Since time immemorial, through herbs, womb coverings, and sheaths for the penis, women have been trying to control their reproductive lives – to increase the likelihood of becoming pregnant, prevent pregnancy, and terminate a pregnancy. In the mid-to-late 20th century, with advances in medical technology, women who couldn’t conceive a child received a new lease on creating a family through in vitro fertilization (IVF), which fertilizes an egg outside the body and implants the embryo into the uterus to create a pregnancy. By 2023, approximately 2.3% of all infants born in the United States were conceived using assisted reproductive technology, of which IVF was the most common.
Then, in February 2024, an Alabama Supreme Court decision in LePage v. Center for Reproductive Medicine legally recognized frozen embryos as “extrauterine persons,” jeopardizing the accessibility of IVF and establishing a dangerous precedent that could fuel the proliferation of fetal personhood laws.
For over a millennium, unknown women healers have been at the forefront of aiding infertile women in achieving pregnancy. Trótula di Ruggiero, a remarkable physician from the 11th century, challenged prevailing medical beliefs. Her treatises, attributed to her husband, posited that menstruation was not the origin of all women’s ailments and fertility problems did not always originate in women – revolutionary concepts that were inconceivable to the male medical establishment of that time.
Nonetheless, the breakthrough in fertility treatment came in the 1940s from the ground-breaking work of a scientific researcher, Miriam Menkin (1901-1992). After graduating with a master’s degree in genetics from Columbia university in 1923, Menkin worked in pathology research at Harvard Medical School and as a lab technician for George PIncus at Harvard.
When, in 1938, she joined the lab of the Harvard fertility expert John Rock, she began experiments to fertilize eggs outside the womb. Since Rock was rarely present, Menkin pursued her own ideas, developing her own protocol to fertilize eggs in vitro. Finally, after much patience and persistence, in February 1944 Menkin successfully fertilized an egg outside the human body, the first person to do so. In 1948, Rock and Menkin published a full report on their IVF achievement in The American Journal of Obsteterics and Gynecology, with Menkin listed as first author.
When in 1944 Menkin followed her husband, who had lost his job at Harvard, to North Carolina, IVF research in Boston ground to a halt. Without Menkin’s skills, none of Rock’s assistants succeeded in fertilizing an egg in vitro ever again. Until Menkin divorced her husband in 1949, she sought opportunities to continue her research, chasing down lab space and eggs without success. By the time Menkin moved back to Boston in 1950 and rejoined Rock’s lab, his attention had shifted to developing a hormonal contraceptive pill to prevent pregnancy. Now a single mother with an epileptic child, Menkin set aside her dreams to pursue fertility treatment research and became Rock’s “literary” assistant.
Nonetheless, her perseverance over the six years from 1938–1944 played a pivotal role in the advancement of IVF. While Menkin and Rock only let eggs fertilized outside the body develop for a couple of days, and did not attempt to transplant the embryos into a woman’s body, their revolutionary work laid the groundwork for subsequent IVF fertility treatment research.
In 1959, the first birth in a nonhuman mammal resulting from IVF occurred. By 1978, the world’s first baby conceived by IVF was born in England, enhancing women’s ability to take charge of their reproductive destinies. Since then, subsequent medical advances that stimulate the production of eggs, pinpoint the most opportune time to extract an egg, and freeze and preserve a woman’s eggs to be used at a later date, have made IVF easier and more successful, bringing hope to millions of couples and single people. For the approximately 13.4% of women aged 15 to 44 in the United States who are infertile, an estimated 9.7 million individuals, IVF offers hope.
Since the natural fertility rate declines with age — women aged 40 experience less than a 5% chance of pregnancy per cycle — IVF offers the many women today who prioritize education, careers, and financial stability before starting a family, the means to delay parenting until it’s the right time. For those with medical complications such as endometriosis, or who are about to undertake treatments like chemotherapy or radiotherapy that decrease their fertility, IVF preserves their ability to have children. And IVF offers same-sex couples and single individuals the ability to create a family.
Despite IVF’s transformative potential, its accessibility is limited to those with substantial financial resources. The steep cost of a single IVF cycle, averaging between $12,000 and $23,000, combined with the potential need for multiple cycles, renders it financially out of reach for most of those who need it. Compounding this, most public and private insurers do not cover fertility services. While 21 states plus DC have enacted fertility insurance coverage laws, only 15 include IVF coverage, and 17 address fertility preservation for iatrogenic (medically-induced) infertility, with significant variation between states.
Moreover, many large employers in the US do not cover fertility treatments, citing them as not “medically necessary,” leaving a substantial portion of individuals without access to these vital services. In addition, most poor women are generally excluded from the ability to choose when they want to become parents. While Medicaid supports over half of births in the US and the majority of publicly funded family planning services, only the New York and Illinois Medicaid programs cover any fertility treatment, and no Medicaid program covers artificial insemination or IVF. For most poor women, made up of many women of color, Medicaid provides many health services to prevent pregnancy and to support a healthy pregnancy. Still, there is almost no access to either terminate or achieve a pregnancy.
The February 2024 decision by the Alabama Supreme Court in LePage v. Center for Reproductive Medicine was based on the idea of fetal personhood – that life, thus personhood, begins at the moment of conception, whether inside or outside the womb. The decision threatens IVF as well as other reproductive technologies such as hormonal based birth control and medication abortion. At the heart of LePage, Alabama Chief Justice Tom Parker wrote, “Human life cannot be wrongfully destroyed without incurring the wrath of a holy God,” expressing both Roman Catholic doctrine as well as a view held by many Evangelical Christians.
While fetal personhood laws, which are at the forefront of the anti-aborion movement, endanger reproductive freedoms, they also have far-reaching implications. Would these extrauterine “children” be subject to child abuse if they are locked up and frozen? Does a pregnant woman count as two passengers if she’s traveling in the carpool lane? These are not hyperbolic fantasies. Already in Georgia, a fetus now qualifies for tax credits and child support, and is to be included in population counts and redistricting.
We honor Miriam Menkin’s legacy – her patience and persistence in her research; her monumental breakthrough in fertility treatments, successfully fertilizing an egg outside the body, which laid the groundwork for IVF that has empowered countless individuals to exercise control over their life choices by controlling their reproduction. We decry the decision of the Alabama Supreme Court in LePage v. Center for Reproductive Medicine that imperils the accessibility of IVF, potentially unraveling Menkin’s legacy, and threatens to fuel fetal personhood laws that jeopardize women’s reproductive freedom. We call on us all to remember that it is through collective action and unwavering solidarity that we will safeguard the hard-fought gains of the reproductive justice movement and ensure that all persons have the autonomy and agency to make decisions about their own bodies and lives. Watch our Stand UP, Speak OUT docuseries to learn more about the history of women’s rights and hear from women who experienced its impact on their lives.
