After three miscarriages in less than a year, Gabby Goidel said she was diagnosed with unexplained genetic infertility.
For reasons that aren't clear to doctors, any fetus she carries has a higher-than-average likelihood of genetic abnormalities, she said, so there is a slim chance she'd be able to carry a pregnancy to term without in-vitro fertilization.
To avoid the possibility of additional miscarriages, Goidel and her husband, Spencer, decided last year to pursue in vitro fertilization in their home state of Alabama.
IVF allows doctors to test embryos for genetic abnormalities, then implant only the ones that are healthy.
The Goidels were on track to freeze embryos later this month, and they planned to only store the ones that were genetically normal.
But on Friday, the Alabama Supreme Court ruled that frozen embryos created through IVF are considered children under state law, meaning that people could theoretically be sued for destroying an embryo.
The Goidels began to worry whether they might be forced to store — or even use — embryos they had intended to discard.
"Most of our embryos are not going to be genetically normal," said Goidel, a 26-year-old property manager in Auburn. "My hope would be that we could let those embryos naturally pass, but now it’s, 'Do we have to save them?' I don’t necessarily want to implant a child that I know is going to miscarry."
Roughly half of first-trimester miscarriages are due to a chromosomal abnormality in the fetus. In addition to vaginal bleeding, abdominal pain and cramping, miscarriages can increase the risk of anxiety, depression, post-traumatic stress disorder and suicide.
An uncertain future for IVF patients
In the wake of the Alabama ruling, many patients and providers are unsure of how to navigate the IVF process, given that embryos are often discarded if they have genetic abnormalities or after patients decide they will not need to use them. The decision raises questions about whether those who undergo IVF will have to store all their embryos indefinitely — but experts said the answer is not yet clear.
Storing frozen embryos can cost between $350 to $1,000 per year.
The court's decision was issued in a case in which a person removed embryos from storage at a fertility clinic and dropped them on the floor accidentally.
Gail Deady, senior staff attorney at the Center for Reproductive Rights, said that because of that, the ruling "does not appear to create criminal liability for IVF providers."
Instead, she said, "what it does implicate is the Wrongful Death Act, which is civil liability and negligence," meaning people could be sued for the destruction of embryos and have to pay monetary penalties.
Nevertheless, “anyone who cares about reproductive autonomy should be terrified of this decision,” Deady added.
Dr. Mamie McLean, a reproductive endocrinologist at Alabama Fertility, said she is concerned about the survival of IVF services in Alabama. Clinics may need to raise prices if they have trouble staffing providers or have to pay more for medical malpractice insurance, she said. As a result, fewer people may be able to afford IVF and fewer insurers may be willing to cover treatments.
The cost of insurance to defend against wrongful death lawsuits “might actually prevent us from practicing, it would be so high,” said Dr. Brett Davenport, a reproductive endocrinologist at Fertility Institute of North Alabama.
Davenport, too, worries the new law could penalize doctors for helping people start families.
