The battle against IVF isn’t protecting children. It’s devastating families

The Alabama Supreme Court ruled in February that frozen embryos have the same legal protections as children in the state. Some lawmakers have since passed bills that would protect IVF services, but ongoing access to fertility treatment remains uncertain. Meredith Clark and Olivia Hebert spoke to women who have undergone IVF, revealing how such a ruling could only worsen the mental, emotional, and physical toll

(iStock)

When you’re a teenager, you have a basic understanding of how you came into the world. You don’t tend to ask your parents questions about your conception. At least, I didn’t because I wasn’t inclined to die of mortification.

Growing up, I’d only heard that my parents had tried for a child for a long time, so when my 70-something-year-old grandmother made a passing comment about how I’d had a twin in the womb, I took it as another one of her jokes. Offbeat and out there, but classic grandma.

I mentioned what she had said off-handedly to my mother as we were driving on the 405 Freeway, when I noticed that she had frozen in place. When I asked what was wrong, she paused and then told me: “I was planning on telling you when I was ready.”

I was shell-shocked as she continued, glassy-eyed with grief. She gestured to a building we had just passed, saying: “That’s the clinic we used to go to… where you were made.”

I was conceived through in vitro fertilisation (IVF) in the late 1990s in what my parents would later explain to me was a gruelling four-year process. I would come to learn that IVF often increases the chances of twins by 20 to 30 per cent, which is what occurred with me – except only I survived after a complication four months into my mother’s pregnancy.

The story of how I came to be is bittersweet for my parents. Losing my twin was a tough loss for them; even decades later they still get tears in their eyes talking about it. But in all my conversations with them, one thing they are certain of is that if it wasn’t for IVF, I wouldn’t exist.

It isn’t just me. Through IVF technology, more than eight million babies in the United States may not have been born. In fact, an estimated two per cent of births in the country have resulted from IVF; that’s two of every 100 babies born in the US, according to the Columbia University Fertility Center.

But earlier this year, access to IVF faced an unprecedented attack.

In February, the Alabama Supreme Court decided in a landmark ruling that frozen embryos are classified as children under state law. The ruling came after three couples, whose frozen embryos were accidentally destroyed at a fertility clinic, brought wrongful death lawsuits against the facility. The decision sent shockwaves throughout IVF centres, as providers feared they could soon face prosecution for the fairly normal practice of freezing and discarding embryos. Alabama’s three largest IVF centres subsequently paused treatment over concerns they could face criminal charges, while earlier this month, it was announced that the Mobile Infirmary Medical Center – the IVF clinic at the centre of the wrongful death lawsuits – will stop its IVF services at the end of the year.

The ruling appeared to be yet another attack on reproductive rights since Roe v Wade, a decision that legalised abortion nationwide more than 50 years ago, was overturned in June 2022.

That’s why it came as a surprise to some when Alabama lawmakers – a number of them Republican representatives - acted quickly to pass bills that would protect IVF services in the state. In March, Alabama governor Kay Ivey, a Republican, signed into law a bill that would give legal protection for fertility clinics. Conservative group Eagle Forum of Alabama issued a statement urging lawmakers to “avoid hasty or ill-informed legislation that may be in direct violation of our Constitution as well as the clear definition of human life”. Eric Johnston, president of Alabama’s Pro-Life Coalition and a lawyer who helped draft Alabama’s anti-abortion laws, said they support legislation to make IVF services available again.

With such bipartisan outrage aimed at Alabama’s Supreme Court ruling on IVF, it soon became clear that legislation initially intended to roll back abortion rights in the state had backfired – causing a ripple effect that put millions of families undergoing IVF treatment at risk.

The treatment itself is considered a feat of modern medicine, with the first successful birth of a child via IVF taking place in 1978. Louise Brown was conceived at Dr Kershaw’s Cottage Hospital in Royton, England, through a treatment developed by physiologists Patrick Steptoe, Jean Purdy, and Robert G Edwards – who was awarded the Nobel Prize in Physiology or Medicine in 2010 for his groundbreaking contributions. His colleagues had already passed years before.

Since the trio’s first “test tube baby,” fertility specialists have finetuned and advanced the pioneers’ original procedure into what is now known as an “IVF cycle,” a multi-step procedure that begins with patients injecting themselves with ovary-stimulating hormones. Then, the eggs are retrieved from the ovaries and fertilised with sperm on a petri-dish in a laboratory. These embryos are then transferred into the patient’s uterus. From that point on, patients and doctors play the waiting game, anticipating whether or not the embryo attaches to a patients’ uterine lining – which typically indicates a pregnancy.

However, there are still many stigmas and misconceptions surrounding IVF: that it’s always successful, that infertility is the woman’s fault, and the surmounting pressure from certain religions, such as Catholicism, that believe IVF to be “morally unacceptable”. Really, women aren’t the only targets of certain evangelical groups that deem the IVF process as immoral; these religious groups are intent on forcing their beliefs on the greater population.

Perhaps it’s the spread of disinformation that led the Alabama Supreme Court to make such an unprecedented ruling on IVF. But according to both providers and patients who’ve previously undergone fertility treatment, there’s a lot that people don’t know about IVF. That is, not unless they’ve experienced it for themselves.

“IVF, or assisted reproductive technology, is not an exact science. It’s not a person outside of the body that’s just waiting to be alive. It’s more so a chance for pregnancy,” Brandon, an embryologist at an Illinois-based fertility clinic who preferred not to disclose his real identity, told The Independent. “We’re trying to create families, not play God.”

When the Alabama Supreme Court ruled that frozen embryos were considered children under state law, fertility specialists across the country felt a sense of uncertainty, fearing that doors to their clinics would imminently close too.

“We were definitely concerned that it sets a dangerous precedent,” Brandon said. “To me, an embryo is not a person; it’s a chance of pregnancy. We kind of have to think about frozen embryos and this sort of technology as in likelihoods and chances.”

For many people who undergo IVF, it is in fact the likelihood and chance of conceiving a child that’s the motivator in continuing such a gruelling process. Of course, it’s important to note how individualised fertility treatments can be, and that one person’s IVF experience may be entirely different from the next. Oftentimes, there’s no telling how many cycles a patient may have to undergo until they finally get pregnant. It can take anywhere from a year to as long as a decade for some. There’s also the chance that the process may not work at all, even after numerous cycles.

Lindsay Gonzales – a 42-year-old dental hygienist who underwent multiple IVF cycles over seven years – noted that the daily shots, day in and day out, were especially draining. “Progesterone shots are probably the worst because it’s really thick oil and the needle’s very thick and it has to go into your muscles,” she said to The Independent.

Progesterone in oil is often prescribed by doctors after the egg retrieval to help prepare the patients for pregnancy. Patients – whether with the help of their loved ones or not – are told to conduct these intramuscular injections until they see a positive pregnancy test result. The hormone is naturally secreted by the ovaries within the first 10 weeks of pregnancy, and is produced by the body to prepare the uterine lining for an egg to implant. Unlike oestrogen, which serves to prepare the body for a potential pregnancy, progesterone is secreted to help the body maintain the pregnancy.

As patients inject the hormone over time, they may experience changes in their mental health, exhibiting signs of depression, anxiety and mood swings. Physically, they may gain or lose weight, or have acne, nausea, hair loss, drowsiness or dizziness – all of which take their toll.

The well-known saying, “The body keeps the score,” is perhaps no truer than in terms of the physical trauma of IVF, with infusions or injections that can leave the body sore and bruised. Teff Nichols, a New York-based therapist whose nearly two-year-old child was born via IVF, referred to the process as “the Wild West” because of its differing perspectives, approaches, and protocols. While her experience undergoing IVF was “thankfully successful,” Nichols said, she can’t help but recall feeling incredibly bloated and uncomfortable most of the time.

“I know I’m not alone in this feeling that your body is not doing what it’s supposed to be able to do, like a feeling of failure,” she told The Independent. “For me, there was a certain amount of armour that had to go on to just sort of get through it. Getting through IVF was like you just had to put on this armour and try not to think about it and try not to think about the fact that it could literally all be for nothing.”

Indeed, there is the possibility that going through IVF could really be all for nothing. There are many reasons why an IVF cycle may not result in a pregnancy. For one, it’s astronomically expensive, with one average round of IVF costing between $12,000 and $17,000 – though in some instances, it’s covered by insurance. According to benefits consultant Mercer, 54 per cent of US companies with 20,000 or more employees covered IVF in 2022. Although that number seems to be on the rise, coverage from smaller employers leaves something to be desired, with low-income families often the most likely to be at a disadvantage.

Essentially, much of the IVF process involves a certain kind of mental gymnastics, in which you convince yourself that it’ll be worth it in the end. “There’s plenty of people in the IVF community that don’t really feel great about doing IVF for personal, religious, whatever those reasons might be,” said Nichols. “They’re doing it because they’ve prioritised having a family.”

With no telling how many IVF cycles it will take for the treatment to work, many aspiring parents are often put in a tough spot when the money runs out and they’re forced to decide if they want to keep trying to have a family, or cut their losses. Educator Irma Vasquez recalled having to travel to Mexico to purchase hormone treatments at a cheaper price due to her insurance not covering her mounting IVF costs. At one point, she noted that she and her husband had spent upwards of $70,000 as she neared four years into her IVF journey, leading her to try to find other avenues like Mexican pharmacies that sold what she needed at a fraction of the cost they were sold in the US. Looking back on that time, she remembered the sheer desperation that drove her to make these decisions.

“It was one of those chapters in your life that kind of moulds you and makes you who you are,” Vasquez recounted, reflecting on the grief that stemmed from her several unsuccessful rounds of IVF. Although she eventually went on to adopt and have two children without IVF, she noted that the heartache of the process – from miscarriages to financial setbacks – has left a long lasting impact.

“There are moments in your life where there are events that happen, either death or a move or a divorce or some big tragedy going through infertility treatment,” she said. “At the beginning, you know, you’re kind of naive and you’re going through the process. You don’t really know what the toll that it’s going to take on you because you don’t know how long it’s going to be. But as the years go through and you do more and more treatments and you escalate things to more involved procedures, the toll is great. The toll is great in emotional, financial, spiritual, physical, in every way that you can imagine.”

That’s why it’s easy to assume that the Alabama Supreme Court’s ruling on IVF would only worsen the anxieties that many people going through fertility treatment are already experiencing. On top of undergoing weekly infusions and daily injections, many women are now forced to wonder how the state’s decision could impact their own frozen embryos.

“I have embryos on ice that we are not sure what we want to do with. I’m not even sure I quite understand what happens to all the embryos that are on ice,” Nichols explained. “Nobody wants to be going through IVF, so to add on this additional anxiety and fear is just cruel.”

Fortunately, those who undergo a process like IVF aren’t entirely alone. Through social media, such as IVF support groups on Facebook or TikTok and Instagram pages dedicated to sharing information, access to an online community can make the IVF journey a lot less isolating for some patients, especially those who do not have a support system around them. To be able to connect with others who are going through a similar process can be a huge relief, in a period rife with destabilising hormones and bodily changes.

Vasquez noted that it took a village to help her through her IVF process, recounting how her friends, family, and colleagues rallied around her during the tough time. Her sister notably donated her own eggs for IVF, giving the siblings a rare opportunity to go through the experience of injections and hormonal changes together. She added that if it hadn’t been for her community, her experience would have been vastly different.

As the Alabama Supreme Court announced its unprecedented ruling on IVF, it didn’t take long for the public to chalk it up as just another attack on women’s bodily autonomy. After all, justices cited the anti-abortion language added to the state’s constitution in 2018, which made it the policy of the state to “ensure the protection of the rights of the unborn child,” as the primary influence in its decision on frozen embryos.

For Paula, who lives in New Jersey, she recalled feeling shocked but not entirely surprised that such a decision was made in our current post-Roe era. “Since Roe v Wade was overturned, I’ve been very apprehensive of what would be the future of IVF. IVF is a scientific tool that has existed for many years so when I saw the ruling in Alabama, to me it was like history reversed,” she told The Independent. “To think about this Alabama ruling, if I didn’t have frozen embryos I would never be going through this. That was the only way I could get pregnant, is through having frozen embryos and being able to implant them when I was ready to receive them.”

However, Nichols believed the ruling simply highlighted the “hypocrisy” of anti-abortion lawmakers. Typically, the majority of Americans who support pro-choice legislation (a whopping 69 per cent, according to a 2023 Gallup poll) would profess that politics has no place in what a woman decides to do with her body, including IVF. But Nichols argued that it’s “naive” to assume they wouldn’t come after IVF next. The ruling in Alabama exposed how pro-life advocates aren’t just intent on stopping abortion, but controlling women and reproduction entirely. Of course conservative lawmakers wouldn’t just stop at abortion; really, attacking IVF treatment was just collateral damage.

Despite the physical challenges and emotional toll many people have undergone through IVF, the process has changed many lives for the better – by giving them the opportunity to have a family. For Lindsay, all she and her husband wanted was to become parents and now their lives have been “completely turned around” with their twin boys. While Irma ultimately adopted and had two children without the help of fertility treatments, she noted that undergoing IVF taught her about “resilience” – something she otherwise would’ve never experienced.

The fate of IVF treatments in Alabama still remains undetermined. Yes, bipartisan lawmakers are currently passing bills that will hopefully challenge the state’s Supreme Court ruling that frozen embryos are legally considered children. But nevertheless, that doesn’t take away from the fear and anxiety felt by fertility clinics and hopeful families across the country. Not only are women facing challenges to their bodily autonomy, but also the autonomy of parents – including heterosexual and homosexual couples, as well as single parents. Roe v Wade was the tip of the iceberg, and some note that it is more obvious than ever that this is a part of a larger overall movement to strip people of their hard-won freedoms.

“I tend to think that women, or people with uteruses, who go through this process, lots of them are suffering but quietly,” said Paula. “It’s something that we choose ourselves to go through but at the same time, you’re suffering in order to achieve a goal that is hopefully very fulfilling and positive… but it’s difficult.”

“Some people may look at this like you’re not entitled to suffering, because we chose to go through this. When this ruling came out, it made it even more evident.”

IVF has opened the door for so many people to become parents. Legislators should be expanding access to it – making it easier to obtain hormones or insurance coverage – rather than restricting it, or making it illegal entirely. There are millions of babies born thanks to IVF, even in the face of uncertain odds. People struggling with fertility shouldn’t be forced to jump through even more hoops to be able to have a child; they should simply have the support they need.