In vitro fertilization, or IVF, is one of the last bastions of hope for couples unable to conceive on their own.
“IVF is really common. Infertility affects 1 in 6 people in the United States, and annually in the US alone, we perform about 400,000 cycles of in vitro fertilization,” fertility expert Dr. Eve Feinberg, an associate professor of obstetrics and gynecology at Northwestern University’s Feinberg School of Medicine, told CNN Chief Medical Correspondent Dr. Sanjay Gupta on his podcast recently.
“If you look collectively at the population of the US just over time, in the 40 years since Louise Brown was born, about 2% of the current population has been conceived with IVF,” she said of the first “test tube baby,” who was born in 1978.
But for people experiencing infertility, hope is one hill on the rollercoaster. Undergoing in vitro fertilization is extremely challenging — it is often a long, physically demanding and financially draining undertaking — and there is no guarantee of a baby at the end.
Feinberg knows this all too well. She has gone through the process multiple times. Now, there’s a new challenge for some people relying on IVF: The Alabama Supreme Court ruled that frozen embryos are children and protected under the state’s Wrongful Death of a Minor Act.
The ruling has alarmed patients, health care providers and reproductive rights advocates in the state and beyond. A number of clinics in Alabama have already paused treatment, and patients’ lives have been thrown into uncertainty.
“I think it most seriously impacts those who are most vulnerable. We have patients who want to go through IVF, who save up for years to go through it. We have patients who mortgage their houses because their desire to build their family is so profound,” said Feinberg, a practicing reproductive endocrinologist.
Alabama resident Gabrielle Goidel, 26, has had three miscarriages and was a few days away from having her eggs retrieved at an Alabama fertility clinic when the ruling came down. She and her husband have spent more than two years and $20,000 trying to get pregnant.
“It’s very scary to think how much I’ve invested into this, how close I am to the end of this procedure,” she said.
During an IVF cycle, eggs are retrieved from a patient’s body, combined with sperm in a laboratory and then transferred back into the patient’s uterus in the hopes of establishing a pregnancy. But because only some of the eggs exposed to sperm will become fertilized, and not all of those embryos will be viable, doctors give patients hormones to stimulate the ovaries to produce multiple eggs, and then fertilize them all.'
Typically, only one or two resulting embryos are transferred to the uterus at a time; the rest are frozen for later. This lowers the cost and the inconvenience of the procedure. Freezing embryos also allows patients to test them for genetic abnormalities or preserve fertility if they are undergoing certain treatments, like chemotherapy for cancer.
In a move that added more financial and emotional strain to an already stressful process, Goidel and her husband have decamped to Texas to continue their fertility journey.
“I mean, if they tell me to stop now, I genuinely don’t know what I would do. I’ve been waiting over two years to be pregnant,” she said. “There is no world where I could see me stopping this process right now.”
Feinberg was 34 when she underwent an IVF cycle and became “fairly sick” with ovarian hyperstimulation syndrome, an excessive response to the hormones used to stimulate the development of eggs in the ovaries, creating build-up of fluids in her abdomen and bad pain.
“We had transferred one embryo, and we cryopreserved the remaining nine,” she recalled. “And that one pregnancy was not growing normally.”
She said the embryo had a heartbeat, but it wasn’t measuring properly. A few weeks went by, yet Feinberg didn’t miscarry, as unviable embryos naturally do, and continuing the pregnancy was causing her “terrible” health problems.
“I elected to terminate the pregnancy. It was a highly, highly desired pregnancy after two years of infertility and three miscarriages,” she said. She later went through the procedure again and now has healthy teenage twins.
Saying embryos are babies is an “overstretch of what the science tells us,” Feinberg says.
“I like to think of it as something that has the potential to become a human life, and in most circumstances, the overwhelming majority [of embryos], depending on the age of the woman, will not actually grow to become a human.”
In general, Feinberg says, IVF typically takes a number of embryo transfers before resulting in a pregnancy. And she thinks difficult medical situations that crop up unexpectedly — but not infrequently — are better left to the doctor and patient to resolve.
The consequences of the Alabama decision are only just beginning to be felt.
“I have found, when speaking with legislators, that they don’t really understand the science,” Feinberg said. “And I think that in the Alabama case, they probably didn’t quite understand the implications of what their ruling is now going to do for those families that so desperately want children.”
Families like hers 15 years ago and Goidel’s today.
— CutC by cnn.com
