[00:00:04] Speaker A: Welcome to start to finish motherhood, a podcast for those thinking or already single mothers by choice. Just looking for practical advice for navigating life's relationships.
[00:00:14] Speaker B: When you decide to have children on.
[00:00:16] Speaker A: Your own, it doesn't mean that you're completely alone.
[00:00:19] Speaker B: I'm Aisha Jenkins, and I'm partnering with you every step of your journey.
[00:00:25] Speaker A: So, hi, everybody. I'm here with Elise, the embryologist, who is a friend to the podcast. And Elise has a wonderful social media following on Instagram. I love her stuff. And I really pulled Elise in to get an update and some information on the recent Alabama ruling. So can you introduce yourself quickly and then take us through what this ruling is?
[00:00:48] Speaker C: Absolutely. So my name is Elise. I'm an embryologist. I am in the North Carolina area, but do kind of COVID the southeast in terms of where I travel, because I'm a travel embryologist. Started my Instagram and TikTok a couple of years ago and use it to educate patients on what we do in the lab. So she'll have the behind the scenes, and it's really exciting to be back because it has been a while since we talked.
[00:01:10] Speaker A: Yes.
[00:01:11] Speaker C: Thank you.
[00:01:11] Speaker A: Okay. All right, so let's talk about the Alabama ruling.
[00:01:16] Speaker C: Yeah. So I'll start from the beginning as to what happened, because it took me a couple of days to even figure out what went down. They weren't super clear about that. So this incident actually happened in 2020. So it's taken this long to get this far because the court system take a little while. Essentially what happened is this clinic is in a hospital setting, so it is attached to a hospital. There are lots of other clinics out there like that. What happened is the cryo tank room, which is where we store the embryos and sperm and eggs, is typically locked under fingerprint id or a code or something like that. This room was not locked appropriately. And so someone, a patient, not an IVF patient, a patient in the hospital, was able to walk into this room, open the tanks, and touch them and mess with them when they clearly were not supposed to be. So they were able to pull out a cryocaine, which is how we store embryos. And because we store them in liquid nitrogen, he was burned. Or this person, I don't know if it was male or female. This person was burned by liquid nitrogen and dropped the canes on the floor. And essentially, once those embryos are outside of liquid nitrogen, they're damaged.
They're no longer able to be used. They die very quickly, which is a reason why we store them in liquid nitrogen. So it was a couple of couples. So there was multiple couples involved. They sued, and rightfully so. There is no debate that they shouldn't have sued for negligence, because that is absolutely what happened. But then I think that there may have been an attorney that may have pushed for something a little bit more, and they actually ended up suing for wrongful death of a minor as well. Of course, this created some controversy. It bounced around the court system for a little while, and eventually the Alabama Supreme Court had to make a decision on whether they were going to allow the couple to sue for that, for those reasons. And the Alabama Supreme Court said, yes, we will let you sue.
Know. They ruled in favor of the couple and said, we will let you sue for death of a minor, wrongful death of a minor. And that has very large implications for whether IVF is able to still. Whether embryos are people now or children.
Can we even do IVF on children? Can we biopsy children? It leaves it very much open to interpretation as to what are we allowed to now do? Because that's kind of where we're at now.
[00:03:47] Speaker A: Okay. All right, so let's go from the beginning. What is art, and where does iVF fall? Within art?
[00:03:56] Speaker C: Yeah. So art stands for all assisted reproductive technologies, anywhere from artificial insemination to full on IVF with ixi and genetic testing. So I really is where we are taking eggs from one patient, sperm from another patient, and inseminating that egg in the lab and culturing that fertilized egg in the lab until it reaches the blastocyst stage or embryo stage. And at that point, we can then do genetic testing. We can freeze the embryos. We can do an embryo transfer.
[00:04:30] Speaker A: Okay, and so what exactly is an embryo, then? Just to clarify?
[00:04:35] Speaker C: Yeah. So an embryo is a fertilized egg that has divided and grown into a group of cells, typically about 100 cells, 100 to 150, that has the potential to create a pregnancy and a live birth.
[00:04:50] Speaker A: Okay, so I love that you said potential, because those of us who go through art, IVF, we know that it is potential. There's no guarantee. And so when we talk about there's an attrition that happens. Right. You start, let's say, with 100 eggs, you might get, like, 50 that are mature. So can you take us through the process? So when we say it's potential, what does that mean?
[00:05:16] Speaker C: Yeah, absolutely. So out of the number of eggs we retrieve, which is much less than 100, I mentioned, usually we're getting, like, ten to 20 eggs per patient. Typically about 80% of those eggs that we retrieve will be mature, and we can only inject mature eggs because those are the only ones that will fertilize. So 80% of eggs retrieved will be injected. Of those eggs that we injected, only about 80% of those will fertilize. So not every egg will fertilize, and then only about 50% of the fertilized eggs will create blastocysts. So if you've got eight fertilized eggs, we're expecting three or four embryos, blastocysts. And then from that point, every embryo transfer has about a 50 or 60% pregnancy rate, depending on the patient and the practice and the embryo quality and all of these other factors. So even with a handful of embryos, say five embryos, we're looking at maybe one or two. Two if we're doing great pregnancies in live births. So that chance of pregnancy really starts to dwindle down when you look at it from a big perspective.
[00:06:29] Speaker A: Okay, so I'm going to explain it the way that I explain it to my children, because the policymakers are saying that embryos are extra uterine children. So both of my children are donor conceived. So when I explain to them their conception story, I tell them that there are four things that are required to make a baby. An egg, a sperm, a uterus, and love. And so it boggles my mind that people who don't know where the clitoris is is helping to make this decision. So can you clarify for us, how long can an embryo live outside of a uterus?
[00:07:08] Speaker C: Yeah, so we do culture embryos out to day five, six or seven, and that's about as far as we can culture them out to. We're not able to grow them any further because the technology isn't there. So eventually, if we had a living embryo, living blastocyst on day five and let it just sit in culture media, it would die in a couple of days. That's about as far as we can culture them out. And so they eventually do die if they haven't been either frozen or put back into a patient.
[00:07:36] Speaker A: Okay, so thank you for that clear, definitive statement. So I've been getting some questions within my community, melanated single mothers by choice on my podcast, community start to finish motherhood. So I'm just going to run through these questions in no specific order. So what can people do? If they are currently in the middle of a cycle and they live in Alabama, what are their options?
[00:08:00] Speaker C: Yeah, so some of these questions are a little hard because we don't 100% know, and it's because practices and lab staff are talking with attorneys because they don't want to misguide patients and get them in legal trouble. So a lot of clinics are telling patients to stay put, which is very hard because you may have a retrieval in two days and you don't know what to do. So I believe patients, there may be the opportunity for patients to go out of state for their egg retrievals.
I haven't gotten updates on my end as to patients who are actively in a retrieval cycle, what their options are. But even if their options are to move to another state for that treatment, that's hundreds of patients that other clinics don't necessarily have the capacity to handle. So I think there are going to be a handful of patients, probably more than a handful, a large percentage of patients who are now out that cycle, who have to stop their medications, who have their cycle canceled because there are no other options and they don't want to get anybody in trouble.
[00:09:05] Speaker A: Okay, so are we hearing anything about people being refunded for the medication that's been used already? Because I know I paid out of pocket, and it is very expensive.
[00:09:16] Speaker C: It is very expensive. To my knowledge, I haven't heard anything. Now, in general, even when Covid was happening, the pharmaceutical companies were pretty good at being able to refund patients. They put something in place to help protect patients who had been impacted by that. So I'm hoping that they're working on something, but I think at this point, it's too early to tell. We don't know. I hope that they will be compensated in some way and get refunds or maybe replacements for meds or something like that. But to my knowledge, nothing has been publicly said, so it's very possible that they could be out that money as well.
[00:09:53] Speaker A: And your eggs are only as old as they are today, which is scary. Okay, next question. What can patients do if they currently have embryos on ice frozen in Alabama? What are the options?
[00:10:06] Speaker C: So, again, they may not have any options. So last that I heard from the clinic that I work at down in Florida, which is actually just very connected to Alabama, and they've got, like an Alabama satellite location.
They don't know. Things are kind of paused. Essentially, the clinic has to go to an attorney and say, hey, we tell patients to do this. What could that mean for the patient's safety, for the patient's legal liability and our legal liability? Are we trafficking people? Are we trafficking people over state lines? We don't know. And so that's where it gets to. What are the legal ramifications of anything that we're doing. So I do think at some point there will be the opportunity for patients to move their embryos either to a storage facility outside of Alabama or to another practice outside of Alabama. But right now, it's kind of cut and dry. We're going to pause until we know for sure, because like I said, I saw your face. But people are saying that, is this trafficking? Are we trafficking people now that we're moving things out of state? We don't know. I mean, if someone's crazy enough to say that this is a death of a minor, then who's to say that they're not going to come for something like that?
[00:11:18] Speaker A: Okay. All right, so we're going to walk this walk into the twilight zone. Now, is there a possibility that if I have, like, eight embryos, would I be forced to transfer eight embryos if I was only anticipating one additional child?
[00:11:36] Speaker C: Yeah. So if we're going to go down the rabbit hole, there are a lot of places in the process that we could see changes. So currently, the ruling, again, it's not a law, it is a precedence that's been set by a specific ruling, like the overturning of Roe v. Wade and Roe v. Wade in general, that was a set of precedents. This can definitely have implications on a larger national scale. So there is currently a bill in Congress. It was introduced last year, about a year ago. Check it out. I posted it on my stories. That defines life at conception, and that is a national bill that would impact every single state. And that, for sure would have implications on IVF. So they could still allow it. But say you only are allowed to fertilize three eggs at a time. All those eggs that you fertilize, you have to transfer. You're not allowed to do PGT testing, which is genetic testing. You're not allowed to freeze them. And if that doesn't work, then you thaw the next three. And for me, that is just absolutely ridiculous because IVF is already such a financial and time consuming process. Could you imagine the amount of costs involved in having to thaw three eggs at a time to inseminate them and then do a transfer and then start over? And there's a reason why we want more than one egg and we want more than one embryo because it's not a guarantee, like you said. So having to do it on a small scale like that makes things very inaccessible to patients, and it's already a treatment that is inaccessible to a lot of patients.
[00:13:09] Speaker A: And not to mention the emotional impact so the next question is, can the state take your embryo?
[00:13:16] Speaker C: There's a possibility. There's a possibility that if you. I mean, and, and then you get these questions, like, see, can come and take your child if you're not a fit parent, is that the same thing with your embryos? If you have created embryos and then you're having a tough time and maybe wouldn't be able to care for a child, and you don't even have living children, you've got embryos. Does that mean they can come take your embryos, too? I mean, who knows?
And that's where we get like, okay, can I claim them as dependents? Can I claim them on Social Security?
If you want to go that far, let's go that far.
[00:13:49] Speaker A: Can we? That's a question we get like, I got eight embryos. Can I claim them on my taxes? Right, exactly. Okay, so let's talk a little bit about the impact to specific groups of people. Right? So we have same sex couples, we have single parents who are pursuing donor conception. We also have people who are getting divorced and have existing embryos. So if a lawyer says that part of the contract was to destroy them, are we inciting murder? Right? Or are we forcing couples to conceive children outside of the bounds of marriage? What are people actually thinking about what the future implications are? If I carry a few embryos that have not been PGS tested and I have a child with a survivable anapoid, right, what does that mean to the quality of life for that child who's paying those bills?
[00:14:49] Speaker C: Yes, that. And for patients who already have had PGT testing. PGT stands for pre implantation genetic testing for anuploidy is the most common. And this testing, tests for genetic disorders and chromosomal abnormalities is a better way to say it, that happen during the growth of the embryo, not abnormalities that are passed from parent to child. So we're talking about things like down syndrome, trisomy 18, trisomy 13, Kleinfelter's terror syndrome, those sort of abnormalities. And without PE because it's like, oh, can we take a biopsy of a person without their consent because they can't consent because they're embryos. So that sort of testing is jeopardized. And for those who already have that testing, they may have embryos that are amipoid and they may not be able to discard those embryos. So what do they do with them? Do they have to pay storage forever and then when they die, someone else has to pay storage? Are they going to have to transfer those embryos, we don't know. So that's where these rulings, while I think people try to make them seem like, oh, they've now narrowed down what's okay and what's not okay for us, this opens the door because there's no protection for IVF and protection to access to this type of care, that it leaves more questions than answers. It's like, okay, we have nothing to protect us. So who's to say someone can't come and sue us because John Doe down the street doesn't like me and he keeps calling CPS on me even though I have no living children. But he knows I've got embryos and he doesn't like me. Are they going to be taken from me? We don't.
So that's the really scary part, is the unknown.
[00:16:33] Speaker A: So what does this mean for the fertility industry at large?
Are people raising the flags? What's being said from the industry perspective?
[00:16:44] Speaker C: So I will say the industry is in an uproar, as they should be. This directly impacts our ability as embryologists and providers to care for our patients. I mean, like, there are, most clinics in Alabama have stopped treatment cycles and there are a lot of people who can't just stop what they're doing. Cancer patients who need fertility preservation, other patients who are going through treatment, patients who are older and can't wait to do another cycle. Because this is the time that I have now. I mean, it has a huge impact on this field as a whole. And so pretty much everyone I know in this field is speaking out, is going to advocacy events, is talking to their legislation. You can actually see what of your legislators, of your voted representatives are voting for bills like this that would impact IVF care and access to IVF care and fertility treatments and reproductive health care. So my biggest advice is always to stay informed. These bills you can look up, I posted it on my story, you can literally look them up and see who voted for them is someone in your district? Because I could call them up and have a conversation. This is absolutely ridiculous. And so I do think that people are listening. Hey, we're not going to just take this lying down. This is something that we are going to change because it impacts our patients. And for politicians who want to go back in time where mothers are at home and everyone's having all these babies, they're restricting family building care, which is so hypocritical, it's so conflicting. Hey, we don't want you to get rid of, we want you to not be allowed to get rid of embryos, but then we want you to have babies.
That doesn't make any sense.
[00:18:35] Speaker A: We're not going to give you any means of supporting, no means of having a quality of life.
Elise, what are some resources that folks can look to who have questions, additional questions? What can they do? How can they support? I know you said reach out to your legislature. What else can they do? What are the resources?
[00:18:55] Speaker C: Yeah, so my favorite resource, and I talk about them all the time because they're a fantastic one, is resolve. Resolve. They have specifically put together tools and support for patients in Alabama. They will actually be marching in Alabama's capitol in person on Wednesday of this week. So they will be in person marching on the Capitol saying, this is unacceptable. They have fantastic resources for advocacy for people who want to get involved. They make it very easy. They have a national advocacy day every year in May. I signed up. Last year was my very first year. I was very scared to get involved in this because it's politics.
I know what I know, and politics is not really up there. And so I was like, I don't want to misspeak. I don't want to come off as someone who doesn't know what they're talking about when it comes to politics. It was by far one of the most inspiring and uplifting things I've ever been a part of. They made it so easy. They made it so easy. They literally schedule the calls for you with the representative, and they tell you about the bills that are being introduced and based on your district, which representatives are going to be voting for these bills, they do it all for you. So I definitely recommend reaching out to resolve. They're a great organization. They've already got things in place, like I said, to support those in Alabama. There are lots of great organizations, other organizations that are doing that as well. So ASRM, which is American Society of Reproductive Medicine, that is our kind of governing body, they put out statements and are talking with legislators as well. The third that I'll mention is doctors for fertility. It doesn't necessarily have to be physicians. I'm an embryologist, and I am part of that organization as well. That was started by a group of physicians who had bills that were introduced in their state that was going to impact their ability to provide care for their patients. So they started an organization. So all three of those work very closely with each other and are putting lots of steps in place to ensure that not only do these bills that are going to harm IVF or harm access to reproductive care are shot down, but putting bills into place that will protect IVF and protect access to reproductive care. So it's on both sides. And there are some great initiatives out there. I definitely recommend checking them out and seeing how you can support, even if it's just from your house, because like I said, I was just at home when I did that meeting and it was absolutely fantastic. So definitely recommend getting involved.
[00:21:32] Speaker A: Well, thank you, Elise, for taking this time. I know it was quickly scheduled. Where can the listeners find you and find out more about your advocacy or what's happening with Alabama. I know you mentioned that you've got it all over your feed. Where can they find you?
[00:21:49] Speaker C: Absolutely. So you guys can find me at the embryologist on Instagram. And one, because there are so many great resources out there. I've been sharing a lot of what other resources are out there because I don't want to bog up people's feed too much. But there are some, I talk about it daily on my stories and post resources where I can so definitely try to get out there and at least be informed. Even if you're like, hey, I don't know if I'm comfortable with this. At least understand what's happening and so that you can make an informed decision about your care about who you vote for in November because we're not going to forget this and make sure you stay informed.
[00:22:26] Speaker A: All right. Well, ailees, thank you for your time. I so appreciate this.
[00:22:31] Speaker C: Yes, thank you.
[00:22:38] Speaker B: Thanks for listening to start to finish motherhood with Aisha. If you want to keep the conversation going, follow start to finish motherhood on Instagram or email me at
[email protected] if you love this episode, please share it with anyone who's thinking of becoming a single mother by choice. Choice. Anyone who's already parenting as a single mother by choice and just looking for advice on navigating it all, or a friend or family member who's looking to support someone else's single mother by choice journey. Until next time. Bye now.
