The Future of IVF Post-Roe

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S1: Hey, everyone. Just wanted to give a special welcome to all of our new listeners from over at Spotify. Yeah, we see you guys. Welcome. And just make sure you go and click that follow button. It’ll make sure I am sitting in your feed day in, day out. You won’t miss a thing. All right. On with the show. Earlier this week, our producer Carmel called up a woman. We agreed to simply call Emily. So I’m wondering if we could start off with you just introducing yourself and a little bit of your story.

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S2: Yeah. So my name is Emily. I’ll go ahead and give the reference that I’m from West Virginia, because I do think that kind of affects the conversation and laws that get made in my state.

S1: Emily’s a mom. Before she had her son. She was a science teacher. We’re concealing her identity so she can speak honestly about her fertility treatments.

S2: Actually, my husband’s family doesn’t know about all of it yet because they are very.

S1: Uncomfortable.

S2: With the IVF process.

S1: And just a.

S2: Couple of years ago we kind of mentioned it in passing.

S1: And.

S2: They let us know that they had a problem with it.

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S1: So Emily’s in-laws are uncomfortable with IVF because they believe fertility treatments are playing God. That life begins at conception. The debates a lot of Americans are having about abortion these days. Emily’s been having them within her own family for years. And now Emily sees her in-laws ideas reflected on the Supreme Court. What was your reaction when you first heard about the draft opinion leak?

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S2: The first thing I told my husband actually was, well, I’m glad we started this now because it’s been something we’ve gone back and forth on. And I mean, like we had to get alone to do this. Like, this isn’t something we just had the money for. And I’m glad we pulled the trigger now.

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S1: Being so intimately familiar with the logic of the anti-abortion movement. It means Emily doesn’t look at Roe being overturned as settling an ethical debate. Instead, she sees all the ways this opinion, if it stands, is going to open up dozens of new ethical quandaries, ones that could affect her for years to come.

S2: Many people want to say, Well, this is just late term or this is just this, or this is just that. But it’s not just that. It’s me having an IUD. It’s me having embryos frozen. It’s me having the rights to birth control.

S1: It’s so many different things. There’s one more thing I need to tell you about Emily. It’s the reason she’s getting IVF. She’s not actually dealing with infertility. But her son. He’s four now. He’s got a chromosomal abnormality. He doesn’t speak. He can’t walk unassisted. He’s had eight surgeries already. And if Emily got pregnant the old fashioned way, there’s a pretty good chance her next kid would have the same kinds of challenges. Fertility treatments mean her second child can be healthy, but only if she can screen her embryos.

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S2: My son is profoundly disabled. I knew he was disabled. I was offered termination twice for me. I decided that wasn’t the right option. But that’s my choice. It’s not. I don’t get to put that choice in anybody else. I am used to.

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S1: Kind of.

S2: Being a blue dot in a sea of red and being just a little bit more liberal or progressive or whatever you want to call it than most of the people.

S1: I’m surrounded by.

S2: But the biggest thing I wish people would just understand is like the one on one conversations I’ve had with people. When I try to explain how far reaching this is, a lot of times they’re like, Oh, I didn’t know that.

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S1: Today on the show, if Roe v Wade gets overturned, it won’t just impact women who need an abortion. Why women like Emily and their fertility doctors are so concerned. I’m Mary Harris. You’re listening to What Next? Stick around. To get a feel for how this potential battle against IVF could play out in a post-racial America. I called up Dr. Natalie Crawford. She’s an ob gyn and reproductive endocrinologist in Austin, Texas. She says her patients these days, they sound a lot like Emily you just heard at the top. They’re nervous.

S2: Every patient I’ve seen since the draft got leaked has asked about this. Right. So here are patients in the middle of their own IVF or embryo transfer cycles. They should be focused on what is at hand and they are nervous and anxious about what the future could hold. And in our state and so this is something that we’re not just considering, but we’re also thinking closely about what does it mean right now? What does it mean for the future?

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S1: The big concern Dr. Crawford and her patients have is the foundation of the fight against abortion, fetal personhood. Because if a fetus is a person, it raises all kinds of questions. This isn’t a paranoid fear. Six states have introduced fetal personhood bills this year. A few months back, Senator Rand Paul sent a fundraising letter to his constituents where after arguing the time to grovel before the Supreme Court is over, he asked for their support for the Federal Life at Conception Act. It would declare fertilized eggs to be persons. Dr. Crawford deals with fertilized eggs all the time. A normal round of IVF means creating lots of them, watching them develop into embryos, and then implanting one or more right back into the uterus. She and her patients can see how every part of the way this medical procedure works might be about to change.

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S2: Right now, we’re able to walk through a lot of scenarios. The other thing that IVF has allowed us to do is do genetic testing for aneuploidy, which is the top reason why it’s harder to get pregnant after age 35. That means random, random chromosome abnormalities. And so with IVF and genetic testing of embryos, we’re able to know which embryos have the highest chance of turning to a life born baby. Which ones are going to result in miscarriage or genetic abnormality?

S1: And you make choices based on that.

S2: Exactly. So you might be 40 and you might send off eight embryos, but only two of them may actually be genetically normal. You don’t want to worry about the other six. You don’t want to be forced to transfer the other six. You’d like to transfer the ones that’s genetically normal and save another one for a future child. And if none of them were normal, you’d probably want to do another cycle and not be transferring abnormal embryos. What we’re fearful of is one scenario we could see is that all genetic testing is now off limits. How do you remove 5 to 8 cells from an embryo if it’s its own independent life and has rights?

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S1: I actually sort of wonder if you begin thinking about the way limiting abortion rights could impact you as a practitioner. Way before the last week or two. Like, can you take me back to when the six week ban passed in Texas? What were you thinking at the time?

S2: So definitely at the time I was already thinking about how it’s impacting a lot of my patients. I’ll give an example. Infertility patients have highly, highly desired pregnancies. There are circumstances in which you might not ever be able to fathom being an and I had a patient who conceived naturally right before she was going to do an IVF cycle and the pregnancy ended up being genetically abnormal. And she was told this child wouldn’t survive. She could carry it to term and try to give birth or she could terminate the pregnancy. And this was right before the ban went into place. And so she was able to choose for her and her partner that termination was the right choice. That also allowed us to fast track her onto getting to IVF sooner, you know, figuring out which embryos are genetically normal.

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S1: You have your own story that you decided to go public with in the wake of SB eight. Can you tell me about your story and why you wanted to go public with it?

S2: I had an ectopic pregnancy, and what that means is a pregnancy in the fallopian tube and.

S1: Non-Viable.

S2: Non-Viable not going to be highly desired. I had had three miscarriages before that. This was my fourth pregnancy. I was an infertility fellow. I was very excited. And, you know, we realized that it was in my in my fallopian tube, and it was it was devastating. And the choices at that time were, you know, it was twofold. It was to either get it surgically removed or to try and use methotrexate, which is an chemotherapy agent that kills rapidly dividing cells, and so essentially terminate the pregnancy so that you don’t have it rupture in your fallopian tube and so that you can recover from the situation because there is no scenario where you could take the pregnancy from your fallopian tube and implanted in the uterus. I know there are people saying that there are and there’s states trying to pass that. And I, I swear, if that was an option, I would have gone to the moon to have it done, and I would have had anybody do that. But that’s not an option. Once that pregnancy starts to implant, it’s creating a blood connection. It created a blood connection in my fallopian tube. The fallopian tube does not have the muscular support of the uterus to get a strong enough connection. And if I if that had happened to me, you know, a many hundred years ago, I would have just died. And that would have been the end of my story. That’s that’s what happens. It ruptures and you bleed to death. So I was able to get methotrexate. It was terrible. It was emotional. Physically. It’s it’s a terrible injection of a chemotherapy medication. You feel like you got hit by a truck. But I was able to do that and I was eventually able to go on and have my two kids. And if I hadn’t been able to receive that medication that terminated that pregnancy, I wouldn’t have been able to keep on and have my children later on.

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S1: Now, you compared yourself to a woman in south Texas.

S2: Yes. Who had to travel out of state?

S1: Yeah. What happened to her?

S2: This was right after SB eight, when there was a lot of fear in Texas that people, you know, would be turned down or would be prosecuted. And she went to an emergency room in south Texas, was diagnosed with an ectopic pregnancy, and she was told they couldn’t do anything about it. And so she got in her car and drove out of state, I believe, to New Mexico and was able to receive treatment there. So she ended up being fine. But that’s an extremely dangerous situation. And it could have ruptured while she was in the car or she could have died on the way. She could had a medical emergency.

S1: Yeah, it seems like a life threatening situation to me, which there’s supposed to be workarounds for that.

S2: You should be treated right away and and it should be right under SB You should be able to treat somebody for the life of the mother. It does have that exclusion, however. Who decides that? Right. And in this scenario, the person in the E.R. who saw her was too fearful because of SB eight to treat her and sent her in her car across the state of Texas to another state, risking her life for that treatment. And that to me is just the wild west of medicine. We have a treatment that could save her life. And because of fear, because of this bill, a provider or somebody who saw her sent her away. That is just so beyond what is appropriate medical care. And we’re going to see more and more stories like that, especially as states are impacting felony laws and, you know, limiting access to some of the early medical treatments we use for, you know, to aid in miscarriage or for early termination of pregnancy.

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S1: You’re raising this point, which I think is really important, which is once Roe versus Wade is overturned, there’s going to be some confusion about what the law means and how people can act. And it means that individuals will have a weird amount of power, like the person you meet in the E.R. who just says, oh, I guess I’m not allowed to do this procedure now. Or the prosecutor who’s like, I think I should charge you with something now. Like, there was a case in South Texas of a woman charged with murder for self-induced abortion in the last month.

S2: Right. It ended up getting dropped, but she got charged with it. I mean, that is mind boggling. And you’re correct that there’s going to be so much uncertainty that individuals are going to be left up to decide what they think. It’s going be trial by error, what they think is best, and then then things will start being taken to court. And if that woman who was charged for her own self, abortion, if that had stood, you know, what kind of precedent are we setting? Right. You know, what kind of charges are we starting to see? And I’ll even just say, as somebody who who’s a fertility doctor, you know, one of the medications I prescribe, misoprostol I use just to soften the cervix before surgery. So sometimes I do surgery called history of. These are on nonpregnant patients who want to be pregnant. They put a camera through the cervix, into the uterus, look around fake scar tissue, take out polyps or fibroids. This medication makes it a lot easier of a procedure. It’s easier to get the camera to the cervix. It’s safer and makes the procedure carry less stress. Well, that is also a medication that can be used for an early abortion, a medical abortion. And pharmacies here now do not want to fill the medication, even though my patients aren’t pregnant, even though I’m using it for a different indication. And we’re seeing the same thing with physicians who use medications for conditions not related to pregnancy. But if you use methotrexate for an autoimmune disease or, you know, misoprostol prior to surgery or misoprostol to help somebody who’s already in the process of a miscarriage. Right. Their baby’s lost a heartbeat. Pharmacies are now refusing to fill those medications because pharmacists have the power. Right. They don’t feel comfortable under these current laws. And so we are starting to make medical care for women much more dangerous.

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S1: Hmm. I want. Do you ever, like, call the pharmacy and just say, hey, like, what’s going on?

S2: Oh, ma’am. Yes, I am. I’m not a nice person when it comes to that. I’m like, come on. Like, I understand where you’re coming from. You’re fearful of it, but I’m telling you exactly what we’re doing. But that’s what’s happening, is that people who have to make the decisions, they start to feel uncomfortable, they’re scared. And, you know, in Texas we’re talking it’s like a $10,000 fine. It’s not a felony like it might be in certain states. Right. That’s going to really start to make people trigger shy to fill or prescribe or or to help people who need help.

S1: When we come back, how protests in the early days of IVF mirrored the protests we’re seeing now about abortion. Dr. Natalie Crawford wanted to make a few simple facts crystal clear when we spoke. First, how common IVF is.

S2: No 2% of the U.S. population is is conceived from IVF. So that’s not a small number. You know, millions of people access IVF to grow their family. And we need to be really loud about how this technology has enabled so many more people to be parents and what that means.

S1: She also emphasized this common medical procedure has only ever been available in a Post-Roe America. No one imagined doing this fertility work without abortion protections. One more thing. If you go back to the early days of IVF, you can see the same language. It’s now being used against abortion, being deployed against people who saw it, fertility treatment and their doctors. Her industry had to adjust to it.

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S2: I think it’s also interesting, we just remember just the history of IVF, right? Our oldest IVF babies, only in our early forties. Roe v Wade was well around before that. And these people who went through IVF early, I mean, they were hugely stigmatized. People protested outside their houses. You know, they it was a very different world. And we’ve made huge progress and getting IVF to all over the country and helping people grow families. But it really changed people’s viewpoint on how they felt about it. Right. That big news article, the world’s first test tube baby, people felt really mixed about it. And so I tell people all the time, you’re allowed to have your own personal beliefs. And sometimes those impact how we do IVF cycle for get all these laws like we talk about if you believe life begins at fertilization and you don’t feel comfortable freezing any embryos, that’s what we do. That’s what we do. We do it the way that you feel comfortable about it to help you grow your family and we talk through, while it might cost more, take longer, but if that’s what you feel comfortable with, and that is absolutely what we do. And I think every fertility doctor has been in that situation.

S1: I wonder if that history with fertility treatments where you mentioned how people protested in front of folks houses because they were scared of IVF. They didn’t like the sound of it. I wonder if. That kind of gives you a little bit of hope for where things might go now. Just because it’s evidence that people’s minds can change about something big.

S2: It is hope. You know, I do think that when we step back and we look at we’ll look at IVF, what are we trying to do, trying to help people have families and how is that inherently a bad thing? Maybe you believe that it is, but to me, I feel like overall we really should want each other to be happy and to have the family we want when we want it. I received an Instagram message I’ll read to you just to gain perspective on this. Thank you for your voice on IVF and the threat with Roe versus Wade and the first IVF baby who was born in Kentucky 1986. I’m likely one of the first 100 in the world. My parents had people who had stopped them in the street and say I was an abomination and that they killed babies to get to me. They would ask where my clone was. They would belittle them. The Catholic Church refused to let me be baptized. One priest did it anyway, saying that I was a child of God since I was a child. It was awful. Since my birth, so much has changed and now so much is threatening families. They may not have this option to grow. This is so sad, and I just think that that gives us really a perspective that a lot of us don’t think about right now, about what fertility has gone through to be able to have this technology. And I feel strongly that we really don’t want to be rolling back the clock and limiting this for people. We want to help people get to that next step and have a child. So we really need to be amplifying, trying to get people in the position of power who value that a person has the right to choose their own reproductive future, because that extends to all reproductive rights and not just not just abortion. It’s a much bigger issue than only abortion.

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S1: Well, you’re an Austin. I mean, you could walk right down to the legislature like.

S2: They don’t just they don’t just let you in. Yeah. I mean, to like to see to to get in front of somebody who has the power to do something about it is an extremely hard thing. I mean, certainly even talking with advocacy groups to try to see, can we get a seat at the table or can we get a meeting? So we’re really up against a lot in Texas when it comes to talking about reproduction. A lot of, you know, people who have the power don’t even want to be associated with the side of the conversation. And that’s why we need them to be hearing about it and the message that I heard. Well, I don’t hear about this from my constituents. People don’t call and talk about needing access to IVF or needing these things. So I don’t think it’s an important enough issue.

S1: Well, it hasn’t been taken away yet.

S2: Right.

S1: Something that I noticed when I looked into the history of these personhood laws and amendments was that they’re a place where people like you become a really important part of the conversation. Like back in 2011, Mississippi was trying to pass a fetal personhood amendment and it was going through a ballot initiative. And a lot of people said, oh, this will fly through. They just assumed like, this is a very conservative state, very pro, very anti-abortion. This will just happen. But it was rejected by 58% of the state’s voters. And part of the reason was because of a group called Parents Against T6. It made ads basically outlining how this bill would make fertility treatments unavailable. It strikes me you’re. In a little bit of a powerful position for this next round of the battle. But I wonder if you feel like that.

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S2: I’m. I’m happy to hear that you say that. I’ll be I’ll admit it’s a fight I never I never foresaw would be in my future. When I went into this field, I became a doctor to help people help people get pregnant, because I liked I liked reproductive medicine. And I really feel like there’s nothing you can do that changes the course of a person’s life as much as it’s helped them conceive a child that they so, so very much want and have a hard time.

S1: Being an Austin. There’s at least a chance you’re treating someone who’s pretty involved with Texas state politics. I kind of wonder at this point, do you talk politics with your patients? Like I imagine you might have avoided politics in the past. But does it become more urgent now?

S2: You know, a few things have happened. That’s a really fair point. Early in my career, I think we’re all trying to cut our teeth, but I was really hesitant to talk. Anything political with patients was the message that I got when I was an employee at a prior practice was, You shouldn’t talk politics because you’ll alienate people who don’t want to come see you. And I’m like, I don’t have to be for everybody, but I think there’s more good that can come from it and harm. And if it’s if you’re not really comfortable, see me because I’m advocating for your reproductive rights and that’s okay. And I’m probably not going to be a good fit of a doctor for you. And I’m fine accepting that I don’t have to see everybody. But I do think some physicians are scared about how their patients will take it, or they don’t want them to think bad of them, or they don’t want to limit people who will walk in their doors. So they’re just staying silent, you know, in silence. Not a neutral position, silent as in the vote of whatever the majority as of the moment.

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S1: Dr. Crawford, thank you so much for joining me.

S2: Thank you so much, Mary. I really appreciate you shedding a light to this topic. And I’m happy to help out in any way that I can.

S1: Dr. Natalie Crawford is an OBGYN and reproductive endocrinologist at Fora Fertility in Austin, Texas. And that’s the show. What next is produced by Carmel Delshad Alina Schwartz and Mary Wilson. Special shout out to Kamal for Finding Emily, who we spoke to at the top. We’re getting a bunch of help these days from Sam Kim and Anna Rubanova, and we are led by Alisha Montgomery and Joanne Levine. I’m handing off the reins to Lizzie O’Leary. And what next TBD for the next couple of days. And I’ll be back in this feed on Monday. Catch you then.