In France and US, two wildly different takes on IVF

Ariel Cohen | CQ-Roll Call (TNS)

MONTPELLIER, FRANCE — In vitro fertilization, a procedure first used more than 45 years ago, has suddenly become the topic of political debate on both sides of the Atlantic — but for wildly different reasons.

In France, President Emmanuel Macron’s government is eyeing policies to promote the use of assisted reproductive technology, including IVF, to increase the nation’s declining birth rate. But French feminist groups say the proposal unduly inserts the government into private lives of women. They also worry that nationalist sentiment is driving the effort to boost birth rates.

The political fault lines look quite different in the U.S. where conservatives are the primary obstacle to IVF access. Despite former President Donald Trump’s endorsement of IVF this month, the fertility treatment has left many ultraconservative and evangelical conservatives conflicted, particularly when it comes to the disposal of unused embryos.

Legislatures in at least 13 states have introduced so-called personhood legislation that would classify an embryo as a human life. And in February, the Alabama Supreme Court ruled that frozen embryos created for the purpose of IVF can be considered children — a decision that caused some IVF clinics to close their doors.

By comparison, fertility experts in France are drafting a national fertility plan at Macron’s request to combat the country’s declining fertility rate. Those drafting the plan are recommending increased government investment in IVF as well as other fertility treatments.

Birth rates in France have been steadily declining in recent years, and decreased roughly 7 percent between 2022 and 2023. This isn’t as sharp a decline as in some other European countries, but in a January speech, Macron declared that France needs a “demographic rearmament.”

In France, IVF is paid for by the French national health plan, and each woman is entitled to four cycles of IVF per child. About 4 percent of French births are a result of IVF, and in the process the country discards roughly 150,0000 embryos per year.

In 2021, slightly more than 2 percent of U.S. births were a result of IVF. But Democrats and advocates now worry access to the procedure may become more challenging, as some fertility clinics are shutting their doors out of fear that they could be criminalized for discarding embryos.

Despite public comments from many Republicans in support of the procedure, it’s clear some hesitation remains: Last month, when Senate Democrats brought up a vote to protect IVF, Republicans shot it down.

“It’s crazy, it’s absolutely crazy,” Samir Hamamah, a Montpellier, France-based infertility doctor charged with writing Macron’s fertility plan, said of the IVF landscape in the U.S. “It’s strange and stupid to consider an embryo with five, six cells a human.”

Parisian pregnancy push

In a Jan. 16 address, Macron said he wanted to prioritize fertility. Part of that effort is making IVF and other forms of medically assisted reproduction more widely available while limiting factors that cause infertility.

“You have to consider that infertility is a disease like others,” Hamamah said, when asked why the French health system covers the costs of IVF.

France is a rare Western country to fully cover the costs of IVF. There are 103 IVF centers across France to serve a population of about 68 million.

By contrast, U.S. health plans, including Medicaid and TRICARE, do not cover infertility treatments. The 2010 health care law does not mandate coverage of infertility services on the health exchanges, but at least eight states mandate coverage of IVF on exchange plans.