The ruling – handed down in wrongful death cases brought by couples whose frozen embryos were destroyed in an accident – could leave clinics exposed to lawsuits and restrict access to treatment. On Wednesday, the University of Alabama at Birmingham hospital suspended IVF treatments while it studies the content of the ruling.
Here’s what you need to know about this increasingly common fertility treatment:
What is in vitro fertilization (IVF)?
In vitro fertilization offers a possible solution when a woman is having trouble getting pregnant. It involves extracting her eggs and combining them in a laboratory dish with a man’s sperm to create a fertilized embryo, which is subsequently transferred to the woman’s uterus in an attempt to generate a pregnancy.
According to the American College of Obstetricians and Gynecologists, IVF is performed in cycles and more than one may be necessary to achieve a successful pregnancy. The procedure can use the couple’s eggs and sperm or those of a donor.
How are embryos made?
Treatment typically uses hormones to trigger ovulation, so many eggs are produced and a needle is used to remove them from the ovaries, the American College of Obstetricians and Gynecologists said.
The eggs can be fertilized by adding sperm to the eggs in a laboratory, or a single sperm can be injected into each egg.
“We culture that fertilized egg for a period of time — typically five to six days — to create developmental stages called blastocysts. And these are transferred or stored for future use,” explained Dr. Jason Griffith, a reproductive endocrinologist in Houston.
A blastocyst is the initial phase of an embryo, and is defined as the stage of development that begins at fertilization and lasts up to eight weeks.
Griffith explained that on day 3 after fertilization, an embryo has between 6 and 10 cells. By day 6, you have between 100 and 300 cells.
“We’re talking about something that’s still microscopic,” he said, adding that there are more than a trillion cells in a person.
How are they frozen and stored?
The freezing process involves replacing the water in the embryonic cells with a protective liquid and rapidly freezing them with liquid nitrogen, according to Johns Hopkins Medicine, an institution specializing in medical education, research and clinical care. Frozen embryos can be used for future pregnancies, and the vast majority survive the thawing process.
Frozen embryos are stored in tanks containing liquid nitrogen in hospital laboratories or reproductive medicine centers. Griffith explained that they can also be kept in warehouses contracted by healthcare facilities, especially when stored for many years. Frozen embryos can be safely preserved for a decade or more.
Griffith said the conditions of these facilities are monitored, and that physical security mechanisms are in place to safeguard warehouses and backup generators in the event of blackouts.
Dr. John Storment, a reproductive endocrinologist in Lafayette, Louisiana, said his state has a special law that prohibits doctors from discarding viable embryos that are still dividing, meaning they must be preserved and stored. That’s why he and other doctors ship embryos out of state to a secure storage facility once a patient has finished using them in a given IVF cycle.
“When they need embryos again, they can send them here,” he explains. “But we don’t keep them stored here.”
In other states, he said, patients can choose to use them, throw them away or donate them to other couples or for research.
How Could Alabama’s Ruling Affect IVF?
The U.S. Supreme Court’s decision to overturn Roe v. Wade in 2022 — which legalized abortion nationwide — sparked speculation about how the ruling could lead to problems in fertility treatments, said Greer Donley, associate professor from the University of Pittsburgh School of Law.
“This is one of the first places that is demonstrating that,” he said.
Donley hopes that IVF will continue to be available in Alabama, but that embryos will not be stored there. And moving them to other states for storage will increase the cost, logistical challenges and risk associated with the procedures.
“This opens up the possibility of using child welfare laws more comprehensively to criminalize anything that could harm the embryo,” Donley said.
Donley said that pressure could continue: “The future the anti-abortion movement wants to see is one in which fetuses have federal constitutional protections from the moment of conception.”
Since 2022, four states have amended their constitutions to protect abortion access, and several others are considering putting measures on the ballot this year. In many, the language goes beyond allowing abortion to give people rights to reproductive freedom more broadly, which could guarantee access to IVF.
What do the doctors say?
Doctors outside Alabama are concerned about the possible national implications of the recent court decision.
It could “substantially restrict access to a very vital fertility treatment that has helped countless people today expand their families,” Griffith said. “If you look at the percentage of pregnancies in the United States that result from in vitro fertilization, it is around 2%.”
It could also increase the cost of IVF for many families — although it’s unclear by how much — due to issues such as additional storage fees and liability costs, he said. One IVF cycle, including all embryos transferred, currently costs between $15,000 and $25,000, Griffith said.
Another possible consequence is that there will be fewer IVF providers.
“We have to safeguard access to this very valuable treatment,” Griffith said.
Storment agreed that the Alabama ruling could have a ripple effect across the country.
“It is one of the most important events of the last decade in terms of reproductive rights,” he said.
Source: With information from AP
