State Legislative Threats to IVF and Assisted Reproductive Technology: What Healthcare Executives and Physicians Need to Know Now

In vitro fertilization (IVF) and other assisted reproductive technologies (ART) are under escalating legal threat across the United States. What was once a settled area of clinical practice—governed by federal reporting requirements, professional accreditation standards, and state medical boards—is now the subject of aggressive state legislative activity that could fundamentally reshape how fertility care is delivered, documented, and regulated.

The pivotal turning point came on February 16, 2024, when the Alabama Supreme Court held in LePage v. Center for Reproductive Medicine that frozen embryos are “children” under Alabama’s Wrongful Death of a Minor Act. That decision—which prompted at least one major university medical center to pause embryo-related procedures—demonstrated how swiftly a single judicial ruling can disrupt an entire field of medicine. In the years since, a wave of state legislation has emerged that, taken together, threatens to subject IVF to burdensome and concerning reporting mandates, redefine medical terminology, and create incremental personhood frameworks that could expose providers to civil and even criminal liability.

This post summarizes the current legislative landscape, draws lessons from the Alabama experience, and offers practical guidance for physicians, health care systems, and hospital administrators navigating these developments.

The State Legislative Landscape

As detailed in a recent New England Journal of Medicine Perspective published July 4, 2026 (subscription required), Texas, Arkansas, and Oklahoma have each advanced nearly identical ART reporting legislation drawn from a common Heritage Foundation model. Understanding that model is the key to understanding the state bills—and to anticipating what may surface in other legislatures.

The Heritage Foundation Model Legislation

The Heritage Foundation’s “ART Reporting Requirements—State Model Legislation” is a fill-in-the-blank template designed for adoption by any state legislature. Its stated premise, set out in a findings section, is that the federal Fertility Clinic Success Rate and Certification Act of 1992 “lacks a strong enforcement mechanism and is too limited in scope,” and that state law generally does not require clinics to report data on ART, maternal and neonatal health, and the total number of embryos created. As a result, the model legislation contends, prospective parents, lawmakers, researchers, and clinics lack an adequate understanding of how ART functions in the state.

The model legislation is organized in seven sections: (1) findings; (2) definitions; (3) a brief section captioned “Prohibition Section” that, despite its title, contains no prohibitions and instead directs that the law be enacted within the state’s existing ART statute or another statute offering the best enforcement and data-collection mechanisms; (4) clinic reporting requirements; (5) an annual public report; (6) maternal and neonatal health outcome tracking; and (7) a severability clause.

Its most consequential provisions are definitional. The model legislation defines a “human embryo” as “a distinct and living organism of the species homo sapiens” from “the moment of fertilization (including the single-celled stage) until natural death,” expressly including embryos in cryopreservation or otherwise unused. It defines “infertility” not as a disease but as “a symptom of an underlying disease or condition,” diagnosed after 12 months of unprotected intercourse for women under 35, or six months for women 35 and older.

The model legislation would require fertility clinics to report annually on nearly every embryo they handle, including all the following:

• the number created in total and per cycle; 
• the number negligently destroyed through cryopreservation tank failure or technical or human error; 
• the number that perish naturally or due to preimplantation genetic testing; 
• the number relinquished to embryo “adoption” or donated for research; 
• the total number in cryopreservation; and 
• those used in pregnancy, live-birth, miscarriage, stillbirth, and multiple-gestation outcomes. 

For embryos “intentionally destroyed,” clinics would have to specify why, selecting from four categories: (1) genetic or physical health concerns, (2) “wrong biological sex,” (3) unwanted or unused embryo, or (4) “other.” Clinics would also report lost reproductive material and any knowing transfer of non-viable material. The state would then publish, within twelve months, a public report aggregating these data together with clinic counts, cycle volumes, procedure mix, and success rates by age and donor status.

Finally, the model legislation reaches well beyond the clinic. It directs the state to track maternal health outcomes through pregnancy, labor, and at least eighteen months postpartum for women who conceive, or carry through gestational surrogacy, a child through ART, and to track the neonatal health of ART-conceived children—including birth defects, chronic conditions, and mental health—through an ongoing review of each child’s genetic, physical, and emotional health until age eighteen, with a self-reporting option offered only in a bracketed note “[g]iven potential privacy concerns.” Notably, the model text contains no express confidentiality protection for clinic-reported data and no penalty provision.

Texas’ Proposed ART Reporting Legislation (HB 3132)

Texas’ HB 3132, which was filed in the 89th Regular Session of the Legislature by Representative Alders with two dozen Republican coauthors (alongside an identical Senate companion, SB 2447), tracked the Heritage model’s reporting framework nearly line for line. It would have required every ART provider to submit an annual report to the Texas Health and Human Services Commission covering 19 categories of data drawn directly from the model—including the model’s four-option list of reasons for discarding embryos, with “wrong biological sex” rephrased as “undesired biological sex”—and would have required the Commission to publish a statewide report on its website by December 31 of each year.

Key features of the bill, and its departures from the model legislation, included:

• Added enforcement: The bill authorized administrative penalties, including fines or other disciplinary action, for failure to comply with its reporting requirements—a feature absent from the model legislative text.
• Embryo personhood language: The bill defines “embryo” as a distinct and living organism from the moment of fertilization, including the single-cell stage and embryos in cryopreservation—language that could lay groundwork for personhood-based restrictions on reproductive tissue as early as the moment an egg is fertilized, even in a laboratory––before it even develops into a viable embryo, not to mention well before such embryo may implant into a uterus and begin developing further. Unlike the model, however, the Texas definition ends at “death or eight weeks gestation” rather than “natural death.”
• Reporting beyond federal standards: The bill mandates reporting of embryo disposition—including patients’ reasons for discarding embryos—beyond requirements under the federal Fertility Clinic Success Rate and Certification Act, raising confidentiality concerns. The bill did, however, narrow the model in other respects: it adopted only four definitions (omitting the model’s definition of infertility as a “symptom”), added an express bar on personally identifiable patient information in reports, and dropped the model’s maternal and neonatal tracking provisions.

Status: HB 3132 was referred to the House Public Health Committee on March 20, 2025, and SB 2447 to the Senate Health & Human Services Committee on March 25, 2025; neither bill advanced out of committee, and both died when the session ended. Although bill filing for the next legislative session has not yet begun, a similar bill is likely to be introduced for the next regular session of the Texas Legislature (the 90th Legislature), which convenes on January 12, 2027, and runs through May 31, 2027.

Arkansas: The Source Legislation (HB 1554)

Arkansas’ HB 1554, the “Assisted Reproductive Technology Reporting Act,” filed February 21, 2025, by Representative Alyssa Brown and Senator Jim Dotson, is the most faithful adoption of the Heritage template and the source of the language later appearing in Oklahoma’s proposed legislation. It reproduces the model’s findings nearly verbatim; adopts the model legislation’s core definitions, including both the “human embryo” definition running “until natural death” and the definition of infertility as a “symptom”; and it tracks the model legislation’s clinic reporting and annual public report provisions. 

The Arkansas bill does, however, diverge in two respects: (1) it requires clinics to state why an embryo was discarded or destroyed without using the model legislation’s four categories, and, as the Arkansas bill was amended in the House, it limits reports to aggregate statistical information with no personally identifiable information. Like the Texas bill, it omits the model legislation’s maternal and neonatal tracking provisions.

Status: After the House adopted a floor amendment on February 26, 2025, the bill was withdrawn by its author and, on April 1, 2025, recommended for interim study by the House Committee on Public Health, Welfare and Labor. It died when the 2025 regular session adjourned on May 5, 2025, but remains likely to resurface. 

Arkansas separately enacted Act 859 in March 2025. The Act is a “restorative reproductive medicine” (RRM) law emphasizing non-IVF treatments for infertility, which could delay or limit patient access to IVF, and shares ideological similarities with the model legislation’s redefinition of infertility as a “symptom.” More than 18 months after enactment, the law’s implementation remains unsettled.

Oklahoma’s Comparable Proposal (HB 2948)

In February 2026, Oklahoma State Representative Jim Olsen introduced HB 2948, which is substantively identical to the Arkansas bill and, through it, the Heritage Foundation model legislation. Like Arkansas’ HB 1554, the Oklahoma bill did all of the following:

• adopted the model legislation’s definitions of “human embryo” and of infertility as a “symptom,” 
• required clinics to report why embryos were discarded or destroyed (without using the model legislation’s four categories),
• directed the Oklahoma State Department of Health to publish a public report within twelve months,
• limited reported information to aggregate statistics, and 
• omitted the model legislation’s maternal and neonatal tracking provisions. 

The Oklahoma bill therefore carried the same substantive risks described above.

Status: The bill was introduced on February 2, 2026, and referred to committee on February 3, 2026, but did not advance. It is now listed as inactive, having missed the committee deadline, and the 2026 session of the Oklahoma Legislature has ended. Had HB 2948 passed, it would have taken effect November 1, 2026. 

A similar bill may resurface during the next legislative session, underscoring the need for ongoing monitoring across all three states.

Lessons from Alabama

The LePage decision from the Alabama Supreme Court remains the most consequential judicial ruling affecting ART providers to date. The case arose after an unauthorized individual entered a fertility clinic in 2020 and removed and destroyed several frozen embryos from cryogenic storage. The couples to whom the destroyed embryos belonged sued the clinic and the hospital association that owned and operated it under Alabama’s Wrongful Death of a Minor Act.

The trial court dismissed the wrongful death claims, holding that cryopreserved embryos do not fit the statutory definition of “person” or “child” under the law. The Alabama Supreme Court reversed, holding that “unborn children are ‘children’ under the act, without exception based on developmental stage, physical location, or any other ancillary characteristics.” Justice Jay Mitchell’s majority opinion relied on prior precedent and on the Alabama Constitution’s “Sanctity of Unborn Life” provision (Art. I, § 36.06(b), ratified December 3, 2018), which requires courts to construe ambiguous statutes to protect the rights of the “unborn.”

Chief Justice Tom Parker’s concurrence discussed imposing limits on embryos created or transferred to a patient’s uterus to suggest that IVF could continue in a modified form. In contrast, Justice Greg Cook’s dissent warned that the ruling “almost certainly ends the creation of frozen embryos through IVF in Alabama” and noted that no other state had allowed wrongful death or criminal homicide actions for the destruction of a frozen embryo.

Immediate impact: The University of Alabama at Birmingham’s Division of Reproductive Endocrinology and Infertility paused all egg fertilization and embryo development following the decision. While IVF was not formally outlawed, providers faced immediate civil liability exposure under the Wrongful Death Act for any embryo loss—whether intentional or accidental—during treatment.

The ruling raised numerous unresolved legal questions: indefinite embryo storage obligations; custody and “personal representative” status of embryos; provider liability for embryos lost during thawing, biopsy, or transport; extraterritorial application of the law if embryos are moved out of state; the ability to waive Wrongful Death Act claims contractually; and potential criminal liability. In response to public outrage, Alabama lawmakers subsequently enacted a narrow statutory “fix” shielding IVF providers from civil and criminal liability for embryo loss or damage during treatment, but the underlying constitutional and jurisprudential framework remains in place.

You can read a more extensive analysis of the Alabama decision in this article that we wrote for Law.com (subscription required).

Emerging Threats from Reporting and Surveillance Legislation

The American Society for Reproductive Medicine (ASRM) has warned that state reporting bills in Texas, Arkansas, and Oklahoma “risk turning private medical decisions into political targets and making IVF harder to access for the families who need it.” ASRM’s Chief Advocacy & Policy Officer, Sean Tipton, has emphasized that “patients deserve fertility care guided by trained medical professionals, evidence-based standards, and their own values, not politicians bypassing medical expertise to reshape reproductive medicine through state law.”

The reporting bills pose several distinct risks to providers and patients:

• Politicization of private medical decisions. By requiring granular reporting on embryo disposition—including patients’ reasons for discarding embryos—these bills transform confidential clinical decisions into matters of public record subject to political scrutiny.
• Undermining of medical definitions and expertise. Replacing consensus medical definitions (e.g., of infertility) with politically motivated redefinitions erodes the clinical foundation of fertility care and could compromise treatment decisions.
• Compromise of patient confidentiality. Reporting requirements that exceed federal standards under the 1992 Fertility Clinic Success Rate and Certification Act (FCSRCA) risk exposing sensitive patient information without clear clinical justification.
• Precursor to personhood-based restrictions. The NEJM authors draw a direct parallel to Targeted Regulation of Abortion Providers (TRAP) laws, which began with intrusive “transparency” reporting requirements before evolving into punitive consequences—including license and credential revocation threats—and eventually restrictions or outright bans on evidence-based medical practice. The reporting bills’ definitional framework (defining embryos as “living organisms from the moment of fertilization”) provides the doctrinal foundation for subsequent personhood legislation.

ART is already one of the most highly regulated areas of medicine, subject to oversight by federal agencies, state medical boards, professional accrediting bodies, and laboratory certification requirements. As ASRM has noted, replacing these evidence-based standards with politically driven definitions “undermines patient care and erodes trust.”

Practical Tips and Issues to Watch

For Physicians Performing IVF

• Assess regulatory exposure. Evaluate whether your state has introduced or is likely to introduce ART reporting bills, RRM legislation, or fetal personhood measures. Engage state medical society tracking resources and specialty-society legislative updates (e.g., ASRM, American College of Obstetricians & Gynecologists, etc.).
• Review documentation practices. Ensure clinical records clearly document the medical basis for treatment decisions, including embryo creation, cryopreservation, and disposition. Anticipate that documentation may be subject to state-mandated reporting or legal discovery.
• Revisit informed consent. Update informed consent forms to address embryo disposition risks in light of evolving state law. Patients should understand that legislative developments may affect their ability to discard, donate, or transfer embryos in certain jurisdictions.
• Monitor state legislative developments. Establish a compliance monitoring process—or engage outside counsel with reproductive health law expertise—to track legislative and regulatory developments that could affect your practice on short notice.

For Health Systems and Hospitals

• Evaluate institutional liability exposure. The Alabama decision imposed potential wrongful death liability on the hospital association that owned and operated the fertility clinic. Health systems should assess whether their corporate structure, insurance coverage, and indemnification arrangements adequately address embryo-related liability.
• Review credentialing and privileging. Consider whether credentialing and privileging criteria for ART providers should incorporate compliance with emerging state-specific requirements, and whether medical staff bylaws address the unique risks of reproductive medicine.
• Update embryo storage and disposition protocols. Review institutional policies governing embryo cryopreservation, storage duration, security, disposition, and patient communication. Ensure protocols are consistent with the legal framework in your jurisdiction and anticipate possible personhood-based restrictions.
• Engage government affairs and advocacy resources. Health systems with government affairs functions should actively monitor and engage with state legislative processes affecting ART. Early engagement—including providing clinical expertise to legislators—can shape legislation before it reaches final passage.

Reed Smith will continue to track developments with regard to IVF and other ART laws. If you have any questions about these laws or any reproductive health topics, please reach out to the authors of this post or to the health care lawyers at Reed Smith.