Alabama Supreme Court ruling halts IVF treatment at UAB

In vitro fertilization (IVF) treatment has been halted by the University of Alabama at Birmingham (UAB) following a decision from the Alabama Supreme Court that embryos created through IVF are children.¹

Takeaways

The Alabama Supreme Court's decision classifying embryos as children under the Wrongful Death Act has immediate and significant legal consequences, affecting in vitro fertilization (IVF) procedures and raising concerns about reproductive rights and healthcare practices.
The ruling has created uncertainty within the reproductive health community, with experts unsure how the law will be interpreted in future cases, leading to the suspension of IVF services at the University of Alabama at Birmingham (UAB) and potential impacts on other reproductive health services.
The halt of IVF services may have economic repercussions, including potential price increases because of staffing challenges and higher medical malpractice insurance payments, which could limit access to IVF treatment for patients and reduce insurer coverage for such procedures.
Legal experts and healthcare professionals express concerns about the broader implications of the ruling, including its potential impact on abortion rights, medical practice, and the autonomy of individuals seeking reproductive assistance.
The decision is seen as controversial, with some viewing it as based on religious doctrine not widely shared by the majority of Americans, highlighting tensions between legal, ethical, and religious viewpoints regarding reproductive rights and health care practices.

According to Hannah Echols, a UAB spokesperson, egg retrieval will still be available from UAB's Division of Reproductive Endocrinology and Infertility, but egg fertilization and embryo development will no longer be offered. This announcement is the first significant impact of the court’s decision which has led to uncertainty surrounding IVF procedures.

The Alabama Supreme Court ruling was based on a case where an individual dropped multiple frozen embryos on the floor of an unlocked storage area at a fertility clinic. According to the court, failure to secure the storage area violated the Wrongful Death Act because the embryos were considered human beings.

The Wrongful Death Act states negligence leading to an individual’s death is a civil offense.During the ruling, the Alabama Supreme Court reinforced that it considers unborn children as “children” under the Wrongful Death Act, and this applies to all unborn children regardless of location.²

An unborn child was agreed to be a genetically unique human being by all members of the court and all parties to the cases. Therefore, the ruling centered on whether unborn children not located in utero are an exception to this rule.

While the defendants stated an unborn child is not considered a “child” or “person” if located outside the womb, the plaintiffs argued that this exception would lead to discontinuity within Alabama law. The court concluded there are no exceptions to unborn children being considered “children” based on physical location, developmental stage, or other characteristics.

“The Wrongful Death of a Minor Act applies on its face to all unborn children, without limitation,” the court said. “That language resolves the only issue on appeal with respect to the plaintiffs' wrongful-death claims and renders moot their common-law negligence and wantonness claims.”

The court’s ruling has left reproductive health experts unsure how the law will be interpreted in future cases.1Assisted reproductive technology such as IVF was utilized in over 97,000 births in the United States in 2021, and over 500,000 deliveries occur using IVF globally per year.

The National Infertility Association has warned about the consequences of the court ruling. According to the organization, the UAB was "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."

Additionally, the Medical Association of Alabama has called for the Alabama Supreme Court to reconsider the ruling, stating that other health care services will likely follow UAB’s decision to halt IVF services, leading to few available reproductive assistance options.

Prices may rise if clinics struggle to staff providers or face higher payments for medical malpractice insurance.³ This may lead to less patients being able to afford IVF and less insurers willing to cover treatment.

According to Brett Davenport, MD, reproductive endocrinologist at Fertility Institute of North Alabama, the cost of insurance to protect against wrongful death lawsuits may be significant enough to prevent clinicians from practicing. Legal experts have also expressed concerns about future abortion restrictions being stricter and potentially punishing women who receive abortions.

Other clinics have already begun to halt IVF treatment.⁴ On February 24, 2024, the Center for Reproductive Medicine at Mobile Infirmary will halt its treatment programs. Mark Nix, the CEO of Infirmary Health, has cited the court's decision has the reason IVF treatment will be paused.

These announcements have led state legislators to search for a solution. A bill was proposed by Democrats in the State House declaring frozen embryos outside the uterus would not be considered unborn children. Currently, it is unlikely this case will reach the US Supreme Court.

"Reverence for life and the desire to create families are universal values shared by all cultures and religions, including individuals working in the reproductive healthcare community,” said Steven J. Ory, MD, professor of Obstetrics and Gynecology at Florida International University, and advisory board member for Contemporary OB/GYN.“In the process of creating life, either conventionally or with artificial means, there is much wastage of gametes and sperm. “

“Reproductive healthcare providers have long accepted this reality in the hopes of ultimately enhancing the chances of individuals having difficulty conceiving to have a child,” Ory added.“The decision of the Alabama Supreme Court, apparently based on a religious doctrine not shared by the majority of Americans, has effectively revoked the right of Alabama citizens to pursue safe and effective fertility care.”