How Could The End of Roe v. Wade Impact IVF, Fertility Treatments, and Genetic Screening?

Although the Supreme Court's Roe v. Wade ruling only applies explicitly to abortion, health care providers say the decision may have broader ramifications.

Closeup process of laboratory fertilization with material in petri dish and needle in modern reproductive medicine clinic

When the landmark Roe v. Wade abortion rights decision was overturned by the Supreme Court in June, individuals across the nation suddenly found their right to choose when to have children in jeopardy. But now another group is also expressing concerns about the repercussions of the court's ruling—those who are actively trying to have children through fertility treatments and in-vitro fertilization (IVF).

Although the Supreme Court's Roe v. Wade ruling only applies explicitly to abortion, health care providers say that it may impact what is—and is not—allowed moving forward when patients undergo IVF, fertility treatments, and in some cases even genetic screening.

"When does life or personhood actually begin? Is it after fertilization or another stage of development?" said Shefali Mavani Shastri, MD FACOG, clinical director and physician partner at the fertility clinic RMA New Jersey. "There's going to be blanket statements and extreme laws, there's a risk that people will have to use all of the embryos that are developed [through fertility treatments and IVF], forcing an individual or a couple to expand their family whether they have the means or the desire to do so—or not."

RELATED: Here's Where Abortion Is Banned—And Where It's Still Legal in the U.S.

The Cause for Concern Surrounding Fertility Treatments

Fertility treatments can involve a range of procedures including the use of medications that are designed to help with a patient's hormones and ovulation, according to Planned Parenthood. Fertility treatment may also encompass the use of Assisted Reproductive Technology (ART) that facilitates sperm fertilization of an egg and assists with implanting eggs in the lining of the uterus.

In-vitro fertilization, or IVF, through which eggs are taken from a patient's ovaries and fertilized by sperm in a lab where they develop into embryos, is another common fertilization treatment.

The current cause for concern about the future of these treatments stems from the fact that fertilization treatments may produce multiple embryos. And at a time when abortion laws across the nation are changing, the result in some states may be that patients are required to implant and produce all of the embryos that result from fertility treatments, said Dr. Shastri. If this is the case, there could be a variety of ramifications including more people simply forgoing the opportunity to have children.

"If I had to use all the embryos developed, I would try to limit the number of embryos to one or two and hope that they are chromosomally balanced and result in a live birth," Dr. Shastri said. "If that doesn't work and you have to put this [patient] through IVF stimulation over and over again, there are not only financial implications; there are emotional, psychological, and physical implications."

Patients can opt for other routes to pregnancy that produce only one or two embryos, as Dr. Shastri indicated. Intrauterine insemination, a process that involves collecting healthy sperm and inserting directly into the uterus during ovulation, is one such example. The downside however, is that the chances of success using this type of approach are roughly the same as conceiving without intervention, Dr. Shastri said.

Additional Threats to IVF

The world of IVF is susceptible to other impacts of overturning Roe v. Wade as well, Dr. Shastri told Health.

"The success of IVF is a numbers game," Dr. Shastri explained. "There is a need to fertilize multiple eggs to have a healthy embryo, and we can't precisely determine how many eggs an individual will need to develop a healthy embryo."

While most fertility specialists aren't aiming to create excess viable embryos, it's simply a hazard of the process, Dr. Shastri said. But what happens to the embryos that couples decide not to use?

Typically, patients sign contracts that determine what will happen to any excess embryos before they begin the process, Aziza Ahmed, JD, professor of law at Boston University School of Law, told Health. The options generally include storage, donating them to science, or discarding them.

If states take abortion bans to the extreme and specify that life begins at fertilization, each excess embryo would have the same rights as an embryo that had been successfully implanted. Such 'personhood' bills haven't been passed, but they have potential, according to RESOLVE: The National Infertility Association.

Yet another option for excess embryos is what's known as compassionate embryo disposal, which involves the embryo being implanted in the wrong place in a patient's body, essentially dooming it to failure. But this procedure places the burden on the woman and may also anger hardline conservatives, said Ahmed.

In addition to impacting the ways in which embryos may be disposed, the IVF process known as selective reduction could also be outlawed in a post Roe v. Wade world, said Ahmed.

Within the world of IVF, sometimes multiple embryos are inserted into the uterus with the hopes that one would implant fully. If all of the embryos are implanted successfully, it could lead to high-risk pregnancy of multiple babies, risking the life of the mother and the children. Selective reduction effectively aborts one or more fetuses while increasing the odds of survival for the others, Ahmed explained.

Ramifications for Genetic Testing

Prenatal genetic testing is used to provide parents with information about whether their fetus may be born with a certain genetic condition or birth defect. The information gleaned from these tests is helpful for parents and medical practitioners in deciding if the pregnancy requires special attention to support the baby's survival. A pregnancy may sometimes be terminated based on what these tests find as well.

While genetic testing isn't expected to be outlawed or eliminated, the ability to terminate a pregnancy based on congenital abnormalities could be, depending on the state. The most significant fallout from the Roe v. Wade decision would likely occur in states that ban abortions based on genetic abnormalities, Ahmed said.

"For example, if there was a 15-week ban, and they do Down syndrome testing at 12 weeks, then, in theory, that person would still have time to terminate before 15 weeks," Ahmed said. "But if there's a ban on abortion for disability purposes, then they wouldn't be able to get the abortion. It depends on context."

There are currently six states that ban abortions based on disability—Mississippi, Missouri, North Dakota, South Dakota, Tennessee, and Ohio, according to the Guttmacher Institute. A 2012 study revealed that 67% of Down syndrome pregnancies were terminated.

If genetic abnormalities are found, women would have the option of traveling to other states that have a longer period to consider abortion options, but this incurs a much higher cost in time and money. Additionally, the care may take place out of a patient's healthcare network and thus the financial burden would fall entirely on the individual.

Genetic testing also plays a role in IVF. Preimplantation genetic testing or PGT allows parents to select the healthiest embryo, screening for single-gene disorders such as cystic fibrosis or sickle cell anemia, said Dr. Shastri.

Because of the ambiguity in the way abortion law language is written in many states surrounding PGT and IVF, it could be "a slippery slope of restrictions that could eliminate options for people trying to start a family," said Dr. Shastri.

Options Moving Forward

While the language in many states doesn't precisely address IVF and genetic testing policy, both Ahmed and Shastri agree that this ambiguity leaves the potential for further restrictive measures to be adopted. For now, Ahmed says 'forum shopping' may become more prevalent.

Forum shopping entails looking at the legal protocols in each state to find the most favorable place for your goals. Many people already forum shop for states that require insurance to pay the costs of fertility treatments. Now, they may do the same to find states that give them control over their fertility journeys.

Ultimately however, Ahmed says that it's difficult to predict how the decision to strike down Roe v. Wade will impact IVF and genetic testing options on a grand scale. This is because the Supreme Court has essentially handed the job of defining when life begins back to the legislature.

"The Supreme Court and Justice Roberts said in an earlier decision, June Medical Services vs. Russo, that these are existential moral questions about life and death," Ahmed said. "And it's not the job of the court to decide the answers."

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