Thirty-seven-year-old Corinn O鈥橞rien is about two months pregnant through 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, 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 鈥� women over 35 and those with serious diseases 鈥� worry about whether those options will be there when they need them. O鈥橞rien and Greenwood are among the many whose dreams are in limbo after paused IVF services ruling that described frozen embryos as 鈥渆xtrauterine children.鈥�
鈥淚t鈥檚 been hard,鈥� O鈥橞rien said, her voice breaking. 鈥淚 have no idea what will happen next, and that鈥檚 really scary.鈥�
An estimated 1 in 6 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鈥檝e 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, and on Tuesday, committees in the state House and Senate advanced from prosecution and civil lawsuits. Lawmakers hope to get the measures to the governor this week.
But some doctors and patients worry they won鈥檛 go far enough 鈥� and that legislation or court rulings in other states could eventually put IVF at risk more broadly.
Dr. Beth Malizia, Greenwood鈥檚 doctor at Alabama Fertility, a clinic that paused services, said the upheaval has made life even tougher for women who are already struggling.
鈥淟ook, nobody wants to be in our clinic. 鈥� No one chooses fertility issues. No one chooses cancer. No one chooses recurrent pregnancy loss,鈥� she said. 鈥淲e鈥檙e 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.鈥�
DREAMS INTERRUPTED
After losing her mother to pancreatic cancer and having no brothers or sisters to turn to, O鈥橞rien realized how important it was for her young daughter 鈥渢o have a sibling, to navigate life with after we鈥檙e gone.鈥�
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.
鈥淚t was kind of a double punch 鈥� like, this might not work and you might not have access to IVF,鈥� she said.
For Greenwood, IVF is the only way she can have children.
The 31-year-old Montgomery woman was diagnosed with Hodgkin鈥檚 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 鈥渋s something I鈥檝e always dreamed about my whole life,鈥� she said.
Last year, Greenwood became pregnant with her little girl through an embryo transfer and is now in her third trimester. She doesn鈥檛 want to stop at one child, though. 鈥淚 definitely want at least two, if not more,鈥� she said.
She鈥檚 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.
鈥楨VERY MONTH THAT YOU鈥橰E NOT PREGNANT FEELS LIKE GRIEF鈥�
Dr. Kara Goldman, 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 鈥� 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.
鈥淲hen you are ready to have a child, every month that you鈥檙e not pregnant feels like grief,鈥� said Goldman, 41, who had her 9-month-old son through IVF.
Doctors said the turmoil in Alabama has deepened that grief for many.
Dr. Mamie McLean, O鈥橞rien鈥檚 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鈥檚 considering doing that in Georgia.
鈥淪he would much prefer to stay in Alabama,鈥� McLean said. 鈥淏ut she also knows that time isn鈥檛 on her side.鈥�
Dr. Jennifer Kawwass, medical director of the Emory Reproductive Center in Atlanta, said she鈥檚 already seeing an influx of Alabama patients, and many are stressed out.
鈥淔ertility treatment already puts patients at so much social and financial stress,鈥� she said. 鈥淭he unexpected, sort of indefinite pause on IVF in Alabama is compounding this.鈥�
Without insurance, one cycle of IVF costs about $15,000 to $25,000. Travel and lodging costs can add thousands more 鈥� especially since an IVF cycle requires six to 10 visits over two weeks.
As patients consider their options and push for solutions in Alabama, they and their doctors also hope that threats to IVF don鈥檛 spread to other states.
鈥淚 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,鈥� Kawwass said. 鈥淚t is somewhat ironic and also tragic that this is actually hurting individuals that are trying to build their families.鈥�
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Reporter Kim Chandler contributed to this report from Montgomery, Alabama.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute鈥檚 Science and Educational Media Group. The AP is solely responsible for all content.
Laura Ungar, The Associated Press
