IVF After the Alabama Supreme Court's Frozen Embryo Ruling

The case began with an accident in a hospital in Mobile, Alabama, in December 2020. According to the court record, a patient wandered into the area where a fertility clinic kept embryos frozen in a tank of liquid nitrogen, reached in, and picked some up. The cold burned the person's hand. The embryos fell to the floor and were destroyed. Three couples whose embryos were lost sued the clinic and the hospital. The question they put to the courts sounded technical: could they bring a claim under Alabama's Wrongful Death of a Minor Act? On February 16, 2024, the Alabama Supreme Court said yes. Frozen embryos, it held, are children under that law. Within days, some of the state's largest fertility providers stopped transferring embryos, and couples who had spent years and savings on treatment found their next appointment cancelled.

In short: In February 2024 Alabama's Supreme Court held that frozen embryos are children under the state's wrongful-death law, and several IVF clinics paused treatment over fear of liability. The legislature passed an immunity law within weeks so clinics could reopen, but it left the court's reasoning about embryos in place, and the wider question of fetal personhood remains open in Alabama and beyond.

What the court actually held

The decision, LePage v. Center for Reproductive Medicine, turned on a nineteenth-century statute and an amendment Alabama voters added to the state constitution in 2018. The old statute lets parents sue for the wrongful death of a minor child. Alabama courts had earlier read it to cover a fetus at any stage of development, inside the womb. The question was whether it also covered an embryo outside the womb, frozen in a lab.

The majority said the statute made no distinction based on location and that the word "child" covered all unborn children without exception. It pointed to the 2018 amendment, which declared it the public policy of the state to recognize and support "the sanctity of unborn life and the rights of unborn children." Chief Justice Tom Parker wrote a separate concurrence that drew heavily on scripture and theology, describing human life as made in the image of God and arguing that destroying an embryo offends that image. That concurrence drew national attention, partly because it made explicit what the majority's reasoning implied.

One dissent warned of exactly what followed. If embryos are children for wrongful-death purposes, every IVF clinic that freezes, tests, stores or discards embryos faces potential liability every time one does not survive. And in IVF, embryos often do not survive. That is not a failure of the process; it is part of how the process works.

Why IVF and personhood collide

In vitro fertilization usually involves stimulating the ovaries to produce several eggs, fertilizing them in a lab, and growing the resulting embryos for a few days. Some develop normally; many stop growing. Doctors typically transfer one embryo at a time to reduce the risks of twins and triplets, and freeze the rest for later attempts. Many patients also have embryos tested for genetic conditions, and embryos found unlikely to result in a healthy pregnancy are usually not transferred. Over time, some patients finish building their families with embryos still in storage, and must decide whether to keep paying to store them, donate them, or let them be discarded.

Each of those steps is routine medicine. Under a rule that a frozen embryo is a child in the same legal sense as a toddler, each becomes a potential lawsuit or worse. That is why the University of Alabama at Birmingham's health system paused IVF treatments soon after the ruling, as did other providers in the state. The pause was not a political statement. It was a liability calculation made by lawyers and doctors who could read the opinion.

IVF is not a niche service. According to federal data, assisted reproductive technology accounts for roughly 2 percent of births in the United States. In real terms that means tens of thousands of babies a year, born to families who in many cases spent tens of thousands of dollars to have them. A ruling that threatened IVF threatened some of the most deliberate, longed-for pregnancies in the country.

The quick fix and what it left out

The political reaction was swift and, at first, bipartisan in tone. Republican leaders across the country, many of whom had celebrated the end of Roe, said they supported IVF. In Alabama, the legislature passed a bill granting civil and criminal immunity to providers and recipients of IVF services for the death of or damage to embryos, and Governor Kay Ivey signed it on March 6, 2024. Clinics resumed treatment within days.

The fix was narrow by design. It did not say that embryos are not children. It did not overrule the court's interpretation of the wrongful-death statute. It simply shielded the people involved from liability. Lawmakers who might have preferred a broader repair said, fairly, that clinics needed to reopen immediately and that the deeper question would take longer. But the deeper question is precisely the one that matters for every other state. A court reasoning that unborn life at any stage is a legal person, entitled to protection under general laws, can apply that reasoning to more than wrongful-death cases. Statutes about child endangerment, inheritance, or custody could all be read the same way. Immunity laws are a patch over a crack in the foundation.

The strongest case on the other side

Many people who supported the Alabama ruling hold a sincere, consistent view: that human life begins at conception, and that the law should protect it regardless of where an embryo happens to be. For them, the moral status of a frozen embryo is the same as that of an embryo in the womb. They argue that the IVF industry has grown with little regulation, that the United States lets clinics create and discard embryos far more freely than some other countries do, and that a society serious about life should ask hard questions about that.

Those are real arguments, and some people who hold them have proposed alternatives, such as creating fewer embryos per cycle or encouraging embryo adoption. Here is where I think the argument fails as public policy. Personhood laws do not settle the moral question by persuading anyone; they settle it by turning medicine into a minefield. Families who use IVF overwhelmingly do so to have children. A legal regime that treats their doctors as potential defendants every time an embryo fails to grow will not make IVF more careful. It will make it less available, more expensive, and more likely to move to states or countries where it is legal. People of different faiths, and of none, have different answers to when personhood begins. A pluralistic country lets families make that call with their own doctors and their own consciences.

Washington's response so far

In Congress, Senate Democrats brought a bill establishing a federal right to IVF and other fertility treatment to the floor twice in 2024. Both times it fell short of the votes needed to advance, with most Republicans opposed. Some Republican senators argued the bill went too far and offered their own narrower proposals focused on protecting IVF access from state bans, which in turn did not pass.

In February 2025, President Trump signed an executive order directing his administration to produce recommendations on protecting IVF access and reducing its costs. The administration has since announced steps on fertility drug prices and employer benefits. Whether those steps make a large difference to what patients pay is something to watch rather than assume. Meanwhile, the underlying legal question, whether state constitutions and statutes treat embryos as persons, remains a matter for state courts and legislatures. The federal government has not settled it, and under current Supreme Court precedent, states largely decide it.

Who gets to build a family

There is a fairness dimension that often goes unmentioned. IVF is expensive, and most of the cost is paid out of pocket. A minority of states require insurers to cover fertility treatment, and coverage varies widely in those that do. That means access already depends heavily on income, employer and geography. For same-sex couples and single people who want children, assisted reproduction is often the main route to parenthood, and they face extra hurdles in coverage rules written around heterosexual infertility.

A legal climate that makes IVF riskier for clinics compounds those inequalities. Clinics in states with uncertain law may close, consolidate, or raise prices to cover legal costs. Families with money will travel. Families without it will wait, or give up. The people most affected are often ones politicians of both parties claim to champion: young married couples, military families, people trying to start a family later after school and work.

Personhood at the ballot box

The idea behind the Alabama ruling did not originate there. For decades, some anti-abortion activists have pushed what are called personhood measures: proposals to define a fertilized egg as a legal person from the moment of conception. Their supporters see them as the logical end point of the pro-life position. Their opponents, including some people who oppose abortion, have warned that such measures could threaten IVF, some forms of contraception and the treatment of miscarriage and ectopic pregnancy.

Voters have generally rejected personhood when asked directly. Colorado voters turned down personhood amendments three times, in 2008, 2010 and 2014. In 2011, Mississippi, one of the most conservative states in the country, rejected a personhood amendment at the ballot box. North Dakota voters rejected one in 2014. Those results matter because they suggest that, when the practical consequences are spelled out, many voters who describe themselves as pro-life are uneasy with treating embryos as full legal persons.

Alabama's 2018 amendment was different in form. It did not declare embryos persons outright; it stated a public policy of protecting unborn life. Few voters at the time likely imagined that it would be cited, six years later, in a case about frozen embryos. That is a lesson about how general language in a constitution can be put to specific uses later, by courts reading it in ways its supporters never debated in public.

For patients, the practical questions are immediate. People with embryos in storage want to know whether they can move them to another state, whether they can choose to donate or discard them, and whether a clinic will keep them if the law changes again. Some Alabama patients looked into moving embryos out of state in the weeks after the ruling. Those are not abstract choices; they involve contracts, fees and, for many families, deep emotion. A legal regime that leaves them uncertain imposes real costs even when no lawsuit is ever filed.

What the scare did to doctors and patients

Even after the immunity law, the episode left marks. Fertility specialists are a small group, and the doctors who train them choose where to practise with care. A state where a court ruling can halt treatment overnight is a harder sell to a young physician deciding where to build a career, and to the embryologists and nurses who run a lab. Clinic owners must also weigh insurance: malpractice carriers price risk, and legal uncertainty is a kind of risk that is hard to price.

Patients felt it differently. Couples who were in the middle of a cycle when the clinics paused described the shock of having a transfer cancelled after weeks of injections and appointments. Some had embryos created years earlier and suddenly worried about what would happen to them. Others, still deciding whether to start IVF at all, chose to wait or to seek care in another state. The fix came quickly enough that many cycles resumed, but the sense that the ground could shift again did not fully go away.

There is a political lesson here too. The public reaction to the Alabama ruling was overwhelming, and it came from people across the spectrum, many of them families who had never thought of themselves as activists. Lawmakers responded within weeks. Few policy fights move that fast. When ordinary people see a direct threat to something they value, and say so loudly, the system can still respond.

What you can do

Fertility decisions are personal medical choices; for questions about your own treatment, talk with your doctor and check your state health department.

1. Ask where your lawmakers stand on embryo personhood, not just on IVF. Many will say they support IVF; fewer will say whether they would protect it from personhood rulings. Use the representatives finder to get your legislators' phone numbers and contact forms and ask both questions.
2. Find the groups doing this work locally. The organizations directory lists health, LGBTQ+ and legal aid nonprofits in every state; some help families with fertility coverage and legal questions.
3. Track the federal side. When agencies propose rules on insurance coverage or drug pricing, those proposals open for public input on the public comment page, with tips on how to write a comment that counts.
4. Keep up with the bigger picture. The reproductive rights page follows personhood measures, state court rulings and ballot questions as they develop.
5. Share stories with permission. If you or someone close to you built a family through IVF and is willing to talk about it, those stories have moved legislators of both parties. They are the reason Alabama acted within weeks.

The Alabama ruling showed how quickly a legal theory can reach into a doctor's office and a family's plans. The quick fix showed that public pressure works. The open question is whether that pressure will be used to patch one crack at a time, or to settle the foundation.