Feb 27, 2024 - Health

What to know about IVF after Alabama ruling

Collage of culture dishes being prepared to collect eggs egg retrieval surrounded by radial lines

Photo illustration: Sarah Grillo/Axios. Jens Kalaene/picture alliance via Getty Images

The Alabama Supreme Court's ruling on in vitro fertilization (IVF) has created a flurry of legal questions, liability risks and uncertainty over the nearly 50-year-old fertility treatment.

The big picture: The ruling throws into flux the IVF process for many families in the state who are hoping, or are in the process of, using the treatment to have children, and launches concerns in a post-Roe landscape.

  • The state's ruling is the first time a court has recognized frozen embryos as human beings.

What is IVF?

This medical procedure and treatment helps individuals who are unable to conceive on their own have a child.

  • During IVF, an egg is combined with sperm outside the body ("in vitro" is Latin for "in glass.")

How common is the procedure?

By the numbers: About 2.3% of all babies born in the U.S. every year are conceived using assisted reproductive technology (ART), according the Centers of Disease Control and Prevention.

  • ART includes all fertility treatments in which either eggs or embryos are handled, and the main method is IVF.

What does the procedure consist of?

A full cycle of IVF usually takes about two to three weeks.

  • During IVF, a patient will take hormone injections to stimulate eggs in their ovaries to become mature. The patient takes injections for about nine to 14 consecutive days.
  • Then the eggs are harvested by a fertility team in a procedure with the patient under sedation.
  • The eggs are then studied and cleaned by an embryology lab team to find the useable eggs.
  • Next, the eggs are fertilized by sperm in a lab to create embryos.
  • Over a week's time in an incubator setting, an embryology team monitors to see if any of the eggs successfully fertilized. If none did, the patient has to start the process over again.
  • If they're successful, the embryo most likely to result in a healthy pregnancy is placed in the uterus, where the baby develops.

Between the lines: Remaining embryos may be frozen, leading to the question of what to do with them — the issue at the center of the Alabama ruling's aftermath.

What is the success rate?

The chance of having a full term, normal birth weight for a single live birth per ART cycle (using fresh embryos from non-donor eggs) is 21.3% for women younger than 35, according to a 2015 report by the U.S. Society of Assisted Reproductive Technology.

What they're saying: The success rate is wildly variable, Dr. Janet Choi, the chief medical officer of fertility benefits provider Progyny told Axios.

  • "One of the big factors in terms of predicting successful outcomes is the age of the egg source," she said. "Infertility is definitely on the rise."

The cost of IVF

The IVF process not only takes a mental and physical toll on a patient's body, but it also has a steep price tag.

  • A single round of the procedure can cost anywhere from $10,000 to $30,000 or more depending on many factors including location.

What the Alabama ruling means for IVF providers

Some providers in Alabama have paused offering IVF over concerns of liability risks, which could in turn drive up the costs of providing IVF services and force the industry to a halt in the state.

  • "What I find upsetting is they're there to try to help patients and it's hurting the patients the most, the ones who really want to grow and add to their families," said Choi, who is board-certified in Reproductive Endocrinology and Infertility.

Physicians worried about penalties might be less likely to recommend, for instance, genetic screening of embryos, Choi said. Patients, too, may be wary of such screenings, in fear of consequences they may face if they have a genetically abnormal embryo they choose not to proceed with.

  • Choi said it's "like turning the clock back 20 plus years" in the state, at least temporarily.

Go deeper: Alabama Supreme Court ruling adds to legal uncertainty around IVF

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