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Diagram of the blastocyst stage of embryonic development approximately 5-9 days after fertilization. The outer layer grows to form the placenta. The cells inside become a fetus.
Juan Gartner/Getty Images/Science Photo Libra
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Juan Gartner/Getty Images/Science Photo Libra
Diagram of the blastocyst stage of embryonic development approximately 5-9 days after fertilization. The outer layer grows to form the placenta. The cells inside become a fetus.
Juan Gartner/Getty Images/Science Photo Libra
The Alabama Supreme Court’s ruling that frozen embryos can be considered “children outside the womb” under state law has a major impact on how in vitro fertilization, commonly referred to as in vitro fertilization, is performed.
The ruling was handed down in a wrongful death lawsuit brought by a couple whose frozen embryos were destroyed in an accident at a fertility clinic in Mobile, Alabama. The couple reached an agreement that the child would be protected based on the law. Forensic and reproductive health experts said the ruling increases the risks and costs of IVF for both patients and health care providers.
Already, at least three health care providers in Alabama have announced they will suspend IVF treatments in light of last Friday’s court ruling. Alabama lawmakers also said they would introduce state legislation that would make it clear that in vitro fertilization can continue in the state. At this time, the legal implications of IVF only affect the state of Alabama. That situation may change as other states adopt “personhood” statutes that say life and rights begin at conception.
Here’s what you need to know about the science of how the IVF process works and how this ruling could affect its future.
1. IVF is a multi-step process and timing is critical.
Each IVF cycle is a multi-step process that initially aligns with the patient’s menstrual cycle. First, patients need to receive hormone injections every day for 10 to 12 days, explains Dr. Eve Feinberg, a reproductive endocrinologist and infertility expert at Northwestern University in Chicago. These hormones prepare multiple eggs to mature in the ovaries, in small fluid-filled sacs called follicles. Patients are monitored regularly, often daily. Once the follicles reach a certain size, the patient takes another hormone to prepare the eggs for retrieval.
The second step in the process is egg retrieval. This is done while the patient is under anesthesia. Once the egg is removed, it is placed in a dish containing sperm so that it can be fertilized. This is step 3 of the process.
Step 4 then follows, where the fertilized eggs are incubated in the laboratory for approximately 3 to 7 days until they reach the blastocyst stage. The blastocyst stage is a highly developed embryo that contains two distinct cell layers: cells that will become the placenta and cells that will become the placenta. Then there are the cells that become the fetus,” Feinberg explains.
At this point, the embryo is either implanted into the woman’s uterus (step 5) or frozen for future use. In some cases, both scenarios may occur. This means that one embryo is transferred and the extra embryos are frozen for later use.
If the embryo is transferred immediately, the IVF cycle will take about 2.5 weeks from hormone injection to implantation, Feinberg said. In many cases, the embryos are frozen and implanted into the uterus in another cycle, she says.
Of course, embryos can also be frozen for years before being implanted in a woman’s uterus. And one of the big questions raised by Alabama’s decision is whether all frozen embryos in the state must be stored indefinitely.
2. Fertilized eggs often do not survive, both in nature and in the laboratory.
Feinberg says it’s common for a fertilized egg to fail, which is how fertility works naturally. ”She says many women walking around each month have fertilized eggs or embryos floating around in their bodies that probably won’t result in pregnancy. The fertilized egg must reach the uterine cavity to implant and continue. Even though she is a healthy 28-year-old woman, she says it only happens naturally in about 25% of her cases.
When it comes to IVF, she says that once eggs are fertilized in the lab, only about 55% of embryos reach the blastocyst stage. And that’s the best IVF clinic. Feinberg said the Alabama Supreme Court’s decision raises the risk that doctors could be charged with wrongful death for embryos lost at any point in the process. .
“By definition, 45% of all embryos grown in the laboratory are ‘dead,’” she says. “And now there’s a wrongful death charge. As a reproductive professional, that idea is scary.”,Feinberg says. “Who would want to take that risk?”
More than 97,000 infants were born in the United States in 2021 after more than 400,000 cycles of assisted reproductive technology (ART), according to data collected by the Centers for Disease Control and Prevention.
3. IVF can be used to avoid genetic diseases. It is also available to same-sex couples who want to have children.
Some patients choose to have their embryos genetically tested before implantation. For example, older patients may choose testing because the risk of chromosomal abnormalities in the embryo increases with age. And parents who may have a genetic condition they don’t want to pass on may also choose to get tested, Feinberg says. His test, known as PGD-IVF, which stands for “preimplantation genetic diagnosis,” can help people avoid serious illnesses such as Tay-Sachs disease and other diseases.
Waiting for those results before transferring the embryos can add weeks to the IVF cycle, she says.
Same-sex couples may also use IVF, surrogacy, and other ART procedures and treatments to have children.
4. Surplus frozen embryos reduce the cost and risk of IVF.
“Our ability to freeze embryos has revolutionized the way we care for infertile patients,” Feinberg says.
First, multiple eggs can be collected, fertilized, and frozen for future use during a single ovarian stimulation cycle, helping to reduce health risks for patients. This, she says, moved her toward transferring her one embryo at a time, reducing the risks associated with twin or triplet pregnancies.
She says freezing the embryos before implanting them in the uterus also essentially eliminated the risk of ovarian hyperstimulation syndrome. OHSS is a potentially life-threatening reaction to fertility drugs that can cause fluid to build up in a woman’s abdomen and increase the risk of blood clots entering the lungs.
Freezing the embryo increases the chance of success. Many patients do not have success with IVF after one cycle. Having multiple frozen embryos makes it economically viable for couples to try again for a successful transfer, she says, since most of the cost of IVF is in the ovarian stimulation and egg retrieval process.
“From a cost-effectiveness standpoint, you should obtain multiple embryos so that you don’t have to repeat multiple egg retrieval cycles,” she says.
This is important because IVF is very expensive. The cost of a typical IVF cycle can range from $12,000 to $24,000, depending on where you go, Feinberg said. And that doesn’t include the cost of the drug, which can cost thousands of dollars per cycle.
By comparison, frozen embryo transfers typically cost between $2,500 and $6,000 each time, she says.
A few states require employers to offer infertility coverage, but most insurance policies do not cover the cost of in vitro fertilization. Many people borrow money to realize their dream of having a child.
5. It remains unclear how the Alabama ruling will affect IVF in the state and beyond.
Mary Ziegler, a law professor at the University of California, Davis, said one question the ruling raises is: “If an embryo is a person under the law, then all embryos produced in a particular IVF cycle… The question is, “Do I have to transplant it?”
Extra frozen embryos that are not transferred to the uterus are usually saved, donated for research, or destroyed. But Ziegler said it’s not clear whether donation or destruction is still a legal option under the Alabama ruling. If that were the case, the state’s health care providers might feel the need to create just one embryo per IVF cycle, she says.
“If we weren’t allowed to produce multiple embryos per cycle, IVF would become economical for people who don’t have insurance and struggle to pay the high costs,” Ziegler told NPR. “There is a strong possibility that it will become even more unaffordable.”
Feinberg said it’s possible that health care providers could store surplus frozen embryos out of state, but the costs would rise significantly, especially if patients had to pay to store the embryos indefinitely. He says he will.
Ziegler said the ruling could have implications beyond Alabama, especially as part of a broader strategy by the anti-abortion movement to have fetuses and embryos legally recognized as people under the federal constitution. , said it could have an impact.
“The anti-abortion movement gradually realized that the more state courts that recognize fetuses and embryos as human beings in a variety of circumstances and for different reasons, the more state laws there are, the more persuasive their case becomes. “I think you can see that they’re arguing that ‘fetal sexuality is recognized under the Constitution,'” Ziegler said.
Feinberg said the ruling could also make it too expensive for donors to provide IVF, and they may have to pay more for malpractice insurance in states where embryos are considered human. He said that there is a sex.
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