A year after the U.S. Supreme Court overturned Roe v. Wade — a landmark decision in U.S. abortion rights — some IVF patients worry that potential new laws could jeopardize their fertility treatment.
Some women are even considering moving their frozen embryos across state lines.
Julie Eshelman has had a long and difficult journey trying to start a family.
"My husband and I got married in 2015," she tells me.
"We naively decided to wait a year before having a baby.
"We started trying in 2016 and after six months, I said, 'This isn't working, maybe something is wrong.'"
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And so began years and years of fertility testing, treatment, three miscarriages and many tears.
Finally, in June 2021, she had a baby girl.
"We now have a beautiful, sassy little lively two-year-old girl," she says, with joy in her voice.
But when Julie and her husband tried to have a second child, things got complicated.
The US Supreme Court has just overturned the 1973 Roe v. Wade ruling, meaning women no longer have a guaranteed right to an abortion nationally.
Individual states can now ban or restrict access to abortions, and in the process of redefining the rules, some lawmakers have drafted bills that define life as beginning at fertilization.
This has raised some key questions in fertility treatment.
“If they say life begins at conception, what does that mean for an IVF embryo?” asks Julie.
During IVF, eggs are usually taken from a woman's ovaries, fertilized in a laboratory, and then tested.
Some healthy embryos are transferred into the uterus, while others are frozen for future use.
Those that are not considered good are either not used or can be destroyed.
But if life is considered to begin at the moment of fertilization, doctors and patients like Julie fear it could have consequences for the IVF process itself.
At the time of the Supreme Court decision, Julie was preparing to move to Pennsylvania because of her husband's job in the military.
She was concerned about a bill there that she fears could have implications for embryo storage and IVF.
She thought the risk was too great and decided to leave the embryos in the state of Illinois, where the Democrats are in power and where she had her last IVF cycle, until she knew the outcome of the vote in Pennsylvania.
She says the decision to wait a little longer added at least six months to her IVF process, delaying what was already a long, stressful and expensive procedure.
Next year, her family will have to move again when her husband takes over.
Julie doesn't know where they will be transferred or what the laws will be there.
She worries that the delays could affect her chances of a successful pregnancy.
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When does life begin?
Laws that define life as beginning at conception or fertilization are sometimes called "personhood laws," because the fetus or embryo is granted the rights of a person.
This year, 20 bills on the status of persons have been introduced in the US, according to the Center for Reproductive Rights.
None have been voted, but activists fear that a similar law could be adopted in the future.
Two states - Georgia and Arizona - currently have wording in their abortion bans that reproductive rights advocates say effectively establishes personhood for the fetus.
Dr. Natalie Crawford is a fertility doctor in the state of Texas, which has an almost total abortion ban.
She says many of these bills were written by people with no medical knowledge, using words like "fertilization" and "implantation," which have very specific meanings in a scientific context.
"When someone writes these words with the intention of trying to eliminate abortion, it starts to affect our ability to potentially do IVF in a safe way," she says.
"If you say that life begins at fertilization, then how can I grow an embryo in a lab or biopsy it for genetic testing, or freeze it or thaw it, or implant it in someone, or leave it frozen? "
She tells me that when Roe v. Wade was overturned, the phone at her clinic "didn't stop ringing" as worried patients tried to find out what it would mean for their treatment.
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The American Society for Reproductive Medicine says there is currently no federal state where the legal position on in vitro fertilization has changed, but it also says definitions of personhood status "have the potential to condemn or even prohibit the use of ART [assisted reproductive technology], including in vitro fertilization ."
Not everyone who advocates for the introduction of a ban on abortion wants to affect the way in vitro fertilization is carried out, but some are quite explicit that this is exactly what they want.
Jim Baksa, president of West Texas for Life, believes the medical practice of discarding non-viable embryos "is murder and should be punished as murder."
He tells me: "Life was created by God, not man." If God allows life to be created through in vitro fertilization, then it is to his credit. But creating life is not a human right."
"All laws are based on faith. And I only apply the commandment 'Thou shalt not kill' to every human being."
Jim wants Texas lawmakers to "fill in the loopholes" when it comes to IVF.
For example, he says, doctors need to make "just one or a few embryos and implant all those embryos" at once.
But Dr. Kroford objected to the approach.
"In other countries that have religion-based laws regarding IVF procedures, IVF is much less successful, and can be more risky to health and more expensive."
She says that in the best cases, the live birth rate is 65 percent, which means that it often takes multiple attempts - and multiple embryos - to achieve a successful pregnancy.
There are also safety concerns when implanting multiple embryos at once, for both the mother and the fetuses, as multiple births can lead to medical complications.
'Waiting to cross the finish line'
Kristin Dillensnyder uses her own experience of undergoing fertility treatment to coach other women through the emotional rollercoaster of IVF, a process that often takes much longer than people expect.
"It's like signing up for a five-kilometer race, only to realize you're actually running a marathon," she says.
“It takes a lot longer than you thought. There is no rest and you feel unprepared."
Some clients tell her they are considering transferring their embryos to another state, "where they are protected."
Although she doesn't know anyone who has taken that step yet, Kristin says that women are "arming themselves with information, so if, say, we switch from yellow to red danger, they'll know exactly what to do and they'll be ready."
For the national infertility association Resolve, the solution lies in changing the law at the federal level.
Its president, Barbara Kolura, is now working with lawmakers to help pass legislation that would protect IVF nationwide.
"We have a bill that was presented at the last session of Congress. It has been redone and will be proposed again soon."
She says it will protect people who need access to IVF medical care: “They cannot be prosecuted, their access cannot be denied. It also protects the medical professionals who provide that care."
Crucially, she says, this will mean that "people have rights over their sperm, eggs or embryos, and can do what they want with them to start a family".
"That's the goal."
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