The Supreme Court’s decision to overturn Roe v. Wade, eliminating women’s constitutional right to abortion, has sent shock waves through another reproductive health/family planning field: In vitro fertilization.
At present, so-called trigger laws banning abortions in 13 states are not expected to have any immediate effects on doctors providing IVF, a process that involves combining parents’ sperm and eggs to create embryos in a laboratory, then testing and discarding those that aren’t viable, according to a policy statement from the American Society for Reproductive Medicine (ASRM).
But doctors in the Bay Area and elsewhere who specialize in IVF — increasingly used by couples unable to conceive naturally — are nonetheless bracing for the long-term ripple effect of abortion bans, especially those with language that defines life as beginning at conception. They also are watching growing efforts to grant legal rights to human embryos, because so-called “personhood” laws also could impact the way they use advanced medical technology to help individuals and couples have babies and start families.
“We’re all in this limbo position and not sure of what’s going to happen next,” said Nicole Haggerty, director of marketing and communications at Laurel Fertility Care, which has clinics in San Francisco and Oakland.
Doctors at UC San Francisco and Stanford say they already have begun to field inquiries from people in states that have issued total or near-total bans on abortion, wondering if those restrictions can be used to prohibit the IVF process. In scenes out of dystopian science fiction, the doctors say, couples fear they could lose their rights to embryos they’ve had cryogenically frozen for future family planning. They may not have a say over how these embryos are used, and they may be blocked from discarding or donating ones they don’t use.
“We have gotten calls from patients out of state worried about their embryos. Should they move them? Can they move them?” said Marcelle Cedars, director of UCSF’s Center for Reproductive Health and the president of the American Society for Reproductive Medicine.
”We’ve heard concerns from patients locally,” Cedars added. “Fortunately for them, we’re in California.”
Doctors at Laurel Fertility Care want to make sure that people know that California “is a welcoming state,” Haggerty said.
Similar to the way that women can expect financial help to travel to California for abortions, Laurel Fertility has vowed to help out-of-state residents defray some of the travel costs associated with visits to the Bay Area for IVF treatments, Haggerty said. Even before travel, the total cost for IVF typically falls between $10,000 and $12,000 per cycle, with the price going up if repeat cycles are needed, the clinic states on its website.
Attorneys general in Arkansas, Alabama and Oklahoma told NBC News that their abortion bans have “no implications” for IVF and other forms of assisted reproductive technology. Leading anti-abortion groups have also said that embryos created through IVF are not a priority, while the ASRM noted that some states’ abortion bans apply to embryos in “gestation” or “in the body,” which presumably spares embryos created in a lab.
However, other states don’t specifically address how IVF would be affected, leading to a potential patchwork of regulations across states and myriad challenges to the $8 billion infertility industry, according to the ASRM. IVF and other forms of assisted reproduction technology contribute to the births of about 55,000 babies a year, or about 2 percent of all births.
For Bay Area infertility specialists, the most immediate concern is how far abortion foes take arguments about when life begins. Those whose “ethical construct is that life begins at the time of fertilization and embryos are persons” will likely be focused on what “we do in the lab,” said Ruben Alvero, professor of Obstetrics and Gynecology at Stanford School of Medicine and Division Director of Reproductive Endocrinology and Infertility at the Lucile Packard Children’s Hospital Stanford.
During IVF, eggs from a female patient are fertilized with sperm in the lab to create multiple embryos. Over the next five to seven days, doctors observe the embryos to find those that are likely to grow successfully when implanted.
“This testing really helps us pick the best embryo,” said Alvero.
Under “personhood” laws, Cedars imagines that genetic testing of such embryos, even for a fatal disease such as Tay-Sachs, could be at risk. For testing, Cedars said, “We need to do a biopsy on the embryo. But if an embryo is a ‘person,’ how do you get consent?” Cedars added: “If the embryo is affected by the disease, can we discard it?”
She wonders if the language of some abortion bans could make doctors and clinicians criminally liable for the embryos that don’t thrive or that aren’t viable. “Would practitioners and physicians be accused of murder?” Cedars asked.
To Cedars and most other scientists, the idea that a several-days-old embryo could be considered a person “like you and me” is contrary to science and human biology. Indeed, the failure of embryos to thrive in the lab mirrors what happens in nature.
“What is often misunderstood is that even in the uterus, in the human body, which is the best possible environment possible, only one in four fertilized eggs makes a baby,” she said, adding that the “vast majority of eggs are not capable of producing healthy pregnancies” and miscarriages are more common than people realize in the first trimester due to chromosomal abnormalities. “It’s nature’s way of taking care of its own mistakes.”
Contributed by local news sources