BALTIMORE — Following the 2024 Alabama Supreme Court ruling that frozen embryos could be considered children in the state, most patients at a clinic in neighboring Georgia didn’t make different disposition choices about their frozen embryos than before the ruling, with the exception of one group.
In the 2 years before and 2 years after the ruling, there were no significant changes in the percentage of patients that opted for minimal-harm frozen embryo disposition in some circumstances, including patient death, death of a spouse or partner, simultaneous death of patient and partner, or divorce, according to Leah Ginn, DO, of the Medical College of Georgia at Augusta University, and colleagues.
However, among couples who mutually decided to discontinue in vitro fertilization (IVF) treatment, there was a shift towards embryo destruction after the ruling, with fewer choosing minimal-harm disposition methods (80.3% versus 67.9%, P=0.03), they reported at the American Society for Reproductive Medicine (ASRM) annual meeting.
Ginn told MedPage Today that the shift in this group was interesting but unexpected. It may reflect that “patients were likely concerned about the legal and ethical implications of their embryos” sitting in storage, she said, and they may be electing to make more definitive decisions about what to do with those embryos in some circumstances.
“Policy decisions that are made at not only the federal level, but also the state level, are really likely to impact the decisions that patients are making about their reproductive care,” Ginn said.
Rachel Weinerman, MD, an ob/gyn and reproductive endocrinologist at Case Western Reserve University in Cleveland who wasn’t involved in the study, told MedPage Today that the Alabama ruling “was very challenging for everybody in the field of IVF because it demonstrated the risks that we are taking.”
“If the legal climate were to consider a fertilized egg the status of a person under the law, then there’s really no way that IVF can be done,” Weinerman said. Discarding embryos is inherent to the IVF process, hence why many clinics in Alabama paused their operations after the ruling.
For physicians, it’s legally risky to do IVF in that climate, she said. Moreover, patients may be nervous that they won’t have the autonomy to make decisions about their embryos.
“I think that we have to understand that the legal climate not only affects the physician’s ability to perform IVF, but also affects patient choices and may limit their ability to grow their families because they’re concerned about lack of autonomy over embryo disposition choices,” Weinerman said.
Ginn said her team’s Georgia clinic saw an influx in out-of-state patients around the time of the Alabama ruling and they were curious if patients’ frozen embryo disposition choices were changing.
To assess the impact of the Alabama ruling, Ginn and team conducted a retrospective analysis from June 2022 to February 2026. They included patients at their clinic undergoing IVF for the first time who completed embryo disposition consent forms on what to do with embryos in various circumstances.
In all, 145 patients presented to the clinic during this time period, with 61 before the ruling and 84 after. Patients had similar sociodemographic and clinical characteristics. Nine patients who were single were excluded from the analysis.
The primary outcome was the selection of minimal-harm options before and after the February 2024 ruling. Minimal harm options included embryo donation, use by one partner, use or donation as part of a court decree, and transfer to a storage facility. On the flip side, discarding embryos or donating them to research were considered likely to result in harm to the embryo.
Ginn noted the modest sample size, which was not powered to detect very small differences, as a limitation. She also said this analysis was around the time of the Dobbs v. Jackson Women’s Health decision that upended the federal right to abortion, which likely shaped patients’ understanding of the legal reproductive care landscape.
