They spent years trying for a baby. Then the hurricane hit.
Climate disasters are threatening access to IVF and other forms of fertility treatment.
In September 2022, the Mahons were preparing for the final stage of IVF: the embryo transfer.
Kirsti had already undergone the grueling egg stimulation and retrieval process, which produced 23 eggs. Four had turned into embryos, and three were genetically tested. Two came back healthy and had been frozen.
Her transfer had initially been scheduled for August, but it got canceled when Kirsti contracted Covid-19 that July. Now, as summer turned to fall, Kirsti spent five weeks injecting herself with hormones at their home on the outskirts of Naples, Florida, where she worked as an animal supervisor at the area zoo. Naples sits on Florida’s Gulf Coast, about 40 miles north of the northern edge of the Everglades.
Less than a week out from her transfer, she was at the clinic for a final ultrasound and some blood work when she asked whether she should be worried about a coming storm she had seen on a weather forecast. She remembers the nurse telling her, “We’ll keep an eye on it, but I really wouldn’t worry about it.” At that time, the storm system still looked like it might miss Naples.
As a result, Audubon had to cancel at least 10 IVF cycles and delay the start of several others. This included patients who were preparing for embryo transfers and others who had started injecting the hormones needed for egg retrieval. The clinic also had some embryos growing in the lab. It usually takes five or six days to tell which embryos are healthy and suitable for freezing, but Ulrich’s clinic had to quickly decide to freeze them early, on days two and three instead, just in case their backup power generator failed.
Once the clinic was back up and running, it took months before Ulrich and her team could fit in all the patients whose cycles had been canceled or delayed — patients who were anxiously awaiting the chance to restart the process.
“For most people, waiting a month is not going to make that big of a difference. But when you're in that moment and you're 42 and you know your egg count is low, it feels like just the most devastating thing that could happen,” said Ulrich. “There is a chance that, especially when you get closer to 43, it might make a difference.”
The embryos Audubon froze early had to be thawed in order to mature and then refrozen. The clinic is still analyzing data from that change in protocol to understand if it affected pregnancy outcomes.
Thanks to that experience, Ulrich published a paper in 2022 that calls for more research on the topic of IVF and climate change, with a focus on the particular challenges posed by rapidly intensifying hurricanes. “It had a huge impact on our clinic and our patients, and for months afterwards, we were still dealing with the aftereffects,” she wrote.
But the experience taught Ulrich lessons other IVF facilities could benefit from. Ulrich said she’d love to see clinics establish better relationships with other fertility treatment centers in their region so that patients could transfer to them in times of disaster. She also encourages clinic staff to review their emergency action plans to ensure they are prepared to meet the changing nature of storms, and to be ready to make decisions quickly to salvage cycles and protect embryos. All clinics store embryos in nitrogen tanks, which do not rely on electricity and are typically safe from blackouts or issues with electrical grids. But the labs that embryos mature in before they are frozen do depend on electricity — and if a disaster takes out power for too long, even backup generators can run out of fuel. During Hurricane Katrina, embryos were lost at one clinic for this reason.
IVF clinics are currently not required to have emergency plans in place, but it is recommended by the American Society of Reproductive Medicine. In 2022, the society published its own paper highlighting the need for clinics to adapt to increasingly threatening hurricane seasons.
“Clearly, climate change means you are having more extreme weather events, and [I] think that, like every other part of society, from homeowners to hospitals, fertility clinics have to think a bit more about how they can build more resilient systems,” said Scott Tipton, chief advocacy and policy officer with the American Society of Reproductive Medicine.
Within a few hours of Kirsti’s final hormone injection, she saw her nurse’s name light up on her phone. Before ducking into her bedroom to get some privacy from the houseguests, she exchanged a despairing glance with Justin. “I just looked at my husband and I was like, ‘It's not happening, it's not happening,’ and I took the phone call.”
The nurse immediately assured her that her embryos were safe but confirmed her suspicion: The clinic was closing because of the storm, and Kirsti wouldn’t be able to go through with the transfer the following day. In fact, they would have to start her cycle all over again. (Kirsti’s clinic did not respond to requests for comment.)
“It just felt like our earth was shattered,” she said. Five weeks of hormone injections had taken their toll on her body, both emotionally and physically. She had grown to dread the shots, which caused swelling in her buttocks, thighs, and stomach. “We had spent so much money, so much time. I was covered in bruises,” she said. “I hung up the phone and I just lost it. I lost it. I wasn’t even angry. I was just heartbroken.”
Aside from the sadness she felt over yet another hurdle in their fertility journey, Kirsti thought about all the money she and Justin had poured into the treatment, including borrowing from family. The $2,500 the couple had spent on fertility medications that month evaporated the moment Kirsti’s phone rang. If the couple were to restart the embryo transfer process, they would have to spend thousands more.
The average cost of one cycle of IVF in the US is $12,400, but prices can vary depending on the clinic, the cocktail of fertility medicines used, and the number of embryos collected and frozen. Some clinics charge as much as $30,000 per cycle. And many patients need more than one cycle to get pregnant.
Because IVF is so costly, there is a large access gap between those who can afford the treatment and those who can’t. In a 2021 survey administered by researchers in Illinois who sought to better understand the demographics of IVF patients in the state, 75.5 percent of the respondents were white, 10.2 percent Asian, 7.3 percent Black, and 5.7 percent Latina.
“I wasn’t even angry. I was just heartbroken.”
Despite these hurdles, IVF is becoming increasingly popular. The treatment allows people to delay pregnancy for any number of reasons — to build a career, save money for a family, or find the right partner. And it’s a crucial tool for people struggling with infertility. In the US, that’s one in five women.
More than 40 percent of all American adults now say they have used fertility treatments or know someone who has had them, as the number of people who delay childbearing grows. In 1970, the average age of a person giving birth for the first time was 21.4. In 2021, that average was six years higher.
As IVF has grown more common, it has also become the target of political and legal attacks. In February, Alabama’s Supreme Court, dominated by conservative judges, ruled that embryos created in vitro should be thought of as children for the purposes of wrongful death lawsuits. The ruling had an immediate chilling effect on clinics throughout the state. A month later, Alabama lawmakers extended criminal and civil immunity protections to IVF clinics for their day-to-day operations. Manufacturers of products used in the course of IVF treatment get some immunity protections under the new law, too. But the law still leaves providers at risk because it doesn’t challenge the court’s assertion that embryos are people.
This decision also has possible implications for doctors practicing IVF when a disaster hits, said Ulrich. “If you had an incubator on a power grid that failed, and you didn't have a backup or the backup failed, those embryos would have been lost,” said Ulrich. Perhaps patients would see the loss as an unavoidable accident — or perhaps they’d sue for wrongful death, she said. “It’s another reason to be careful.”