She also created her own family using IVF. "Future parents should have the freedom to decide how they want to start their family without government interference." The legal and hypothetical scenarios that could unfold are still to be seen. However, the potential is quite frightening.
The new laws that were developed as a result of the court ruling could have significant implications for eight out of ten couples in the U.S. who are dealing with infertility and rely on assisted reproductive technologies to start their families.
The IVF Process: A Closer Look
IVF, in its simplest form, is the process of fertilizing an egg outside the uterus with the aim of transferring the healthy embryo to a person's body. In the United States, two of every hundred children are born through IVF. More than 300,000 ART cycles were performed in America alone in 2020.
Once fertilized, certain eggs can develop into embryos which can be transferred into a woman's uterus. It is possible to get pregnant if the embryos are successfully implanted. It is important to remember that, just like in traditional pregnancy, there is no guarantee that embryos will reach the correct stage. IVF clinics create multiple embryos in order to increase the chance of a healthy pregnancy for the couple or individual.
Most people who undergo IVF freeze their embryos to use them in the future. Freezing embryos can also help maximize the cost-effectiveness of the IVF procedure. Saving or freezing embryos will allow for only one embryo to be transferred at a given time during the transfer phase of a cycle, preventing multiple pregnancies. According to the American Society of Reproductive Medicine, having multiples via IVF increases the Risk of adverse health outcomes both for babies and pregnant women. Additionally, the remaining embryos frozen can be used in later cycles when a transfer cycle fails or when couples or individuals wish to grow their families again.
IVF is not an exception to the fact that advances in science and technologies are changing possibilities in reproductive healthcare. There are devices such as remote monitoring for patients and at-home urine tests to monitor hormones, along with technological advancements in artificial intelligence (A.I.) and data-driven platforms.
The IVF industry and the broader reproductive health sector will be watching closely to see what impact the Roe decision has on individual rights and technology.
Roe Overturn and IVF
Gary Nakhuda is the co-founder of Olive Fertility Center, a fertility clinic in Canada. He says: "The government's control over women's reproductive choices is alarming at all levels. Fertility treatment cannot be assumed in this environment."
Clinics are moving frozen embryos from states in the U.S. that will likely ban abortions. This is a sign of collective concern about the reproductive autonomy of IVF.
Katherine Kraschel is Executive Director of the Solomon Center for Health Law and Policy and Lecturer at Yale Law School. She says that without Roe, states could feel more empowered to regulate other forms of reproductive healthcare providers, such as fertility care.
In IVF, the eggs are fertilized by a laboratory. Stephanie Boys, Assistant Professor of Social Work and Adjunct Faculty of Law at Indiana University, says that IVF may be affected in states which have passed laws defining the beginning of life as fertilization. If a state declares life to begin at fertilization, it may limit the number of embryos produced in each IVF cycle. They could also outlaw cryopreservation and stop destroying any embryos currently preserved.
Technology and IVF
Nakhuda says that the adoption of telehealth has been a huge benefit to patients since they can consult with their doctors without having to travel to the office. Nakhuda says that "at-home tests are accelerating".
Mira says that "patient care in the U.S. is rapidly changing due to the pandemic. Virtual care has become accepted across the board as a treatment method." Access to fertility treatment is limited to those who can afford to spend a whole month in the city of the clinic or live close to one.
Paxton Maeder York, CEO and founder of Alife Health, says that "every clinic/clinician in the U.S. has a unique process to decide medication dosage and timing". This important part of the procedure directly impacts the number and quality of eggs that are retrieved. It also affects the number of embryos produced, and ultimately the chances of a clinical pregnancy," Maeder York adds.
The tools available today are geared towards solving problems and supporting the various healthcare It solutions professionals who manage IVF procedures for patients. This helps to improve patient outcomes. The embryology lab can show better results in terms of fertilization and embryo culture.
AI-driven tools, which use baseline data for predictions of egg retrieval, are used to improve outcomes and standardize processes. These tools can then be used to help reproductive endocrinologists choose the best medication dosage and timing in order to maximize the number of mature egg retrievals from an ovarian stimulation cycle.
The technology providers working in the field of fertility treatments have recognized the difficulties in aggregating huge datasets and are now developing solutions that will help them better understand these datasets. Reporting on embryo quality is usually done manually by embryologists. They grade embryos under a microscope and then enter the information into their EMR systems. Then they generate reports that can be shared with the treating doctor. The use of embryo image capture systems simplifies the capture, storage and organization of images of embryos while increasing the efficiency of grading by synchronizing with EMR.
What Are The Latest Technological Updates Post-Roe?
People may worry that reproductive health tools may be affected by the adoption of fertility technologies.
Boys say that U.S. courts are currently deciding which technology will be admissible in court cases involving prosecution for performing, obtaining, or assisting abortions. Boys say that "many" technologies are at Risk. These include Google searches, period-tracking apps, and Uber.
IVF clinics, doctors and patients await clear guidance on how the ruling will affect IVF laws and medical technology. Boys say that there is still a lot of uncertainty about the laws and how they will be implemented. This makes it a "very scary time" for fertility centers and patients.
Patients are advised to consult closely with their doctors, fertility teams, and educational resources while staying up-to-date on local laws.
Interpretation and Application of the Law
The overturning of Roe v Wade has created "numerous ethical dilemmas". Boys say that the main ethical dilemmas are caused by the "uncertainty and fear" it creates for doctors who practice reproductive medicine.
Kraschel says that "State laws restricting access to embryo destruction place the state in between a patient's fertility doctor and the law." Kraschel says that, to date, abortion restrictions or bans have not affected access to IVF. IVF patients are affected by abortion bans, however, because they hope to become pregnant. IVF can lead to twins, triplets or multiple pregnancies. Patients may also need IVF if they are older when they get pregnant. These are two examples of high-risk pregnancies that could leave IVF patients untreated.
This raises concerns about the quality of the treatment if states restrict IVF, such as by limiting the destruction of embryos. Kraschel says that patients and doctors would have to make decisions based on state laws, not the best standard of care, most likely for a healthy pregnancy or child.
The patient may be forced to choose between generating fewer embryos or undergoing multiple expensive, time-consuming and emotionally draining rounds of fertility treatment. It may be necessary to freeze eggs rather than embryos, reducing the chances of becoming pregnant.
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Further Research
Kraschel says that some patients, even before Roe was overturned, wanted to reduce the number of created embryos due to the moral importance they attach to them. Some researchers have therefore tried to determine the optimal number to collect in an IVF cycle to produce a live birth without creating excessive embryos.
According to a study published in January 2023, a newly developed tool for predicting embryos' fate could help reduce the number created and unused and address immediate patient and clinician concerns.
Kreschal says that "work like this could continue." She continues that its continuation is a good illustration of the questions that would be asked in research, such as: "How do we provide the best care possible for patients with fertility issues?" "How do we reduce the cost of fertility treatment to make it more affordable?" and "How do we maximize the chances of having a healthy child?"
The question should be, "How can we alter the standard of care in order to conform to the restrictions imposed by the state, which ignores clinical evidence and imposes its moral value on embryos?"
Future of Fertility Health
Boys say that the issue of possible state legislation defining embryos as persons are most concerning to reproductive technologies. Louisiana is currently the only state that has defined embryos to have rights. Embryos created for IVF can't be discarded. Boys explain that "any state which defines life as beginning at fertilization opens the door to fetal persons."
Some states have laws that establish legal personhood as early as embryonic or fetal development. Kraschel says that state legislatures are being careful to draft laws that severely or completely restrict abortion and mention life starting at "conception" or "fertilization".
The legislatures, however, have restricted abortions to an embryo or terminating a pregnancy. Kraschel explains that laws to date have "evoked the idea of protecting life at the moment of fertilization". Experts say that while this could apply to frozen embryos produced by IVF in the U.S., at present, "the laws don't operate so as to include embryos outside a pregnant woman's body".
IVF: How it Could be at Risk
The National Infertility Association, IVF can be accessed by those who wish to start a family across all 50 states and Washington, D.C.4 A report from ASRM shows that trigger laws in thirteen states are not a threat for infertility practitioners or their patients right now.5
Experts in law and fertility are concerned that this situation could change. IVF may be affected either accidentally or intentionally depending on the legislator's goals, especially as more states pass anti-abortion laws. According to the Guttmacher Institute, more than half the states (as much as 26) in the U.S. will likely ban abortions.
Although the primary purpose of these bans is to limit abortions, experts in fertility and law worry that state legislators could introduce legislation that could potentially threaten access to family-building treatments like IVF.
Susan L. Crockin is a J.D. and an attorney at Crockin Law & Policy Group. She is also a senior scholar and adjunct faculty member of the O'Neill Institute. Georgetown Law Center, Georgetown Center for National and Global Health Law. She wrote a paper for ASRM in which she stated that if the state law did not exempt IVF and embryos specifically, it could have a multi-faceted impact on patients and providers.
Crockin writes that not only would storage and disposal choices be limited or questioned, but the discarding of embryos may be prohibited. Even "compassionate transfer" could be considered illegal, which involves transferring embryos into the uterus at a time when the uterus is not fertile without the expectation of pregnancy.
Crockin continues, "IVF patients have concerns." Many IVF patients are considering moving their embryos in order to avoid future restrictions or uncertainties.
Read More: What's the Future of Software Development in Healthcare 2023
Personhood Rights: The Impact on Embryos
Resolve reports that over the past decade, states across the country have tried to pass laws declaring "personhood", or human life begins the moment a sperm fertilizes an egg. These personhood laws could unintentionally limit IVF procedures and practices, like testing embryos before transfer for genetic abnormalities. These bills could also make IVF more expensive and difficult. They could make IVF illegal in some cases.
The biggest concern for patients is the definition of a state legislator's view on when a human being or a person starts. Brooke Rossi, MD, an OB/GYN and reproductive endocrinologist with Ohio Reproductive Medicine, as well as an assistant professor at The Ohio State University, explains. These laws are often referred to as personhood laws, and they have [huge] consequences for the way we practice medicine. If a state says that a person starts at fertilization, this may affect how we do IVF."
Dr Rossi says it's important to remember that not all fertilized eggs become babies, even for those who are trying to get pregnant naturally. It may be overreaching to say that a fertilized embryo is a human being before it has been implanted.
She says that it will be difficult to practice IVF when every fertilized egg is viewed as a human. Most IVF laboratories decide on how to use embryos by evaluating the quality, growth, and implantation potential. This all changes when we lose the ability to evaluate these things.
If state legislators stipulate that life begins with fertilization or conception rather than implantation of the embryo, then each embryo created in a lab could potentially enjoy the same rights as one successfully implanted during a pregnancy. Although such personhood legislation has not yet been passed, it could in the future.
In states that might pass a personhood law, [providers] may not be able to use IVF as intended," explains Kara N. Goldman, MD, FACOG. She is an OB/GYN and reproductive endocrinologist at Northwestern Medicine, as well as the medical device director of Fertility Preservation and an associate professor in obstetrics gynecology at Northwestern University. Someone may be restricted in how many eggs they can fertilize and then transfer back into the uterus. It could result in fewer embryos for older patients. It could also be problematic for young patients, resulting in triplet pregnancies.
To increase the chances of success, multiple eggs are retrieved during an IVF cycle. Levich says that it also gives future parents a chance to have more than one child from a single IVF.
She says that if embryos were granted the same constitutional rights as humans, fertility doctors would have to modify their medication protocol in order to only retrieve a few eggs per cycle. This would, in turn, reduce success rates and increase IVF costs by forcing patients to pay for multiple cycles, medication etc.
A small number of states are also considering legislation to establish personhood.
Levich says that officials in Alabama, Arkansas and Oklahoma have made it clear that their abortion bans will not impact IVF. Many are concerned that their laws, which define life as beginning at conception, could be interpreted to include IVF.
The Impact of IVF on the Process
New laws could also impact IVF and may require unsafe practices. Dr Goldman says that anything between the patient and the physician can lead to less-than-optimal and unsafe outcomes.
She says that future laws may require IVF to be performed with limited fertilization, no embryos will be frozen, and all the embryos created will be transferred back into the uterus. "I hope these restrictions will never be required because they are an unsafe and ineffective way to perform IVF."
Also, restricting IVF or using restrictive language could affect people with special circumstances such as cancer. Dr Goldman says that restrictive legislation or laws could make it difficult for an individual or couple to have the family they want, especially if there is a restriction on embryo freezing.
She says, "We spend a great deal of time caring for patients who have been diagnosed with cancer and try to preserve their fertility before their cancer treatment." "The only way to ensure that patients receive the best care is by freezing their eggs or embryos. It is crucial for cancer patients to be able to freeze embryos and use them later.
Consequences of Other Activities
The second potential problem is that laws may have an impact on the way embryos are maintained, stored or disposed of. Clinics and patients could be forced to pay for the long-term storage of embryos, especially if destroying embryos is considered an abortion.
Crockin says, "I am not aware of any state laws that define abortion that way." If life begins at fertilization, either in an abortion statute or so-called personhood laws, there may be significant limitations to the use and disposal of embryos.
Dr Rossi worries that new laws could also limit access to IVF. This is especially true for those who don't have the means to travel or move to another state. IVF is not only a costly procedure, but for some people, they can only afford to do it once.
Dr Rossi said that if there are some states with such strict laws, embryologists or fertility clinics will not be able to work in this type of environment. Legally, it would just be too difficult, so some practices may close.
According to Dr Rossi, strict laws and restrictions have limited the number of practices available in some states. She says that in those states, the only options available to families are what was available during the 1990s.
It is frustrating in states with limited access, Dr Rossi says. They are forced to use treatments that are less effective or safer, or they have to travel in order to get the same treatment as someone from another state. It is a very frightening and disheartening situation for patients because they just want to have a family. But they're caught up in it. My heart goes out to these people."
Infertility and IVF can be stressful. The physical and mental toll that couples and individuals experience during the IVF process, including egg extraction and implantation, could be increased by adding restrictions or limitations.
Dr Goldman continues, "I do not want to add anxiety or fear to a stressful process." I want to make it clear that we're not trying to scare people. The option of pursuing a pregnancy should be available to people when they feel ready, as well as not pursuing a pregnancy. IVF and other reproductive technologies are also reproductive choices. "Any decision should be made between the patient and doctor."
Will Ivf Become A Target Of Anti-Abortion Groups?
Research shows that many people don't view IVF and abortion the same way. Less than 20% of people who consider abortion to be morally wrong describe IVF the same way.
It is difficult to predict the future, given the many changes that are on the horizon in terms of reproductive rights and healthcare solutions.
In an open letter to lawmakers, NRTL, which is a coalition of anti-abortion groups such as Americans United for Life and National Right to Life, did not reply to comments. However, the group urges them to make sure that "the laws being advanced to protect unborn babies do not harm mothers." NRT L's letter also states that they will continue to oppose any legislative or policy initiatives which "criminalize women seeking abortions." "13
In the end, IVF's impact will be determined by the state in which a person resides and the laws that apply to eggs fertilized through IVF. Experts in the field urge patients who use or have used IVF to contact their state representatives.
Levich states that "IVF has been an important tool to create families for more than 40 years. It will continue to be a valuable tool in helping hundreds of thousands of people every year, regardless of whether new laws close certain loopholes within certain states." IVF gave my husband and me our children, and I'm grateful for that. I am also thankful to medical professionals/healthcare professionals to have seen thousands of clients achieve their goals with IVF. I hope that everyone who wants children as much as my clients and myself can access this opportunity.
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