Brittany Pettaway’s journey to motherhood has been a long and winding road. Since 2018, the Montgomery, Ala. resident has weathered the emotional rollercoaster of fertility treatments, enduring failed attempts, miscarriage, and the strain on her marriage. Just as she and her husband, Byron, were ready to try again, they found themselves caught in a political and legal storm that threatened to upend their dreams of parenthood.

“We were getting ready to start the process again,” Brittany says, her voice tinged with frustration. “You have to go through so many steps, like tests and stuff, and then Alabama was being Alabama and things came to a halt.”

In early 2024, Alabama’s all-Republican Supreme Court ruled that life begins at conception, a murky scientific and legal distinction, which granted personhood to embryos. The decision sent shockwaves through the state’s fertility clinics, temporarily shutting them down and leaving couples like the Pettaways in limbo.

For Brittany, the timing couldn’t have been worse. After two failed embryo transfers in 2021 and a miscarriage that required a D&C, a common surgical procedure to remove tissue from the uterus – cruelly, on her and Byron’s wedding anniversary – the couple had taken a year-long break to heal. When they decided to try again in 2023, things finally seemed to be looking up. They retrieved 29 eggs, more than double their previous attempt, and had five embryos frozen.

“I thought, I don’t want to think about anything right now. It was so much, it was so hard on our marriage. It was just a lot to deal with,” Brittany recalls of their earlier struggles. “I was like okay, I got that out of the way. Now I’m about to take my time. We got through the hump.”

But before the Pettaways could start the implantation process, Alabama’s IVF nightmare began.

The ripple effect

This Alabama case stems from a 2020 incident where an unauthorized person accessed and destroyed frozen embryos, prompting three couples to sue the Mobile Infirmary Medical Clinic and the Center for Reproductive Medicine.

Though a lower court ruled  that embryos did not qualify as people under the state’s Wrongful Death of a Minor Act, the state Supreme Court ruled in February that they did. This fetal personhood decision by the Alabama Supreme Court thrust the question whether IVF patients and providers could face prosecution into the national conversation, causing local clinics to temporarily cease operations in fear of prosecution.

The ruling created a precarious legal situation for medical professionals. With embryos now legally considered people, any accidental damage or loss during the IVF process could lead to criminal charges such as manslaughter or negligent homicide. Even routine procedures like discarding non-viable embryos could be interpreted as a criminal act. This legal uncertainty forced many clinics to suspend operations, fearing that continuing to provide IVF services could put their staff at risk of prosecution.

“The significance of this decision impacts all Alabamians and will likely lead to fewer babies — children, grandchildren, nieces, nephews, and cousins — as fertility options become limited for those who want to have a family,” the Medical Association of the State of Alabama said in a statement after the decision.

With embryos being legally equivalent to living and breathing children another accident like in the 2020 case, or mishaps during storage or implantation, could leave medical professionals or even IVF patients liable – a scenario Republicans who applauded the ruling say they did not anticipate.

“When lawmakers try to turn this fetal personhood ideology into law, they create these kind of one size fits all laws that are always going to do more harm than good in ways that even they didn’t anticipate because laws and court rulings on reproductive rights are just not nuanced enough to consider all the different circumstances,” said Courtney Andrews, a reproductive rights policy strategist at the ACLU of Alabama.

Dr. Mamie McLean, a reproductive endocrinologist and fertility specialist, at Alabama Fertility Specialists, where Brittany has been undergoing treatment for four years, described her struggle to deliver the harsh news to her patients.

“My heart was heavy and I felt powerless, since I was now unable to complete the course of treatment that she, her husband and I agreed to months ago since the loss of their third pregnancy,” McLean wrote in a Feb. 22 AL.com op-ed. “This decision is a terrifying, existential threat to thousands of Alabamans whose most precious and longed-for dream is a baby.”

U.S. Sen. Tammy Duckworth, who conceived two children through IVF, proposed legislation to establish a right to access assistive reproductive technologies, like IVF, at the national level, but the measure was blocked by Senate Republicans in March, according to ABC.

“It’s a little personal to me when a majority-male court suggests that people like me who are not able to have kids without the help of modern medicine should be in jail cells and not taking care of their babies in nurseries,” Duckworth said during a press conference in February.

It only took one objector to block the proposal, Mississippi Sen. Cindy Hyde-Smith, who objected because she believes the proposal would violate religious freedoms and argued that the Alabama bill did not ban IVF.

“The court’s holding in favor of the parents found that these frozen human embryos are children under Alabama law. It did not ban IVF, nor has any state banned IVF,” Hyde-Smith said in February. “The bill before us today is a vast overreach that is full of poison pills that go way too far, far beyond ensuring legal access to IVF.”

The following day, Alabama passed its own bill, granting civil and criminal immunity to IVF providers which allowed clinics to reopen, Reckon reported in March.

New challenges

But patients now face a new challenge in growing their families: their embryos will be moved across state lines, some as far as Minnesota, in an effort to prevent lawmakers from interfering with IVF on the basis of “protecting life” again, but leaving patients and the future they’ve envisioned once again caught in the mix.

According to the New York Times, four of the state’s seven fertility clinics are moving cells and embryos out-of-state, including Alabama Fertility Specialists.

“I think that’s the point that’s not talked about. It’s like, what do I need to focus on right now?,”  Pettaway said. “It’s such an odd position to be in because I don’t want to overwhelm myself with that, but it is just as important because you have to have a plan.”

Over the summer, as IVF patients met in support groups that formed to advocate for the future of fertility treatment in Alabama and to allow prospective parents the comfort in knowing they aren’t alone, whispers began swarming that clinics would soon transport embryos.

Brittany knows that she wants multiple children and with five embryos frozen, the chatter left her with more questions than answers.

“If that happens, what happens when we want to do another one? Me and the doctor are going up [to Minnesota]?”

She asked sarcastically, but it was a real question.

‘There is a lot of uncertainty in our state’

The uncertainty Brittany felt mirrored the uncertainty for the future of fertility treatment in Alabama and how swiftly one’s fertility journey can take a turn. At her latest appointment in August, Brittany learned her embryos would not be transported out-of-state after all.

“Because we are actively preparing to transfer, mine will stay here,” she explained. “It’s for those who say [for example] when I get pregnant, and I don’t know if I’m gonna want to do a transfer right afterwards or if I’m gonna wait a few years, they will send those off.”

For other patients, Alabama Fertility patients’ frozen embryos will be transferred to a clinic in Minnesota, more than 1,200 miles away from Birmingham, Alabama, where one of their three clinics is located. This recent decision leaves patients facing a difficult choice that could impact their future family building plans.

The logistics are important. Frozen embryos need to be stored in specific conditions, often in labs or medical centers, which keep them in liquid nitrogen at -321 degrees Fahrenheit. Dr. Thomas A. Molinaro, a reproductive endocrinologist and chief medical officer of IVI RMA North America told Reckon that these temperatures are essential because frozen embryos exposed to room temperature will cause them to degrade in less than a minute.

Still, he says, moving embryos is quite common.

“Patients have transferred embryos from clinic to clinic, across state lines for decades. It is a relatively common practice that happens every day,” he said. “If patients are using a reputable cryo-shipping company that follows best practices then this is generally a safe process.”

According to Johns Hopkins Medicine, embryos can be safely preserved for 10 years or longer, but sometimes systems can malfunction. A 2020 Seattle Reproductive Medicine study found 133 lawsuits centering on destroyed or damaged embryos between 2009 and 2019, with more than 65% of the suits tied to two 2018 cases in Ohio and California where embryo storage tanks failed.

McLean told the New York Times Minnesota was chosen because it offers a safe place for patients, where they can maintain rights over their cells, no matter what happens in Alabama. Last year, Gov. Tim Walz signed a bill enshrining abortion and reproductive healthcare into Minnesota state law to ensure protection in the state, regardless of the future court.

“There is a lot of uncertainty in our state about what might lie ahead,” she told the Times.

For some families, this uncertainty has rushed their decision to transfer their embryos.

“We were hoping to maybe have some more time to kind of save up more for that, but now we’re just like, ‘let’s go ahead and just do the transfer, and we can figure out the finances on the back end of that,’” Jamie Heard, an IVF patient told the Alabama Reflector in July. Heard says she moved her transfer to September, rather than in 2025 like she originally planned.

Though the bill Gov. Kay Ivey signed in March shields providers from prosecution or civil lawsuits for damage occurred during IVF services, the law leaves ambiguous the definition of when life begins. Legislators have expressed concerns that it might take a new constitutional amendment to override a 2018 amendment that gives the state the right to “support the sanctity of unborn life and the rights of unborn children, including the right to life.”

“I don’t think people fully realize the irony that instead of addressing the root of the problem they just said in the context of IVF, there will be no consequences if embryos or fertilized eggs are destroyed,” said Andrews of the ACLU.

Andrews said she does not see a resolution to the issue while the 2018 sanctity of life amendment is intact.

“Now that the context has changed, we better understand the consequences. I think Alabamians deserve a chance to re-vote on that,” she said, adding that this would expand protection over reproductive health more broadly, preventing future rights from being stripped.

The hidden costs of IVF

When the IVF crisis first began unraveling, the Pettaways thought through their options and considered transporting her embryos to another state on their own, though they hesitated because of the distance and unknown logistics.

“There’s so many things you need to take into consideration. When we were looking before, my main goal was just to have them in a place where I felt comfortable and I would have access to them,” Pettaway  said. “That’s another thing. I don’t want to be in a situation where something happens to them and I can’t even get to them.”

Fertility treatments have become a regular option for Americans looking to grow their families, but for some the upfront costs are just as jarring as the ongoing crisis in the state. As Reckon reported in March, about 2% of U.S. births result from IVF, though it can be a significant financial investment, costing $15,000 to $30,000 for a single cycle.

Brittany told Reckon she’s spent around $10,000 on her first round of IVF, $15,000 on the second, plus $2,000 each for her last two embryo transfers – totaling $29,000 in out-of-pocket fees, which were reduced because of her insurance coverage.

The financial, physical, and emotional investment that fertility treatments pose for those who pursue them fuels the fire for those speaking out against what they believe is a violation of their rights. Abbey Crain, a creative strategist for Reckon, is also currently undergoing IVF treatment in Alabama, and shares Brittany’s concerns.

(Editor’s note: Crain formerly covered reproductive-health issues for AL.com and Reckon but is no longer in a reporting role. We included her voice in this story because she has been a central figure in the Alabama IVF story, her experience widely covered by national media outlets)

She has been outspoken about the Supreme Court ruling since February, sharing that watching her future family building plans decided by legislators has made her angry, frustrated, and stressed during an already stressful journey.

“Having to deal with all of this anxiety and logistical nightmares that have come with the politicization of IVF has just sent me over the edge, adding so much extra stress that I’m sure is not good physically for me when I’m trying to get pregnant,” Crain said.

What’s next

The ongoing threat to reproductive autonomy in Alabama and beyond has left patients and advocates in disbelief.

“Whether or not you view embryos as your human children or your property, it’s insane that they’re being moved across state lines because of policy,” said Crain. “It’s literally only being done because of our current laws, and the way it’s taking the autonomy out of potential parents is really scary.”

Crain said that while it’s easy for individuals in Democratic-leaning blue states, especially outside of the South, to dismiss what’s happening in Alabama, conservative institutions have laid out their plan in Project 2025 to implement similar policies federally.

“You’re not safe. We are the blueprint. Places like the Heritage Foundation look to states like Alabama to figure out how to replicate it in other states,” she said. “And with the (U.S.) Supreme Court where it is, it doesn’t matter who wins the election in states like Alabama.”

Andrews echoed that sentiment, believing Alabama could be a precursor to what could happen next in the nation based on policy proposals that conservative groups have already laid out.

“I think that you’re going to see other state legislatures and courts try to do the same thing and use the same language, and then at the federal level I think there are plenty of reasons to be worried,” she said, citing birth control like “the pill” and IUDs as the potential next big battle in the fight for reproductive freedom.

As IVF moves back into national conversation after speeches by Tim Walz and Michelle Obama at the recent Democratic National Convention, it’s important to highlight the real people directly impacted by these severe restrictions on bodily autonomy. This politicization of medicine, as Andrews referred to it, poses a threat beyond state lines.The fallout further harms those already struggling through a difficult journey, Pettaway says.

“IVF is not an elective procedure or journey for a lot of people and I just really wish politics were not involved,” she said. “[Politicians] are not here helping me raise a family or helping me to get to the family– it’s me and my doctor, and I just think it affects so many people.”