Ill., and Patty Murray, D-Wash., have introduced the Access to Family Building Act, which would codify the right to "assisted reproductive technology" without overly burdensome regulation. President Biden called on Congress to pass those protections during his State of the Union address.
Republican Rep. Nancy Mace, R-S.C., has also introduced a resolution expressing support of assisted reproductive technology, but it would not be legally binding or enact any policy change.
The Heritage Foundation and Susan B. Anthony Pro-Life America came out against both of those efforts. SBA said in a statement that the Access to Family Building act is a "sweeping anything goes" bill that would violate religious freedoms. Waters said the bill would "open the floodgates to a host of really concerning practices," such as cloning and genetic editing.
So far, New York Rep. Marc Molinaro is the only Republican to sign onto the legislation. Molinaro has taken a softer stance on abortion than many of his Republican colleagues; while he says he is "personally pro-life," he does not support a national ban, and supports exceptions for rape and incest.
In a statement first shared with Axios, Molinaro said, "I'm a parent who has personal experience with IVF and support all women and families who choose IVF to bring life into this world. Protecting it is just common sense."
Rep. Anna Paulina Luna, R-Fla., announced Thursday that she is introducing a "Right to Try IVF" bill. Text of the bill was not yet available.
But any legislation is unlikely to advance in the House: Republican Speaker Mike Johnson has said he supports IVF access, but that it is "a states issue" that Congress will not take up.
That doesn't mean, though, that it won't be an issue on the campaign trail. Michigan Congresswoman Elissa Slotkin is running for Senate. And she says Republican messages of support are meaningless unless they sign on and support legislative action.
"I'm running against someone who came out loud and proud, 'I support IVF,' except he co-led four bills that would do the exact same thing as the Alabama ruling," Slotkin said. "It's not what these guys say. It's what they do."
