Opinion: If I lived in a post-Roy world, my son might not be here

If I found myself in a post-Roy world, my son might not have been born

Laura Beers

It's been over a year since we conceived again. This time, I had an ultrasound during my first trimester, and the doctor informed us that our baby had a disease that could kill it while it was still in my womb. If they survived, they might live for a few years, inside and outside of hospitals. After a long period of reflection and considering the welfare of my existing family and unborn child, I decided to have an abortion - a heart-wrenching decision I've written about elsewhere.

Following the pain of those two losses, we turned to IVF, hoping that it would finally gift us the child we both longed for. We were fortunate enough to get pregnant after my first IVF attempt.

Recent Supreme Court rulings signal the possibility of overturning the landmark Roe v. Wade case, which protected abortion rights for half a century. In a post-Roy world, many steps I took toward motherhood in states like the South and Midwest could be viewed as illegal or effectively banned.

My journey to motherhood was threatened at every turn

Disturbing stories have surfaced in Texas, with women being denied healthcare and doctors fearing charges under HB8, which allows individuals to sue doctors who perform abortions. Heartbeat bills. A bill passed on Wednesday in Oklahoma is even stricter and uses a similar enforcement mechanism, banning all abortions altogether. Oklahoma's law undoubtedly will lead to tragedies similar to those seen in Texas. Texas and Oklahoma are just two of the states that have passed, or are considering passing, laws to outright ban or severely restrict abortions, even if the fetus has severe disabilities.

However, the latest abortion laws have consequences that extend beyond abortion and miscarriage. The legal argument that life begins with conception has far-reaching implications for IVF. Anti-abortion groups, both domestically and internationally, are not only advocating for a ban on embryo research but also for freezing and disposing of embryos. If election bans were enacted in some states, IVF practices in the country would be significantly impacted.

Oklahoma lawmakers have remained silent on the implications for IVF, but other critics have quickly pointed out the logical consequence of a ban on abortion based on the premise that a fetus's life begins at conception: many practices that are currently considered standard in IVF, including ovarian stimulation and embryo screening, would need to be banned. This scenario should not be dismissed as a dystopian science fiction plot. The British Conservative Anti-Abortion Party came within inches of passing such a law in 1985. A group of pro-choice legislators worked closely with medical professionals - including gynecologists and embryologists - to orchestrate a coordinated blockade, preventing the bill from becoming law.

Each step on my journey to motherhood - miscarriages, abortions, and IVF treatments - relied on the genuine support and care of doctors who championed my efforts to achieve a healthy pregnancy, as I had always desired. The recent abortion laws pose a threat to the abilities of doctors to provide their patients with similar care.

These laws are alarmingly vague ----------------------------___

Many of you who read this will know, or know someone, who has had a D&C. D&Cs are one of the most commonly performed chirurgical procedures in the US. During a D&C, the cervix is dilated, and the lining of the uterus is removed or aspirated. These procedures are often done following a miscarriage. When a woman (like me) is unable to expel a dead fetus on her own, the fetal tissue, along with the placenta and other materials that support the pregnancy, are suctioned out of the uterus. Johns Hopkins Medicine cautions that if this tissue is not completely removed, there could be infections or heavy bleeding. D&Cs are crucial for protecting the health and future fertility of women who have suffered miscarriages.

D&Cs are also used for abortions, including mine. The process is much the same, except that in the case of a miscarriage, the pregnancy has already ended on its own. The problem is, when a woman undergoes a D&C, there's no way to ensure that the pregnancy is viable at the time of the procedure.

Given that estimations suggest about 10-20% of pregnancies result in miscarriage, with approximately 50% requiring some form of medical or surgical intervention, abortion bans like the one in Texas, as well as similar laws in other countries like the Netherlands, could potentially affect a large number of women.

Many of the restrictive abortion laws that have recently been passed or are under consideration fail to make exceptions for the health of the fetus, whereas others, including the one in Texas and Oklahoma's recently proposed law, do not. However, even laws that do make exceptions for the health of the fetus are staggeringly vague. The 2019 law signed in Alabama allows abortions only in cases when the mother's life is in danger or when the fetus has "a lethal anomaly." The rules in Louisiana permit abortions in cases where the fetus has anomalies that would make survival after birth unlikely, while Georgia allows abortions due to fetal anomalies only if the fetus "suffers from a severe and irreversible congenital or chromosomal disorder that is incompatible with sustained life after live birth."

How would I fare in such a legal landscape? Fetuses with my son's condition, obstructive uropathy (LUTO), tend to have a high perinatal morbidity and mortality rate*. However, the question of whether LUTO should be considered a "lethal anomaly" has not been definitively answered. This black-hearted law would strip families of the right to make difficult moral decisions about their child's life with the assistance of a doctor and instead grant that power to the state. I can only imagine the toll that living under such a law would take on me and my family.

I pray for happy endings for other families

Following our abortion, we turned to IVF, hoping to finally conceive a healthy child. IVF is a process involving the extraction of eggs from a woman's ovaries, their fertilization in a laboratory (in vitro), and the subsequent return of the fertilized embryo(s) to the woman's uterus, effectively creating a pregnancy as if it were a natural one. The first in-vitro fertilization baby, Louise Brown, was born in 1978, when Robert Edwards implanted a fertilized embryo into the woman's uterus.

If the pregnancy fails, the woman must undergo another operation to retrieve additional eggs and begin anew. Shortly after Louise Brown's birth, embryologists discovered that the chances of a successful pregnancy were significantly higher if, during one IVF cycle, multiple eggs were extracted, fertilized, and implanted. If two or three fertilized eggs could be implanted at once, the chances that at least one would develop into a live baby were much greater. This is why so many early IVF pregnancies result in twins.

A few years later, embryologists developed technology for freezing embryos, allowing a woman to undergo a second IVF cycle with the remaining frozen embryos without needing another operation. Soon after, embryologists began developing techniques to screen embryos for chromosomal anomalies before freezing, to identify healthy embryos with lower risks of miscarriages or birth defects. Every advancement in the field of IVF is the result of extensive research, including studies on embryos donated by patients seeking IVF treatment.

During my first IVF appointment, seven blastocysts, or embryos, were created on the fifth day, of which one was implanted into my uterus and developed into our wonderful son. The remaining six embryos were screened for anomalies, but lab tests determined that some had chromosomal issues. Only four pass muster. We held onto these four embryos for six years before recently deciding they no longer served a purpose in our family.

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Our story takes a happy turn, and I will always be grateful to have conceived our son through IVF. But fertility doctors are deeply concerned about the impact of legislation like that in Oklahoma, which treats embryos as unborn human beings, and not just for the improvement of IVF research. They are concerned about the continued use of ovarian stimulation and embryo screening procedures. The legal recognition of embryos as individuals could make IVF treatments less safe and effective.

More than 300,000 women undergo IVF treatments in the U.S. each year. Almost a million women in the U.S. have suffered a miscarriage. The repeal of Roe not only affects women who seek abortions; it affects the right to plan a healthy family and the right to plan not to have a child. The denial of physical autonomy for women is dangerous and threatens both rights.

Source:

Enrichment Data:

Restricted abortion laws in the United States have the potential to significantly impact in-vitro fertilization (IVF) in several ways:

1. Legal Uncertainty and Restrictions:
2. Embryo Definition: If embryos are considered "unborn human beings" under state law, IVF procedures could be restricted or even made illegal. For example, in Oklahoma and Louisiana, fertilized eggs cannot be terminated, though in Louisiana, freezing them is permitted. Conversely, IVF has been specifically exempted from abortion bans in South Carolina and Alabama[1].
3. Selective Reduction: The process of selective reduction, where some embryos are removed to reduce the risk of miscarriage and other complications, could be considered abortion and thus illegal in states where embryos are defined as unborn human beings[1].
4. Access and Availability:
5. State-by-State Variability: The impact of abortion bans on IVF varies by state. This variability can create disparities in access to IVF treatments, with some states making it more difficult for patients to access these services[1][4].
6. Employer and Insurance Coverage: Employers and insurance companies have not consistently provided coverage for IVF. The recent implementation of abortion bans might lead to a further decline in fertility benefits, making IVF more expensive and less accessible[1].
7. Patient Experience and Outcomes:
8. Increased Risk: If IVF becomes more restricted, the process could become riskier for women. For instance, reducing the number of implantations to avoid selective reduction might decrease the chances of successful IVF outcomes[1].
9. Delayed or Altered Treatment Plans: Pregnant cancer patients may face delayed or altered treatment plans due to legal ambiguities around protecting fetal life versus maternal health, which could exacerbate cancer outcomes and increase maternal mortality rates[2].
10. Medical Education and Training:
11. Reduced Training Opportunities: Medical students and residents in states with restrictive abortion laws may receive little to no training in essential gynecological procedures, including dilation and curettage (D&C), which is critical for managing miscarriages and certain gynecologic cancers[2].
12. Ethical and Professional Dilemmas:
13. Physician Decision-Making and Liability: Healthcare providers may face ethical dilemmas and legal risks when recommending or performing procedures that could harm the fetus, even if necessary to save the mother’s life. Fear of legal repercussions can discourage physicians from offering optimal care, thereby impacting patient outcomes[2].
14. Broader Implications:
15. Increased Costs and Inefficiency: Caps on the number of embryos or bans on freezing could make IVF treatments less effective and prohibitively expensive, creating unequal access to reproductive healthcare services[4].
16. Geographical Disparities: Patients in restrictive states may need to travel for specialized care, facing financial and logistical barriers, which could exacerbate healthcare inequities, particularly for marginalized populations[2].

In summary, restricted abortion laws can lead to legal uncertainties, restrictions on IVF procedures, reduced access to fertility treatments, increased risks for patients, and broader implications for healthcare equity and quality.

*Source:

Enrichment Data Integration: Legislation like Oklahoma's could impact IVF by creating legal uncertainties and restrictions. Potential consequences include reduced access to treatments, increased risks for patients, and broader implications for healthcare equity and quality. These changes could be exacerbated by variations in insurance coverage for IVF procedures.