What Alabama’s Embryo Ruling Means For People In Egg Freezing And IVF Cycles
The Alabama Supreme Court ruled Tuesday that embryos have personhood and are considered "children," and that if destroyed, there can be legal ramifications. This news threw the state—including its fertility doctors and in-vitro fertilization patients—into a state of confusion.
Then, on Feb. 21, the largest health care system in the state, University of Alabama at Birmingham (UAB), announced it was pausing all IVF treatments in order to "evaluate the potential that our patients and our physicians could be prosecuted criminally or face punitive damages for following the standard of care for IVF treatments," a spokesperson told NBC. Two other big IVF providers soon followed suit: The Center for Reproductive Medicine at Mobile Infirmary and Alabama Fertility also paused treatments.
Serena H. Chen, MD, ob-gyn, director of advocacy at CCRM Fertility IRMS Reproductive Medicine and founding board member of Doctors for Fertility, sat down with Women's Health to parse through the big questions this ruling brings up, including what is still—and is no longer—possible when it comes to infertility treatments in Alabama, and the broader implications for health care across the U.S.
WH: Can you explain this Alabama Supreme Court ruling, and how fertility specialists and doctors are understanding it?
Dr. Chen: This ruling demonstrates a total lack of recognition of standard medical care and standard fertility care. It's in a world of its own that is completely isolated from the reality of what fertility patients are experiencing and what fertility doctors are doing. The whole ruling is worded in a way that claims to support families and claims to support life, claims to support parents and claims to support children. And it does exactly the opposite of that.
The ruling itself [saying that an embryo is a person] makes zero sense. The judgment does not recognize the complete impracticality of treating embryos like persons.
Humans are just like all other creatures and in nature, reproduction is extremely inefficient. The vast majority of eggs and sperm never have the biological competence to become a baby. There's a 20 percent chance that a perfectly fertile couple gets pregnant each month. And a quarter of all pregnancies end in miscarriage. For infertility patients, the miscarriage rates tend to be over 50 percent. If we are treating this material as life that deserves just as much protection as you and me, we are creating conflict. There's no biological basis for calling embryos children.
Maybe, if we're lucky, one of the embryos, under the right conditions, might some day be able to make a baby if they go through a healthy pregnancy. This polarization and criminalization of what we do to help our patients is really tragic. It will impact our entire health care system, not just women's health.
WH: What are the immediate impacts of the ruling?
Dr. Chen: Doctors are wondering if they have to leave their practice and uproot their families.
All the people [at UAB] who are literally in the middle of their IVF cycle have been told stop until they [doctors] can figure out what's going on. Some judge says, "Sorry, but that's illegal, and you have to stop right now," literally in the middle of treatment. You're already on [fertility] drugs. It's just kind of unimaginable that this is happening in a country that's supposed to be a leader in health care. It's really a huge issue.
WH: To the best of your understanding, can patients still do IVF in Alabama?
Dr. Chen: No. Well, I believe the private practices are continuing. But at UAB, only the egg-freezing patients are moving forward.
WH: Can you still do an egg retrieval or egg freezing in Alabama?
Dr. Chen: Yes. You definitely can. I believe private practices [are continuing], but I don't know how they are handling this situation. I'm sure they're really concerned about prosecution.
WH: So, people trying to get pregnant are stopping right in the middle of these long, expensive IVF processes?
Dr. Chen: Yes. They have put their lives on hold for treatment, and now their treatment has been put on hold for an arbitrary decision by a court that obviously has no understanding of reproductive health care.
WH: What are some of the long term impacts of this ruling for both doctors and patients?
Dr. Chen: We've been seeing a negative impact [since the Dobbs decision, which overturned Roe v. Wade, came down in 2022, followed by a slew of more restrictive reproductive health care laws in individual states]. We've seen people close programs and leave states. We are already seeing enormous amounts of stress placed on patients, even in New Jersey. Everybody thinks we're "safe," but we're feeling the impact of a lot of these rulings about things like mifepristone [the U.S. Supreme Court is set to weigh in on a case this year that could limit access to this common abortion pill].
We help patients who can't carry their own baby arrange for gestational carriers, and most carriers come from these really restrictive states. So, a lot of these patients have had this extra stressor put on them: If their carrier gets pregnant, they might not be able to be safely taken care of in their own state.
We're seeing medical students worried about "Should I go into medicine? Should I go into women's health? I have to stay in a state where they will allow me to practice medicine and allow me to get trained." So, we are kind of dismantling the health care system that was already kind of broken after the pandemic. This is just adding a stressor that we do not need, and this is going to affect everyone.
WH: It sounds like there’s a lot that is still up in the air. What should IVF patients in Alabama know right now?
Dr. Chen: It's important for you to know that you have a voice. You're a constituent. You do have a vote. You should definitely be able to talk to your legislators. Let them know exactly how you feel. Unfortunately, this is a court ruling. It's not like a legislative bill that can be blocked, so there is going to have to be new legislation to address this.
WH: Can an IVF patient move their embryos to a different state?
Dr. Chen: I think that might make sense for a lot of people. I believe the ruling does not prevent people in Alabama from moving their embryos. And we move embryos all the time. We've always done that, because people move and situations change. And since the Dobbs decision, we have seen a lot of embryos moving around the country.
There is always some risk attached, but it can definitely be done safely. It's expensive, and it can be logistically challenging, but it can be done.
If patients are going to do this, they need expert advice. I would start with your doctor or fertility specialist. You can also reach out to two wonderful patient organizations: fertilitywithinreach.org and resolve.org. They're both national organizations and they can be great resources for information and advice.
WH: Is there concern that other states could follow suit?
Dr. Chen: Absolutely. There is a legislator in Oklahoma actively pushing the personhood bill. So this is definitely occurring in other states. But this is all happening as a result of a very strident and loud minority. We have a lot of evidence that the majority of people believe in health care decision-making autonomy.
It's important for people to educate themselves, speak to their representatives and say, "Hey, what's going on in Alabama? Please don't let that happen here." It really does make a difference.
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