The U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization has widespread consequences, but one that has not been fully discussed yet is the potential consequence for people who desperately want to become pregnant. Families struggling with infertility and undergoing in vitro fertilization, or IVF, may unwittingly become caught up in the political aftermath of this ruling.
IVF involves stimulating a patient’s ovaries to produce as many mature eggs as possible, retrieving those eggs and then fertilizing them with sperm to be implanted or frozen — and hopefully lead to pregnancy.
IVF is performed for a number of reasons: unexplained infertility; recurrent pregnancy loss; fertility preservation in patients who need to wait to have children due to their career, relationship status or other reasons; fertility after cancer diagnosis and treatment; selection of embryos to prevent inheritance of genes that lead to disease; use of donor eggs or sperm in LGBTQ+ couples; and more.
The one thing that unites these reasons is the desire to have a baby, but future laws may make this process complicated or impossible.
In a post-Roe country, if a state decides to define “personhood” as an egg fertilized by sperm, all embryos produced by IVF will be considered persons. Currently, patients undergoing IVF often create multiple embryos, as the chance of pregnancy with one embryo is low at approximately 30%. This is especially true for patients who want multiple children, as more embryos are needed to increase the odds of multiple pregnancies.
However, if all of these embryos are considered persons, this leaves the question of what to do with leftover embryos after a patient feels they have reached their ideal family size.
Currently, extra embryos are usually discarded. It is unlikely patients will ever be forced to have these embryos implanted. Rather, they may be required to only fertilize eggs they will use, reducing their overall chances of pregnancy. If a patient freezes embryos, they may be required to keep them in storage in perpetuity, paying monthly fees for the rest of their lives and well past their fertile years.
This is not just an unlikely possibility — it is happening in other countries. In Italy, every embryo created during IVF must be implanted, so doctors are limited to creating three embryos at a time, all of which will be transferred into a patient. This not only reduces the overall pregnancy rate, but increases the risk of dangerous twins and triplets. Families more often have to undergo multiple IVF cycles, which in the United States would be prohibitively expensive and exclude all but the richest patients from fertility care.
Beyond this, there is still the question of what will happen if an embryo does not successfully implant and lead to pregnancy and a live birth. Women have already been prosecuted and imprisoned for miscarriages in the past year. Will the same happen to patients undergoing IVF who do not give birth? Will fear of this imprisonment lead to fewer IVF attempts?
As a medical student and future obstetrician-gynecologist, some of the greatest joy I saw during my rotations was in the Reproductive Endocrinology and Infertility Clinic. The look on a future parent’s face when they saw their developing baby during the first six-week ultrasound was indescribably elated. These patients had been through so much — multiple miscarriages, painful and invasive testing, devastating diagnoses and the exorbitant cost of it all.
Finally, finally, they were able to see the baby they had dreamed of and worked for.
There are many problems with the Dobbs ruling and the detrimental effect it will have on the lives of so many Americans. Patients going through infertility treatments, however, have largely been left out of the public conversation thus far.
If lawmakers claim to be pro-life, they need to protect patients trying their hardest to bring life into this world. Pre-emptive laws must be passed on the national and state levels to exclude IVF embryos from restrictive legislation and preserve fertility care for patients who want to become parents.
Leah Thomas is a fourth-year medical student at the University of Chicago Pritzker School of Medicine and plans to becomes an OB/GYN.
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