Roe v. Wade’s Impact on IVF

The potential overturn of Roe v. Wade could impact IVF as we know it, and I’m worried about its impact on my fertility patients and the broader fertility community. Let me explain. 

What’s going on with Roe v. Wade?

Please watch my YouTube video or read this blog post for a full in-depth recap of why Roe v. Wade has been in the news so much over the past few weeks.

For a quick recap: 

• On May 2, 2022, Politico wrote a story about a leaked document from the Supreme Court

• The leaked document was the draft of a majority opinion on Dobbs v. Jackson Women’s Health Organization, a case that the Supreme Court has been deliberating

• The case argues for banning abortions in the state of Mississippi after 15 weeks of gestation

• If the Supreme Court judges side with the state of Mississippi and ban abortions after 15 weeks, Roe v. Wade would be egregious on a federal level

Roe v. Wade was a Supreme Court decision made in 1973 that has protected access to abortion—and, indirectly, other reproductive rights—for nearly 50 years. If it's overturned, reproductive rights could be at stake, such as access to various types of birth control and in vitro fertilization or assisted reproduction. 

What does Roe v. Wade have to do with IVF? 

You might be wondering what limiting abortion access has to do with fertility treatments and building families. It all comes down to the language of the law. 

Today, there are trigger laws in 13 states that will go into immediate effect if Roe v. Wade is ever overturned, which aim to limit access to (and even criminalize) abortion. The language of some of these laws gives rights to life starting at fertilization. In essence, the laws are trying to protect human life at any stage, which would give personhood rights to an embryo. 

If embryos receive personhood rights in the eyes of the law, any intervention that could be argued as harmful to the embryo—whether it's certain types of birth control or IVF treatment—could be deemed illegal.

What does this mean for IVF? 

Overturning Roe v. Wade could impact the fertility community. Two percent of the population in the United States is a result of assisted reproduction. One in eight couples has infertility and needs help building their family. 

In the most extreme case, IVF could end as we know it. Between fertilizing eggs and sperm outside of the body, transferring embryos, freezing embryos, and doing testing on embryos, the way that we practice IVF could be dramatically changed and extremely limited.

However, I do want to emphasize that, right now, there are no laws that would actively limit any IVF intervention or the way that we practice. But, personhood laws that give rights at the fertilization level could interpret any action on embryos as harm. That’s where the threat lies.

What limits could happen to IVF if Roe v. Wade is overturned? 

First, let’s go over how IVF works: 

• We give gonadotropins to recruit and retrieve multiple eggs in one cycle via egg retrieval

• Those eggs are fertilized with sperm

• The lab watches embryos grow, which sometimes involves testing and freezing

• Eventually, one or more embryos are transferred

Today, if we transfer one tested embryo through IVF, we have a high success rate, often due to genetic testing of the embryo. We don't need to run the risk of high-risk pregnancies. The way we practice now optimizes outcomes for our patients by dramatically decreasing the number of transfers that people have to do to have their families. 

If we are limited in what can be done with embryos, the process of IVF will be dramatically changed: 

• We might have limits on the number of eggs we can fertilize at a time, which won’t “harm” embryos, but it will increase costs to our patients

• We could have limits on the number of embryos we create through fertilization 

• We might have limits on how we discard embryos

• We might have limits on the ability to discard embryos at all

• We could be required to transfer all embryos, resulting in miscarriages, failed treatment cycles, and high-risk pregnancies. (This one is particularly concerning because multiple gestations can have a higher chance of preterm delivery, NICU stays, cerebral palsy, and even death.)

• We might face limits on what can be done with unused embryos, such as storing them indefinitely (which could be interpreted as abandonment)

We have come so far in our field by practicing medicine in a way that lowers risk and increases success rates. Seeing that go backward, and watching our patients suffer for it, would be heartbreaking. Costs would increase. Miscarriages would increase. Multiple gestations would increase. Risks of pregnancy would increase. 

What’s the recap? 

There are a lot of unknowns right now, but here’s what I do know: 

• There are no laws that are automatically limiting IVF right now, but there is serious potential depending on the passage of personhood laws

• The language in some pending laws restricting access to abortion gives the rights of personhood to embryos

• With this nuance in mind, if IVF could be argued as harming an embryo (with personhood rights), the way we practice assisted reproduction could be changed

• There are additional potential downstream effects, such as less genetic screening of embryos, higher costs, increased multiple gestations, and adding to an already complex and expensive process

This is not just about abortion or limiting access to abortion. Overturning Roe v. Wade is about reproductive rights, and there are broader impacts, including family building through IVF, that need to be considered. 

What can be done? 

Use your voice. Reach out to your legislators. Write letters and call the city, state, and federal representatives. Donate to organizations that are fighting to protect reproductive rights. This isn’t over.

I hope that this has opened your eyes to the potential impact of overturning Roe v. Wade. Please go to my YouTube video on this topic for any questions or comments.