Thirty-seven-year-old Corinn O’Brien is about 2 months pregnant through in vitro fertilization (IVF), but an ultrasound recently showed the fetus might be in trouble, and she wants the option to try again if she needs to.
Cancer survivor Kailani Greenwood, PA-C, due to give birth in spring after undergoing IVF, hopes to have more children in the future and has four frozen embryos in storage.
But the Alabama women who represent two groups most likely to turn to IVF to build the families they desperately want — women over 35 and those with serious diseases — worry about whether those options will be there when they need them. O’Brien and Greenwood are among the many whose dreams are in limbo after three of Alabama’s largest clinics paused IVF services in the wake of a state Supreme Court ruling that described frozen embryos as “extrauterine children.”
“It’s been hard,” O’Brien said, her voice breaking. “I have no idea what will happen next, and that’s really scary.”
An estimated one in six people are affected by infertility worldwide. In the U.S., women increasingly delay motherhood even though fertility gradually declines after age 30, particularly after 35. That raises the need for treatments like IVF. Women 35 to 44 are more than twice as likely as younger women to say they’ve used fertility services, according to a 2023 Pew Research Center survey.
Besides the growing ranks of older patients, doctors point to a smaller but significant number of women facing treatment for conditions such as cancer, lupus, and sickle cell disease who want to preserve their fertility.
In Alabama, doctors say many of these women are in a holding pattern or seeking help outside the state. Some are also pushing for a legislative solution; committees in the state House and Senate advanced legislation that would shield clinics from prosecution and civil lawsuits. Lawmakers hope to get the measures to the governor this week.
But some doctors and patients worry they won’t go far enough — and that legislation or court rulings in other states could eventually put IVF at risk more broadly.
Beth Malizia, MD, Greenwood’s doctor at Alabama Fertility, a clinic that paused services, said the upheaval has made life even tougher for women who are already struggling.
“Look, nobody wants to be in our clinic. … No one chooses fertility issues. No one chooses cancer. No one chooses recurrent pregnancy loss,” she said. “We’re trying to provide the best care that we can, and this decision has really limited us in our ability to do that. We just want to grow families.”
Dreams Interrupted
After losing her mother to pancreatic cancer and having no brothers or sisters to turn to, O’Brien realized how important it was for her young daughter “to have a sibling, to navigate life with after we’re gone.”
The Birmingham woman and her husband had tried for a baby for a few years, and she suffered through a dangerous, nonviable ectopic pregnancy. She tried various fertility treatments before starting IVF. Ten eggs were retrieved in October, and three were fertilized and frozen. Her doctor transferred one of the embryos into her womb in late January and she became pregnant.
But the same day the court ruling came down, an ultrasound showed problems with the fetal heartbeat.
“It was kind of a double punch — like, this might not work and you might not have access to IVF,” she said.
For Greenwood, IVF is the only way she can have children.
The 31-year-old Montgomery woman was diagnosed with Hodgkin’s lymphoma 11 years ago. She went into remission after chemotherapy, but the cancer returned when she was 25. The ensuing radiation, chemotherapy, and stem cell transplant led to infertility. So she had her eggs harvested and frozen.
Being a mom “is something I’ve always dreamed about my whole life,” she said.
Last year, Greenwood became pregnant with her little girl through an embryo transfer and is now in her third trimester. She doesn’t want to stop at one child, though. “I definitely want at least two, if not more,” she said.
She’s been trying to stay hopeful that IVF will resume at her clinic. But each day brings fresh reminders of the court decision in her job as a physician assistant in surgical breast oncology, where many of her patients hope to preserve their fertility.
Deepened Grief
Kara Goldman, MD, medical director of fertility preservation at Northwestern Medicine in Chicago, said older patients and those with serious diseases face different challenges.
Patients with cancer, for example, urgently need cancer treatment. This means they must begin taking medications to get ready for egg retrieval almost immediately. They can choose to freeze their eggs or fertilize them and freeze embryos — which have a greater likelihood of surviving the thaw later.
Older patients face a decreasing likelihood of pregnancy and an increasing chance of chromosomal abnormalities in their offspring the longer they wait. The time it can take to get pregnant often exacts an emotional toll.
“When you are ready to have a child, every month that you’re not pregnant feels like grief,” said Goldman, 41, who had her 9-month-old son through IVF.
Doctors said the turmoil in Alabama has deepened that grief for many.
Mamie McLean, MD, O’Brien’s doctor, said a patient in her 40s who desperately wants a second child had an unsuccessful IVF cycle and wanted to begin the process again this month. She’s considering doing that in Georgia.
“She would much prefer to stay in Alabama,” McLean said. “But she also knows that time isn’t on her side.”
Jennifer Kawwass, MD, medical director of the Emory Reproductive Center in Atlanta, said she’s already seeing an influx of Alabama patients, and many are stressed out.
“Fertility treatment already puts patients at so much social and financial stress,” she said. “The unexpected, sort of indefinite pause on IVF in Alabama is compounding this.”
Without insurance, one cycle of IVF costs about $15,000 to $25,000. Travel and lodging costs can add thousands more — especially since an IVF cycle requires six to 10 visits over 2 weeks.
As patients consider their options and push for solutions in Alabama, they and their doctors also hope that threats to IVF don’t spread to other states.
“I would hope that as a country, we can unite over the fact that these treatments are really aiming to help people grow families and bring life into this world,” Kawwass said. “It is somewhat ironic and also tragic that this is actually hurting individuals that are trying to build their families.”
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