As we approach 2025 several trends in reproductive medicine, IVF, and fertility law are emerging, driven by technological advances, political reform, and a collective focus on reproductive rights throughout the United States and beyond. Here are some key trends likely to shape the conversation in 2025:
Embryonic Personhood and Abortion Ban Legislation
With a new conservative administration we are guaranteed to see more embryonic personhood legislation introduced in red states along with more abortion bans and regulation. The Ninth Circuit just rled that Idaho can prohibit and criminally punish anyone "harboring or transporting" a minor traveling out of state to access abortion. Florida voters failed to overturn the 6 week abortion ban enacted in May 2024, and many other states have complete abortion bans including Texas, Oklahoma, Arkansas, Tennessee, Louisiana, Mississippi, Alabama, Kentucky, West Virginia, Indiana, and South Dakota. And before you come at me with information about exceptions for medical necessity, I urge you to familiarize yourself with Kate Cox and the plaintiffs of Zurawski v. Texas. Medical exceptions to abortion bans are a fallacy.
Expanded Access to IVF and Fertility Treatments
On a more positive note, growing momentum towards requiring insurance companies to cover the cost of IVF and other fertility treatments is translating to more couples and individuals having access to fertility care. Several U.S. states (including New York, Maine, and Massachusetts) have already laws mandating insurance coverage for fertility preservation, IVF, and fertility treatments, with more states to follow.
Beyond the U.S. borders countries like France and the UK continue to expand public healthcare access to IVF with a spirit of inclusivity and efforts to include single women and LGBTQ individuals.
Fertility Preservation
Oocyte (egg) freezing is becoming more prevalent among women who want to keep their future reproductive options open. While insurance coverage for elective fertility preservation is wholly lacking, with more women opting to cryopreserve their eggs in 2025, legislation and reglation may evolve to better protect these choices. Legal framework around informed consent, storage duration, dispositional control, and posthumous reproduction are also going to emerge.
Disposition of Genetic Material in Legal Documents
In a similar vein, as couples create and cryopreserve embryos for their family building, we are going to see more embryo disposition agreements and other legal documents addressing dispositional control of embryos and legal parentsage of resulting children. Putting embryos and cryopreserved genetic material in prenups is already a trend, and will certainly continue into 2025. For more on embryos and prenups, listen to this podcast with Janene Oleaga and Julia Rogers: Including Fertility Treatment Costs and Embryo Clauses in Your Prenup
Legal Framework for Reproductive Rights
LGBTQ+ Parental Rights: It isn't news that LGBTQ+ rights are at risk with the new incoming administration, specifically in regards to access to care and legal parentage. While some states are likely to construct barriers and enact legislaiton mkaing it more difficult for LGBTQ+ individals to access care and secure their legal parentage, other states will move in the opposite direction creating a more streamlined process for parents through assisted reproduction to secure their legal parentage. In the past 2 years, both Maine and Rhode Island joined a handful of states in enacting confirmatory adoption legislation. More on confirmatory adoption here.
Donor Conception and Anonymity: Balancing the rights of individuals entering into reproductive arrangements against the rights of donor conceived people to know the identities of their progenitors will continue to be hotly debated topic. Colorado became the first state to ban anonymous gamete donation through the enactment of the Donor-Conceived Persons and Families of Donor-Concieved Persons Protection Act, and other states may follow.
Globalization of Fertility Treatments and Reproductive Arrangements
The United States isn't the only country electing more conservative politicians. As most of Europe moves in a more restrictive direction regarding third party assisted reproductionm we can expect international couples to enter into surrogacy arrangements and egg donation arrnagmeents in the US. Issues around conflict of laws and other concerns regarding cross-border arrangements will continue as the world of third party assisted reproduction becomes even more globalized.
Italy criminalied surrogacy even beyond its borders earlier this year. As surrogacy laws continue to evolve, and as more people engage in international surrogacy arrangements, there may be an increased push for standardization of ethical practices and other regulations aimed at protecting intended parents and surrogates.
Ethical Concerns: IVF, AI, and Fertility Clinics
Artificial Intelligence (AI) is expected to play a larger role in every field, and fertility is no exception. Research evaluating the use of AI in embryo selection and genetic screening are among the top trending topics in the future of reproductive medicine, with ethical concerns regarding the use of AI in fertility clinics a primary concern. Laws may emerge to ensure transparency surrounding the use of AI by medical practitioners.
Technologies like CRISPR may allow for more advanced prenatal testingg, embryo screening, and even genetic modifications. As the use of hese technologies becomes more widespread, new laws and regulations will spring up addressing the ethical use of such advances, with policy decisions being made around genetic discrimination, designer babies, and access to the use of these technologies.
Mental Health and Reproductive Arrangements
Climbing infertility rates combined with changing social dynamics and increased awareness about the mental health aspects of infertility will prompt continued involvement of mental health professionals for anyone navigating infertility and assisted reproductive arrangements. The overlap of mental health professionals with legal professionals and medical professionals will continue to support that approaching assisted reproduction as a collective informed group is preferable to practicing as a detached professional.
As medical and technological advances continue to outpace legislation and caselaw, it's important to remain informed about ethical concerns and best practices. In 2025 I hope to see an increase push to support reproductive rights encompassing access to fertility care and abortion for all individuals - regardless of state of residence, country of residency, gender identity, sexual orientation, or relationship status.