They were desperate to get pregnant. Then IVF gave them extra embryos.

One morning last spring, Ashley Harrolle put her 1-year-old daughter down for a nap and went to the kitchen. She pulled up her fertility clinic’s contact information. It was time to make the call.

In a freezer several hundred miles away sat a single embryo belonging to Harrolle and her husband. Once, it had represented a possible second child, but the couple had known for months that they wouldn’t be able to use it. After a rare and dangerous complication with her pregnancy, Harrolle couldn’t go through another.

It had been easy for the couple to decide to donate the embryo to science. They liked the idea that it would be used in training IVF providers.

But now, Harrolle was finding that actually giving it up was harder. She sat at the kitchen table in her Birmingham, Ala., home and stared at the number on her phone screen. Sudden grief hit her for the future that could have been — the future her family would never have.

“It all slapped me in one moment,” the 35-year-old therapist recalled in an interview. “I kind of realized, like, ‘Oh, s---. This is harder than I thought it was going to be.’”

She put down the phone.

What happens to spare embryos created during IVF is a question that was thrust into the national spotlight in February, after the Alabama Supreme Court ruled that frozen embryos were people and characterized discarding them as killing unborn children.

The ruling drew attention to a part of IVF considered standard practice in the United States - creating as many embryos as possible, which doctors say provides the best odds for success. Antiabortion advocates have long objected to it based on the argument that destroying unused embryos constitutes ending lives.

Those who have faced the dilemma of what to do with leftover embryos, however, say it is a highly personal and often emotional process. For many, it represents making a choice about whether to have more children.

They and reproductive health experts described the decision as both medically routine and subjectively delicate, wrapped up in questions about family size, maternal health and personal finances. Many wait months or years to decide - or keep their embryos frozen indefinitely.

Watching the topic be turned into a campaign issue and dissected by strangers online has been difficult for some who have been through IVF, several women told The Washington Post. The discourse, they say, has obscured what families in fertility treatment experience.

“[To] find embryos that are potential success stories, we have to get a lot of eggs and a lot of embryos to select from,” said Michael Alper, a doctor and medical director at the multistate fertility provider Boston IVF. “That’s just the way human biology is.”

Some patients never end up with extras because they use all their embryos in attempts to conceive, said fertility doctor Serena Chen, director of advocacy at CCRM Fertility in New Jersey. For those who do, the amount of “blood, sweat, tears, money” that goes into creating the embryos can contribute to the difficulty of the decision.

Families who don’t want to use the embryos or keep them frozen can discard them, which doctors described as common; donate them for use in scientific research and training; or donate them to others seeking to have children. A fourth, relatively uncommon option discards embryos by transferring them into a woman’s body at a time when she’s unlikely to become pregnant.

“It’s a really personal conversation,” said Kimberly Mutcherson, a professor at Rutgers Law School and reproductive justice scholar. “It varies from person to person and couple to couple.”

The best chance

The July 2022 date was marked in Kaytee Schwartz-Davis’s Google calendar - the day the embryos she and her husband had created would no longer be theirs.

The couple had tried to conceive for 2½ years and gone through two failed IVF embryo transfers before getting pregnant in 2020. When they ended up with six extra embryos after the birth of their son, Felix, they immediately thought of other families waiting and wanting to have children.

There was a long wait list for donated embryos, their clinic told them. Six would provide three families with two chances each at babies. Schwartz-Davis felt like they had to do it.

“It was more about helping other people” than feeling a strong attachment to the embryos, said Schwartz-Davis, 36, of Belmont, N.C. “Just hoping that maybe this will help someone not have to go through … the emotional devastation” of being unable to start a family.

Schwartz-Davis and her husband, Ryan Davis, didn’t struggle with the idea of having their genetic children born to other families, regarding them as the kids of whoever raises them. The difficult part was closing the door on having more children of their own.

“We were definitely sad,” she said. “It’s so final. Like, this is it. … There is just no chance that we’re going to have more kids.”

Embryo donation is a less commonly chosen option, said Chen, the doctor. It requires more effort and paperwork, and some parents balk at the idea giving their embryos to strangers. It’s the path favored by antiabortion groups.

Schwartz-Davis and her husband had always wanted a big family, but after she navigated a pregnancy that included hyperemesis gravidarum - debilitating nausea - and intermittent bleeding, they decided not to try for a second child. Though that felt right, it wasn’t easy, especially as they watched friends have second babies.

Schwartz-Davis had been an egg donor after college, so she was familiar with donation. The couple decided to leave their information on the DNA-testing site 23andMe so they could be found. Otherwise, they were comfortable with never knowing whether children resulted from their donation.

The couple waited a year to fill out the paperwork after first contacting the clinic about donating, “just to be sure, 100 percent sure, we’re definitely not going to go through this again,” she said.

Finally, Schwartz-Davis decided it was now or never. The couple did bloodwork and urine testing. They provided childhood photos and answered questions about their favorite colors, movies and sports.

A three-month waiting period followed, giving them a window to change their minds. Schwartz-Davis watched the date on her calendar, but she was at peace. They had done the right thing for their family.

A biology major in college, Schwartz-Davis said she views embryos as cells, not people - and she knows from difficult personal experience that not all embryos result in pregnancies. Donating doesn’t necessarily mean their embryos will become people, but she looked at it as their best opportunity.

“At least this way, they have a chance of being a person and having a life - and maybe changing the world. Who knows, that sounds silly, but …” she said. “Otherwise they would just sit there frozen forever.”

Finding peace

On a cloudy morning in late January, Emily Ibison and her husband, Bryan, left their doctor’s office with good news - her second pregnancy, a surprise after an IVF-conceived baby, appeared healthy. They got in the car and, for the last time, drove to their fertility clinic in Indianapolis.

With them was the paperwork that would allow their embryos to be discarded through donation to science. They signed the papers at the front desk. It took only a few minutes.

Then they were driving home, not feeling much more than relief.

“It’s nice to have a sense of closure,” Ibison, 31, of Lafayette, Ind., said in an interview. “Being able to breathe that little sigh of relief that’s like, we’re getting off that roller coaster.”

After one successful IVF transfer in 2021, resulting in the birth of daughter Hazel the following July, Ibison had waffled about what to do with their 15 leftover embryos. While she and her husband were fairly certain they would be happy as a family of three, they hadn’t made a final decision.

Ibison was most worried about later wishing for another child. After seeing her daughter born from one of the embryos, it was natural to wonder “who each one of those embryos could’ve become,” she said.

“That fear of regret was definitely part of it,” she said. “It’s hard to make a decision in one moment of life that’s going to affect the rest of your life.”

At the end of last year, the couple’s annual notice from the fertility clinic came in the mail: It was time to renew their embryo storage. Before Ibison could make a final decision, she discovered she was pregnant.

If the pregnancy appeared on track, the couple would be ready to discard the embryos, they decided. When they got to the clinic after their first OB/GYN appointment, the Ibisons checked the box to allow the embryos to be used in training.

A few weeks later, the Alabama ruling came down. When she saw it, Ibison was relieved she and her husband had already made their choice. Even though there was no threat to embryo disposal in Indiana, she could imagine state lawmakers someday restricting it.

“I definitely wouldn’t have wanted to end up in a decision where we couldn’t discard them and had to continue paying for that storage forever,” she said.

She said she wished people who haven’t gone through IVF, including politicians, understood the desperation couples feel when trying to start families and understood how little is in their control.

“Nobody wants to be in this situation, and nobody wants to have to make the decision of whether or not to discard embryos,” Ibison said. “These are all the things we put ourselves through so we can just have a family.”

Closing a chapter

In Birmingham, Harrolle realized that giving up her single spare embryo felt like a shift in her life path. She would have to grieve it - the loss of a vision she’d once had for her life, the loss of her ability to choose how big her family would be, the loss of a potential future with two children.

Harrolle spent some time mentally preparing through therapy and journaling. Finally, she called the clinic. She and her husband, Jeff, filled out the paperwork and got it notarized.

They initialed the boxes: Donate all embryos that we have stored for research/training use.

Harrolle remembers relief, numbness and grief. With it came closure, knowing the decision was right.

After that, Harrolle didn’t think too often about the embryo - which she never viewed as a person - until the ruling in her state came down in February. Though Alabama legislators later passed a law shielding patients and providers from any liability for destroying embryos, Harrolle was shaken, worried for those in the thick of IVF.

“It felt as though it was being discussed in such a callous way. … Like, oh, if you throw away these embryos, you’re a murderer. Well, no! Not at all,” Harrolle said.

“I don’t think that people who are making the [policy] decisions understand the nuance. It’s not right or wrong; it’s not alive or not,” she said. “There’s nuance behind it.”

Harrolle - who was born through IVF in the late 1980s - described a sense of satisfaction in knowing their embryo would have a small purpose in research.

Without science, she wouldn’t have gotten the best thing in her life - little Alice, who was on the backyard swing on a recent weekday, chasing sunshine.

Talking about it, Harrolle began to cry.

“If we hadn’t gone through all this,” she said, “she wouldn’t be here.”