Will States Follow Alabama in Ending IVF Access?

This post originally appeared on The 19th.

An Alabama Supreme Court has effectively ended access in the state to IVF, leaving families navigating infertility in limbo.

The decision has sent shockwaves across the country. Democratic lawmakers have used the ruling to push for nationwide IVF protections, promoting a bill that Senate Republicans blocked on Wednesday afternoon. President Joe Biden has criticized the decision, and Health and Human Services Secretary Xavier Becerra traveled to Alabama this week to meet with affected patients.

Outside of Alabama, IVF patients have begun to question the security of their own treatment. Amanda Zurawski, the lead plaintiff in a case challenging Texas’ abortion bans, said this week she is moving her frozen embryos in case her state is next to curb access to IVF.

But the ruling’s implications outside of Alabama remain uncertain. Legal researchers have their eyes on a handful of states where similar changes could take effect, though it’s unclear when or how that might happen.

“It’s always difficult to predict what will happen in other states,” said Sonia Suter, a legal professor and bioethicist at George Washington University. “But there are other states that are very, very conservative that have strong evangelical leanings. You worry about it happening in those states.”

Now, the future of IVF access in other states boils down to how the treatment works, how state courts and legislatures decide to treat the rights of embryos, and the ever-evolving politics of restricting access to forms of reproductive health care.

Below, The 19th explains what that means in practice.

How does IVF work?

People receive hormones that allow doctors to retrieve their eggs, which are then fertilized with sperm in a lab setting. Some of those develop into embryos. Doctors screen those embryos to determine which are able to yield a viable pregnancy, and patients can then choose to have one implanted in their uterus. Excess embryos can be frozen for potential future pregnancies, can be donated to other families or for research, or can be discarded. IVF is considered the most effective option for people with infertility, and almost 100,000 babies a year are born through the process in the United States.

Why has IVF become controversial?

Because not every cultivated embryo will keep growing, and not every embryo will be healthy enough to implant, doctors say that creating multiple embryos is critical to the process. But that component of IVF, and in particular the potential discarding of any embryos that are not implanted, has made the procedure a target for a contingent of the anti-abortion movement. With Roe v. Wade overturned and states moving to ban abortion, limits on IVF could emerge as a subsequent goal.