What Is IVF
In vitro fertilization is a medical procedure that helps people have a baby when infertility prevents them from conceiving on their own. A doctor retrieves eggs from the ovaries, fertilizes them with sperm in a lab, and transfers a resulting embryo to the uterus. Extra healthy embryos are usually frozen so a patient can try again later without starting over.
A lab-assisted path to pregnancy, built on extra embryos. IVF stands for in vitro fertilization. Because not every embryo survives or implants, the standard process creates several at once and freezes the ones not used right away.
Key facts
- In 2024 U.S. clinics performed 449,772 IVF cycles and 100,158 babies were born, the first year the annual total passed 100,000 (ASRM)
- On February 16, 2024, the Alabama Supreme Court ruled frozen embryos are “children” (Sidley), and fertility practices across the state paused IVF within days (USA Today)
- At least 17 states and one territory introduced 36 personhood bills in 2026 as of June 3, and none were enacted (Guttmacher)
- Only five states have written IVF protection into law since the ruling (LegiScan)
If your IVF cycle has been disrupted or you need help finding care, RESOLVE: The National Infertility Association runs free support groups, a helpline, and a directory of fertility resources. It also tracks state legislation that affects access so patients know what is changing where they live.
The reason personhood laws collide with IVF is the extra embryos. Standard, safe fertility care depends on creating more embryos than a patient will use, testing them, and storing or discarding the ones that are not viable. A law that treats a frozen embryo as a legal child puts every one of those steps in question.
Who Needs IVF and Why
Infertility has a handful of common causes, and they point toward different treatments. Blocked fallopian tubes prevent an egg and sperm from meeting at all, which is the problem in vitro fertilization was invented to solve. Endometriosis, male factor infertility, and unexplained infertility account for much of the rest.
Most patients do not start with IVF. Intrauterine insemination, or IUI, places prepared sperm directly in the uterus and costs a fraction of a full cycle. It is also untouched by embryo personhood, because no embryo is created outside the body. Patients move to IVF when IUI fails or when the diagnosis rules it out.
Two other groups rely on the same lab work. People facing cancer treatment freeze eggs or embryos beforehand, which is called fertility preservation. Patients who cannot carry a pregnancy work with a gestational carrier. Both depend on embryos that exist outside a body, and both sit inside the reach of a personhood rule.
How One IVF Cycle Works
The legal problem lives inside the steps of a cycle. A cycle is a sequence that runs several weeks, and a personhood rule attaches partway through, once an embryo exists in the lab.
One IVF cycle, start to finish
- 8 to 14 days Ovarian stimulation Daily injections prompt the ovaries to mature several follicles at once instead of the single egg a natural cycle produces.
- 34 to 36 hours Monitoring and trigger shot Transvaginal ultrasound and blood tests track follicle growth in the ovaries. A trigger shot sets final maturation, and egg retrieval follows before the body ovulates on its own.
- 20 to 30 minutes Egg retrieval A needle guided by ultrasound collects eggs from the follicles under sedation. The lab sorts which eggs are mature enough to fertilize.
- Checked at 16 to 18 hours Fertilization Eggs and sperm are combined in a dish, or an embryologist injects one sperm directly into an egg, a step called intracytoplasmic sperm injection or ICSI. A personhood rule attaches here, while the embryo is still in the lab.
- Days 1 to 5, sometimes 7 Embryo culture Fertilized eggs grow in the lab and many stop developing on their own. The ones that continue reach the blastocyst stage around day five.
- Results in weeks Genetic testing In preimplantation genetic testing, or PGT, a few cells are removed from the outer layer and the embryo is frozen while results come back.
- Day 3 to 6, or later Embryo transfer One embryo is placed in the uterus through a thin tube. A pregnancy test follows 8 to 14 days after.
- Day 5 to 7 Freezing the rest Remaining viable embryos go into cryopreservation so a patient can try again without repeating ovarian stimulation and egg retrieval.
Sources: SART patient guide; ASRM; University of Rochester Medical Center.
Four of those eight steps involve an embryo outside the body. Under a rule that grants legal personhood at fertilization, each one becomes a decision about a person, made in a lab, before any pregnancy exists.
Most eggs never become a baby, and that is the ordinary result of a healthy cycle. The attrition is not a sign that something went wrong. It is why doctors retrieve many eggs in the first place.
| Stage | Eggs or embryos |
|---|---|
| Eggs retrieved | 10 |
| Mature enough to fertilize | 7 to 9 |
| Fertilize normally | 5 to 7 |
| Reach the blastocyst stage | 2 to 4 |
| Chromosomally normal | 0 to 3 |
| Transferred | 1 |
Ranges from population data, shown to explain how the procedure works. Individual results vary widely with age, diagnosis, and clinic. Sources: peer-reviewed attrition literature; Progyny summary of 2023 research.
Clinics report these outcomes nationally under the heading of assisted reproductive technology, or ART, through the Society for Assisted Reproductive Technology. The drop-off compounds. Roughly 70% to 80% of mature eggs fertilize, and only 30% to 50% of fertilized eggs reach the blastocyst stage. Age drives the last step hardest, because the share of chromosomally normal embryos falls as patients get older.
This is the answer to the question the personhood argument raises. Doctors do not create extra embryos as a matter of convenience. Fertilizing one egg at a time would put patients through repeated rounds of injections, sedation, and surgery for a single egg that will probably not survive to transfer.
Transferring several embryos at once is a separate question, and medicine has already answered it. The American Society for Reproductive Medicine and SART recommend moving one embryo at a time, because multiple pregnancies carry real risks of preterm birth and low birth weight. In 2024 about 79% of embryo transfer cycles used elective single embryo transfer (ASRM). Creating several embryos and transferring several embryos are opposite trends, and only the first is standard practice.
Stimulation carries its own risk, and it explains why embryos often wait. Ovarian hyperstimulation syndrome, or OHSS, happens when the ovaries respond too strongly and fluid shifts into the abdomen. When the risk is high, clinics freeze everything and schedule a frozen embryo transfer in a later cycle. Creating embryos and transferring one are separate clinical decisions, made weeks apart.
What Personhood Laws Would Change
Fetal personhood is the idea that legal rights begin at fertilization, the moment an egg is fertilized. Applied to IVF, it would treat a five-day-old embryo in a freezer the same as a born child under the law. The American Society for Reproductive Medicine and Scientific American both warn that this reclassification reaches the routine steps clinics perform every day.
The collision is not between two medical views. It is between what fertility medicine has settled and what a legal rule would assert about the same cells.
What the medicine settled
Attrition is built in
- Stimulation matures many eggs because most will not survive to transfer
- Only 30% to 50% of fertilized eggs reach the blastocyst stage, with no intervention possible
- Freezing surplus embryos spares patients repeat surgery
- Single embryo transfer is the recommended practice, so surplus embryos are expected
What a personhood rule asserts
Each cell is a person at fertilization
- An embryo that stops growing on its own becomes a death with legal consequences
- Removing cells for genetic testing becomes a procedure performed on a child
- Freezing becomes indefinite custody of legal persons
- Discarding a nonviable embryo becomes an act the state may punish
Sources: ASRM practice committee opinions; SART; Scientific American; Alabama Supreme Court, LePage v. Center for Reproductive Medicine.
The clearest way to see the stakes is to put standard practice next to what an embryo-personhood rule would do to it.
The bottom row is what shut Alabama’s clinics down. Once a court treats a lost embryo as a wrongful death, clinics face open-ended liability for accidents that are an unavoidable part of the science, and many decide they cannot keep operating.
Nobody knows how many embryos such a rule would cover. The most-cited national count of embryos in storage is 396,526, and it measured storage as of April 11, 2002 (RAND). No agency has published a current figure. A law that would make each one a legal person would apply to a population the country has not counted in more than twenty years.
The Alabama Ruling and What Followed
IVF became a national fight after a single 2024 ruling. The technology arrived in 1978. The Dobbs decision in 2022 returned abortion law to the states, Alabama’s court applied a wrongful-death law to embryos in 2024, and Congress and the White House have acted on the issue since without a binding federal law.
- World's first IVF baby born Louise Brown is born in England, proving lab-assisted conception works.
- Dobbs ends the federal abortion right The Supreme Court returns abortion to the states and empowers personhood arguments.
- Alabama rules embryos are children Several clinics, including UAB, pause IVF within days of the decision.
- Alabama shield law reopens clinics Lawmakers pass it overwhelmingly, and clinics say they will resume.
- Senate blocks the Right to IVF Act A motion to advance it fails 51-44, short of the 60 votes needed.
- Life at Conception Act introduced H.R. 722 would extend constitutional protection from fertilization. It has 116 cosponsors and no hearing.
- Trump signs an IVF order The order asks for policy recommendations only and creates no rule or coverage mandate.
- Drug discounts and employer guidance An EMD Serono agreement cuts three IVF drug prices by up to 84%, and federal guidance explains how employers can offer fertility benefits.
- Four states protect IVF in law Colorado, Georgia, Tennessee, and Louisiana pass protections. Alabama had acted in 2024.
- Right to IVF Act returns Senators Schumer, Duckworth, Murray, and Booker reintroduce it. No vote has been scheduled.
Sources: ASRM; Alabama Supreme Court; Congress.gov; White House; state legislature records.
IVF from the first baby to the personhood fight, 1978 to 2026: 1978: World's first IVF baby born (Louise Brown is born in England, proving lab-assisted conception works.). June 2022: Dobbs ends the federal abortion right (The Supreme Court returns abortion to the states and empowers personhood arguments.). Feb 2024: Alabama rules embryos are children (Several clinics, including UAB, pause IVF within days of the decision.). March 2024: Alabama shield law reopens clinics (Lawmakers pass it overwhelmingly, and clinics say they will resume.). Sept 2024: Senate blocks the Right to IVF Act (A motion to advance it fails 51-44, short of the 60 votes needed.). Jan 2025: Life at Conception Act introduced (H.R. 722 would extend constitutional protection from fertilization. It has 116 cosponsors and no hearing.). Feb 2025: Trump signs an IVF order (The order asks for policy recommendations only and creates no rule or coverage mandate.). Oct 2025: Drug discounts and employer guidance (An EMD Serono agreement cuts three IVF drug prices by up to 84%, and federal guidance explains how employers can offer fertility benefits.). 2025 sessions: Four states protect IVF in law (Colorado, Georgia, Tennessee, and Louisiana pass protections. Alabama had acted in 2024.). July 2026: Right to IVF Act returns (Senators Schumer, Duckworth, Murray, and Booker reintroduce it. No vote has been scheduled.).
1978: Louise Brown became the first baby born through IVF, in England.
June 2022: In Dobbs v. Jackson Women’s Health Organization, the Supreme Court ended the federal right to abortion and returned the question to the states. That opened the door for state courts and legislatures to define when legal life begins. Roe had set viability as the line states could not cross, as our Roe v. Wade explainer shows.
February 2024: In LePage v. Center for Reproductive Medicine, decided February 16, 2024, the Alabama Supreme Court held that frozen embryos are “children” under the Wrongful Death of a Minor Act (Sidley). Within days, fertility practices including the University of Alabama at Birmingham paused IVF. UAB said it had to weigh whether patients and physicians “could be prosecuted criminally or face punitive damages for following the standard of care” (USA Today).
March 2024: Alabama lawmakers passed a shield law, SB 159, that gives civil and criminal immunity for the death of or damage to an embryo during IVF services. Both chambers passed their versions overwhelmingly, and Governor Kay Ivey signed the final bill on March 6, 2024, saying she expected clinics to “resume services immediately” (NBC News).
September 2024: On September 17, 2024, the U.S. Senate blocked the Right to IVF Act (S. 4445), which would have established a federal right to fertility treatment, on a 51-44 cloture vote. Lisa Murkowski and Susan Collins were the only Republicans to vote to advance it (Senate roll call 242).
January 2025: Representative Eric Burlison introduced H.R. 722, the Life at Conception Act, on January 24. It would apply constitutional protection from the moment of fertilization. The bill has 116 cosponsors, all Republicans, and has never had a hearing (govinfo). Senator Mike Rounds introduced a Senate companion, S. 3667, on January 15, 2026.
February 2025: President Trump signed Executive Order 14216, “Expanding Access to In Vitro Fertilization,” on February 18, 2025. It directed the Assistant to the President for Domestic Policy to submit policy recommendations within 90 days (Federal Register). In October 2025, the Labor, Health and Human Services, and Treasury departments issued guidance on how employers can offer fertility benefits outside their main health plan (Department of Labor). In May 2026 they proposed a rule that would make certain fertility benefits a new category of “limited excepted benefits,” which employers could offer separately, like dental or vision coverage (Federal Register). Comments closed July 13, 2026, and the rule is not final.
July 2026: Senators Schumer, Duckworth, Murray, and Booker reintroduced the Right to IVF Act, with a House version led by Representative Lori Trahan. It would create federal rights to provide and receive IVF and require coverage across federal health programs. No vote has been scheduled.
Alabama’s shield law has never been tested in court. No reported case has challenged it, and no ruling has decided whether it holds. The protection that reopened those clinics has not yet met a plaintiff.
Where the Law Stands in 2026
Two years after Alabama, many bills have been filed and few have become law, in either direction.
Start with what passed. Five states have written IVF protection into their statutes since the ruling, and four of them did it in the 2025 sessions rather than in the panic of 2024.
States that enacted IVF protections after the Alabama ruling
The timing carries the finding. Outside Alabama, the bills written in the immediate aftermath all failed. Illinois HB 581, Illinois SB 2412, Kansas HB 2436, and Louisiana SB 276 each died in 2024. Louisiana returned a year later with a different bill and passed it. The response that stuck came from the following session, not from the news cycle.
Personhood bills move in the opposite direction and almost never become law either. They are filed in volume, and the volume is the signal.
- 36
- personhood bills introduced in at least 17 states and one territory in 2026, as of June 3
- 5
- states that have written IVF protection into law
- 116
- House cosponsors of the Life at Conception Act, with no hearing
Those bill counts describe introductions, not laws. None of the 2026 personhood bills had been enacted as of Guttmacher’s June 3 count.
The federal picture is mostly proposals. Two actions reach patients or employers now, a drug discount and guidance on employer benefits, and the rule that would go further is still a proposal.
Where Each Federal Action on IVF Stands
As of October 3, 2026
- H.R. 722, Life at Conception Act Proposal
In House Judiciary since January 24, 2025. 116 cosponsors, all Republicans, and no hearing. (source)
- S. 3667, Senate companion Proposal
Introduced by Sen. Mike Rounds on January 15, 2026. 13 cosponsors, all Republicans, and no action. (source)
- Executive Order 14216 Agency action
Signed February 18, 2025. It asked for policy recommendations within 90 days. (source)
- Employer fertility benefit guidance Agency action
Labor, HHS, and Treasury guidance of October 16, 2025 on offering fertility benefits separately. (source)
- Excepted fertility benefits rule Proposal
Proposed May 13, 2026. Comments closed July 13, 2026. Not final. (source)
- Fertility drug discounts Agency action
October 2025 agreement: an 84% discount off list prices when Gonal-f, Ovidrel, and Cetrotide are used together in a typical protocol. (source)
- Military egg and sperm freezing Agency action, three-year demonstration
Published August 13, 2026 for certain active-duty service members, including some with deployment orders. Reimburses freezing and storage of eggs and sperm, not IVF. (source)
- HOPE with Fertility Services Act (H.R. 8119) Proposal
Introduced March 26, 2026 with 21 cosponsors from both parties. In committee. (source)
- Right to IVF Act Proposal
Reintroduced in both chambers in July 2026. No vote scheduled.
Source: govinfo bill status; Federal Register; Department of Labor; EMD Serono
The October 2025 drug agreement is the one item that reached patients. EMD Serono said patients using Gonal-f, Ovidrel, and Cetrotide together in a typical protocol would get an 84% discount off list prices (EMD Serono). A manufacturer discount is not insurance coverage.
IVF by the Numbers
IVF reaches enough families that a single state ruling drew national attention.
- 449,772
- IVF cycles performed in the U.S. in 2024
- 100,158
- babies born through IVF that year, the first time above 100,000
- ~70%
- of Americans call IVF access a good thing, across both parties
- 15
- states that require private insurers to cover IVF
Those two numbers measure different things. Cycles are not babies: 449,772 cycles led to 97,549 cycles with a live birth and 100,158 babies. More than 97% of those births were single babies, and twins were about 2.6% (ASRM).
Cost and age shape who uses IVF and how often it works. Medications, genetic testing, storage and frozen transfers add to the cost of each cycle, and success rates fall with age. The CDC publishes success rates by age and by clinic (CDC).
Support crosses party lines. In an April 2024 survey, Pew Research Center found that 70% of Americans call access to IVF a good thing, including 63% of Republicans and Republican-leaning independents and 79% of Democrats and Democratic leaners (Pew).
What Would Make IVF Secure
Legal access is only the first of four gates, and it is the one that stops the fewest people. A patient also needs a plan that covers treatment, the money to cover what the plan does not, and a clinic close enough to reach for monitoring every few days.
Insurance is where the gap is widest. RESOLVE counts 25 states and the District of Columbia with a fertility-insurance law of some kind, and only 15 states with a mandate to cover IVF (RESOLVE). The rest cover diagnosis, fertility preservation, or other services without paying for IVF itself.
A mandate is also not the same as coverage. Self-funded employer plans are governed by federal law and sit outside state mandates entirely, so a patient can live in a mandate state and still have no benefit. Some laws require insurers only to offer a rider a customer may buy, which is a weaker protection than it sounds.
For the military, a three-year demonstration published in August 2026 reimburses egg and sperm freezing for certain active-duty service members, including some with deployment orders. It preserves fertility but does not pay for IVF (Federal Register).
Three things would make access real rather than nominal. A federal statutory right, which the Right to IVF Act is written to create. A coverage requirement, which the HOPE with Fertility Services Act (H.R. 8119) would apply to plans that already cover obstetrical care. And state protection in the 45 states that have none, which four legislatures did in a single session and the rest have not.
100,000 Babies a Year and No National Guarantee
IVF matters because it is how more than 100,000 American babies were born in a single year, and the people who depend on it have no national guarantee it will stay available. A treatment that survives in one state on an untested shield law and in others on the absence of a personhood ruling is not secure. What happened in Alabama can happen anywhere a court or legislature decides a frozen embryo is a legal child.
When Alabama clinics paused, the legislature passed a shield law within three weeks, and majorities in both parties tell Pew that IVF access is a good thing.
One caution belongs here. Resist Now found no verified account of a cycle cancelled or a clinic closed because of a law passed after early 2025. The Alabama pause remains the documented disruption, and it is now more than two years old.
The Honest Disagreement
The case against standard IVF comes from the anti-abortion and personhood movement, including groups like SBA Pro-Life America and the argument the State of Mississippi advanced in Dobbs. They hold that a human embryo is a human life with moral and legal rights from the moment of fertilization. On that view, creating embryos that will not all be used, and freezing or discarding them, treats human lives as disposable, and the law should recognize the embryo as a person.
The case for protecting IVF access comes from medical groups like the American Society for Reproductive Medicine and patient advocates like RESOLVE. They hold that embryo-as-person rules criminalize standard, safe fertility care, because creating, testing, freezing, and discarding embryos are unavoidable parts of how IVF works. On that view, treating a frozen embryo as a child strips patients of decisions about their own treatment and shuts down the only path to a baby that many families have.
One fact cuts across the disagreement. When Alabama’s ruling paused IVF, the state’s Republican-led legislature passed a shield law within three weeks.
Frequently Asked Questions
Why do doctors create more embryos than they transfer?
Because most will not survive. Out of ten retrieved eggs, roughly seven to nine are mature, five to seven fertilize, two to four reach the blastocyst stage, and often only one is chromosomally normal. Fertilizing one egg at a time would mean repeated rounds of injections and surgery for a single egg that will probably fail.
Did the Alabama ruling ban IVF?
Not directly. The Alabama Supreme Court ruled that frozen embryos are “children” under a wrongful-death law, which exposed clinics to lawsuits if an embryo was lost. Several clinics paused IVF on their own to avoid that liability until the legislature passed a shield law.
Is IVF legal now?
Yes. IVF is legal in every state as of September 2026. The concern is that it has no federal protection, that only five states have protected it by statute, and that personhood bills in other legislatures could revive the same liability that paused Alabama’s clinics.
Does insurance cover IVF?
Sometimes. Fifteen states require private insurers to cover IVF, and 25 states plus D.C. have some fertility-insurance law. Self-funded employer plans fall outside state mandates entirely, so many patients in mandate states still pay out of pocket.
What are the risks of IVF?
Most are rare, and the medical group that sets IVF standards lists them plainly. Ovarian hyperstimulation, a reaction to the fertility drugs, leads to blood clots or kidney failure in fewer than 1% of cases, and ectopic pregnancy occurs in about 1% (American Society for Reproductive Medicine). Miscarriage rates rise with age, from about 15% for patients in their 20s to more than 50% in their 40s, and newer studies no longer show a clear link between fertility drugs and ovarian cancer.
Could a personhood law shut down IVF nationwide?
No federal personhood law exists. The Right to IVF Act (S. 4445), which would guarantee access nationwide, fell short of the 60 votes needed to advance in the Senate on September 17, 2024, 51 to 44.
What You Can Do
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Tell your state lawmakers to protect IVF by statute. Only five states have. Colorado, Georgia, Tennessee, and Louisiana all did it in one session, so there is recent language to copy. Ask your state representative and senator to introduce or cosponsor it.
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Oppose personhood bills that carry no IVF exception. At least 36 were introduced in 2026 as of June 3. Ask your state lawmakers to reject any bill defining life at fertilization without explicitly protecting fertility care.
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Ask your representative where they stand on H.R. 722, the Life at Conception Act. It has 116 cosponsors and has never had a hearing, and a Senate companion, S. 3667, arrived in January 2026.
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Support patients whose care was disrupted. RESOLVE: The National Infertility Association runs support groups, a helpline, and a resource directory for people whose treatment has been interrupted or who cannot afford care.
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Ask your members of Congress to cosponsor the Right to IVF Act. It was reintroduced in July 2026 by Senators Schumer, Duckworth, Murray, and Booker, with a House version led by Representative Lori Trahan. A federal law is the only thing that protects IVF in every state at once. Use the letter below to send the ask.