For fertility specialists across the country trying to help those looking to start a family, abortion bans in many states after Roe v. Wade was destroyed, have raised new questions and concerns about the practice of in vitro fertilization.
Perhaps the most important concern, experts say, is the potential for state laws specifying that life begins at the moment of conception, and what that might mean for embryos, including whether they can be frozen for future use, or whether they can be discarded. and whether patients could ultimately choose to do whatever they want with their own embryos.
Currently, there are tens of thousands of embryos in cryopreservation across the country, Ginny Ryan, MD, a reproductive endocrinologist and fertility specialist at UW Medicine in Seattle, told me. MedPage today.
For patients undergoing IVF, confusion about what new state laws might mean for their embryos is an added stressor, and it’s not the only one that’s been brought up. by the end of roeRyan noted, adding that a patient recently told her, “I don’t feel like I even want to be pregnant in this current climate.”
Challenges to standard practice?
The idea that life begins at conception is concerning to IVF providers because of the way the process works intrinsically.
Once a patient’s eggs are collected, they are inseminated and all the embryos are cultured in a dish and viewed in an incubator, Ryan explained. After 5 to 6 days, those that have not progressed to a normal state are usually discarded. Biopsies are often performed on the remaining embryos for chromosomal abnormalities, especially in women in their late thirties or older. After the genetic testing is complete, there may be additional embryos that are discarded or donated to research.
IVF collects a significant number of eggs, many of which are genetically abnormal, said Jennifer Makarov, MD, an obstetric and reproductive endocrinology and fertility specialist at the New Hope Fertility Center in New York City. Providers can determine which fertilized eggs are likely to give birth and which are not. However, if new laws specify that embryos are protected from conception, that could pose a major problem for patients.
In general, the potential for such laws shows a lack of understanding of how biology works, Makarov . told MedPage today. Take, for example, a patient in her thirties who collected 10 eggs during an IVF cycle. “We’ll be lucky if we eventually have one that shows the potential to grow into a pregnancy,” she noted.
If you have to treat all the other abnormal eggs and you can’t throw them away knowing they don’t have the potential to grow into a pregnancy, that’s a real problem when it comes to doctors doing their job. she said.
There are also concerns about the ability to screen embryos for certain diseases and possibly using an embryo carrying one, Makarov added, as well as concerns about the potential for embryologists and doctors to be targeted for doing their job. work and make decisions with patients.
Fertilizing one egg at a time and implanting it in the uterus would involve a tremendous amount of expense and travel for treatment, putting women at risk for multiple miscarriages and not being able to receive proper care for those miscarriages, she noted.
‘It’s all a bit dark’
Makarov said she and her colleagues have been asking many questions from patients wondering what the end of? roe resources for their treatment, as well as their existing and future embryos.
“Right now, here in New York, we feel quite protected about the ability to practice medicine and make decisions with our patients,” she said. “However, we don’t know what will happen in some of these ‘trigger-law’ states.”
In general, health care morale has plummeted, Makarov noted. Many healthcare professionals have left the field due to the effects of the COVID-19 pandemic, and now, the overthrow of roe is an “additional hit to our autonomy and our ability to practice medicine.”
Ryan said she hopes the end of abortion protections will encourage people who feel passionately about access to care to pursue health care careers, though she worries that institutions will become less willing to support practices financially and legally. support in such an uncertain environment. and what that means for supporting mainstream practice and the next generation of providers.
“It’s all a bit cloudy and unclear at the moment,” Makarov said. “It’s always this fear of what the legal ramifications might be, or might change.”
Legal experts weigh in
Molly O’Brien, JD, a partner at the International Fertility Law Group in Los Angeles, said she and her colleagues also answered a host of questions from domestic and international clients who wanted to know what the end of roe resources for IVF-related services, mainly from those currently undergoing processes or treatments, but also from agencies that match egg donors with parents, as well as doctors.
A particular concern is when embryos are not kept in the same condition the supplier’s office is in, she noted. Some people may not want to take the risk of transporting embryos, while others may feel uneasy about preserving embryos in a state that has enacted or enacted new abortion laws.
As it stands, there is a constitutional right to travel to another state or territory for any reason, especially to seek medical care, O’Brien said. As long as that fundamental right is not affected, people can technically move their embryos if necessary.
Lisa Ikemoto, a professor at the University of California Davis School of Law, said: MedPage today that it is already common for people to travel to access reproductive health services, which could limit access to these services.
In addition, new laws could affect private equity investments in fertility clinics, including large systems that operate in multiple states, she said.
Ikemoto also pointed out that biomedical research conducted with the aim of improving IVF — some of which uses embryos — could be affected, as new laws could make it more risky for researchers to conduct these types of studies, creating a trap of sorts. in which the laws would undermine efforts to improve the pregnancy success rate.
Ultimately, Ryan said it’s important to remember that fertility care is not just a niche and glamorous practice, but is designed to help a large number of patients achieve their goal of starting a family.
“We don’t just see your standard infertility patient,” she said of her practice. “This affects people who have cancer or have other reasons to preserve their fertility for the future.”
It can also affect same-sex couples, transgender patients, and patients with a wide variety of health conditions, such as uterine abnormalities and recurrent pregnancy loss.
“We are concerned about the ability to provide good care,” she says.