Among many reproductive-rights advocates and physicians, the end target for the antiabortion movement has always been clear: protecting the unborn at the precise moment of fertilization. “Everyone that is following this battle definitely thinks personhood is the ultimate goal—defining fetal personhood at conception seems to be the goal,” Seema Mohapatra, a health and ethics professor at Southern Methodist University’s Dedman School of Law, said. “This is the whole point of the movement.” 

That reality, which is coming into greater focus, has rattled reproductive endocrinologists, who now fear that in vitro fertilization services (IVF) might be next on the legislative chopping block. “There’s this history of names associated with famous court cases around reproduction,” Sean Tipton, the chief advocacy, policy, and development officer for the American Society for Reproductive Medicine, said. “There’s Griswold, which found there was a constitutional right to contraception. There was Roe, which found that there was a constitutional right to abortion. Now there’s Dobbs that says there’s not a constitutional right to abortion. Nobody—no patient, and no physician—wants their name on that next case.” He added: “Nobody wants to be the Roe of if IVF is protected.”

Already, reports have surfaced of IVF patients frantically calling their doctors, wondering if they need to move their frozen embryos across state borders in anticipation of possible restrictions on the procedure. At least three practices within IVF treatment could be impacted by antiabortion legislation at the moment, as Judith Daar, dean of the Salmon P. Chase College of Law at Northern Kentucky University, explained to me. Among them are the discardment of embryos (i.e., fertilized eggs) that are not implanted in a patient; preimplantation genetic testing to determine the genetic health makeup of the embryo; and fetal reduction in cases of multiple pregnancies, which can result in higher mortality rates. The concern is how broad the terms in some antiabortion laws are, said Jessica Klemens, a Pennsylvania-based ob-gyn who provides abortion care. “What term are they using, and do they even know what the term means? In regards to IVF, you know, the concern is if they use the word fertilization versus if they are using the word conception.”

Of late, such concerns have been brought into sharp relief by the rather risible exchanges between abortion-rights advocates and state lawmakers, who have displayed confusion around antiabortion language that they themselves wrote. Last week, in a viral TikTok video, Tennessee resident Sara Chambers detailed a back-and-forth she said she had with her state representative, Ryan Williams, who signed Tennessee’s abortion ban—one of the most stringent in the country to date—and informed her that “life does begin at conception either in the womb or in the IVF clinic,” and that discarding embryos would be a violation of state law, according to a screenshot of an email shown in the TikTok. “I admit it is an unusual question for someone who struggled to have children and wants children to ask the question ‘can I discard my embryos’ but I hope this answers your questions,” he added vaguely, likely because the Tennessee law does not clearly encompass IVF. (Vanity Fair contacted Rep. Williams’s office to confirm and comment on the exchange with Chambers and has not yet received a response.)

Less laughable are the explicit threats made against IVF in the wake of Roe’s rescission. Steve Aden, chief legal officer for the anti-choice Americans United for Life, for instance, has called the procedure a form of “eugenics.” And in a May interview with The Guardian, Aden laid out his thoughts more clearly. “I do think that as people understand better what IVF does—even people who are engaged in the process of IVF sometimes don’t understand the implications of it—that we will turn away from this creation and freezing of hundreds of thousands of distinct individual human beings who remain in limbo forever or are ultimately cast off as if the trash,” he said. “I think that’s untenable in a culture that respects all human life.”

Republican lawmakers have introduced legislation that would seem to encompass certain practices within assisted reproductive technology. For instance, in July, Ohio state representative Gary Click introduced a bill that would recognize “personhood” at the moment of conception—which would impact common IVF practices. “The Personhood Act affirms what our founders declared, and science has discovered: A person is a person from the moment a new human being is created,” Click wrote in a statement announcing the bill. “From the moment of fertilization that zygote, embryo, or whichever depersonalizing term you choose to use is not merely a potential human but rather human with potential.” Similar “personhood” legislation has been proposed in Georgia, Iowa, Oklahoma, Nebraska, and South Carolina. Still, IVF technically remains legal in all 50 states; only one, Louisiana, has a decades-old ban on discarding embryos. “We’re in for a prolonged period of uncertainty,” said Tipton. (Vanity Fair contacted Rep. Click’s office to clarify whether his bill would include IVF and has not yet received a response.)

As doctors await more explicit attacks on IVF across the country, many said they’ll continue to provide reproductive services, even if the scope of what they can offer to patients is likely to be curtailed. “It’s definitely added a lot of anxiety and stress to my patients—to anybody who’s trying to get pregnant, not just about what is gonna happen to the IVF process, but just fear if they are going to be able to have the quote, unquote, ‘normal’ complications of pregnancy managed appropriately,” Natalie Crawford, MD, an Austin-based fertility doctor, said. “A lot of people I see are very anxious about just getting pregnant in this timeline.” Robert Rydze, MD, a Wisconsin-based reproductive endocrinology physician, is another physician who found themselves alarmed when Wisconsin’s near-total ban on abortion from the 1800s went into effect after the fall of Roe. “When that ban fell into effect, we of course met with our legal team to go through what the repercussions potentially could be for our clinic.” Ultimately, he said his office decided to ignore the new law because it predates IVF technology by more than a century. “It was written in such a way that it’s been interpreted as: everything we do in our world—fertilizing eggs outside the body, for various reasons—happens before [implantation] and so for us, it’s been more or less business as usual.”

The sheer prevalence of IVF should not go unnoticed in the discourse around the GOP’s assault on abortion rights. In the United States, approximately 2% of all infants born each year are conceived through assisted reproductive technology, according to data from the Centers for Disease Control. “IVF does not discriminate,” Crawford said. “Some people need us who have no idea that they would ever be in that position. And so, to walk backwards when we’ve come so far in this ability to help people have families—it’s so sad.”