What is in vitro fertilization? A nurse explains the evolution and legality of this method

The Conversation

Since the cancellation of the Roe v. case Wade in June 2022 ended the federal right to abortion, legislative attention has expanded to other aspects of reproductive rights, including access to assisted reproductive technologies such as in vitro fertilization, or IVF, following an Alabama Supreme Court ruling in February of 2024.

Heidi Collins Fantasiaassociate professor at the University of Massachusetts Lowell and department head of the school of nursing, explains how this procedure works and what their current legal situation means for prospective parents.

What is IVF?

IVF is a type of artificial reproduction technology that allows people with various fertility problems to conceive a child. It consists of fertilizing an egg with sperm outside the body to form an embryo that is then transferred to the uterus for development.

It is used as a treatment for infertility, which the American Society for Reproductive Medicine defines as the inability to achieve pregnancy “based on the patient’s medical, sexual, and reproductive history, age, physical findings, diagnostic tests,” or “need for medical intervention.”

Although it was developed as a fertility treatment for blocked fallopian tubes, it is currently used for other conditions such as low sperm count or when the cause of infertility cannot be determined. LGBTQ people and single parents can also turn to IVF and other reproductive technologies to start a family.

How does IVF work?

Normally, during IVF the patient takes hormones to stimulate the ovaries to produce eggs. When a healthcare professional removes the eggs using ultrasound and a fine needle, they incubate the sperm with the egg or inject the sperm into the egg in the laboratory to fertilize it. The specific type of IVF procedure a patient undergoes is determined individually with a healthcare professional.

Scientists began developing this technology in the 1930s, with the birth of live rabbits and mice using this procedure. This research eventually led to the birth of the first “test tube baby” in 1978. Physiologist Robert Edwards received the Nobel Prize in Physiology or Medicine in 2010 for his research into IVF.

(Alabama passes laws proposed by Republicans to protect in vitro fertilization after controversial state court ruling)

Technology has expanded rapidly since the first birth of a human being thanks to IVF. The development of cryopreservation, that is, the freezing of human eggs and embryos, has allowed people to become pregnant later. Genetic screening of cells from a developing embryo can identify genetic diseases and abnormalities.

The probability of a live baby being born through assisted reproduction techniques is variable. Success rates depend on many factors, such as the underlying cause of infertility, age, and the type of technology used.

Who currently has access to IVF?

The use of IVF has increased steadily since it was first introduced. In 2015, about 2% of all U.S. babies were conceived through IVF, and public support for the technology is generally high.

Approximately 10% of American women have used some type of fertility service to achieve pregnancy. This includes fertility counseling, medications to increase ovulation, fertility testing, surgery, and IVF.

As infertility increases with age, women over 35 tend to use these services more frequently than younger women. U.S. women who access infertility care the least are typically foreign and uninsured, and tend to have lower incomes and less education than women who do.

Geographic differences also affect access to IVF. In 2021, more than 5% of all babies in Massachusetts were conceived through IVF, but this number dropped to less than 1% in New Mexico, Arkansas, and Mississippi.

Service availability and insurance coverage for IVF procedures differ by state, which could explain some of the differences in use. Only a few states require private insurers to cover this type of fertilization. Public insurance coverage for infertility services is even lower.

The cost of IVF has been the biggest obstacle to infertility care. Expenses for people without insurance coverage can range from more than $10,000 to $25,000 per cycle, with increasing costs per cycle.

How do debates about when life begins affect IVF?

Political opinions vary around reproductive rights, and access to IVF is likely to become a topic of debate in upcoming election cycles.

The Alabama Supreme Court ruled in February 2024 that frozen embryos created during the IVF process are people. Although the ruling currently only applies in Alabama, it has caused shock, confusion and concern among health care providers.

(Study associates frozen embryos with increased risk of maternal hypertension during pregnancy)

As a result of the ruling, two of the largest IVF providers in Alabama have suspended infertility treatments due to potential legal risks to healthcare workers. The biggest concern is whether they could be found liable for wrongful death if the frozen embryos do not survive the thawing process.

Since the elimination of federal abortion protections in 2022 with the overturning of Roe v. Wade, states have instituted their own laws regarding access to the procedure. Many patients, health care workers and lawmakers see Alabama’s decision on IVF as a continuation of the growing erosion of women’s reproductive rights.