IVF

ala.-hospital-halts-ivf-after-state’s-high-court-ruled-embryos-are-“children”

Ala. hospital halts IVF after state’s high court ruled embryos are “children”

Alabama, assisted reproductive technology, children, embryo, fertility, frozen embryo, health, IVF, Science / /

Consequences —

Anger and uncertainty spread in wake of Friday’s ruling by the state’s Supreme Court.

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Nitrogen tanks holding tens of thousands of frozen embryos and eggs sit in the embryology lab at New Hope Fertility Center in New York City on December 20, 2017.

Enlarge / Nitrogen tanks holding tens of thousands of frozen embryos and eggs sit in the embryology lab at New Hope Fertility Center in New York City on December 20, 2017.

The University of Alabama at Birmingham (UAB) health system is halting in vitro fertilization treatment in the wake of a ruling by the state’s Supreme Court on Friday that deemed frozen embryos to be “children,” The ruling opens up anyone who destroys embryos to liability in a wrongful death lawsuit, according to multiple media reports.

The announcement—the first facility to report halting IVF services—is the much-feared outcome of Friday’s ruling, which was widely decried by reproductive health advocates.

“We are saddened that this will impact our patients’ attempt to have a baby through IVF, but we must 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,” UAB said a statement to media. The statement noted that egg retrieval would continue but that egg fertilization and embryo development are now paused.

Ars has reached out to UAB for further comment and will update this story with any additional information.

Production of extra embryos is a normal part of IVF treatment for several reasons. Most notably, not all embryos will be viable, implant in a uterus, and lead to a live birth. So, creating as many embryos as possible is a common strategy to ensure that people who wish to conceive have the best chance of doing so. Embryos can also be screened for genetic conditions, allowing only the healthiest to be implanted, while those with debilitating or fatal abnormalities can be discarded.

In 2021, approximately 238,126 patients in the US had 413,776 rounds of IVF, resulting in 97,128 live-born infants, according to the Centers for Disease Control and Prevention. The percentage of egg retrievals that lead to a live birth ranges from 54 percent to 9 percent, depending on a patient’s age.

But, the standard practices of IVF used for hundreds of thousands of patients each year were thrown into question and upheaval Friday when the Alabama Supreme Court ruled that all embryos, even those outside of a uterus or frozen in storage, are “children” under state law. Anyone who destroys them is liable under the state’s Wrongful Death of a Minor Act, the court concluded. Chief Justice Tom Parker cited his religious beliefs and quoted the Bible to support the stance.

Reproductive health experts quickly speculated that the ruling would roll back IVF treatment in the state. Some facilities, such as the case of UAB, may halt treatment entirely. While others may choose to fertilize eggs conservatively, adding cost and time to the already arduous process of IVF. Genetic screening of embryos from couples who carry debilitating or fatal mutations may no longer be possible. Doctors could be sued if an embryonic ball of a few cells does not survive the treatment. Insurance rates for fertility clinics could skyrocket. Patients, meanwhile, may have to keep unneeded embryos frozen indefinitely.

On Tuesday, The Washington Post reported that the ruling had created a wave of anger, shock, and confusion across the state. Patients are considering moving frozen embryos—some leftover from IVF rounds, some purposely banked for future use—to storage facilities out of the state. Lawyers cautioned that divorce settlements that stipulate frozen embryos must be destroyed may now be void.

But the fear and confusion don’t end there. Health advocates worry more states will follow Alabama’s lead. And, if small clumps of cells gain personhood rights in more states, liability could spread to contraceptive use and people who suffer a miscarriage.

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Frozen embryos are “children,” according to Alabama’s Supreme Court

Alabama, Alabama Supreme Court, art, embryos, fertlized egg, IVF, reproductive health, Science / /

frozen cell balls —

IVF often produces more embryos than are needed or used.

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January 17, 2024, Berlin: In the cell laboratory at the Fertility Center Berlin, an electron microscope is used to fertilize an egg cell.

Enlarge / January 17, 2024, Berlin: In the cell laboratory at the Fertility Center Berlin, an electron microscope is used to fertilize an egg cell.

The Alabama Supreme Court on Friday ruled that frozen embryos are “children,” entitled to full personhood rights, and anyone who destroys them could be liable in a wrongful death case.

The first-of-its-kind ruling throws into question the future use of assisted reproductive technology (ART) involving in vitro fertilization for patients in Alabama—and beyond. For this technology, people who want children but face challenges to conceiving can create embryos in clinical settings, which may or may not go on to be implanted in a uterus.

In the Alabama case, a hospital patient wandered through an unlocked door, removed frozen, preserved embryos from subzero storage and, suffering an ice burn, dropped the embryos, destroying them. Affected IVF patients filed wrongful-death lawsuits against the IVF clinic under the state’s Wrongful Death of a Minor Act. The case was initially dismissed in a lower court, which ruled the embryos did not meet the definition of a child. But the Alabama Supreme Court ruled that “it applies to all children, born and unborn, without limitation.” In a concurring opinion, Chief Justice Tom Parker cited his religious beliefs and quoted the Bible to support the stance.

“Human life cannot be wrongfully destroyed without incurring the wrath of a holy God, who views the destruction of His image as an affront to Himself,” Parker wrote. “Even before birth, all human beings bear the image of God, and their lives cannot be destroyed without effacing his glory.”

In 2020, the US Department of Health and Human Services estimated that there were over 600,000 embryos frozen in storage around the country, a significant percentage of which will likely never result in a live birth.

The process of IVF generally goes like this: First, egg production is overstimulated with hormone treatments. Then, doctors harvest the eggs as well as sperm. The number of eggs harvested can vary, but doctors sometimes try to retrieve as many as possible, ranging from a handful to several dozen, depending on fertility factors. The harvested eggs are fertilized in a clinic, sometimes by combining them with sperm in an incubator or by the more delicate process of directly injecting sperm into a mature egg (intracytoplasmic sperm injection). Any resulting fertilized eggs may then go through additional preparations, including “assisted hatching,” which prepares the embryo’s membrane for attaching to the lining of the uterus, or genetic screening to ensure the embryo is healthy and viable.

Feared reality

This process sometimes yields several embryos, which is typically considered good because each round of IVF can have significant failure rates. According to national ART data collected by the Centers for Disease Control and Prevention, the percentage of egg retrievals that fail to result in a live birth ranges from 46 percent to 91 percent, depending on the patient’s age. The percentage of fertilized egg or embryo transfers that fail to result in a live birth ranges from 51 percent to 76 percent, depending on age. Many patients go through multiple rounds of egg retrievals and embryo transfers.

The whole IVF process often creates numerous embryos but leads to far fewer live births. In 2021, nearly 240,000 patients in the US had over 400,000 ART cycles, resulting in 97,000 live-born infants, according to the CDC.

People who have extra embryos from IVF can currently choose what to do with them, including freezing them for more cycles or future conception attempts, donating them to others wanting to conceive, donating them to research, or having them discarded.

But, if, as Alabama’s Supreme Court ruled, embryos are considered “children,” this could mean that any embryos that are destroyed or discarded in the process of IVF or afterward could be the subject of wrongful death lawsuits. The ruling creates potentially paralyzing liability for ART clinics and patients who use them. Doctors may choose to only attempt creating embryos one at a time to avoid liability attached to creating extras, or they may decline to provide IVF altogether to avoid liability when embryos do not survive the process. This could exacerbate the already financially draining and emotionally exhausting process of IVF, potentially putting it entirely out of reach for those who want to use the technology and putting clinics out of business.

Barbara Collura, CEO of RESOLVE: The National Infertility Association, told USA Today that the ruling would likely halt most IVF work in Alabama. “This is exactly what we have been fearful of and worried about where it was heading,” Collura said. “We are extremely concerned that this is now going to happen in other states.”

But the hypothetical risks don’t end there. Health advocates worry that the idea of personhood for an embryonic ball of a few cells could extend to pregnancy outcomes, such as miscarriages or the use of contraceptives.

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