Title: How IVF Challenges Our Understanding of Embryos

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Amina Srna: It's the Brian Lehrer Show on WNYC. I'm Amina Srna, filling in for Brian today. Now we'll take a closer look at in vitro fertilization, also known as IVF. IVF is the most common type of infertility treatment in the United States. More than 8 million babies have been born via IVF since 1978. That's according to the Cleveland Clinic. IVF is only growing in popularity. About four in 10 Americans, that's 42%, say they've used fertility treatments or personally know somebody who has in 2023. That's up from 33% in 2018, according to Pew.

The demand has created an industry to store frozen embryos that have yet, or may never get implanted to go on and become babies. Beyond the personal ethics, the fate of those embryos is also a political story. President Trump recently declared himself the "fertilization president" while touting efforts to expand IVF. At the same time, the team that tracked how well in vitro fertilization worked across the US was abruptly cut as part of the sweeping layoffs at the Department of Health and Human Services.

A new three-part series for the New York Times explores the legal and ethical considerations people have to manage when they create embryos as part of the IVF process. We're joined now by its author, Anna Louie Sussman is a freelance journalist covering gender, economics, health, and reproduction. Anna, welcome to WNYC.

Anna Louie Sussman: Thank you so much for having me, Amina.

Amina Srna: Listeners, we'lll open up the phones now for people who have undergone IVF. The process in general is so underreported that maybe you just want to share your journey. How did it go, and what do you wish people would know about it? For those of you who have embryos in storage, in particular, do you want to reserve the right to implant them? If not, what other considerations are you making? Have you ever felt unsure or even got into a dispute, say, with a former spouse on what to do with your embryos? Call us now and share your stories at 212-433-WNYC. That's 212-433-9692. You can also text that number.

Anna, before we dig into some of your reporting, you note, "A majority of IVF patients are white, and even in states where the cost of IVF is covered by private insurance, Black and Hispanic women are less likely to use the technology." The Trump administration says it wants to expand access to IVF, as I said in the intro, but broadly speaking, what is the landscape now, and how accessible is it?

Anna Louie Sussman: The first thing to know is, like a lot of healthcare in the US, because we don't have a socialized medicine, the healthcare is expensive. IVF in particular is about 15,000 to $20,000 if you're paying out of pocket. Now, some employers cover it. There's a group called Mercer, a consultancy that analyzes workplace benefits. Their most recent report found that 47% of all large employers cover it now. I know places like Starbucks and Amazon, there was a story once about people getting jobs in warehouses or working as baristas just to get the IVF treatment.

It's not that it's totally out of reach to everyone. There are ways to get some of your fertility coverage paid for, but in general, it's quite expensive relative even to other countries, for example. There's also 19 states that have some sort of mandate that insurance plans in their state cover fertility care, but it varies quite widely on what's covered, what size employers have to cover it, which treatments precisely are covered.

Then I would also add that there's something that's sometimes called social infertility. I've reported on, for example, a lesbian couple who were told by their insurer that they had to have been trying for 12 months, having unprotected sex for 12 months without successfully conceiving to get a diagnosis. Certain groups are going to run into barriers.

Amina Srna: As the phone lines are filling up, I just want to-- We have a few more slots left, so I want to give that number one more time. For those of you who have undergone the IVF process, we're taking your stories at 212-433-WNYC. That's 212-433-9692, and you can also text us with that number. Anna, in one part of your series, you try to answer the question, are embryos property or people? You really focus on parental rights. Before we get into it, what are some of the options that people have undergoing IVF generally? What can they do with their embryos if they choose not to implant? That's a decision that's made very early on in the paperwork, right?

Anna Louie Sussman: Yes. Typically, when you start treatment, one of the first things you'll do is fill out a bunch of forms, same as going to any doctor, but one of the things they'll ask you is what you intend to do with any remaining embryos once you've finished your course of treatment. Some of the options you might have are discarding them, disposing of them. That's typically just their medical waste or tissue. You can donate them to research. That might be-- a clinic might use these donated embryos to help train their embryologists. You'll be contributing to them becoming better at what they do.

You can donate them to a lab that's doing basic science research. This is really important research that helps shed light on the process of human development, going from one cell to two cell to four cells to eight cells, and how these things work and what genes are involved. Much of this research is done with the goal of trying to improve fertility care and unlocking some of the mysteries of why do embryos fail to implant in the uterine lining, or what causes miscarriage early on, or what happens with chromosomal abnormalities. Can an embryo self-repair? Some of these really fundamental questions.

Not every fertility clinic will have an agreement in place with a lab. That's not always an option for everyone. You can donate them to another person or couple who's experiencing infertility. Embryo donation has been around for a long time. There's also something called embryo "adoption", which is another name for that that comes with a little bit more bells and whistles. It tries to mimic the more formal or regular adoption process by having a home screening. The families get to know each other.

There's also something called compassionate transfer. I first heard about that after Dobbs, because I was wondering what would happen to embryos if embryonic personhood were to be established. A patient on Reddit who I was messaging with was saying, "I've heard a lot of talk about compassionate transfer." That involves transferring an embryo at a time of the month where it's just highly unlikely that the embryo will implant and become a pregnancy. I've heard some clinics don't do it because there's a very tiny risk of infection, but it's one other option.

You can do an embryo burial. I spoke to a priest and a woman who, together they have this charitable operation in Minnesota affiliated with the Catholic Church. They'll accept embryos from anyone. You don't have to be Catholic. They just do a burial. There's some ritual involved, and you can Zoom in if you're not based in Minnesota, but you can have your clinic send them the embryos. You can take it home and do something yourself. I've witnessed a patient just say, "Oh, can I have it?" and the clinic say, "Yes, you can have it."

You can also do none of the above, and you can pay money every year, every six months, to store them indefinitely to put off this really miserable decision that a lot of people don't want to make.

Amina Srna: Anna, we're getting so many interesting texts and calls. Let's go to Christina on Staten Island. Hi, Christina, you're on WNYC.

Christina: Hi. Good morning.

Amina Srna: Good morning.

Anna Louie Sussman: Hi, Christina.

Christina: Hi. I've been undergoing the IVF process for the last three years and had a lot of trouble creating embryos. We did end up with one normal embryo and I was deeply, deeply invested in that. Even though it's just a group of cells, that embryo was more about the potential of what it could be, but the ones that we have that are abnormal, I don't know, it doesn't feel the same as a baby or a person in any sort of way. It's a group of cells.

We ended up donating the abnormal ones to science for the purposes of studying whatever needed to study. If it could become something viable eventually, because I want this to become perfected at some point for other women who are also experiencing infertility.

Amina Srna: Christina, thank you so much for sharing your story. Anna, some of your reporting gets into a little bit more specific on embryonic screening, I guess. What came up for you as you were listening to Christina's story?

Anna Louie Sussman: A few things. I think what she was reflecting on speaks to what I was trying to do with this entire project, which is that for a long time, there's been this debate, people who support abortion rights typically dismiss an embryo as a clump of cells, and people who are against abortion rights say, "No, this is a person, full human being, just like those of us who are sitting here debating abortion today." I think what Christina said is that it's much more complex, and you can feel one way about an embryo--

I should say I'm also an IVF patient myself, and you can feel one way about them one day and another way about them another day. I was really hoping to generate more conversation about these entities because there's no precise estimate of how many are in storage. Even the US-based professional body that-- Oversees is the wrong word, but that's the organized voice of the fertility sector, they don't have data on this. We don't keep data on just how many embryos in storage, but it's anywhere from 500,000 to more than a million, or who knows? It's really hard to get data on this.

The fact that there's so many in storage, I think speaks to the fact that it's really hard to say anything final about them or make a decision because they're very hard to grasp.

Amina Srna: Anna, you were speaking about day-to-day sentiments changing. I believe we have a caller on this. Casey in Ditmas Park, hi, you're on WNYC.

Casey: Hi, thanks so much. Just generally, thank you so much for this segment. I'm a parent of a child who's here thanks to IVF. She's a year old, and we actually have five more eggs on ice. Speaking to that changing day-to-day sentiment, when my husband and I were initially deciding what to do with any extra embryos we have, we felt like just dispose of them. We don't feel attached. Now we're thinking about if we want to use them in the future or what exactly we want to do with them.

Now that I have a little baby who is one of those embryos, full potential realized, it's really changed the way I think about those embryos and what I might want to do with them. I've thought about donating them for adoption. I've also thought about family proclivities and medical issues that I wouldn't want someone other than me to help my child through. It's ultimately really complicated. Where I've netted out is that it's just so important to preserve a parent's choice about what happens to their embryos, their eggs, their babies.

Amina Srna: Casey, thank you so much for sharing your story. I want to read one more text that is in line with what Casey was saying. A texter writes, "Both of my children were born via IVF. We have one more viable embryo, and I'm in my late 30s. Due to a complicated pregnancy with my youngest, I've decided not to have a third. It's never an easy decision. I think about it often. Thank you for explaining that this is a grueling process and people do not make these decisions lightly."

I think also what's adding to the complexity now is that you write about how the legislation of embryos, like abortion, depends largely on state-by-state laws. In your reporting, you write about Texas having one of the strictest abortion laws in the country, but has a carve-out for IVF. Then we have Alabama. In 2024, the Supreme Court there decided that embryos were "extrauterine children." Can you talk a bit about either both of these states or generally this patchwork of laws that we have right now in this country?

Anna Louie Sussman: Sure. I think the part you're referring to about the state laws mirroring abortion access, that was referring to how state laws regulate embryo research. The kind of research that's done in labs. For example, New York state doesn't have a limit on how long you can culture an embryo, grow it in a dish for observational and research purposes, whereas California sets that to 12 days.

The Texas law is actually one of-- There's many states, a lot of them are in the south, that include-- The Texas laws, it's part of its penal code. There's a group of laws called fetal homicide laws that essentially-- They use laws around criminal law to establish embryonic personhood. For example, if there was a car accident and a pregnant woman was killed, the person would be charged for double homicide for killing her and the developing fetus or embryo.

The Texas law defines an unborn child as an individual living member of the Homo sapien species from fertilization until birth. That encompasses embryonic life, but it makes a carve-out for IVF practice. It's saying if an embryo dies during legitimate practice by a licensed doctor, you're not going to get in trouble for that. The Alabama Supreme Court case took this idea of embryonic personhood and brought it all the way into the IVF practice, which most of these fetal homicide laws, they didn't want to touch IVF because it's very popular and even motions around the country to do fetal personhood by ballot initiatives, for example, have largely been unsuccessful.

A big part of that is because the infertility community is very organized. They come out, they tell their stories. We've just heard from people who are so grateful and thrilled to have the families they've always dreamed of through IVF. Nobody wants to crush those dreams. Those political efforts have been pretty unsuccessful. The court case was a different story. That was the judiciary saying, "You know what? Even in IVF, an embryo is a person, and so if you drop one--"

That case was about a clinic having left their embryo storage area unattended. Someone wandered in, picked up a cryogenic storage container, dropped it, and the embryos inside were lost. There were three couples that sued, and it was decided under the Wrongful Death Act. Right afterwards, IVF practice basically paused in the state. Then the legislature very hastily drafted a law that I think was just intended to get IVF going. From people I've spoken to in Alabama, they say this isn't really satisfactory either.

People on both sides of this debate is like, it just gives people blanket immunity. Of course, you want some accountability for people practicing medicine. You can't just do anything and get away with it. I think overall, it speaks to the fact that the people making laws and the people ruling on these laws aren't necessarily super informed about the nuances of the science. You get into a mess with this, which is why I was, again, hoping to stimulate a broader discussion that could bring people together.

Amina Srna: In our few remaining moments, I want to read one more text. Unfortunately, we have so many texts that we're not going to be able to get to, but one listener writes, "There's a lot of pressure to bank embryos, and doctors say it takes two to three embryos per live birth on average. For me, my first embryo took. Suddenly, we have more than we might need frozen. I have some anxiety about laws changing in the future on what is allowed, not allowed, legal, illegal, with frozen embryos."

As we run out of time here, you do write about how, at least on the federal level, President Donald Trump politically stands between two constituencies. There's the conservative agenda put forth in Project 2025, and some influential evangelicals who are opposed to research involving human embryos. Then on the other side, the president is surrounded by vocal natalists like Elon Musk, who is a prolific IVF user. Where do you want to weigh in on this? Has the president-- Is it clear where he's landed on that debate within his two constituencies?

Anna Louie Sussman: I'm not sure he's paying very close attention to this. I think he's pretty caught up in tariffs at the moment, and everything else he's doing, but I do think there are two different constituencies around him, and one is a group of evangelicals who, as you said, opposes IVF on a fundamental basis that it takes life away, you're creating these embryos to destroy them. The way it's practiced, as the person who wrote in mentioned, you're encouraged to bank them. Catholics have long opposed it as well, saying it takes it out of the natural marital sexual union where it belongs.

Then you have the technological side, that crowd. A lot of them are investors in IVF companies and have actual monetary stakes in these things, and they are personal fans of it. I would also note that group brings a engineering mindset to it. There's not just a emphasis on doing IVF, but using it to select and engineer your family in a way. Using technologies like polygenic embryo screening, where you're getting a health risk profile of each embryo, can tell you if it's more likely to have XYZ disease, and also sex selection.

This isn't something I have reported on personally, but that Elon Musk's estranged daughter had posted on social media that she believes her estranged father had chosen for her to be a boy, screened the embryos, selected her, and she said, "My assigned sex at birth was a commodity that was bought and paid for." He's posted really nasty things about his son being dead. I think that does speak to an extreme version of this, where IVF moves away from being a tool to achieve your family from all the people we heard from today, and towards something where you're using it to optimize or design or engineer a certain kind of family or child or society.

I think that really can alter the parent-child relationship in a way that it almost makes you see the point that the conservatives are making of like, "This is unnatural. We shouldn't use this way." I think it's important to bring those sides into dialogue with one another, and that can help us think through how we feel about these technologies.

Amina Srna: Thank you for starting the conversation with us today. Listeners, thank you so much for sharing all of your personal stories with us through text messages and calls. We thank our guest, Anna Louie Sussman, freelance journalist covering gender, economics, health, and reproduction. You can find her new three-part series on embryos in the New York Times. Anna, thank you so much for coming on.

Anna Louie Sussman: Thank you for having me.

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