Briallen Hopper on the Personal and Political Consequences of the New IVF Court Decision

Writer Briallen Hopper joins co-hosts Whitney Terrell and V.V. Ganeshananthan to talk about in vitro fertilization and the recent Alabama State Supreme Court ruling declaring that frozen embryos have the same rights as children. Hopper speaks about the science and thought behind freezing embryos versus eggs, as well as the religious language embedded in the court’s decision. She reads an excerpt from a 2019 Washington Post essay about her choice to freeze embryos as a single person and reflects on repeating the process later, with a partner.

Check out video excerpts from our interviews at Lit Hub’s Virtual Book Channel, Fiction/Non/Fiction’s YouTube Channel, and our website. This episode of the podcast was produced by Anne Kniggendorf.

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From the episode:

Whitney Terrell: I think it’s important for our listeners and maybe ourselves to understand the science behind in vitro fertilization and embryo preservation. What happens during in vitro fertilization? What is an embryo? How big is it? 

Briallen Hopper: Yeah, lots of questions. In terms of what happens, the IVF process is a process where egg production is stimulated through hormonal injection shots that take place over a period of up to two weeks. So there’s a period where women or people with ovaries are injecting themselves every day, going in for daily bloodwork, ultrasounds every day or every other day, to monitor production. So it’s a pretty time consuming process. And then when the eggs are deemed to be ready, there’s actually a surgery called an egg retrieval. Typically, you actually go under full anesthesia, you’re kind of unconscious. During that period of time, they go in to retrieve eggs. And then once they’ve retrieved them—that’s the in vitro part—then they put them in the glass. 

There are a couple of ways that I’ve seen it fertilized. So one is they just kind of put in some sperm with some eggs in a dish and hope for the best and see what happens. The more complicated, tricky way to do it, when they feel like there’s a chance that the sperm might need a little help, is they actually inject one individual sperm into each individual egg to try to create fertilized eggs. Which is obviously very tricky. This is all microscopic. It’s all invisible to the naked eye.

WT: You can’t see any of this without heavy magnification. 

BH: No, we’re talking about individual cells. So that’s basically the process through which IVF happens. In terms of what is an embryo, there’s different names for embryos at different stages of the process. There’s a zygote all the way up to a blastocyst and at different stages—

WT: Oh, I remember learning this in science class! 

BH: Yeah, exactly. There are different kinds of IVF cycles. There’s fresh cycles, where they try to create an embryo and then, once it’s made, put it back in, so it can then just continue to grow. So with those embryos, they usually watch them grow just for a few days to see if they’re growing. If they’re growing well and quickly then they can look and see which ones seem to be doing the best, which have the best likelihood to make it. 

But what the Alabama ruling was about—and what’s a very common thing to happen with IVF—is freezing embryos. And there are different reasons why you would do this. A big one is if you want to test embryos to see if there are any kind of genetic issues, to find out which ones might have problems, that might mean that they would likely result in miscarriage. But they’re not able to really do that till the embryos reach the blastocyst stage, which typically happens at five or six days after the eggs are fertilized. And at that point, they’re a clump of maybe 200 to 300 cells. If they’re testing they take a few cells out, send them off, see if there are any issues that are important to know about before putting the embryo in. 

And at each stage of this process, there’s just a ton of attrition. So you might get a certain number of eggs, only some of them will actually fertilize, only some of those fertilized eggs will make it to a few days, only some of those will make it to blastocyst. It really is not practical to do IVF one egg at a time, you need to know that a lot of eggs are not going to make it, a lot of the fertilized eggs are not going to make it. So you have to really build in enough numbers so there’s a chance that some of the embryos will actually be viable.

WT: I mean, as happens when people are trying to get pregnant naturally. I mean, very often a fertilized embryo will not attach to the uterine wall, or any number of things can happen, right. And I just want to point out, Sugi is going to ask a question about your own personal experience. And we’re gonna get to this legal part. But the Alabama Supreme Court has said that these embryos, these 200 to 300 cell collections are people. They are very small people. Right? That’s what we’re talking about here.

BH: Yeah, I mean, in reality, all that I’ve been describing in terms of the attrition, all of that is happening inside people, they just don’t know about it, or can’t see it, but a huge number of fertilized eggs never turn into full term pregnancies. Like there’s very, very high rates of pregnancy loss and of miscarriage. Often people aren’t even aware of it because it happens so early. So yeah there’s a way that bodies are doing a lot of essentially determining which eggs have a good shot. And then your body decides, “Okay, this fertilized egg has a good chance of making it, I’m gonna go ahead and go through the pregnancy.” So yeah, there’s a lot of pregnancy loss in the normal course of things.

V.V. Ganeshananthan: When you were talking about retrieval before, I was curious… I mean, all of that sounds, as you said, very time intensive and probably very uncomfortable. Is egg retrieval endoscopic, are you getting cut open?

BH: They go in through your vagina, so it’s not actually an incision. But it can be extremely painful. And actually, it shouldn’t be. I wrote an essay recently for the Los Angeles Review Books Quarterly, where I’m one of the people who had an egg retrieval done at the Yale Fertility Center, where they were not properly managing pain as a result of a nurse stealing some fentanyl. So there are cases where it can be a tremendously painful process with a really intense recovery time. Most of the time, it shouldn’t be that bad. But the whole experience of going through the process is an overwhelming hormonal experience. 

I’ve been through it three times. You kind of swell up because typically in any given cycle you’re just dealing with one or two follicles, but because you are dealing with suddenly 20 or 30 follicles that are swelling inside of you like little balls of fluid to protect the microscopic eggs inside, I actually looked like I was maybe four months into a pregnancy and my abdomen was so swollen. The whole process is pretty physically taxing. And there’s often cramping and a difficult recovery period after the retrieval.

VVG: So, along with the science that you’ve so helpfully outlined for us, every person seeking to freeze embryos or to use IVF has, of course, incredibly personal reasons for doing that. And you chose to freeze embryos as opposed to freezing your eggs. [I was wondering] if you could talk a little bit about that choice and also read from your 2019 Washington Post article on that subject. And for our listeners, we’ll put a link to that piece in our show notes.

BH: Sure. So this article is a bit of a time capsule, it’s from four years ago. And it’s about my initial decision to go through IVF treatment. And at that point, I was in my late 30s, I was single, and I was fortunate enough to live in a state where IVF treatment was covered by my insurance. IVF seemed like my best chance of becoming a parent.

Transcribed by Otter.ai. Condensed and edited by Madelyn Valento.

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Briallen Hopper

Hard to Love: Essays and Confessions • Gilead Reread (forthcoming, Columbia University Press) • “Single Women Looking to Extend their Fertility Usually Freeze Eggs. I Froze Embryos.”|Washington Post, May 10th, 2019

Others:

James LePage, et al. v. The Center for Reproductive Medicine and Mobile Infirmary Association | Supreme Court of Alabama • The Human Life Protection Act | Alabama – May 15, 2019 • Tammy Duckworth | Access to Family Building Act • Dobbs | The Supreme Court – June 24, 2022 • The Radical Freedom Of IVF by Krys Malcolm Belc, Romper