Assisted reproductive technologies (ART) have never been more celebrated, or more legally fragile. Championed across the political spectrum as instruments of family formation, they now rest on a legal foundation unsettled by Dobbs v. Jackson Women’s Health Organization and the embryonic-personhood theories it emboldened. Yet the loudest debates ask whether ART will survive rather than whether disabled people can actually use it. For many disabled people, ART is the difference between a formal right to have a child and the practical ability to exercise that right. Prior scholarship about assisted reproduction has focused largely on the imagined future disabled child rather than the disabled adult seeking to become a parent.

This Article centers that adult. For more than a century, law and medicine treated disabled people’s reproduction as a problem to be managed rather than a family life to be supported. That judgment found its most notorious expression in Buck v. Bell, where the Supreme Court upheld compulsory sterilization. Although compulsory sterilization has receded, the fitness judgment behind it has not. Today, clinics determine who is a suitable patient, insurers decide which forms of family formation are worth financing, and parentage law determines which families receive legal recognition. A judgment the state once imposed openly now operates through dispersed institutions, making exclusion harder to identify and harder to contest because no single institution is accountable for the barriers they together produce.

Extending Disability Reproductive Justice to assisted reproduction, this Article argues that antidiscrimination law remains necessary but cannot, by itself, secure meaningful access where exclusion is this diffuse. Instead, meaningful access requires rebuilding the institutions of assisted reproduction around disabled people’s family formation. The right to have a child is incomplete when it disappears at the point where reproduction depends on medicine, money, law, and institutional permission.

For half a century, disability law has promised disabled people equal access to public services, education, and life in the community. That promise rests not only on the Rehabilitation Act, the Americans with Disabilities Act (ADA), and the Individuals with Disabilities Education Act (IDEA) but also on regulations that give statutory commands practical content, civil rights offices that investigate complaints, public enforcement that addresses systemic violations, and Medicaid-funded services that make community living possible. In June 2026, the Department of Justice’s Office of Legal Counsel concluded that neither Title II of the ADA nor Section 504 of the Rehabilitation Act imposes or authorizes the integration mandate on which Olmstead v. L.C. relied. Meanwhile, the federal government has curtailed civil rights enforcement, reorganized the institutions that administer disability programs, and implemented fiscal changes that place home- and community-based services at risk. The statutes remain in force, but the conditions that make them usable are being withdrawn.

This Article argues that disability rights are at risk because their practical force depends on regulatory, administrative, informational, and fiscal frameworks that are less deeply entrenched than the statutes themselves. It details how diminished enforcement, executive reinterpretation, institutional restructuring, budget reductions, and loss of evidence are transforming the federal disability rights framework. Using Olmstead as an example, it demonstrates how a settled right can be narrowed without being repealed. The Article emphasizes that safeguarding disability rights involves more than upholding current laws. It demands enforceable federal standards, consistent enforcement by public agencies, ongoing support for community living, stronger state-level protections, and a disability-led political movement to prevent retrenchment.