In August 2022, when Amanda Zurawski was 18 weeks pregnant, she experienced a preterm premature rupture of membranes, a catastrophic condition that’s fatal to the fetus and can pose serious risks to the mother as well. She and her husband rushed to their local Texas hospital but, because there was still fetal cardiac activity detected, she details in a subsequent lawsuit against the state that attending doctors refused to terminate her pregnancy. Texas, following the overturn of Roe v. Wade in 2022, had banned all abortions, except to save the life of the pregnant patient or prevent serious physical impairment. Zurawski says that according to doctors, her case didn’t qualify. After her health deteriorated dramatically, doctors finally performed an abortion. Because of the delay, though, she would develop an infection, go into sepsis, and spend days in the ICU fighting for her life. Zurawski survived but the traumatic experience impacted her ability to conceive in the future (one of her fallopian tubes was permanently closed), and doctors recommended that she not try to carry a baby again. She and her husband began IVF (in vitro fertilization) intending to conceive via surrogate and created a number of frozen embryos. But she moved them out of Texas this year, terrified that the state could make its laws around IVF more restrictive.
She is not alone in her anxiety. I started reporting this story after Allure spoke to 30 IVF patients earlier this year about the unspoken realities of the treatment, and several shared concerns about how the shifting political landscape could impact laws around IVF in their respective states. When I began to spend time in the #ivfjourney corner of TikTok, I found similar worries expressed again and again.
They are worries that heightened dramatically after a February 2024 decision by Alabama’s Supreme Court that ruled frozen embryos are unborn children, meaning IVF clinics could be subject to wrongful death civil liability. Riley, a self-proclaimed “IVF girlie” in Florida who goes by @journey.to.baby.gersch on TikTok, posted an anxious video from her doctor’s office that month with the caption: “My heart is breaking for all couples who were planning to seek IVF treatment, and currently going through IVF treatment in Alabama. As if IVF isn’t emotionally and physically challenging already. Terrified of Florida following suit. We have two precious PGT normal embryos on ice waiting for transfer. Can I claim our embryos as dependents on our taxes? This is insane.”
According to Hank Greely, a professor of law at Stanford who specializes in the ethical, legal, and social implications of biomedical technologies, the Alabama decision was both odd and narrow, focusing on the damages a couple could claim if their embryos were destroyed as a result of negligence. “The headlines in the news said Alabama Supreme Court decides frozen embryos are children, which was true except they decided it only for the purposes of the Wrongful Death Act,” says Greely, citing a statute dating back over a century that pertains to a civil method of holding someone accountable.
The Alabama decision had immediate medical implications for anyone in the midst of the IVF process in the state. “It contradicts science and not only misrepresents the complexities of reproductive technology but also threatens to undermine the rights of patients and the medical ethics fundamental to our profession,” says Kristin Bendikson, MD, a double board-certified reproductive endocrinologist and ob-gyn, and the chief medical officer at Kindbody, a fertility clinic with locations nationwide. The broadly inflammatory language of the judge’s written opinion (see Chief Justice Tom Parker’s Biblical quotes and the repeated usage of the term “extra-uterine children”) threw gasoline on what should have been a small fire, says Greely. And while the extreme and misguided nature of the decision led the Alabama legislature to respond within weeks to enact statutes to protect IVF, the fact that it even happened was enough to panic many families who were in the process elsewhere. “Families all across the country fear their access to reproductive health care is at risk because of that decision and, sadly, they are not mistaken,” says Dr. Bendikson.
Meet the experts:
- Hank Greely is a professor of law at Stanford who specializes in the ethical, legal, and social implications of biomedical technologies.
- Kristin Bendikson, MD, is a double board-certified reproductive endocrinologist and chief medical officer at Kindbody, a fertility clinic with locations nationwide.
- Julian Escobar, MD, is a double board-certified ob-gyn and specialist in reproductive endocrinology whose fertility practice is in Dallas.
- Jorie Dugan, a lawyer for the Human Rights Counsel at the Center for Reproductive Rights
- Cathryn Oakley is the senior director of legal policy at the Human Rights Campaign.
- Marcelle Cedars, MD, is a double board-certified fertility specialist and reproductive endocrinologist and the director of the UCSF Center for Reproductive Health.
- Lora Shahine, MD, is a double board-certified reproductive endocrinologist at Pacific NW Fertility in Seattle, a clinical associate professor at the University of Washington in Seattle, cofounder of the nonprofit Doctors for Fertility, and host of the Baby or Bust fertility podcast.
- Divya Yerramilli, MD, is a board-certified radiation oncologist at Memorial Sloan Kettering Cancer Center in New York.
- Sean Tipton is the chief advocacy and policy officer for the American Society for Reproductive Medicine (ASRM).
Despite Donald Trump’s recent claims on the campaign trail that he fully supports IVF—and would even somehow make the expensive treatment free—few believe that women’s reproductive rights and IVF would actually be protected in a second Trump presidency. In his last term, he implemented more than 60% of the recommendations of the Heritage Foundation—the extremist architects of Project 2025—and nominated three deeply conservative Supreme Court justices pushed by the group. And as reported by the New York Times, Trump’s 2024 running mate, Senator JD Vance, wrote the introduction to a 2017 Heritage Foundation report that argued in a series of essays, among other things, against IVF access; he was also the keynote speaker at its public release in Washington, DC.
Let’s be clear: To support IVF, you must also support abortion. They cannot be siloed. “They are two sides of the same coin,” says Marcelle Cedars, MD, a double board-certified fertility specialist and reproductive endocrinologist and the director of the UCSF Center for Reproductive Health. “Reproductive care and choice is having children when you want them (IVF, if necessary) and not having them when you don’t (contraception and abortion).” It’s all interconnected and when there are attacks on one aspect of reproductive rights, there are implications for the whole spectrum of care. One social media post that went viral this summer read: “The treatment for ectopic pregnancy is abortion. The treatment for a septic uterus is abortion. The treatment for a miscarriage that your body won’t release is abortion. If you can’t get those abortions, you die.” It’s not surprising that states with the most restrictive abortion laws also have the highest maternal mortality rates.
For the pro-life movement (I will use that categorization here for the sake of clarity, though really it’s a misnomer; anti-choice is more accurate), Roe v. Wade was always the white whale. Since it was overturned in 2022 with the Dobbs decision, activists have had to direct their rhetoric elsewhere. IVF has seemingly become the movement’s new target. “Dobbs energized the pro-life movement and, looking for their next goal, it also redirected the attention of some of these groups to IVF,” says Greely. Pro-life activists and the politicians who share their views want to make health decisions for women when they have no medical training or experience. It’s chaos, says Julian Escobar, MD, a double board-certified ob-gyn and specialist in reproductive endocrinology whose fertility practice is in Dallas. “All these politicians have agendas, and things that affect my patients’ lives tremendously are soundbites for them,” says Dr. Escobar.
The post-Dobbs politicization of reproductive health care has already led to ongoing medical uncertainty and a widespread crisis of care. A recent Associated Press analysis of federal hospital investigations found that since 2022 more than 100 pregnant women in medical distress who went to emergency rooms seeking help were either refused care or treated negligently. Two women in Texas who say they were denied abortions for ectopic pregnancies (the leading cause of maternal mortality during the first trimester, it’s when a fertilized egg is growing outside the uterus and therefore cannot survive) are now filing federal complaints. The Center for Reproductive Rights notes that under current Texas law, doctors can face up to 99 years in prison for performing an illegal abortion. “They weren’t planning to stop at Roe and I think we’ll continue to see IVF be included as part of the criminalization and attacks on reproductive rights,” says Jorie Dugan, a lawyer for the Human Rights Counsel at the Center for Reproductive Rights.