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For many, the right to an abortion is believed to be a black and white issue: you either support it, or you don’t. But for the millions of people globally who are faced with infertility, pregnancy loss, or the heartbreaking decision to terminate a pregnancy for medical reasons, there are many shades of gray when it comes to the topic of abortion. Even if there isn’t a medical necessity, the right to an abortion is a complex issue with lots of nuances.
On June 24, 2022, the United States Supreme Court officially ruled to overturn Roe v. Wade, eliminating the constitutional right to an abortion after almost 50 years. In about half of the states, this could lead to close to complete bans on the procedure.
What does the overturning of Roe v. Wade mean for the future of IVF and miscarriage care?
Wherever you stand on the subject, know this: this landmark decision will affect you or someone close to you, especially since 1 in 4 known pregnancies end in miscarriage and as many as 1 in 5 women struggle with infertility. In fact, over 20 states already have laws in place to immediately ban or restrict abortion based on this ruling, and the implications will be more far-reaching than you might think.
1. Not every abortion is an unwanted pregnancy.
The term abortion is typically seen as synonymous with an unwanted pregnancy, but that is not always the reality. Tens of thousands of Americans have abortions every year for very wanted pregnancies based on medically sound advice from their doctors.
Termination For Medical Reasons (TFMR)
Under Roe v. Wade, if prenatal tests determine that your baby has a serious genetic or structural condition, you may be offered a termination for medical reasons (an abortion) to end your pregnancy. The same goes for pregnancy complications that pose a significant threat to your life if you continue the pregnancy.
In the case of TFMR, individuals and couples are already faced with the devastating decision to end their very wanted pregnancy. Without Constitutional protection for the right to an abortion, in certain states, pregnant people could be forced to carry these pregnancies to term, in some cases risking serious injury or death. When it comes to abortion law if there are no medical exemptions made at the state level, how can we expect any pregnant person in this country to feel safe?
Ectopic Pregnancies
1 in 50, or 2%, of pregnancies in the United States, is ectopic. An ectopic pregnancy is when an embryo grows in the wrong place outside the womb, in most cases attaching itself to a fallopian tube before it reaches the uterus. An ectopic pregnancy always ends in pregnancy loss, and if untreated in time it can lead to difficulty becoming pregnant in the future, serious bleeding, or even death.
So, how does this relate to abortion? Well, to treat an ectopic pregnancy, a doctor will usually recommend either a surgical procedure or a medication called methotrexate, which is considered to be an “abortion pill.” Because of this, some abortion opponents are arguing that patients with ectopic pregnancies should simply be monitored until they miscarry; but waiting too long or failing to treat an ectopic pregnancy can put the pregnant person at significant risk.
2. Taking miscarriage medication could be considered abortion.
1 in 4 known pregnancies end in miscarriage; but while they’re common, that doesn’t make losing a pregnancy any less heart-wrenching. Pregnancies that stop developing normally do not always detach on their own; some will stay attached to the uterine wall and require treatment to be evacuated. If this is left untreated for a prolonged period of time, it can lead to heavy, irregular bleeding, infection, and even sepsis, which can be life-threatening. Therefore, in a scenario where the pregnancy is not being passed on its own, it is often actively managed either medically with oral or vaginal pills (also known as misoprostol) or surgically with a procedure called a dilation and curettage (D&C).
As someone who has been through a miscarriage, I can very clearly tell you that it is not a choice. Yet, one of the medical terms for the termination of a pregnancy is–you guessed it–abortion. And since misoprostol is considered to be an “abortion pill,” it could be banned in certain states in the post-Roe world. This could leave those grieving a miscarriage with one less choice available to them and put them at risk for serious physical complications in addition to the obvious emotional ones.
3. The future of Assisted Reproductive Technologies (ART) like IVF could be at risk.
While it may not seem like abortion restrictions could have an impact on Assisted Reproductive Technologies (ART) like IUI or IVF, this is where the lines get even blurrier. According to former Missouri Senator Claire McCaskill, under Missouri law “life” is defined as beginning at conception. A similar law exists in Louisiana. This would mean that the common procedure of discarding a fertilized egg, or embryo, could be considered abortion in the post-Roe world, virtually eliminating IVF as a family-building option in those states.
According to Dr. Lucky Sekhon, a Double Board-Certified OBGYN/Reproductive Endocrinologist at RMA of New York, “Those who believe life begins at the level of a fertilized egg lack a clear understanding of human biology. Fertilized eggs represent potential, but many do not have what it takes to become a viable embryo or pregnancy. The point of IVF is to grow as many eggs into embryos as possible, in an effort to overcome the inefficiency of human reproduction. Limiting this would severely hinder the success of IVF and the options that fertility doctors can extend to patients who need treatment.”
And we know that we are not alone. In the United States, more than 55,000 women give birth to a baby conceived through Assisted Reproductive Technologies (ART) every year, with one-third of American adults now saying that they have used fertility treatments or know someone who has. With more and more individuals and couples relying upon ART to help them achieve their family-building goals, if SCOTUS' landmark ruling doesn’t frighten you, then you aren’t paying attention.
The right to an abortion is not a black and white issue. Rather, there are many shades of gray when it comes to why someone may or may not make the choice to end a pregnancy. From termination for medical reasons (TFMR) to the impact it will have on the future of IVF, in the absence of Roe v. Wade women in the United States will have less autonomy over their own bodies than in previous generations, and that doesn’t sit well with us. Rescripted stands with all those whose reproductive rights will be affected in the post-Roe world; because reproductive rights are human rights.