Fewer IVF cycles, live births after Alabama Supreme Court’s embryo ‘personhood’ decision

Key takeaways:

• Study found that granting personhood status to embryos in Alabama was not cost-effective.
• A model showed there were fewer births, no change in adoptions and poorer quality of life.

DENVER — Modeling data suggest the decision to grant personhood status to embryos in Alabama was associated with hundreds fewer IVF cycles and live births and poorer quality of life, though there was less monetary cost to the health care system.

In February 2024, the Alabama Supreme Court issued a ruling declaring embryos created using IVF had legal personhood status and should be considered “unborn children” for purposes of civil liability under the state’s wrongful death statute. The decision led to confusion for both fertility clinic patients and providers, David M. Monroe, MD, MPH, a researcher with Oregon Health & Science University, said during a poster presentation at the ASRM Scientific Congress & Expo.

“The ruling immediately had consequences for women and providers in that state, Monroe said.

“Within 1 week, fertility clinics closed or paused their IVF practices so they could reassess their liability under the new ruling. This [decision] was eventually overruled by a state legislative action on March 6, 2024, stating that providers could not be held liable for providing IVF services if an embryo was damaged or destroyed. But it opened our eyes to an important research question: When you have that on/off switch for a policy, it opens up an opportunity for a cost-effectiveness analysis to learn what the impact of this is,” Monroe said during the presentation.

Researchers built a decision-analytic model to compare a lack of IVF accessibility due to embryonic personhood status with adequate IVF services. The researchers used a theoretical cohort of 966 people, based on the annual number of embryo transfers completed in Alabama in 2021. The model included up to three IVF cycles, defined as ovarian stimulation followed by fresh embryo transfer, to achieve pregnancy.

Researchers used national data to estimate the number of people who would travel out-of-state to obtain IVF (27.2%).

Outcomes included number of IVF cycles, adoptions, people with neither genetic offspring nor adopted children, term births, cesarean deliveries, vaginal deliveries and maternal deaths. The cost-effectiveness threshold was $100,000 per quality-adjusted life-year (QALY).

When compared with adequate IVF services, the model demonstrated that the IVF inaccessibility strategy was associated with:

• 1,285 fewer IVF cycles;
• 580 fewer term births;
• 187 fewer cesarean deliveries; and
• 396 fewer vaginal deliveries.

Additionally, the inaccessibility of IVF was associated with 589 more people with no genetic offspring or adopted children.

“This is a major outcome that we care about for our patients,” Monroe said.

The researchers reported no between-group differences in the number of people who adopted children or maternal mortality outcomes; Monroe said those findings were most likely attributable to the small cohort size.

Restricting IVF resulted in $16,794,876 less in health care costs; however, quality of life was worse annually, Monroe said. The incremental cost-effectiveness of adequate IVF services was $6,764 per QALY compared with IVF inaccessibility, suggesting restricting IVF would not be cost-effective, according to the researchers.

“A policy restricting IVF was actually cost-saving,” Monroe said. “There are fewer costs incurred by the health care system by not being able to perform IVF. IVF is expensive, pregnancy is expensive, delivery is expensive. But the quality of life was significantly reduced for those women, who are struggling with infertility and the impact of not having genetic or adopted children.”

The model also showed that 263 women would travel out-of-state for IVF, impacting their cost and quality of life, Monroe said.

“Granting personhood status to embryos in Alabama was not cost-effective, even though it was cost-saving,” Monroe said. “When looking at policies, we should address IVF access in ways that improve health.”

Reference:

• ASRM. Alabama Supreme Court rules frozen embryos are “unborn children” and admonishes IVF’s “wild west” treatment. https://www.asrm.org/news-and-events/asrm-news/legally-speaking/frozen-embryo-destruction-and--potential-travel-restrictions-for-surrogacy-arrangements2/. Accessed Oct. 22, 2024.