A “Silent Holocaust”: The Real Victims of Alabama’s IVF Court Ruling

In the ever-changing environment of the reproductive healthcare system, American legislation faces unprecedented cases without clearly defined solutions. In the past few weeks, Alabama has faced a new challenge: determining the personhood of an extrauterine embryo.

In Vitro Fertilization

In vitro fertilization (IVF) is a fairly new medical practice that was developed in the mid-20th century. Typically, IVF is a main option for those with fertility issues. The way this procedure works is by removing eggs from the patient’s ovaries and then fertilizing them with sperm in a laboratory. The developing embryo is then transferred back into the uterus to complete the impregnation. These embryos are impossible to see by the naked human eye as they are only eight cells large. 

The standard IVF protocol includes extracting as many viable eggs as possible in order to assure a successful fertilization and pregnancy. Only the embryos with the highest development potential will be implanted back into the patient, while the rest are stored in cryo-preservation. Thus, there are over 1.5 million frozen embryos across the United States (U.S.) as of 2024.^[3]

The quantity of frozen embryos can be attributed to the large proportion of women that seek out IVF. The Pew Research Center surveyed women ages 15-44 in the US and found that 1 in 10 participants received some form of fertility service from 2017 to 2019. Additionally, research by the Center of Disease Control found that 91,906 births in the U.S. utilized assisted reproductive technology, including IVF in 2021. Out of that population, 1,219 of those procedures were performed in Alabama. ^[1]

Le Page v. Center for Reproductive Medicine

In December 2020, multiple embryos belonging to three different couples pursuing in vitro fertilization were accidentally destroyed in a fertility clinic. A patient had entered the cryo-preservation unit and burnt their hand from the sub-freezing temperature, causing them to drop the embryos on the floor.^[3] The first attempt at legal justice from the couples were shut down, so the trial was appealed to reach the Alabama Supreme Court. 

The Alabama Supreme Court determined three charges to this case: negligence, wanton endangerment, and the Wrongful Death of a Minor Act. This act was introduced to Alabama legislature in 1872, nearly a century before the first IVF procedure.^[3] Despite being applied to intrauterine embryos in the past, Le Page v. Center for Reproductive Medicine is the first case that takes extrauterine embryos into consideration. 

Many Alabama lawmakers are concerned by the amount of embryos that are intentionally discarded or indefinitely preserved. The court justices referenced anti-abortion language found directly from a 2018 amendment to the Alabama constitution.^[4] Chief Justice Tom Parker bases his stance on religion instead, believing that embryos are an image of God and “cannot be destroyed without effacing his glory”.^[1] Representative Ernie Yarbrough boldly claimed that the destruction of frozen embryos across the U.S. is a “silent holocaust”, comparing a genocide to a medical practice on eight-cells.^[2] Yarbrough also unsuccessfully proposed an amendment to prohibit the intentional discarding of embryos. 

The Resulting Disruption of IVF Treatment

In fear of the Alabama Supreme Court Ruling, multiple providers shut down their IVF services to protect their physicians and patients from criminal prosecution. Out of the seven available clinics in Alabama, three of them halted IVF treatment within a week from the ruling.^[2] One of these clinics is the University of Alabama at Birmingham (UAB) Health System. UAB is the largest hospital in the state, and a main resource for those seeking fertility treatment. 

Despite the court ruling, UAB continued to perform egg retrievals for IVF since at that point the egg is still unfertilized and is not considered an embryo. However, the health system put a pause on sperm fertilization, embryo development, and uterine implantation which are essential steps in continuing IVF treatment.^[1]  Thus, patients who were scheduled for embryonic transfer were forced to cancel their appointments due to the risk of criminal charges if embryos become damaged, destroyed, or unsuccessfully transferred. 

Similarly, hesitancy to pursue pre-implantation genetic testing has risen after the court ruling. Approximately 50% of all IVF treatments involve embryonic genetic testing in a laboratory.^[3] This procedure screens for mutations that indicate certain diseases or conditions in the embryo. 

In addition to the decline of fertility treatment accessibility, the court ruling also caused emotional consequences. Many patients who were mid-treatment at the time of the ruling felt devastated upon discovering they may never bear a child. LeeLee Ray, an IVF patient, had undergone eight miscarriages, a failed ectopic pregnancy, and many surgeries before finding a surrogate. When told that her embryos could not be transferred, she felt as if she lost the “light at the end of the tunnel”.^[4] This feeling describes the pain of many IVF patient populations, those with fertility issues, uterine or fallopian damage, male-factor infertility, and queer couples. 

The unstable state of reproductive healthcare is a burden on both physical and mental health. It is a prime example of human rights and healthcare becoming a matter of politics and religion. With political polarization in America, opposing sides will narrow their perspectives in order to create a strong, yet extreme, belief. In this case, the concept of reproductive healthcare has been reduced to an eight-cell genocide. 

References

[1] Betts, A. (2024, Feb 21,). After ruling, university of alabama at birmingham health system pauses I.V.F. procedures. The New York Times, Retrieved from https://www.nytimes.com /2024/02/21/us/university-alabama-birmingham-ivf-embryo-ruling.html

[2] Quinn, M. (2024). Alabama legislature approves bills to protect IVF after state supreme court ruling. CBS News, Retrieved from https://www.cbsnews.com/news/alabama-ivf-bill-house-to- protect-ivf/

[3] Sharfstein, J. (2024). The alabama supreme court’s ruling on frozen embryos. Retrieved Mar 3, 2024 from https://publichealth.jhu.edu/2024/the-alabama-supreme-courts-ruling-on-frozen- embryos[4] The Associated Press. (2024). Alabama legislature moves to protect IVF services after state court ruling. NPR, Retrieved from https://www.npr.org/2024/02/29/1235023057/alabama-ivf- bill-passes