As abortion bans take root, fertility clinics, including in Las Vegas, grow anxious


Brian Ramos

Dr. Leah Kaye is one of a handful of reproductive endocrinologists (fertility doctors) in Nevada, located in Summerlin. Friday, July 8, 2022. Brian Ramos

In the recent post-Roe United States, Las Vegas fertility doctor Dr. Leah Kaye inquiries from colleagues about how her services could be affected by the loss of the federal right to an abortion.

When the Supreme Court Roe v. Wade overthrew in June and gave individual states control over abortion access, launching “trigger laws” in some states, which immediately severely curtailed abortions, and motivating others to start creating new laws around the loss of federal protections. And abortion laws that indicate the onset of legal “personality” at conception – a process that completes fertility doctors, or reproductive endocrinologists, outside the body – can have consequences for doctors who begin and do not terminate pregnancies.

Nevada has enshrined access to abortions through 24 weeks of pregnancy – and after 24 weeks if a mother’s life is in danger – in state law, and no laws here or elsewhere come directly for fertility treatments such as in vitro fertilization, so Kaye keeps calm and insist the same. But she remains well aware of how legislative interpretations across the state that life begins at conception can ripple in Nevada.

“Right now we’m really happy and it does not threaten us directly, but you certainly do not have to travel far to see where IVF is potentially threatened,” says Kaye, one of three clinicians at the Fertility Center of Las Vegas. ‘We expect kind of traffic from surrounding states, and on top of that it’s so difficult to predict what’s going to happen at a federal level. Being from Nevada and being happy today does not guarantee that it will continue going forward. ”

“This is going to amount to a lot of the very specific wording of any given bills that have been approved,” she added. “At the moment, fortunately, IVF is not banned anywhere, despite many of the trigger laws. And the main reason is that most of these laws that have actually passed refer very specifically to ‘pregnancies’, which implies that a uterus is involved. It is already in the womb. ”

Still, it is a reasonable concern, even for doctors helping women get pregnant. In the July issue of the journal Contemporary Ob / Gyn, dr. Jared Robins and Sean Tipton, executive director and chief policy and advocacy director, respectively, of the American Society for Reproductive Medicine, struck a tangible anxious tone about the future of fertility care.

“Many of the bills that are being introduced in government houses across the country… include language that defines a fertilized egg as a legitimate human entity. The terminology differs, which makes it difficult to generalize, but the danger is clear, ”they wrote. “If the legal status of fertilized eggs or early embryos is codified, in vitro fertilization (IVF) procedures can become legally risky for patients, doctors and staff.”

A bill in Nebraska defined an “unborn child” as a human being “through the embryonic and fetal stages of development from conception to birth.” An Oklahoma bill also defined life as beginning at conception. No law passed this session.

In neighboring Utah, a trigger law defines abortion as the termination of a pregnancy after “implantation of a fertilized ovum,” which Kaye called a vague phrase that may or may not involve a uterus. That law, which was passed in 2020, was repealed, but only until mid-July.

Another potentially worrying possibility for reproductive care is what to do with embryos created for in vitro fertilization, which require egg retrieval, laboratory fertilization and culture in an organism of hundreds of cells, and are transferred back to the uterus.

Some eggs do not even reach the early embryonic stage required for transfer. Those that do do so are placed in cryogenic storage for some time. Some are tested for genetic abnormalities that can lead to a failed pregnancy or severe birth defect; if they are not viable, they can be destroyed.

Clinics store their own embryos privately, sometimes on site, sometimes in other locations, in liquid nitrogen tanks in highly specialized and controlled conditions. Kaye said she has not heard much from potential new patients, but more from colleagues in more restrictive states asking if more permissive states like Nevada – a state with only about half a dozen reproductive endocrinologists like Kaye – might be able to take in their frozen ones. embryos. But Kaye insists on caution.

Embryos are extremely fragile, making transportation and changing hands difficult for those who want to develop doctors and patients into babies. And laws are still in place, which could lead to multiple, risky moves – or not required at all, even in states with strict abortion laws.

“As time goes on, and as we, as a society, see the repercussions and the unintended consequences of Roe’s overthrow, my hope is that our legislators will also realize: ‘Oh, we kind of did not mean that IVF completely so should not be. is threatening as it is now, ‘and the hope is that there will be additional laws on the books to protect IVF, whether at a state or federal level, ”Kaye said.

And so she is optimistic, as she positions her work as a pro-family – as she says anti-abortion activists and legislators also characterize themselves – while remaining open-minded, measures such as interstate embryo shuffling would be needed. She keeps abreast of developments for insecure patients.

“Our responsibility as their healthcare providers is to provide them with options when they come up with questions. It is therefore we who do our caution to have a plan B and a plan C and to be able to assure our patients that it certainly did not go unnoticed, ”she said. “And that when we may not have all the answers today, there are many passionate and sympathetic healthcare providers out there who want to make sure that whatever happens to the best of our patients will happen.”

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