Human reproduction is inefficient. It can take a year or longer of unprotected intercourse to achieve a pregnancy in healthy young couples. This means that many ovulated eggs are either not fertilized or are fertilized but fail to implant into the uterus and develop into a healthy fetus. The process is even more inefficient in women and couples who are infertile for a variety of reasons.
In vitro fertilization (IVF) is an often-miraculous cure for infertility and it is being used with increasing frequency. Indeed, about 2% of all children born in the United States are a result of IVF. IVF takes advantage of the ability to stimulate multiple eggs to develop in a reproductive cycle. These eggs are retrieved from the ovaries and then fertilized in the lab. The resulting embryos are then cultured in an incubator for 5-6 days to the blastocyst stage of embryo development before they are either transferred to the uterus or “frozen” (cryopreserved). A blastocyst is still microscopic and is comprised of about 80-100 cells. Only about 40-50% of embryos develop properly to this stage and can implant in the uterus and produce a healthy pregnancy.
IVF overcomes the inefficiency of human reproduction in part by “brute force”. We increase the number of eggs and embryos produced in a treatment cycle as compared to a natural cycle which ultimately allows us to have good pregnancy rates. Only by generating multiple embryos are we able to select the few good embryos capable of becoming a healthy baby. We can select the best embryos either by appearance and growth in culture or by embryo biopsy to perform genetic analysis of a few cells.
Even with all this technology and effort, the pregnancy rate from IVF in each cycle is only 50% in the best of circumstances and comes at a cost of around $20,000. Fortunately, we can often freeze extra embryos that are not selected for transfer back to the uterus in the first cycle to be thawed and transferred to the uterus in later cycles. These frozen embryo cycles are much less expensive and result in equal pregnancy rates as the first embryo transfer cycle. Sometimes women or couples complete their family size yet still have more embryos remaining in frozen storage. Currently, women are allowed to discard excess embryos rather than being forced to transfer all embryos back to their own uterus with the high chance of conceiving a pregnancy that is not desired. In that circumstance, another option is to donate extra embryos to other infertile patient in hopes that they can have a child. The decision of what to do with extra embryos is a highly personal one currently made by the individuals involved after consultation with their doctor. While some are happy to donate to other infertile women, others do not feel comfortable having another person raising what is essentially their biological and genetic child.
Will an abortion ban adversely affect IVF treatments?
Absolutely! The ability to generate multiple embryos to select from and freeze has led to remarkable increases in IVF pregnancy rates and reduces costs for patients. Generating multiple embryos is simply critical to modern, scientific IVF practice. The “life begins at conception” abortion bans endorsed by some politicians in Iowa eliminate choices people currently have regarding what to do with extra embryos in culture or in a freezer. When such a law passed in Alabama, we saw the consequences on IVF practices- many of them shut down! If discarding extra embryos is banned, practitioners closed their doors rather than face legal prosecution and penalties. Patients left Alabama for care or shipped their embryos to other states where their reproductive rights were not infringed upon. Fortunately, the legislature of Alabama quickly reversed this decision by passing laws to protect infertile patients simply trying to have children.
An early abortion ban (eg- 6 week or fetal heartbeat ban) will also adversely affect IVF practices and infertile patients. Patients seek IVF in hopes of having a healthy child. Although IVF is often successful and safe, some complications are more common in fetuses and babies after IVF. Examples include high order multiple gestations (eg triplets), birth defects, genetic abnormalities associated with aging, and embryos implanting in dangerous locations such as in a cesarean section scar leading to hysterectomies if the pregnancy is allowed to progress. Currently women, in consultation with their physician, reach the heart-wrenching shared decision that abortion is the safest option to preserve their own health and reproductive future as well as meeting their goal of having a healthy child. These abortions always occur after 6 weeks gestational age as it takes longer than that to accurately diagnose the problems.
Another consequence of an abortion ban is that Iowa will become less attractive to OB-Gyn physicians. We already have a severe shortage in general OB-Gyn physicians and the same is true of infertility and IVF care providers. Recently, with the threat of an abortion ban looming, we have noted a marked reduction in applications for Ob-Gyn residency and fellowship training positions in Iowa. Physician shortages will worsen if such laws are enacted. Physicians want to provide modern and effective medical care for their patients. Abortion bans are setting medical practice back decades and access to care will worsen for patients in Iowa upon the enactment of strict abortion bans.
In my 42 years as a physician practicing Ob-Gyn I have come to realize that reproductive freedom is a very valuable right to both men and women. Should I have a child? When should I have children? How many to have? What am I willing to do to pursue the dream of having a child? All these questions are both important and highly personal. Would you prefer to answer them yourself or have a politician do it for you?
