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Since the Alabama Supreme Court released a decision on February 16, 2024, that assigns 'personhood' to frozen embryos, the ripple effects have been tangible, and — for the millions of people who need assisted reproductive technologies like IVF to build their families — it's personal.
Multiple clinics in Alabama have already paused IVF treatments, and as of writing, the state’s largest embryo shipping company has also halted business in the state. The decision’s downstream effect has been palpable, according to Dr. Jessica Ryniec, who specializes in reproductive endocrinology and infertility.
What could this mean for fertility patients?
“The ruling in Alabama is a huge deal for fertility patients, treatment, doctors, and clinics because identifying embryos created through IVF as having the same rights as a child or minor may severely limit and restrict what we are able to do in the IVF lab in the future impacting access to care, efficiency & success of care, and costs of fertility treatments,” explains Dr. Ryniec. “[The decision] opened the door to fertility clinics, fertility doctors, embryologists, and other individuals in the fertility clinics being held civilly and potentially criminally liable for the destruction of embryos.”
Here are three other things to know about the Alabama IVF ruling.
Its impact is still developing
There were only two days between the largest hospital in Alabama pausing its IVF cycles and the largest shipping company halting its business in the state. The ramifications of the decision are unfolding quickly, but also it’s uncharted territory. There is no way to know how far and wide the effects will be, but we do know it sets a dangerous precedent.
Dr. Ryniec adds: “While right now we don't know exactly what the impacts will be and how far-reaching they will be, it raises questions about how we will be able to continue to provide the standard of care in assisted reproductive technology.”
There are unanswered questions abound about the future of IVF in Alabama (and beyond)
While it was recently reported that the Attorney General of Alabama has stated that he “has no intention of using the recent Alabama Supreme Court decision as a basis for prosecuting IVF families or providers,” according to CNN — there are still many blurry lines.
“Beyond the disposition of embryos at the completion of treatment, what will this mean for freezing embryos to improve success or to promote single embryo transfer, thereby lowering multiple gestation and pregnancy risks?” questions Dr. Ryniec. “[Or] biopsying embryos for genetic testing either for aneuploidy, which can lead to failed implantation and miscarriage, or for single gene disorders? Anyone who has gone through IVF and fertility providers knows that attrition from egg to embryo and subsequent live birth is extremely common, and there is a huge dropoff — embryo loss is a normal part of natural development and IVF. What will it mean for embryologists and doctors watching these normal developmental events in the lab — will they be liable for loss at that point?”
These questions (and more) aren’t confined within state lines either. While today it is the decision in Alabama, there is no way to know if other states will follow suit.
“Personhood laws have been proposed in multiple states across the nation, and now that there is a supreme court that has declared embryos to be children, we can expect other courts may follow. This could also presumably be enacted at a national level recognizing that there are those that support a national abortion ban which could lead to similar limitations on IVF at a national level," explains Dr. Ryniec.
Those who go through IVF know that embryos are not 'children'
At the heart of the Alabama decision is an impetus to assign personhood and legal rights to frozen embryos, a notion that those who go through IVF do not relate to or abide by.
According to Dr. Ryniec, it’s actually extremely common for those navigating IVF to be briefed beforehand and to make peace with the fact that your starting egg or embryo count is usually not their final number.
“The majority of patients navigating the IVF process know the attrition that occurs in natural human reproduction and assisted reproductive technology and know that the success of IVF treatment relies on numbers to improve outcomes,” explains Dr. Ryniec. “And these are people who desperately want a child, so it isn't as if anyone who is going through fertility treatment (or fertility providers/clinics) does not value children, family building, and this technology.”
In the wake of the news, both the American Society for Reproductive Medicine (ASRM) and RESOLVE have come out against the decision.
So, what can we do about it?
Dr. Ryniec says, “People need to communicate with their clinics (and I'd imagine any clinics that are changing their current protocols are proactively communicating with their patients) about their next steps. I hope that anyone that is currently in cycle would at least be able to proceed with their retrieval with plans maybe to convert to freezing eggs rather than fertilizing, but this may impact their long-term plans and results. From what I am hearing these clinics are not starting new IVF patients at this time. It would also be worthwhile to see if there are any arrangements that may be made to continue care elsewhere for the time being.”
But you don't have to be an IVF patient in Alabama to take action. While the ASRM team is "working around the clock" to protect access to IVF, they recommend contacting your elected officials to cosponsor and demand that they pass the Access to Family Building Act (S.3612/ H.R.7056), which would protect IVF across the country.
You can send them a personalized message in just a few seconds, or get involved in Resolve's Federal Advocacy Day on May 14, 2024 — because the choice to build a family should be a fundamental right for all Americans.
Vivian Nunez is a writer, content creator, and host of Happy To Be Here podcast. Her award-winning Instagram community has created pathways for speaking on traditionally taboo topics, like mental health and grief. You can find Vivian @vivnunez on Instagram/TikTok and her writing on both Medium and her blog, vivnunez.com.