How Abortion Decisions Could Impact IVF, According To A Fertility Doctor Who’s Done It

Courtney Shea - Yesterday 

Welcome to Refinery29’s Fertility Diaries, where people chronicle their joyous, painful, and sometimes complicated paths to parenthood. Today, we hear from Roohi Jeelani, MD, FACOG, a 39-year-old reproductive endocrinologist in Chicago, IL.

Here, Dr. Jeelani shares her story of going through fertility treatments as a fertility doctor, and her thoughts on the leaked Supreme Court draft document that would overturn Roe v. Wade, and, in many states, criminalize the discarding of frozen embryos.

Working as a fertility specialist, babies are what I do. In my profession, we are always paying close attention to changes around reproductive healthcare: what states are anti-abortion, new regulations around birth control, and so on. Even still, I was stunned the day of the Supreme Court draft opinion leak. For the majority of my life, reproductive rights felt immutable, and now here we are. I want to say that I am still hopeful that this won’t happen — that the outrage will have an impact and Roe v. Wade will stand. But given the work I do, I have to prepare for a worst-case scenario. And that scenario is terrifying.

Within an hour of the leak, I was getting calls from patients asking what this means or could mean for their embryos. Should they consider pausing in vitro fertilization [IVF] treatments? If Roe v. Wade does get overturned, abortion would be outlawed in more than 20 states. Thirteen states currently have trigger laws in place, many of which include language that defines life as beginning at the moment of fertilization. Other states aren’t even waiting, using “vigilante laws” like S.B. 8 in Texas to get around the courts. In Oklahoma, for example, the governor just signed a bill into law that defines life as beginning at the moment of fertilization (“the fusion of a human spermatozoon with a human ovum”). This seems to give a frozen embryo in a lab the same “personhood” as a 30-week-old fetus. The state is circumventing what are still federally protected abortion rights by empowering private citizens to sue a doctor, or anyone who “aids and abets” an abortion, including someone driving a pregnant person to a clinic. The pregnant person can’t be sued, but, of course, that could change. [Editor’s note: The legislator who initially sponsored the Oklahoma bill that’s now law told Politico Nightly that they didn’t discuss the fertility treatment IVF in regards to the bill, and that Republicans in the state currently don’t have interest in limiting IVF. This may not be the case in other states in the future, though.]

Just to clarify, if it eventually becomes illegal to discard frozen embryos, so much of the amazing advancement we have made around in vitro fertilization goes out the window. Treatments are essentially a numbers game — a certain amount of superfluous material (i.e., frozen embryos that don’t get used) is part of the equation for success. When we do a round of IVF, we retrieve as many eggs as possible. Even if the person is just wanting to have one child, you never know how many quality eggs you will end up with, and then, how many viable frozen embryos (fertilized eggs) will come from that. Statistically, we say it takes three quality embryos to result in a live birth, but the reality is that every individual is different. Freezing extra embryos means that if a first — or second or third or eighth — attempt is not successful, we can try again without having to go through another round of IVF, which is physically and emotionally draining and may not even be an option depending on age. IVF is also incredibly expensive in states that don’t have coverage — at least $10,000 per round on the low end — and that is true whether you are creating a single embryo or 10.

The problem is, if new laws come into play and are implemented to criminalize IVF, they would punish anyone disposing of any “leftovers” (or even donating them to science, which is another option). Both the clinician who is performing the procedure and the patient who has their eggs frozen could someday face legal ramifications. That’s not a road most people would want to go down, but the only alternative — creating a single embryo per round of IVF — would make fertility treatments less effective, less safe (for mother and baby because the likelihood of miscarriage would become far greater, and due to laws’ potential implications on genetic testing), less affordable, and largely unviable for women who are fighting against the clock, which is something I know about first hand.

I was diagnosed with polycystic ovarian syndrome when I was 14 years old. My mom was concerned because I wasn’t getting my period. We went to one specialist after another who said I probably had an eating disorder, that I just needed to gain weight, which was so frustrating because I knew that wasn’t the case. Finally, my uncle suggested that I should see a reproductive endocrinologist, which was a turning point for me in so many ways. I got my diagnosis, yes, but even before that, I remember sitting in the waiting room and feeling overwhelmed by the joy and intensity in the space. Even before the doctor asked me about my health, I asked her, What is this place? What do you do? I still remember her answer perfectly: “I’m a fertility doctor, I help to make babies.” From that moment on, I knew what I wanted to do. I went to med school and launched my private practice in 2016.

By that time, I had already dealt with my own reproductive challenges. My husband and I met at school and we were already trying to get pregnant when I was a resident. I did a round of IVF in 2010 and experienced recurrent miscarriages before finally giving birth to my son in 2013. Even though this is what I do, being on the other side of infertility was an emotional rollercoaster. I was just about to start a second round of IVF when we found out that I was pregnant with my daughter in 2015 — a shock, of course, and a joy. I banked embryos again in 2017 and was ready to start implantation in 2020. I had seven viable embryos and none of them worked, which meant another round of IVF and, finally, success. I am currently 32 weeks pregnant — hurray! — but it took an additional seven implantations to get here.

To say my journey to motherhood would not be possible if new laws take effect goes without saying. But I will say it to anyone who will listen because it is so important that we fight to preserve the progress we have made and to protect the bodily autonomy of people who require fertility assistance. I say this as a pregnant person and a doctor. I am lucky to practice in Illinois, but I know that in some of the more conservative parts of the country people are being advised to move their embryos now, just to be safe.

There is a bitter irony to watching this group of politicians argue for the “sanctity of life,” meanwhile these new laws could mean the exact opposite in my field. I’m a fertility doctor. I help to make babies. Babies for people who desperately want to be pregnant. What kind of backwards reality are we living in that would deny me the ability to do what I do?

As told to Courtney Shea.

This interview has been condensed for length and clarity.