A vocal group of conservative intellectuals really, really wants Americans to have more babies. The movement is small, but it doesn’t lack for high-profile adherents. Vice President J. D. Vance, a father of three, recently proclaimed, “Very simply, I want more babies in the United States of America.” Elon Musk, a father of at least 12, posted in 2022, “Doing my best to help the underpopulation crisis. A collapsing birth rate is the biggest danger civilization faces by far.” A recent Department of Transportation memo even instructed the agency to prioritize projects that “give preference to communities with marriage and birth rates higher than the national average.” It was signed by Transportation Secretary Sean Duffy, a father of nine.

If messages like these somehow do not get you in the mood to procreate, well, that’s precisely the problem.

It’s a problem, specifically, for the pronatalists: a group whose members are overwhelmingly conservative, usually religious, and almost always the parents of three or more children. They espouse the view that America’s declining birth rate is an alarming trend we ought to try to reverse. Seventeen years ago, the national birth rate was at the minimum level for a society to perpetuate itself from one generation to the next. Since then, it has fallen well below that, with no signs of bottoming out. In response, a loose cohort of intellectuals, writers, thinkers, and policy makers are doing their best to make friends in high places, get a policy agenda together, and make Americans make families again.

This won’t be easy. The pronatalists combine conservative social nudges (get married, start a family) with liberal policy objectives (give parents more money, upzone the suburbs), which makes for tricky politics. At a time of increased abortion restrictions, many liberals find them creepy—busybodies at best and eugenicists at worst. And many conservatives think they’re Trojan horses for socialism, cloaking their desire to spend taxpayer money in family-values rhetoric. Like parenting itself, giving birth to a broadly popular pronatal movement will take a lot of hard work.

Until recently, the idea that humanity might be growing too slowly would have seemed absurd. During the second half of the 20th century, experts—many swayed by the book The Population Bomb—were far more worried about the opposite problem. They feared that overpopulation would lead to widespread famine and potentially even societal collapse.

Something strange happened next: None of those predictions came true. The population continued to grow, but famine was not widespread, and collapse did not come. Then, seemingly out of nowhere, fertility rates steeply declined, most dramatically in rich countries. Rather than exploding, the global population-growth curve began to level off. At first, few noticed. After all, the birth-rate decline came on gradually. A decade ago, the U.S. total fertility rate was only slightly below the replacement rate of 2.1.

Now, however, that number is 1.6 and falling fast, even as polls show Americans believe that the ideal number of children is two to three. This poses a dire economic problem. Social Security, Medicare, and other old-age programs can’t survive at their current generosity if the number of tax-paying workers continues to decline. Even economic growth itself becomes challenging once a low enough fertility rate is reached; fewer workers means a smaller economy. In East Asia, where the worldwide birth-rate drop has been most pronounced, every country faces serious economic challenges resulting from low fertility; all are now furiously trying to encourage birth. In South Korea, where the total fertility rate is the lowest in the world at 0.68, every 200 fertile-age adults can expect to give life to 68 children; those children will produce 23 grandchildren, who will result in only eight great-grandchildren. That’s a 96 percent population decline over the course of three generations, and that’s if fertility stops decreasing and finally holds steady.

The negative effects of low fertility at home can be mitigated to some degree with immigration, but birth rates are plummeting all over the world—Mexico’s is 1.8—and the amount of immigration sufficient to outweigh the local birth dearth would be a political nonstarter, a kind of Great Replacement theory come to life. To avoid becoming South Korea someday, America needs more babies.

Making that happen is the task the pronatalists have taken on. The effort is new, but beginning to get organized. As of 2023, there’s an annual Natal Conference, and last week, there was a panel at the U.S. Capitol featuring Representative Blake Moore of Utah, a member of the Republican leadership. Every conservative think tank seems to suddenly have an “expert” on birth rates. (Liberal and centrist pronatalists exist, too, but they’re less numerous and less vocal.)

The intellectual force behind the movement lies mainly in a cluster of culturally conservative writers. These include Bethany Mandel, a writer and homeschooling mother of six; Tim Carney, a father of six who wrote Family Unfriendly, a recent book about society’s hostility toward big families; Patrick T. Brown, a father of four and a fellow at the Ethics and Public Policy Center, a socially conservative think tank; and Daniel Hess, a writer more commonly known by his X username, MoreBirths. The informal ringleader is Lyman Stone, a 33-year-old father of three who directs the Pronatalism Initiative at the right-leaning Institute for Family Studies.

[Lyman Stone: Would you have a baby if you won the lottery?]

They generally advocate for a three-pronged approach to lifting the birth rate. First are cultural nudges, which mostly entail spreading the word that kids are more blessing than burden. Second are supply-side housing-reform policies, intended to make it easier for would-be parents to afford a place to raise a family. (“Want fecundity in the sheets? Give us walkability in the streets,” Carney writes in Family Unfriendly.) Finally, there are economic incentives, which resemble the types of family-friendly welfare-state policies familiar to Northern Europeans: child allowances, baby bonuses, long parental leaves.

Stone argues that implementing such policies in the U.S. would have a significant effect. He estimates that pronatal economic policies in France, including maternity leave, child allowances, pregnancy protections at work, and higher Social Security payments for parents, have boosted the French population by 5 to 10 million people. Policy matters, he argues, not just culture.

You might expect such a progressive-sounding agenda to have attracted an enthusiastic liberal following. Not so much. In fact, left-of-center Americans are more likely to be anti-natalists. According to a recent YouGov poll, twice as many people who identify as liberal, and four times as many people who identify as very liberal, think too many children are being born than think not enough are.

To the extent that they’re even familiar with the pronatalist argument, liberals seem to find it creepy and off-putting. The main cause of the global birth-rate decline was women’s growing autonomy and access to contraception. Liberals understandably fear that trying to reverse the decline might involve undoing the progress that triggered it. (This is more or less the plot of The Handmaid’s Tale, the Margaret Atwood novel in which right-wing theocrats revolt over low fertility, and institute sex slavery and totalitarian patriarchal rule.)

Some liberals also pay attention to the context in which pronatalist messages are transmitted and who is embracing them. Vance’s “I want more babies” quote, for example, came at the March for Life, an annual anti-abortion rally in Washington, D.C. Liberals might even know that the birth rate is still far above replacement in much of sub-Saharan Africa and wonder whether pronatalists are worried specifically about a lack of white babies. “For many progressives and liberals, this conversation is tainted by a sense of it being reactionary, conservative, even sort of fascist,” Rachel Wiseman, an “anti-anti-natalist” leftist writer told me.

Then, as one former senior policy aide to a Republican lawmaker told me, “there’s the Elon of it all.” (He spoke on condition of anonymity for fear of backlash for criticizing fellow Republicans.) Musk, the most well-known pronatalist in the world, is also perhaps the most disliked person in liberal America after Donald Trump. Musk is known to have had 12 children with three partners. (Last week, a conservative influencer claimed to be the mother of his 13th child, born five months ago, though Musk has neither confirmed nor denied that he is the father of her child.) He had twins via IVF with an executive at one of his companies while a surrogate was pregnant with the child he was having with his longtime partner Grimes, who was reportedly furious when she found out. Having a dozen kids is good for the birth rate, but making big families look messy and dysfunctional is probably not.

The conservative pronatalist intellectuals, who seem to crave the ideological embrace of liberals, are self-conscious about their creepiness problem. Moore, who last month introduced a bill that would dramatically increase the child tax credit, told me, “Any effort to make this a right or left issue is nonsense and counterproductive.” He and his allies go to great lengths to clarify that they aren’t into eugenics or patriarchy and that they want more babies of all skin colors. “The people who give pronatalism a bad name care for it for reasons that I think are rather unseemly,” Brown told me. “And so it becomes icky because, well, those bad people are very concerned about it.”

Women of childbearing age skew liberal, so liberals’ distaste for pronatalism is a long-term problem. But, at a moment when Republicans have a trifecta in Washington, pronatalists face a more immediate issue on their own flank: Most Republicans still want to slash government spending, not increase it.

[Read: The coming Democratic baby bust]

“There’s a lot of headwinds to a pronatal conservative policy because Republicans have long distrusted urbanist talk, or talk of government supporting people in need,” Carney told me. Many traditional Republicans look at the pronatalist policy agenda (give money to parents, loosen suburban zoning rules) and wonder what happened to the party of fiscal restraint, anti-welfare politics, and the strictly zoned Suburban Lifestyle Dream.

Stone told me that many old-guard Republicans are worried about incentivizing single motherhood. “On some level, we have to be able to say, ‘Look: Supporting people having families is worth it,’” even if that means money flows to unwed parents, he said.

Anti-welfare Republicans aren’t the only intra-coalitional enemy. Pronatalists also face resistance from the so-called Barstool Right, the class of epicurean, anti-woke young men, usually thin in ideology but thick in leftward-pointing resentment. “This is fucking idiotic,” Dave Portnoy, the Barstool Sports founder, wrote on X above a video of Vance clumsily arguing for lower tax rates on parents. “If you can’t afford a big family don’t have a ton of kids.” (Neither Vance nor Portnoy signaled any awareness of the fact that, thanks to the child tax credit, the tax code already favors parents.)

Still, the pronatalists think they are winning, if slowly. Stone told me he understands there to be “a few” Vance staffers tasked with getting Congress to raise the child tax credit in this year’s reconciliation bill. Whether or not that happens, the pronatalists feel they are operating on a longer time horizon.

“Short term: maybe; long term: yes,” Brown told me when I asked if he was optimistic. But they had better not move too slowly. If convincing people takes too long, there might not be enough people left to convince.

The woman, from the state of Georgia, has been forced to give up custody of the child.

After my 20th shot of hormones, I texted my boyfriend, only half kidding, “I’m dying.” We had decided to freeze embryos, but after more than a week of drugs that made me feel like an overinflated balloon and forced me to take several secret naps a day, I no longer cared whether we froze anything. I was not doing this again.

In order to maximize the number of eggs that can be harvested from the human body, most women who undergo an egg retrieval spend two weeks, give or take, injecting themselves at home with a cocktail of drugs. The medications send the reproductive system into overdrive, encouraging the maximum number of egg-containing follicles to grow and mature at once. They can also cause itchiness, nausea, fatigue, sadness, headaches, moodiness, and severe bloating as your ovaries swell to the size of juicy lemons. Some people experience ovarian hyperstimulation, which can lead in rare cases to hospitalization. Studies have found the stress of fertility treatment to be a primary reason people stop pursuing it, even if they have insurance coverage.

Many people who continue with IVF feel that, if they want a child, they have no other choice. “Right now our treatment options are pretty binary,” Pietro Bortoletto, the director of reproductive surgery and a co-director of oncofertility at Boston IVF, told me. “Either you just put sperm inside the uterus. Or you do IVF, the full-fledged Cadillac of treatment.” But a third option is emerging, one that could reduce the cost and time that fertility patients spend at the doctor’s office and mitigate the side effects. It’s called in vitro maturation, or IVM. Whereas IVF relies on hormone injections to ripen a crop of eggs inside the body, IVM involves collecting immature eggs from the ovaries and maturing them in the lab. The first IVM baby was born in Korea in 1991, and since then, the method has generally yielded lower birth rates than IVF. Decades later, new scientific techniques are raising the possibility that IVM could be a viable alternative to IVF—at least for some patients—and free thousands of aspiring mothers from brutal protocols.

The challenge of IVM is to figure out how to make fragile, finicky human eggs mature in a dish as well as they do within the ovaries. The handful of researchers and companies leading the push to make IVM more mainstream are taking different approaches. One Texas-based company, Gameto, uses stem cells to produce something akin to an ovary in a dish, mimicking the chemical signals an egg would receive in the body. Last month, for the first time, a baby was born who was created using Gameto’s stem-cell medium, Fertilo. The fertility clinic at the University of Medicine and Pharmacy at Ho Chi Minh City, in Vietnam, uses a technique that involves first allowing the retrieved eggs to rest, then ripening them. Lavima Fertility, a company that spun out of research at the Free University of Brussels, is working on commercializing that technique.

For now, these new treatments aren’t commercially available in the United States. The Food and Drug Administration hasn’t historically weighed in on the media that human embryos grow in, but it asked Gameto to seek approval to market Fertilo. Gameto is now preparing for Phase 3 clinical trials. Lavima could face similar hurdles. Older IVM methods are available in the U.S., but not widely used. Meanwhile, more than a dozen women in countries where Fertilo has been cleared for use, which include Australia, Mexico, Peru, and Argentina, are carrying Fertilo-assisted pregnancies, according to the company.

Compared with IVF, IVM is far more gentle. Harvesting immature follicles requires only one or two days of hormonal injections, or skips the process altogether. Reducing the hormone doses necessarily means fewer side effects and cases of ovarian hyperstimulation syndrome. (It may also curtail any possible long-term health effects of repeated exposure to these hormones, which have not been well studied.) Skipping or reducing the drugs can also save women thousands of dollars and many visits to a provider for blood work and monitoring. For women who live far from fertility clinics, or can’t commit to so many visits for other reasons, this protocol could make the difference between undergoing treatment and not, Bortoletto said.

Historically, IVM has generated fewer mature eggs and embryos compared with IVF. The stats are improving, but even if IVM maintains an overall lower success rate than IVF, it still could be the better option for several groups of patients. Egg donors, many of whom undergo multiple retrieval cycles, could be good candidates. So could hyper-responders—patients whose ovaries naturally develop more follicles each month, thanks to their young age or conditions such as PCOS. IVM clinicians could gather enough eggs from hyper-responders that even if a smaller number mature in the lab than might have in the ovaries, a patient would still have a good chance of pregnancy. These patients are also at the highest risk for uncomfortable or dangerous IVF side effects. IVM could be a safer choice, and an effective one. In a 2021 committee opinion, the American Society for Reproductive Medicine concluded that IVM reduced the burden of fertility treatment for these groups of patients. Some studies of hyper-responders have found a live birth rate of 40 percent or higher per IVM cycle, a number on par with that of IVF.

Many women seek IVF because they are approaching their 40s and have few eggs left; they will likely never be good IVM candidates. But IVM might work just fine for patients with blocked fallopian tubes, single and LGBTQ people, and young women who want to freeze their eggs. It could also be useful to cancer patients, many of whom don’t have time to undergo a lengthy IVF cycle before beginning cancer treatment that threatens their fertility. The University of Medicine and Pharmacy in Vietnam primarily offers IVM to women with PCOS, women who appear to have a significant reserve of eggs, and women with a condition that mutes their response to hormonal stimulation. Lan Vuong, who heads the department of obstetrics and gynecology, told me the live-birth rate with IVM there is about 35 percent.

IVM could go far in helping to reduce the physical and emotional toll that fertility treatment takes on women at a time when more people than ever are seeking it out. In some ways, IVF’s burden on women has increased: In an effort to improve birth rates, new drugs, with their attendant side effects, have been added to the standard protocols in the decades since 1978, when the first IVF baby was born. Beyond IVM, some companies are exploring new ways to reduce pain points, for instance by replacing needle injections with oral medications, some of which aim to have gentler side-effect profiles, or by having patients monitor a cycle at home instead of schlepping to the doctor every other day. Dina Radenkovic, the CEO of Gameto, told me that, within the fertility industry, there is a “growing recognition that fertility treatments must be not only effective but also more humane.”

Knowing all this, I can’t help imagining how my own experience could have been different. My doctor eventually told me that part of the reason my cycle was so painful was that I was a hyper-responder, even at the advanced age of 37. If a gentler option had been available, I would have been a prime candidate.

Leanne Quigley, from Flintshire, says she would "love to try for another baby and go through IVF again".

The first time Jamie Cassidy was pregnant, the fetus had a genetic mutation so devastating that she and her husband, Brennan, decided to terminate in the second trimester. The next time they tried for a baby, they weren’t taking chances: They would use IVF and screen their embryos’ DNA. They wanted to avoid transferring any embryos with the single-gene mutation that had doomed their first pregnancy. And then they started wondering what other ailments they could save their future son or daughter from.

The Cassidys’ doctor told them about a company, Genomic Prediction, that could assess their potential children’s odds of developing conditions that aren’t tied to a single gene, such as heart disease, diabetes, and schizophrenia. The test wouldn’t be any more invasive than screening for a single gene—all the company needed was an embryo biopsy. The science is still in its early stages, but the Cassidys didn’t mind. Brennan has Type 1 diabetes and didn’t want to pass that condition on, either. “If I can forecast that my baby is going to have less chance to have Type 1 diabetes than I did, I want that,” he told me. “I’d burn all my money to know that.”

Thanks to more sophisticated genetic-testing techniques, IVF—an expensive, invasive treatment originally developed to help people with fertility troubles—is becoming a tool for optimizing health. A handful of companies offer screening for diseases and disorders that range from life-threatening (cancer) to life-altering (celiac disease). In many cases, these conditions’ genetic links are poorly understood or weak, just one factor of many that determine whether a person develops a particular condition. But bringing another human being into the universe can be a terrifying-enough prospect that some parents are turning to extensive genetic testing to help pick their future offspring.

Genetic screening has been a crucial part of IVF—and pregnancy—for decades. Medical guidelines recommend that any aspiring mother should be given the option to test her own DNA and find out whether she risks passing on dangerous genes, a practice known as carrier screening. If both parents carry a particular mutation, doctors will likely suggest IVF and embryo screening. These measures are traditionally limited to conditions linked to single-gene mutations, such as Huntington’s disease, most of which are exceedingly rare and seriously affect a child’s quality of life. During IVF, embryos are also typically screened for chromosomal abnormalities to help avoid miscarriages, and generally nonheritable conditions such as Down syndrome.

[Read: Genetic discrimination is coming for us all]

As the scientific understanding of the genome has progressed, companies including Genomic Prediction and a competitor called Orchid have begun offering a test that promises a more comprehensive investigation of the risks lurking in an embryo's genes, using what’s known as a polygenic risk score. Most common ailments aren’t connected to a single gene; polygenic risk scores aim to predict the lifetime likelihood of conditions, such as diabetes, in which many genes contribute to a person’s risk. Consumer DNA-testing companies such as 23andMe use these scores to tell customers whether they have, say, a slightly above-average likelihood of developing celiac disease, along with a disclaimer that lifestyle and other factors can also influence their chances. These risk scores could theoretically help identify customers who, say, need a colonoscopy earlier in life, or who need to double down on that New Year’s resolution to eat healthier. But the current scientific consensus is that polygenic risk scores can’t yet provide useful insights into a person’s health, if indeed they ever will.  

Analyzing an embryo’s DNA to predict its chances of developing genetically complex conditions such as diabetes is an even thornier issue. The tests, which can run thousands of dollars and are typically not covered by insurance, involve sending a small sample of the embryos to the companies’ labs. In the United States, such tests don’t need to be approved by the FDA. Genomic Prediction even offers customers an assessment of which embryos are “healthiest” overall. But the control these services offer is an illusion, like promising to predict the weather a year in advance, Robert Klitzman, a Columbia University bioethicist and the author of the book Designing Babies, told me. A spokesperson for the American Society for Reproductive Medicine told me there aren’t enough quality data to even take a position on whether such tests are useful. And last year, the American College of Medical Genetics and Genomics published a lengthy position statement concluding that the benefits of screening embryos for polygenic risk were “unproven” and that the tests “should not be offered as a clinical service.” The statement raised the possibility that people might undergo extra, unnecessary rounds of IVF in search of ever healthier embryos.

Genomic Prediction published a rebuttal to the ACMG that cited, among other research, several studies led by company researchers that concluded that among siblings, those with a lower risk score were significantly less likely to have a given condition. The truth is, though, the effect of screening embryos for polygenic risk won’t be clear until the embryos chosen to develop into fetuses are born, grow up, and either develop diabetes or don’t. Genomic Prediction and Orchid both told me that humanity shouldn’t have to wait that long for the insights their tests provide. Polygenic risk scores are “one of the most valuable pieces of information that you can get,” Orchid’s founder and CEO, Noor Siddiqui, told me. Nathan Treff, Genomic Prediction’s chief science officer, was similarly bullish. “Everybody has some kind of family history of diabetes, cancer, and heart disease. So we really don’t have a situation where there’s no reason for testing,” he told me.

Many of the experts I spoke with about these tests are concerned that people might opt into IVF because they’re chasing certainty that companies can’t really promise. A study last year found both high interest and approval among Americans when it comes to screening embryos for polygenic risk. For now, most of the customers I interviewed used advanced tests that included polygenic risk because they were going through IVF anyway. Many of Genomic Prediction’s customers using the scores are participants in a clinical trial. But Tara Harandi-Zadeh, an investor in Orchid, told me she planned to do IVF even though she and her husband have no fertility issues or history of genetic disease. Harandi-Zadeh is especially worried about de novo mutations—genetic changes that occur spontaneously, without any hereditary link. She wants to screen her embryos to weed out monogenic diseases and plan for the risks of polygenic ones. “If I have that information, I can help my child at the stages of life to be able to get treatment or tests or just prepare for it,” she said. Treff told me that people like Harandi-Zadeh make up a small percentage of Genomic Prediction’s customers, but their numbers are growing.

[Emi Nietfeld: America’s IVF failure]

Scientists just don’t understand enough about the genome to confidently predict what any single embryo will be like should it go on to become a person. Most genes influence many facets of our being—our health, our physical traits, our personality—and only a fraction of those interactions have been investigated. “You don’t know the full package,” Klitzman said. “Bipolar disorder is associated with creativity. So if you screen out bipolar disorder, you may also be screening out genes for creativity, for instance.” Because no embryo is completely risk-free, future parents might also have to decide whether they think, say, a risk of diabetes or a risk of heart disease sounds worse. A paper out last week put it this way: “The expected reductions in disease risk are modest, at best—even if the clinical, ethical and social concerns are dismissed.”

Those concerns are significant. More and more people are already turning to IVF for reasons other than infertility. Some select their children based on sex. Jeffrey Steinberg, a fertility doctor with clinics in the U.S. and internationally, offers eye color selection and told me he is working on height. Orchid assesses genetic risk for some autism-spectrum disorders, and Genomic Prediction plans to add a similar screening to its catalog. A paper published last week argued that editing embryos—not just testing them—could mitigate genetic risk for a variety of conditions, while also acknowledging it could “deepen health inequalities.” (In the U.S., clinical trials of embryo editing cannot be approved by the FDA, and public funds cannot be used for research in which embryos are edited.) Critics say that even if technology could cut the prevalence of diseases like diabetes, doing so could drive discrimination against those born with such “undesirable” traits. Social services and support for people with those conditions could also erode—similar concerns have been raised, for example, in Iceland, where pregnancy screenings have all but eliminated Down-syndrome births.

[From the December 2020 issue: The last children of Down syndrome]

Even if the science does catch up to the ambitions of companies like Genomic Prediction, genetics will never guarantee a child a healthy life. “Of the 100 things that could go wrong with your baby, 90 percent of them or more are not genetic,” Hank Greely, the director of the Center for Law and the Biosciences at Stanford University, told me. That’s partly why the Cassidys decided to ignore most of their screening results and simply select the embryo that didn’t have the monogenic mutation that Jamie carried, and had the lowest risk of diabetes. “We’re not trying to have a kid that’s 6 foot 2 and blond hair and blue eyes and going to go to Harvard. We just want a healthy baby,” Brennan told me.

Their son was born in 2023 and so far has been at the top of the curve for every developmental marker: He’s big and tall; he talked and walked early. It will be years, probably, before they know whether or not he’s diabetic. But it’s hard, they said, not to feel that they picked the right embryo.