The highest court in Alabama has declared that frozen embryos may be legally recognized as children, sparking worries about the potential impact on in vitro fertilization, also known as IVF.

The recent ruling in cases of wrongful death involving couples whose frozen embryos were destroyed in an accident may have consequences for clinics, potentially exposing them to legal action and limiting the availability of treatment. In response, the University of Alabama Birmingham hospital has temporarily halted IVF procedures as it evaluates the impact of the decision.

Here is some information to understand about this increasingly prevalent method of addressing fertility.

Using in vitro fertilization is a potential option for women struggling with infertility. This process involves collecting the woman’s eggs and mixing them with the man’s sperm in a laboratory setting, resulting in a fertilized embryo that is then implanted into the woman’s uterus with the goal of achieving a pregnancy.

The American College of Obstetricians and Gynecologists states that IVF is conducted in multiple cycles and may require more than one attempt to achieve a viable pregnancy. This process involves using either the eggs and sperm of the couple or those from a donor.

According to the American College of Obstetricians and Gynecologists, the standard treatment involves administering hormones to stimulate ovulation and produce multiple eggs. A needle is then used to extract the eggs from the ovaries.

Fertilization of eggs can occur through laboratory methods, either by adding sperm to the eggs or by injecting a single sperm into each egg.

Dr. Jason Griffith, a reproductive endocrinologist in Houston, explained that we nurture the fertilized egg for about five to six days until it reaches a developmental stage known as the blastocyst. These blastocysts can then be transferred or preserved for later use.

A blastocyst is the initial phase of an embryo, characterized as the period of growth that begins at fertilization and continues for eight weeks.

According to Griffith, an embryo can have anywhere from six to 10 cells on Day 3 after fertilization. By Day 6, it can have between 100 and 300 cells.

“He mentioned that you’re discussing something on a microscopic level. He also noted that a human body is composed of over a trillion cells.”

According to Johns Hopkins Medicine, the method of freezing involves replacing the water in embryo cells with a protective liquid and rapidly freezing them with liquid nitrogen. These frozen embryos can be utilized for later pregnancies, and most of them successfully survive the thawing process.

Frozen embryos are stored in tanks containing liquid nitrogen at hospital labs or reproductive medicine centers. Griffith said they can also be kept in storage facilities that health care facilities contract with, especially when they are stored for many years. Frozen embryos can be safely preserved for a decade or more.

Griffith stated that the conditions in these facilities are closely observed and that there are safeguards in place, such as physical security measures, to protect the tanks and backup generators in the event of a power outage.

Dr. John Storment, a reproductive endocrinologist from Lafayette, Louisiana, stated that his state has a law that forbids doctors from disposing of any viable embryos that are still actively dividing. This means that the embryos must be preserved and stored. Therefore, he and other doctors send the embryos to a secure storage facility in another state once a patient has completed their use for a specific IVF cycle.

“He mentioned that when they are prepared for embryos again, they can simply return them to this location. However, we do not store them here.”

According to him, in different regions, individuals have the option to utilize them, dispose of them, or offer them to other pairs or for scientific study.

Greer Donley, an associate professor at the University of Pittsburgh School of Law, stated that the reversal of Roe v. Wade by the U.S. Supreme Court in 2022 sparked concerns about potential challenges in providing fertility care.

She stated that this location is among the initial ones to demonstrate such.

Donley anticipates that IVF will continue to be an option in Alabama, but embryos will not be kept there. Transporting them to different states for storage will result in higher expenses, logistical obstacles, and potential risks related to the treatments.

Donley stated that this presents an opportunity to utilize child welfare laws in a more comprehensive manner to penalize actions that may cause harm to an embryo.

Donley stated that the push may persist, as the desired outcome of the anti-abortion movement is for fetuses to be granted federal constitutional protections from the time of conception.

Since 2022, four states have amended their constitutions to protect access to abortion, and several others are considering ballot measures for this year. In many, the language goes beyond allowing abortion to give people rights to reproductive freedom more broadly, which could ensure access to IVF.

Physicians located outside of Alabama are concerned about potential repercussions across the country following the recent ruling by the court.

According to Griffith, this measure could greatly limit the availability of a crucial fertility procedure that has assisted many individuals in growing their families. He also noted that only 2% of pregnancies in the US are a result of in vitro fertilization.

The cost of IVF may potentially rise for numerous families, although the exact amount is uncertain. This could be attributed to factors such as added fees for storage and liability expenses, according to Griffith. Currently, one round of IVF, covering all transferred embryos, typically ranges from $15,000 to $25,000.

He mentioned that there may be a decrease in the number of IVF providers as another potential consequence.

Griffith emphasized the importance of protecting access to this highly valuable treatment.

Storment concurred that the ruling in Alabama could potentially impact the entire nation.

He stated that this is one of the most significant developments in reproductive law in the past ten years.

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Ungar wrote from Louisville, Kentucky. Journalist Geoff Mulvihill also contributed to this report from Cherry Hill, New Jersey.

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The Health and Science Department of the Associated Press is supported by the Science and Educational Media Group of the Howard Hughes Medical Institute. The AP is fully responsible for the content.