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Hi there, Assignment Listeners. Our team is working on upcoming shows. But in the meantime, I wanted to bring you an episode of Chasing Life, which is a podcast hosted by my colleague Dr. Sanjay Gupta. So it's a show he did about IVF when the Supreme Court of Alabama declared embryos as children. And this is something that me and the assignment team, we've been talking about how to do this in our editorial meetings, and then we heard this episode, and we realized there isn't a better version of this conversation than this one. So in this episode, Sanjay explores the handling of embryos during the IVF process. He discusses the controversial nature of the ruling for fertility care providers. And then there are these great insights into the reactions of families and fertility clinics in Alabama. I want to thank you for listening. Please stick around because this is really a fascinating and an important conversation.

It's very scary to I think how much I've invested into this, how close I am to the end of this procedure. I've been waiting over two years to be pregnant, so there is no world where I could see me stopping this process right now.

That's 26-year-old Gabriele Goidal describing the moment she heard about the recent Alabama Supreme Court ruling that frozen embryos would now be considered children. The ramifications of this are enormous. What it means is if the frozen embryo embryos in a fertility center are ever discarded or destroyed, people could be held criminally liable. For Gabby, as well as others in Alabama hoping to become parents through IVF, the ruling was devastating.

On Friday, the justice has ruled that embryos created through in vitro fertilization or IVF would be protected under Alabama's wrongful Death of a Minor Act.

Advocates for infertile couples call the ruling terrifying.

Now, to be clear, freezing embryos Embryos is incredibly common during IVF procedures. The hope is that one of them could lead to pregnancy, but embryos are sometimes damaged or disposed of while in the lab. It's often part of the process. It can even happen as the embryos thaw. The loss of those embryos, for whatever reason, opens the pathway for health care providers or the patients themselves, possibly, being hit with punitive damages. Again, even if those embryos are frozen or outside of the uterus. As a result of all of this, some clinics in Alabama have already paused IVF programs out of legal concerns.

A third fertility clinic has now shut off IVF services because of the Alabama Supreme Court ruling in that state.

All of this happened when Gabby was just three days away from having her eggs retrieved at a fertility clinic. Her fertility journey so far had already been grueling like it is for many.

I've already been so poked and prodded with the IVF process, and now I feel like there's somebody else who's coming into my personal life. It's very invasive emotionally, where I'm already having so much invasion physically. It's been really hard, emotionally.

The state's Supreme Court's decision has shocked fertility experts US, patients, and providers in Alabama, but also the whole country. It's a decision experts say could have further legal and medical implications.

I think it most seriously impacts those who are most vulnerable. We have patients who want to go through IVF who save up for years to go through it. We have patients who mortgage their houses because their desire to build their family is so profound.

That's why on today's podcast episode, we're putting our Chasing Life season all about weight loss on pause to bring you the latest on this breaking story. For more context on what's happening on the ground in Alabama, I'll turn to CNN correspondent, Isabel Rizales, plus fertility doctor and Northwestern University Medicine Associate Professor, Dr. Eve Feindberg. She's going to share how this ruling could impact patients beyond just Alabama. This is a special edition of Paging Dr. Gupta. When Gabby and her husband, Spencer, heard about the state's Supreme Court's unprecedented ruling, the couple told CNN they had spent more than $20,000 and two years of their lives trying to get pregnant through IVF.

We were so close to having a child, to starting a family, that it was taken away last moment, last second. It just feels almost like we're cursed.

My colleague, CNN correspondent, Isabel Rosales, has been in Alabama, talking to Gabby and Spencer, as well as others, going through IVF treatments.

So this is a first of its kind ruling that really puts back into the national focus the question of when life begins. So this really It just raises the question of the future of IVF in Alabama and really beyond.

But how did this issue make it to the Alabama Supreme Court? I was surprised to learn how this all started.

This really stems from wrongful death lawsuits that were filed by the parents of, quote, several embryonic children, children that were created through IVF. So according to the court documents, these embryos, they were in a cryogenic nursery. So they were in liquid nitrogen, awaiting implantation when somehow a patient gained access to that nursery, dropped the embryos on the floor from getting a burn from that liquid nitrogen, and then those embryos were destroyed. So these parents, obviously incredibly distraught, they wanted accountability. They wanted answers for that. So they filed a wrongful death lawsuit. And all of this made its way to the Alabama Supreme Court, because as to this point in time, there was no state that said an embryo is a person. That's what the Alabama Supreme Court established.

Establishing embryos as children. That upended the entire practice of IVF in Alabama. What it meant was that providers would now have to consider the possibility of being criminally liable if an embryo was lost, which created immense obstacles for people like Gabby and Spencer, who we heard from earlier.

They're a young couple, but they have been through a lot. They suffered through three miscarriages. Gabby was told by her doctor that she had a higher than normal likelihood of having a pregnancy with genetic abnormalities. Faced with that, they decided to go through the route of IVF. Gabby was just days away from having her eggs retrieved when this ruling came down and when she got the call from her clinic in Alabama. So her clinic told her that they couldn't guarantee if they'd be able to make, store, or ship embryos. Once Gabby got that call, she was panicked. She called me in tears. This is exactly what she feared would happen after hearing about the ruling.

I was very scared. We got the green light to start our medication on Thursday. The decision came down on Friday. I found out on Saturday, and I was already fully invested in this process. We had paid our clinic in full. We had purchased all of our medication, physically invested into it. And we had been training, like you would train for a marathon. We haven't been drinking, we've been eating healthy. We've been exercising, trying to make sure our bodies are prepared for this. And it just feels like it's been months long. And then to be told that there was a possibility that we would have to stop this in the middle of one of the most important parts of it is really terrifying.

She made calls and she got connected to a fertility clinic in Texas, her home state. That same night, she hopped on a flight and decided, This is the I'm going to go through Texas to continue my fertility care.

I found a doctor that will take me in, and now it's go, go, go, rush, rush, rush, get on a plane and travel to get this done, which, again, it is exciting that I am going to get to continue, but also a ton of stress that we did not anticipate in this very stressful process.

How are healthcare teams and IVF specialists responding in Alabama?

There are not a lot of fertility clinics in Alabama. Seven is what we've counted. One of them belongs to Dr. Andrew Harper. While three fertility clinics so far in the state have halted certain IVF treatment programs, Dr. Harper refuses to stop IVF treatments. He's still seeing his patients. He's still moving forward, but he has paused the disposal of embryos.

They're not respecting women's reproductive autonomy. They're reproductive rights. They have, let's call it what it is, a religious his agenda.

So I asked him, how does he continue his business? How can you do this when so many other clinics have put a stop for right now? Well, he told me he's doing this for his patients. It's their embryos. They should decide. He feels very passionately about that.

It's saddening. It's frustrating. But I'm in a position in my career as a rebuttal chronologist, where I'm not sure I give a damn anymore about what old white guys in Montgomery say. I'm here to advocate for our patients, and we We want all our patients to reach their ultimate family building goals, whatever that might be. We believe in patient autonomy, and that trumps all. Now, since this ruling from the State Supreme Court, we have heard the Alabama attorney general has also to wait in.

This is what came down from the attorney general's office saying, quote, attorney general Steve Marshall has no intention of using the recent Alabama Supreme Court decision as a basis for prosecuting IVF families or providers. That's from their chief counsel, Katherine Robertson.

Many of you may be wondering, so what does this all mean in your state and for the country as a whole?

Medical experts and critics, they're worried that this ruling will have wider consequences way beyond Alabama. They're worried that this ruling essentially created a roadmap where groups or legislators across the country may try to target fertility treatments. So outside of Alabama, the national repercussions we could be looking at is whether other states could attempt to define embryos as people, as we're seeing now in Alabama. Already, there's one religious group using Alabama's ruling as precedent to target abortion rights in Florida. For many of these critics, they fear that Alabama has opened the floodgates to a whole new frontier in this battle of reproductive rights.

It's Excellent reporting on the ground from CNN correspondent Isabel Rizales. I got to tell you, one thing that really stood out to me from that conversation with Isabel is Dr. Andrew Harper's statement that this is a court ruling based in religion and not science. As a doctor myself, that's incredibly concerning. So I decided to reach out to an expert to continue the conversation.

I think that this was a highly political move and one that really doesn't follow the science and doesn't take into account the needs of the people who live in Alabama.

Fertility doctor and Northwestern University Medicine Associate Professor, Dr. Eve Feinberg, joins me next.

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What was your first reaction when you heard about the ruling in Alabama?

Yeah, I mean, to be perfectly honest, I'm not surprised. I wrote a piece the two co-editors in chief of Fertility and Sterility, which is one of our major medical journals. We basically wrote how the confirmation of Amy Coney-Berrett would lead to upending Roe. And once you take away the viability clause and the protection that Roe offered, then the rest of personhood and this idea that you declare an embryo a person at the time of fertilization, that truly set this into motion. I went back and I read that piece that I wrote back in early 2020, and it was eerie as to how our predictions played out. I think that this is not a one-off case, but probably a very carefully orchestrated, carefully planned move by a whole political movement that is not just seeking to overturn Roe versus Wade, because that's now been accomplished, but really to destroy autonomy for women in a multitude of ways.

You obviously are a reproductive expert, a specialist, but You are someone who's also had personal experience with IVF. You've written about this. I'm wondering if you're comfortable sharing, could you tell us a little bit of what that experience was like for you?

Yeah, I have a lot of experience with IVF, personally and professionally. I went through my own in vitro fertilization cycle. I was 34 years old, and I had a lot of eggs retrieved and was fairly sick with ovarian hyperstimulation syndrome. On that same cycle, We had transferred one embryo, and we cryo-preserved the remaining nine embryos that remained. That one pregnancy was not growing normally. It had a heartbeat. I was six weeks along. It wasn't measuring properly. It was very uncomfortable. I was in a lot of pain. The pregnancy, even though it wasn't developing normally, kept lingering. It was eight weeks, nine weeks, 10 weeks. We had to make a decision on do we continue the pregnancy, which was causing terrible health problems in terms of my own hyperstimulation. It wasn't going away on its own. And by all technical measures, I elected to terminate the pregnancy. It was a highly, highly desired pregnancy after two years of infertility and three miscarriages. And I knew intellectually that a heartbeat was not necessarily a viable pregnancy. So I made that decision, and it was sad because I wanted to be pregnant. I wanted another child, but I didn't want to continue with hyper stimulation, which was putting my life at risk.

Sure. I knew that the pregnancy was going nowhere. I had a D&C and went on to have a healthy pregnancy after that point.

I'm sorry you went through that, Doc. Yeah, thank you. That's a lot.

It was a lot. It was a lot.

But- How's baby or now, I guess, child doing?

Again, this was many, many years ago. My twins are now 14 and a half and freshmen in high school.

Well, I'm so happy to hear that. I think the audience, probably this audience, has a general idea of what IVF is, in vitro fertilization, retrieval of eggs, fertilization with sperm, and then creation of an embryo, and then ultimately implanting that into a woman's uterus. I'm curious if you could just give us some context. I think I'm old enough to remember Baby Louise. It was 40 years ago, I think, roughly 40 years ago. How common is this nowadays?

Yeah, so you nailed it. I don't think I know anything about neurosurgery, so please don't ask.

Many of us are parents, though, so we pay attention to this stuff.

Ivf is really common. Infertility affects one in six people in the United States. And annually, in the US alone, we perform about 400,000 cycles of in vitro fertilization. If you look collectively relatively at the population of the US, just over time in the 40 years since Louise Brown was born, about 2% of the current population has been conceived with IVF. So it is staggering.

That's a lot bigger than I thought. Yeah. Let me ask you some basic questions so people understand what IVF is. You'll forgive my ignorance here a little bit, but why freeze embryos?

Yeah, that's a great question. There are a few different situations where we freeze embryos. The first is when we go through what we call a fresh IVF cycle, and that is when you stimulate the ovaries, you take the eggs out, you fertilize them with sperm, you grow them in the laboratory, then you would transfer. Ideally, you would transfer the single best embryo. I think back in the day before we were really good at embryo freezing, we used to transfer a whole bunch of embryos and hope that one took. With the advent of vitrification, which is a really sophisticated method for freezing embryos that you don't develop ice crystals, we started to transfer just one embryo and then freeze the remaining embryos for the future so that if IVF doesn't work, you have some frozen embryos that can then be utilized. You might do that for a couple of different situations. One of those is in the situation where you want to get genetic information on that embryo. For parents who may carry spinal muscular atrophy or tasax or other fatal diseases, we have the ability to test the embryo in the preimplantation stage to avoid transmission of a fatal disease.

That's probably the most common reason that we freeze embryos or in the situation of a patient facing chemotherapy, where they may lose ovarian function, we would freeze an embryo in the face of a cancer diagnosis so that we could to deserve that couple's fertility for the future.

What do you see when you look at one of these fertilized eggs, these embryos?

I see the potential to become a human life, but I don't see that embryo as a baby. Legally, I would say most states considered in divorce settlements, embryos are considered to be property. I think that undervalues an embryo a little bit, but I think to call it a human life is an overstretch of what the science really tells us. I like to think of it as something that has the potential to become a human life. In most circumstances, the overwhelming majority, depending on the age of the woman, will not actually grow to become a human. I wish they would. It would make my job so much easier if every time I put in an embryo, somebody would have a child. But I think anyone who's been through IVF can tell you it's an iterative process. You do it again and again and again. And ultimately, you probably will be successful. You can think about it as a treatment course where one single cycle is not effective, but the cumulative likelihood of success is much greater when you do it multiple times.

This ruling essentially classifies frozen embryo as children. You obviously say that is scientifically and medically inaccurate.

Yes. I mean, it's a great inaccuracy.

When does an embryo become a child?

I actually think that's somewhat of a religious question. This, again, is where I think that it becomes difficult because people have different religious beliefs. There are some religions that believe that life begins with fertilization, and there are some religions that believe that life begins with brain development. Personally, I think it becomes a child when it has the capability of living and growing and surviving outside of a mother's womb. I really think that the viability clause that was enacted in Roe is probably the one that most closely mirrors the science of what does it mean to be human and what does it mean to actually be a person. I think it means that you're capable of living independently. Granted, at 24 weeks, you still need a tremendous amount of neonatal intensive care unit support, but at least your life isn't entirely dependent on another human being. You can live independently from that person. But I think the bigger question of when should a child be protected by the laws of a state and when is it appropriate for a state to intervene? I think it has to be at the point where it's separate and distinct from a woman's own body.

I think that, again, as a reproductive endocrineologist, as a woman, as a mother, and as somebody who has been put in some difficult medical situations, I think that those difficult decisions need to be between a physician and her patient or a health care provider and their patient, and not decisions made by government who don't have the unique qualifications, training, an experience to have these difficult conversations with patients because they are very nuanced, and they're very emotional, and they're very difficult. But I have a lot of years of education to have these conversations, and I have found when speaking with legislators that they don't really understand the science. I think that in the Alabama case, they probably didn't quite understand the implications of what their ruling is now going to do for those families that so desperately want children.

How much of what is happening right now with a ruling like this do you think is religion-based and how much of it is science-based?

I think it's zero % science-based and 100 % religion/political agenda.

Is there any part of this that makes sense to you? If you had to defend the other side, and I hate asking you that question, but just because you are so knowledgeable, if you had to defend defend the other side of this, what would you say?

Yeah, look, I think that there was a crime that was committed. There was somebody who, again, for motives and reasons that I am not privy to, went in and destroyed something that is tremendously valuable. He went into an embryo tank, dropped very precious material on the ground, and took away the reproductive potential that may have been within those embryos. I think that crimes warrant punishment, and I understand the grief and the loss that infertility patients have when they lose embryos. However, it is in no way, scientifically, the same as the wrongful death of a minor. I think that's a line that was crossed that does not make any scientific sense.

What would you tell patients, families that want to have a baby and we're considering IVF, right now in Alabama, what would be your counsel to them?

Come up to Chicago.

That is where we are, huh?

I mean, It is very sad. I think those patients who need care are probably best served not having their care in the state of Alabama. I think that's a really hard thing to say, but I think the current climate is not I think that this was a highly political move and one that really doesn't follow the science and doesn't take into account the needs of the people who live in Alabama.

The patients, some of them may not have the option to go to a different state. For them, this is not going to be something that's available to them anymore. If IVF services are not available in many of these clinics, what are you hearing from your fellow health care providers there? How are they feeling? What are they planning on doing?

I think there are The same is true. At the other end of reproductive spectrum, I think it most seriously impacts those who are most vulnerable. We have patients who want to go through IVF who say gave up for years to go through it. We have patients who mortgage their houses because their desire to build their family is so profound. And so this ruling is going to impact those patients even more than the average patient going through it. As for my colleagues in Alabama, I think they're reeling. I think they're trying to figure out what makes the most sense. Does it make sense to wait it out and let the pendulum swing the other way? Does it make the most sense to move their clinics across state lines? I don't think anybody has an answer or a plan. It's too raw and too soon, but I really think that it's a huge problem and we need to find a better solution to this.

Sincere gratitude to Dr. Feindberg for sharing both her deeply personal and professional experience with IVF. For stories like these, it's important to me to not let politics drown out the real people being affected, especially people like Gabrielle and her husband, Spencer, and many other families out there now wondering what this all means for their chance at becoming parents. It's something that I've been thinking a lot about as a doctor. These are conversations I've had over the past few days with my own wife and my three teenage daughters at the dinner table. It's not easy, but it's important to talk about. And reporting on this episode has helped me make a little bit more sense of it all. I hope it helped you, too. Thanks for listening. Chasing Life is a production of CNN Audio. Our podcast is produced by Erin Matheson, Jennifer Lye, and Grace Walker. Our Senior Producer and Showrunner is Felicia Patinkin. Andrea Cain is our Medical Writer, and Tommy Bazarian is our Engineer. Dan Dizula is our Technical Director, and the executive producer of CNN Audio is Steve Vita. With support from Jameis Andrest, John Dianora, Haley Thomas, Alex Manasari, Robert Mather's, Lanie Steinhart, Nicole Pessereau, and Lisa Namarot.

Special thanks to Ben Anchor, Amanda Sealy, and Nadia Konang of CNN Health, and Katie Hinman.

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