The moment Gov. Kay Ivey signed the bill to protect IVF treatments in Alabama, Dr. Beth Malizia pulled out her phone and began scheduling fertility procedures.

“I made three phone calls at 9:30 p.m. right after the governor signed the bill and let those three patients know that we were moving forward with their embryos transfers,” Malizia said. “We definitely had some tears on those phone calls.”

Less than 12 hours later, on March 7, she was in her Homewood clinic transferring embryos to women who hoped to become pregnant.

But not all fertility clinics in Alabama have been as quick to restart treatments. The state Supreme Court surprised IVF doctors in February with a ruling that held frozen embryos are children. State lawmakers scrambled and quickly passed the bill designed to fix the problem, protecting IVF providers from wrongful death lawsuits and criminal prosecution.

But lawmakers haven’t been able to persuade everyone it’s safe to resume.

A spokeswoman for the Center for Reproductive Medicine in Mobile said the clinic would not restart treatment, even after Ivey signed a bill that exempts IVF doctors from legal liability for the destruction of embryos.

“At this time, we believe the law falls short of addressing the fertilized eggs currently stored across the state and leaves challenges for physicians and fertility clinics trying to help deserving families have children of their own,” the statement said in a statement last week. A spokesperson did not respond to an additional request for comment.

Rep. Chris England, D-Tuscaloosa, said the IVF immunity bill doesn’t address the underlying Supreme Court decision. Frozen embryos still have the same rights and protections as children under the personhood amendment passed in 2018. The bill could run afoul of the state constitution unless the constitution is amended, England said.

“Our immunity bill was essentially the hope plan,” England said. “Hope that nobody files a lawsuit and hope that a judge doesn’t rule what we’ve done unconstitutional in terms of violating the personhood amendment.”

Four families have sued Infirmary Health and the Center for Reproductive Medicine in Mobile after a patient from the adjoining hospital walked into a storage area and destroyed several frozen embryos. Three filed lawsuits in 2021 that went to the Supreme Court, but one other filed a lawsuit while lawmakers worked on the IVF immunity bill this year.

The Supreme Court decision sent the lawsuits back down to the trial court. The courts could rule that the new immunity law is unconstitutional and leave clinics with no clear guidance about legal liability, once again stopping IVF in Alabama, England said.

Some in the legislature have already said they want to create more comprehensive legislation that will regulate in vitro fertilization, England said. They may put in place restrictions that make the procedure harder to get.

“My prediction is that while IVF will be legal in Alabama, it will be so prohibitively expensive and so risky in terms of liability that most people won’t be able to afford it,” he said.

The initial court ruling mobilized thousands of patients in Alabama, Malizia said. The fertility doctor said she had no experience with state government before this year. Neither did the hundreds of patients who showed up at the statehouse to lobby for the IVF bill.

Hundreds of supporters and thousands of emails showed lawmakers that IVF had broad support in the state, Malizia said. A CBS/YouGov poll found that 86 percent of respondents said women should have access to IVF treatments.

Barbara Collura, president and CEO of RESOLVE: The National Infertility Association, said she hopes lawmakers revisit the law within the year to clarify whether parents have full rights to embryos held in storage.

“The law provides immunity from prosecution; it does not change the status of an embryo or list what can and cannot happen to an embryo outside the uterus in Alabama,” Collura said in an email.

Before the ruling, most parents with leftover embryos had three options. They could discard the embryos, donate them to science or donate to other families. It’s unclear if all three options will remain available to patients in Alabama.

Eric Johnston, an attorney and president of the Alabama Pro-Life Coalition, said he doesn’t think the state needs a new amendment to ensure access to IVF treatment. He said the immunity bill passed by the legislature should provide legal protection for doctors since it modifies a wrongful death law that was also created through legislation.

Like Collura, he said the bill leaves open questions about the status of leftover embryos.

“It comes down to one question that is going to be the difficult one to answer for everyone,” Johnston said. “And it is, ‘What do you do with the leftover embryos?’ That’s it. That’s the whole crux.”

Johnston said his organization supports access to IVF. Some members who are Catholic have adopted that church’s opposition to in vitro fertilization, but other members have used the process to become pregnant, he said.

He said the legislature needs to go back and consider thoughtful regulations on IVF. It’s a complicated issue that requires more than a quick fix, he said. Parents who suffer the loss of frozen embryos through the neglect or malice of clinic employees won’t be able to sue providers for more than the cost of a procedure if the law stays in place, he said.

“I think it was very poorly done,” Johnston said. “It was done too quickly. When you do the important things quickly, you make mistakes.”

If the state considers additional legislation, Malizia said fertility specialists need to be part of the process. She and her colleagues were blindsided by the Supreme Court decision and would like to educate legislatures about how the IVF process works.

Although she never expected to find herself lobbying lawmakers when she started training in fertility medicine, her crash course in Alabama politics may continue to come in handy, Malizia said.

“There’s already talk of further discussion about this issue, and I don’t know exactly where that will go,” Malizia said. “But we will be all in. I think my visits to the state house are not over.”