As people across the United States grapple with the implications of restricted reproductive health access, fertility doctors and their patients face a great deal of uncertainty. While the Supreme Court ruling in June 2022 didn’t immediately or directly impact the ability of physicians to continue offering common fertility treatments like in vitro fertilization (IVF), many experts believe that assisted reproductive technology (ART) could be at risk in the future.
What’s more, patients’ healthcare needs don’t end at fertilization. Those who conceive using ART are at higher risk of pregnancy complications requiring NICU admissions, including premature birth and low-birth weight. OB-GYNs and hospitalists across the country fear the impact of the Supreme Court decision on high-risk pregnancy care and maternal mortality. Already, maternal mortality rates in states that have adopted so-called “trigger laws” are nearly twice as high as other states.
How the shifting reproductive health landscape will ultimately impact assisted reproductive care remains to be seen. Regardless, health plans and employers need to understand the current landscape and how changing laws could affect members and employees.
How could reproductive health restrictions affect fertility care?
The Supreme Court ruling caused certain trigger laws in 14 states to go into effect, which immediately brought about severe restrictions and, in some cases, outright bans on abortion care. While a review and report by the American Society for Reproductive Medicine found that none of these laws pose an immediate threat to patients seeking fertility treatment, experts still raise concerns about the future of IVF and assisted reproductive care due to unclear language in the laws. For example, Oklahoma now bans abortion starting at fertilization, which some fear could broadly be extended to apply restrictions on embryos created for use in IVF. Other states are considering legislation that grants embryos, fetuses, and fertilized eggs either “personhood” or certain constitutional rights.
“Progress in IVF means we’ve seen over 84,000 children born through the procedure in 2019 alone,” says Dr. Wael Salem, a board-certified reproductive endocrinologist at CCRM San Francisco. “Legislation that defines personhood starting at fertilization creates a landscape where the government interferes with scientific decision-making in the IVF laboratory. Laws that restrict discarding genetically abnormal embryos would lead to a monumental step backwards in the scientific progress we have made in the last decade.”
For those further along in their fertility journey, new laws restricting abortion may increase their risks of pregnancy complications by denying them access to clinically recommended care. For example, IVF is associated with higher rates of multiples. During the IVF process, depending on the number of embryos implanted, patients may need to undergo a procedure known as “selective reduction” to protect the health of the birthing parent and remaining fetuses. The procedure can also be used in the case of chromosomal or anatomical abnormalities, which occur with more frequency with older birthing parents. New laws may not support this type of care, forcing patients to continue the pregnancy with multiple or unhealthy embryos and risking complications for both infants and birthing parents.
It’s because of implications like these that Maven’s Chief Medical Officer Dr. Neel Shah says “business-as-usual thinking” with regards to fertility and pregnancy care is irresponsible in a post-Roe landscape. “Whether or not the practice of IVF remains legal, the personal risks of what comes after fertilization have significantly increased.”
What are the implications for those pursuing fertility treatments?
1. Embryo storage gets more complex
New reproductive health restrictions may force many patients to accelerate their IVF timeline, while others seek options to protect themselves from future legal actions. People may fear discarding their embryos and inviting legal scrutiny, and increasing numbers are now debating whether to move their frozen embryos to a state without abortion restrictions. “Any law that limits the choice of creating and cryopreserving embryos massively reduces the efficiency of IVF,” says Dr. Salem. “This would lead to an astronomical increase in costs along with the psychological toll of lengthy treatment cycles for individuals affected by infertility.”
2. The location of IVF treatment matters more
New restrictions on abortion may change where people seek fertility treatments. While traveling to a different state for IVF would be impractical given the number of required appointments, some experts suggest that families may seek to permanently move to a less restrictive state to give themselves the best chance of growing their family. “The state abortion bans may lead some to…make broader changes, including moving to another state to facilitate getting their preferred treatment,” Garrett Hohimer, Director of Policy and Advocacy for the Business Group on Health, told SHRM. “Employers with more onsite or localized operations, and less of a virtual workforce, could see increased turnover in certain demographics driven by these state-by-state changes and dynamics."
3. Patients may choose not to seek fertility care at all
The bottom line is that the uncertainty about the future of assisted reproductive care makes an already stressful and tumultuous experience significantly more difficult and less safe for families across the country, which is why restricting access to the full spectrum of reproductive healthcare may even discourage people away from treatment altogether. "If medical intervention is restricted, or if the process is made to be more difficult than it already is, it will no longer be a viable option for many people," Lauren Winans, CEO of Next Level Benefits, shared with SHRM.
How Maven helps navigate fertility in a rapidly changing reproductive health environment
As the leading digital family health platform, Maven partners with employers and health plans around the country to provide education and support for people considering or pursuing fertility treatments. Our care team and healthcare experts stay up-to-date on the state and national landscape surrounding fertility care and support members on their fertility and pregnancy options journey.
For those navigating IVF amidst today’s evolving landscape for reproductive health, Maven can connect them with mental health providers, reproductive endocrinologists, and OB-GYNs to help inform and support them through their unique health journey. If you have questions about how your organization can best support employees and members seeking fertility care, contact us today and we can schedule time to talk through your concerns.
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