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, 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. Several had 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.
- 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 is human rights counsel at the Center for Reproductive Rights, US Human Rights Program.
- 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.
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.” Between them, the 30 IVF patients that Allure spoke with earlier this year had had 65 miscarriages or chemical pregnancies (a miscarriage that happens within the first five weeks). One was hospitalized for 10 days after she says Georgia's “heartbeat bill” prevented her from getting the treatment she needed during a miscarriage. (That bill was overturned on September 30, 2024.) 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, human rights counsel at the Center for Reproductive Rights, US Human Rights Program.
One of the biggest links between abortion bans and the potential complication of access to fertility care is the push for personhood laws by pro-lifers and conservative politicians. Personhood bills aim to categorize, not just a fetus, but also embryos and fertilized eggs as persons, says Dugan who points out that this year alone 38 personhood bills were introduced or carried over from previous sessions across 21 states; Colorado, Indiana, and Iowa all introduced legislation that would define a person in their criminal code to include an embryo from the moment of fertilization. Last year, Alabama, Alaska, and Illinois had already done the same.
While these bills to include embryos under criminal codes haven’t yet passed, Dugan expects the efforts to be ongoing. If they do become law, the impact would be devastating because they affect the entirety of fertility care. One inevitability of the IVF process is the high likelihood that some embryos will not be viable, explains Dr. Escobar. During the IVF process, the ovaries are stimulated to produce eggs (something which involves extensive monitoring and hormones), eggs are retrieved, and then mixed with a viable sperm sample to create as many healthy embryos as possible.
But there are several stages of embryo growth and there are always embryos that will fail to develop. Eventually, some embryos will be transferred into a patient’s uterus, some embryos may be frozen for future use, some may be donated to research (which means they will eventually be discarded), and some embryos, for a variety of reasons—including personal preference—may be destroyed. Destruction of embryos is simply part of the process of IVF. “Treating these embryos as if they are people creates a level of legal liability that goes above and beyond what is appropriate,” says Cathryn Oakley, senior director of legal policy at the Human Rights Campaign. “This fundamental misalignment around the definition of an embryo as a person creates a really hard to understand, difficult to anticipate, and gnarly situation to navigate.”
These personhood laws would not only restrict the destruction of embryos but also open up a myriad of questions, says Cedars. These include: Would IVF doctors and embryologists be found at fault for the failure of an embryo to grow to the blastocyst stage (as occurs naturally in more than 50% of patients)? Would a miscarriage be considered involuntary homicide? What would a frozen embryo be considered? What about an embryo that doesn’t survive freezing and thawing? Or an embryo that doesn’t implant after transfer? “This personhood concept doesn’t recognize that even in nature, the best possible environment, only about 25% of fertilized eggs will make it to birth,” says Dr. Cedars. “Even in nature not all fertilized eggs become babies, and IVF will never be more efficient than nature.”
The aspect of IVF that Greely believes is most at risk of being in the pro-life crosshairs is preimplantation genetic screening (PGT or PGS), an early form of prenatal diagnosis that identifies embryos with chromosomal abnormalities that can lead to the development of conditions like Tay-Sachs, cystic fibrosis, sickle cell, and Down syndrome. That would open up even more questions, says Lora Shahine, MD, a double board-certified reproductive endocrinologist at Pacific NW Fertility in Seattle 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. Could legislators and politicians argue that biopsying embryos to test for genetic abnormalities be interpreted as harming the embryos? Will patients and clinics be able to discard embryos diagnosed with abnormalities that are not compatible with live birth or are considered significant birth defects?
The passage of personhood bills could also endanger the practice of selective reduction used to improve the health of the pregnancy and decrease the risk of early delivery for someone who conceives with high-order multiple gestation, like triplets. “If IVF treatment is altered due to embryo protections, women could be required to transfer any fertilized eggs that become embryos,” says Dr. Shahine, adding that this is something Italy already did in the 2000s when they allowed only three eggs to be fertilized at a time and mandated that all resulting embryos be transferred. Though the country’s laws have been updated since then, in 2024, Italy—despite its conservative leadership lamenting the country’s plummeting birth rates—excludes any same-sex couples and single women (unless they can prove they were in a heterosexual relationship at the time the embryos were created) from using IVF.
Limiting the number of eggs that can be fertilized would create major financial barriers. “It decreases efficiency and increases cost for fertility treatments, which are already inaccessible to many,” adds Dr. Cedars. IVF is rarely covered by insurance (fewer than half of states have legislated infertility insurance coverage) and only two states have at least some Medicaid coverage for it. “Many civilized countries cover IVF, but of course civilized countries have universal health coverage too,” adds Greely.
Beyond cost though, going through the process of IVF, undergoing the ovulation and induction process multiple times, can be extremely taxing on someone’s body. The fact is, there are countless dangers that these potential regulations, much like abortion restrictions, pose to the mother’s health. “People glamorize pregnancy, but that is not the case,” says Dr. Escobar. Banning embryo freezing (as Italy did) would also increase the multiple gestation rate which ups the risk of problems like diabetes, hypertension, and postpartum hemorrhage; the risk of maternal morbidity and mortality is greater with a multiple pregnancy than a singleton, Dr. Cedars explains. With IVF, time is also of the essence, and prolonging the process can be not only nerve-wracking for couples who have spent years trying to conceive but also hurt their chances of success. “It could put patients at higher risk of miscarriage and impact those who are doing egg retrieval for fertility preservation before cancer treatment and require immediate care,” says Dr. Bendikson.
Pregnancy and cancer care are more connected than people think. “There is no part of a younger woman’s cancer journey that potential reproductive ethics don’t end up affecting somehow,” says Divya Yerramilli, MD, a board-certified radiation oncologist at Memorial Sloan Kettering Cancer Center in New York. Cancer patients of child-bearing age must often quickly consider their fertility preservation options after their diagnosis, freezing eggs or embryos. And a number of cancers, like breast and cervical, can be hormone-receptive and may be affected by pregnancy. Patients who receive a cancer diagnosis while pregnant or while trying to conceive with IVF are faced with the decision to do lifesaving treatment that will compromise the fetus or continue their pregnancy journey and contend with higher risks of the cancer coming back, not being curable, or shortening their life. “If I as a cancer doctor make a decision to treat someone’s cancer and that treatment terminates somebody’s pregnancy, am I then held responsible for murder?” posits Dr. Yerramilli.
The phrasing baked into these laws about a threat to the life of the mother is also problematic. “It’s not imminent that a patient is going to immediately die of their breast cancer, but [delaying treatment because of pregnancy] certainly compromises their outcome and it’s not standard of care,” says Dr. Yerramilli. “To mandate that people take a nonstandard of care approach to cancer treatment is ridiculous and flies in the face of evidence-based medicine.”
Fertility and ob-gyn doctors and providers face their own set of roadblocks. In Texas, Dr. Escobar has struggled post-Dobbs because of a lack of access to essential drugs like misoprostol, which is administered for miscarriages and to soften the cervix pre-surgery, and methotrexate, prescribed for ectopic pregnancies to stop cells from growing and end the pregnancy. In May, Louisiana governor Jeff Landry signed a bill reclassifying mifepristone and misoprostol (commonly used in tandem for medication abortions) as schedule IV controlled substances, and doctors there are panicked about not being able to access a lifesaving medication like misoprostol used regularly for postpartum hemorrhages.
A recent paper published in The American Journal of Bioethics by researchers at the Mayo Clinic and the University of Florida and University of Cincinnati Colleges of Medicine, found that the political fixation on the detection of fetal cardiac activity (as was the case with Zurawski, and one of the subjects in Allure’s recent IVF coverage) is reductive and dangerous because it often supersedes the consideration of the pregnant person. “It not only fails to include the pregnant individual in pregnancy management discussions, but falsely equates the presence of fetal cardiac activity with the birth of a healthy baby,” the authors wrote.
Increasingly, in addition to trying to provide adequate care for their patients, doctors are having to navigate the nuances of unclearly written legislation and consider the legal implications of the medical decisions they make. “Physicians in a lot of restricted states are being compromised when they’re not able to discuss abortion, which is a part of normal health care,” says Dr. Cedars. “To restrict a full and honest discussion of reproductive options is really the antithesis of everything we’re taught as doctors to do.”
This politicization of care and the potential ethical challenges it creates is dissuading doctors from pursuing careers in reproductive health care altogether. In the year following Dobbs, applications to ob-gyn residency programs in states that banned abortion decreased by 10%. As stated in the same paper from The American Journal of Bioethics: “Restrictive political contexts and imparting greater responsibilities on individual physicians to uphold patient rights may contribute to declining willingness to train and practice in these fields, which could contribute to worsening existing maternity care deserts and endangering all pregnancies.” Dr. Yerramilli says even cancer doctors like herself are afraid to practice in states with super-restrictive abortion laws. “It means that states that already have poor access to health care are being drained of the resources of health-care providers,” she adds. Another longer-standing issue within the medical community is the US’s restrictions on embryo research which date back to the 1980s. Greely points out that the federal government has banned federal funding for any research that creates human embryos for the purposes of research or destroys them or puts them at risk (unless it’s intended to help that particular embryo) since 1995 when a rider called the Dickey-Wicker Amendment was introduced. It has to get repassed every year and for nearly three decades it has—at a great loss to the advancement of IVF research and technology.
In this election year, women stand to lose so much more. Democrats, led by Senator Tammy Duckworth (D-IL)—who used IVF to have her two children while in office—have been pushing for passage of the Right to IVF bill (which includes the previously introduced Access to Family Building Act). The bill would codify access to IVF, protect health-care providers, and also require employer-sponsored health insurance plans to cover treatments. In June and then again in September, it was voted down—all Senate Republicans, minus two, were against it. Republican senators (and staunch pro-lifers) Ted Cruz (R-TX) and Katie Britt (R-AL) introduced their version of an IVF bill that, in their words, “affirms both life and liberty.” That bill claimed to protect access to IVF and would deny Medicaid funding to states who banned the fertility technology—which the American Society for Reproductive Medicine (ASRM) quickly pointed out would “only punish vulnerable patients and do little to protect fertility care.” But the bill’s oblique language didn’t mention anything about the potential legal consequences associated with the discarding or storage of embryos, and stated that nothing can block states from “implementing health and safety standards regarding the practice of in vitro fertilization,” as reported in a column by Michael Hiltzik in The Los Angeles Times. It was blocked by Democrats who felt it didn’t go far enough to protect IVF and, in fact, allows states to restrict the treatment in various ways.
Despite a very vocal conservative minority, IVF has plenty of public support—it’s no surprise that as American voters get closer to the ballot box, Trump has quickly made an abrupt campaign trail about-face on the topic of reproductive freedoms. The drastic Alabama ruling this year was met by an immediate public outcry; within three weeks, it was reversed by one of the most conservative legislatures in the country. The Southern Baptist Convention took a position against IVF, and more specifically the destruction of embryos this year, but again it likely doesn’t reflect the feelings of their parishioners. Greely mentions that Southern Baptists are technically against divorce too, but they have high divorce rates. The same goes for the Roman Catholic Church, whose leadership has been vocal about its disapproval of IVF. “It’s nice that the old men in the Vatican think this way, but very few American Catholics follow the church’s teachings on sex and reproduction,” says Greely.
At the Democratic National Convention, protecting IVF came up again and again in speeches, most notably by vice presidential nominee Tim Walz, who credits fertility treatments for helping to build his own family. The enthusiastic DNC audience response is reflected in wider polls: A February 2024 Axios-Ipsos poll found that two-thirds of Americans oppose designating frozen IVF embryos as children and a Mary 2024 Pew Research Center survey stated that 7 in 10 adults support access to IVF.
Much like with IVF, polls show widespread support for abortion. “Whenever American voters have been presented with a choice at the ballot box, they support more access to reproductive medical treatments every single time and that’s why Republicans work so hard to keep these measures off the ballot because they think they’re going to lose,” says Sean Tipton, chief advocacy and policy officer for the American Society for Reproductive Medicine (ASRM). At press time, there are, says Tipton, a number of states with ballot measures around abortion. ASRM is focusing its energy on the states among the ones that already have active restrictions on women's reproductive autonomy, like Florida and South Dakota.
In the US, women’s bodies are more regulated than guns, so this election feels existential. “If we want to continue to live in a world where we have agency over what’s happening in our bodies, at the ballot box there’s only one ticket that supports that,” says Oakley at the Human Rights Campaign. And while many of the most drastic limits on women’s reproductive freedom are happening at a state level, everyone, no matter what their zip code, should be worried. “A Republican president and legislature could affect federal law, so all women should be concerned about access to the full spectrum of reproductive health,” says Dr. Cedars. Reproductive choice is an issue that will define this election: The choice not to parent is as valuable as the choice to parent. Says Dr. Bendikson: “The path to parenthood is a personal decision that should be made by families, not politicians.”
Make your plan to vote at weall.vote/allure.
Read more stories about reproductive healthcare.
- 30 Women Share Unspoken Realities of IVF
- 27 IUD Experiences That Prove We Need Better Birth Control Now
- 26 Women Get Real About Freezing Their Eggs
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