States must protect IVF

Opinion editor’s note: Star Tribune Opinion publishes a mix of national and local commentaries online and in print each day. To contribute, click here.

•••

Belatedly, Alabama lawmakers have passed a bill protecting access to in vitro fertilization (IVF). The measure came two weeks after the state Supreme Court ruled that frozen embryos should be considered unborn children under the law. Three fertility clinics had suspended treatments, citing liability concerns. Would-be parents were caught in limbo.

The court decision, disruptive as it was, stemmed from a tragic case: In 2020, the embryos of three families seeking IVF were accidentally destroyed by a patient who had wandered into an unsecured storage area. The families sued the fertility center under the state’s Wrongful Death of a Minor Act and won on appeal.

The new law, which passed almost unanimously, doesn’t reverse that ruling. Rather, by protecting doctors and patients from civil and criminal liability, it allows IVF treatments to continue.

Swift bipartisan legislation on such a divisive issue is encouraging. Yet Alabama’s work is far from complete: The law expires next year, and it fails to reckon with the larger question of whether IVF can be consistent with the idea that life begins at conception, a position established by law in Alabama and other states. A legal framework that provides more clarity is necessary.

IVF treatment began in the 1970s and has resulted in hundreds of thousands of births in the U.S. It requires a combination of medication and surgery to extract eggs from a woman’s body, which are then fertilized with sperm in a lab. The fertilized egg becomes a pregnancy when it attaches to the walls of a uterus.

IVF success rates are unpredictable. To improve their chances, many patients go through multiple rounds of invasive and at times painful treatment to retrieve as many eggs as possible. Unused embryos are frozen for future use. With the cost of each round of treatment exceeding $15,000, IVF is often a last resort for people who struggle to conceive. It’s also sought by patients with serious medical conditions that could imperil the mother or fetus.

The procedure isn’t without ethical challenges. Opinions vary about what’s to be done with unused embryos, which in the U.S. number about 1.5 million. Some are donated to other parents or scientific research; others are kept frozen in storage and still others are discarded. That has led to opposition by some who believe life begins at conception, despite support for fertility treatment more broadly.

Ballot measures to establish fetal personhood have been repeatedly rejected, and voters overwhelmingly support IVF. More than a dozen states nonetheless have enacted or introduced legislation granting legal rights to fertilized embryos, which could affect access to IVF treatment.

Legislators in these states must work together to set reasonable terms. They should start by making protections from legal liability permanent. They should also consider expanding insurance coverage to include IVF, which is strictly limited in Alabama. Doing so could help limit the number of unused embryos by lowering the out-of-pocket cost for each treatment and dampening the incentive to retrieve many more embryos than a patient could reasonably implant. Germany, for example, caps treatments to three embryos per cycle; this works in part because its health system is more generous. Better oversight of IVF clinics, including stricter security and storage requirements, could prevent lapses like the one in Alabama.

IVF is a critical fertility treatment, and protecting it will require bipartisanship. Ideally, Congress would codify protections for it nationwide. For now, Alabama’s lawmakers have taken an important step forward. For the good of patients across the nation desperate to conceive, such pragmatism must continue to prevail.