University of Alabama health system pauses IVF treatments after state rules embryos are children

ByIsabel Rosales, Christina Maxouris, Meg Tirrell, Chris Youd and Maxime Tamsett, CNNWire
Thursday, February 22, 2024
Alabama Supreme Court embryo ruling legally recognizes frozen embryos as people
The Alabama Supreme Court has ruled to legally recognize frozen embryos as children.

BIRMINGHAM, Ala. -- The University of Alabama at Birmingham health system is pausing in vitro fertilization (IVF) treatment following an Alabama Supreme Court ruling that found frozen embryos are children, the health system said in a statement to CNN.

Please note: The above video is from a previous report

The decision makes UAB the first known organization in the state to confirm it is pausing the treatment.

Its announcement could be the start of what reproductive rights advocates and medical experts have been warning about for days: that the high court's decision could have devastating consequences for Alabamians seeking infertility treatments each year to build their families - and it could soon have profound impacts far beyond the state's borders.

In its unprecedented ruling, the state's Supreme Court said embryos are children - no matter if they're within or out of a uterus - and those who destroy them can be held liable for wrongful death. That decision will likely not only make the already high costs of infertility treatments substantially higher, but will likely also discourage many providers from offering them at all in the state in fear of being held liable for wrongful death, reproductive rights advocates warned.

READ MORE: Alabama Supreme Court legally recognizes frozen embryos as children

UAB said it was pausing IVF treatments while it evaluates the court's decision.

"We are saddened that this will impact our patients' attempt to have a baby through IVF, but we must evaluate the potential that our patients and our physicians could be prosecuted criminally or face punitive damages for following the standard of care for IVF treatments," its statement said.

"We want to reiterate that it is IVF treatment that is paused. Everything through egg retrieval remains in place. Egg fertilization and embryo development is paused."

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In a statement on Wednesday, Alabama's Medical Association warned other health systems will likely soon follow.

"The significance of (the court's ruling) impacts all Alabamians and will likely lead to fewer babies-children, grandchildren, nieces, nephews, and cousins-as fertility options become limited for those who want to have a family," the association said in its statement.

"IVF is oftentimes the only option for couples wanting to conceive," it added.

What the court ruling means

Though the state Supreme Court's decision - which was released Friday - does not prohibit IVF, it's the first known case in which a US court says frozen embryos are human beings, and that could have profound impacts on how the fertility industry in Alabama operates, critics warned.

They say it could send liability costs skyrocketing, making fertility treatment prices prohibitive for many families; it could discourage medical providers from performing infertility treatments in fear of being held liable each time an embryo does not turn into a successful pregnancy; and it could mean parents will now be forced to pay for lifelong storage fees of embryos they will never be allowed to discard, even if they don't want any more children.

In the sole full dissenting opinion to the decision, Alabama Supreme Court Justice Greg Cook warned of the potential consequences.

"No rational medical provider would continue to provide services for creating and maintaining frozen embryos knowing that they must continue to maintain such frozen embryos forever or risk the penalty of a Wrongful Death Act claim," Cook wrote.

The decision will also mean higher costs for people seeking fertility treatments, according to Progyny, a large fertility benefits management company.

"If doctors are now fearful about the penalties associated with offering IVF to their patients, they will instead recommend intrauterine insemination (IUI) treatments, which is a higher risk option that is less likely to result in a pregnancy - so that's an added cost on the front end for patients," Progyny Chief Medical Officer Dr. Janet Choi told CNN.

The company also said patients may now have to travel out-of-state to get the care they need as some providers may choose to leave the state - adding a new cost for those seeking fertility treatments.

'Horrifying signals of what's to come'

Reproductive rights advocates said they were "heartbroken" by the UAB announcement.

"The University of Alabama at Birmingham (UAB) health system - the largest healthcare system in the state - has been forced to make an impossible decision: pause IVF procedures for those hoping to build their families, or put their patients and doctors at risk of prosecution," said Barbara Collura, president and CEO of the patient advocacy organization RESOLVE: The National Infertility Association.

And patients who were already amid a physically and emotionally difficult medical process have had "their lives, their hopes and dreams crushed," Collura said in a statement Wednesday.

Sean Tipton, chief advocacy and policy director for the American Society for Reproductive Medicine, told CNN's "The Lead with Jake Tapper" patients in the state might get substandard care.

"There is a lot we don't know about the impact of this (state Supreme Court) decision. What we do know is that it is already leading to fewer babies and fewer grandbabies that are desperately wanted for their parents and grandparents in Alabama. UAB is the first system to stop. I don't think it's going to be the last," Tipton said.

A fertilized egg in a freezer at a fertility facility is not the same as a born child, he said.

"And I think that legal reality needs to adjust to empirical natural scientific reality," he said. "If you seek to say that a fertilized egg in a freezer is the same as a born child, you can sign patients to getting suboptimal care," he added.

Critics have also expressed concerns the ruling creates a road map that groups and legislators across the country who have previously targeted fertility treatments can now follow.

Liberty Counsel -- a nonprofit that says it works to advance "religious freedom, the sanctity of human life and the family" -- said it is using the Alabama ruling as a precedent to argue a proposed amendment in Florida aiming to protect abortion rights will take away "a protected right to life for the unborn."

Collura told CNN she worries about how other groups and legislators who have previously targeted fertility treatments could use the recent ruling as a precedent.

"This cruel ruling, and the subsequent decision by UAB's health system, are horrifying signals of what's to come across the country," she said in her Wednesday statement.

Could this go to the Supreme Court?

While the US Supreme Court does have the power to review state top court rulings, the justices in Washington, DC, do not typically take up appeals of state court rulings that don't include an interpretation of the US Constitution or federal law.

The majority ruling in this case rested solely on the justices' interpretation of state law and an amendment of Alabama's constitution.

Most likely, there's no route to the US Supreme Court for this case, said Steve Vladeck, CNN Supreme Court analyst and professor at the University of Texas School of Law.

"The US Supreme Court's ability to review state supreme court decisions is limited to decisions that turn on a question of federal law," Vladeck said. "Here, the issue is how Alabama is interpreting its own state constitution."

"There could be a case claiming that Alabama's constitution as so interpreted violates the federal Constitution, but unless I'm missing something, that's not this case," Vladeck added.

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