(Bloomberg) -- Across Alabama, fertility clinics phones won’t stop ringing. The main question from patients: Can I keep doing IVF?

“It’s been a panic,” said Brett Davenport, a doctor at the Fertility Institute of North Alabama, one of the shrinking number of clinics where in vitro fertilization is still available. “There is an overwhelming fear that IVF will not be able to be performed.”

Alabama’s fertility industry is under threat in the wake of a ruling from the state Supreme Court that said frozen embryos are considered children — meaning people who destroy them could be held liable for wrongful death. The decision has left patients and providers in legal limbo, while sparking concerns that other states could impose similar standards. 

The ruling doesn’t expressly prohibit IVF. But it was enough to prompt the University of Alabama at Birmingham to pause IVF treatments, Bloomberg News first reported Wednesday. A spokesperson for the university said the school was reviewing whether its providers and patients could face criminal penalties.

Two more clinics, the Center for Reproductive Medicine at Mobile Infirmary and Alabama Fertility Specialists, have followed suit. Alabama, which has a population of more than 5 million, has only eight clinics across the state, according to data from the Centers for Disease Control and Prevention. 

IVF is often a numbers game — people fertilize as many eggs as possible in hopes that just one will result in a healthy pregnancy. Typically some of those embryos wind up with genetic abnormalities that mean they wouldn’t have a chance at success. They are usually discarded.

Storing embryos is also expensive — as much as $1,000 a year — so they are typically disposed of once people have decided they are done doing fertility treatments. Both of those cases could now amount to a criminal act. Some clinics don’t want to face what could end up being a legal nightmare.

“It is not reasonable to call the death of an embryo the death of a child,” Davenport said.

Some clinic owners say they are wading into uncharted waters by continuing to do IVF in the aftermath of the ruling. Davenport’s facility, in Huntsville, is proceeding to offer the treatment but plans to fertilize fewer eggs in order to avoid the risks associated with discarding unused embryos. 

For patients, that could mean a diminished chance of success. Usually, even if many eggs are fertilized, less than half continue growing to the stage that they could be implanted. Genetic testing also often weeds out embryos that have abnormalities. Success rates vary based on factors including a patient’s age, but in general, the higher the number of embryos, the greater the chances of a healthy pregnancy. With fewer eggs fertilized at a time, the process ultimately could result in longer timelines and higher costs, Davenport said. 

That stands to bring more strain to patients already struggling with the expense of IVF, which can cost upwards of $10,000 for a single cycle — and many people require more than one for success. Most states don’t require private insurers to offer fertility benefits and only 43% of large US employers offered IVF coverage in 2022. In Alabama, the median household income is $59,600, compared with $74,600 for the US. 

Continuing to pay for storage for embryos that aren’t needed could also place additional financial burden on patients. People are asking, “does this mean we'll have to keep our embryos forever?” Davenport said. He said his clinic is considering offering patients the option of transferring their embryos to another state to work around Alabama’s ruling. 

Read More:  All About Personhood, the Concept at the Center of Alabama Ruling on Frozen Embryos

Ten miles down the road, Huntsville Reproductive Medicine also plans to keep offering IVF while fertilizing fewer embryos.

“We're going to continue all our IVF-related practices and policies, save one, and that’s discarding embryos,” said Andrew Harper, medical director at Huntsville Reproductive Medicine, which treats about 120 patients with IVF annually.  “We had five patients in January who wanted to discard their embryos. The clinic had to call them and say, ‘that's not happening, at least for now.’”

The clinic is grappling with what to do with embryos that have been abandoned by patients as long ago as 2008. Keeping them on ice is expensive and takes up valuable freezer space; the clinic has been unable to reach patients via snail mail or phone calls. Harper said the ruling would put pressure on some patients to use leftover embryos they might have otherwise chosen to discard.

Fertility clinics in Alabama are “still in the process of understanding what it means and how they will handle it,” Sean Tipton, chief advocacy and policy officer at the American Society for Reproductive Medicine, said of the court’s decision. The ruling, he said, was “far worse than what we had anticipated.”

--With assistance from Mathieu Benhamou.

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