Last week, I had the honor to be a panelist at the annual meeting of the Pacific Coast Reproductive Society, a medical society for infertility physicians and medical professionals. I was glad to have the opportunity to present to such a well-informed and interested audience, and to work with my co-panelists, Barb Collura of RESOLVE: The National Infertility Association and Sean Tipton of the American Society for Reproductive Medicine. Our talk focused on legal threats to infertility treatment, the same subject which Parents Against Personhood has been discussing for the last 18 months: that there is a fundamental conflict between infertility treatment and personhood.
I always enjoy speaking to other people about personhood, since it’s a passionate and personal subject for me. However, the PCRS Meeting offered me a chance to listen and learn as well as talk, because I was able to attend presentations on embryology, stem cell research, and clinical practice. As a layperson, I’m always working to improve my understanding of reproductive medicine, so that I can be an effective advocate and provide accurate factual information. These panels didn’t disappoint, and I’m grateful to PCRS for allowing me to learn about new directions in infertility treatment from some of the world’s foremost researchers.
The more I learn about the science and medicine behind infertility treatment, the more obvious it becomes that infertility physicians cannot practice under personhood. While some organizations like Personhood USA assert that IVF doesn’t ban personhood because embryo cryopreservation is unnecessary and we can simply freeze eggs, a thorough understanding of the science shows that this is a stunningly uninformed opinion.
A case in point was the embryology panel “Current Hot Topics in the Lab”, conducted by Dr. Peter Nagy of Reproductive Biology Associates and Dr. Catherine Racowsky of Brigham and Women’s and Harvard. One of the topics discussed at length is that new research suggests that embryo cryopreservation and frozen-embryo transfer may actually be more effective than fresh transfers. The idea is that the medications used in IVF to produce eggs may actually alter the uterine lining in a way that makes it harder for embryos to implant. By freezing the embryos and performing a frozen-embryo transfer in a later cycle, doctors can better prepare the uterus to receive embryos, and pregnancy rates increase. Traditionally, FETs have somewhat lower success rates than fresh cycles, but recent advances in cryopreservation mean that the benefits of improved endometrial conditions now outweigh those of using non-frozen embryos. Some clinics are now beginning to treat patients by freezing ALL embryos created and then transferring embryos the next month, after giving the patient a few weeks to recover and prepare a better uterine environment.
From the personhood perspective, this creates a catch-22 situation: If we agree that making it harder for an embryo to implant is the moral equivalent of abortion — and given that this is the core concept behind personhood advocates’ view of emergency contraception and IUDs as “causing abortion”, it’s hard to argue otherwise — then fresh embryo transfers clearly fall into this category, because it’s less likely that the embryos will implant and develop. Unlike the effect of the morning-after pill, this effect is not small or debatable; in the study I linked above, frozen embryos resulted in 63 live births compared to 37 for the fresh transfers.
However, as we have discussed before, freezing embryos is also not permissible, because the process of cryopreservation and thawing sometimes damages or destroys embryos. If we can’t freeze embryos for later transfer, and we can’t perform fresh transfers, there is no possible way to perform IVF. It’s logically impossible.
a person or entity performing in vitro fertilization shall limit the number of in vitro human embryos created in a single cycle to the number to be transferred in that cycle”
“Destructive research” means medical procedures, scientific or laboratory research, or other kinds of investigation that kill or injure the subject of such research.”
(Mississippi HB-819 and HB-937, 2013)
Another topic mentioned during this panel was that physicians don’t necessarily see the same success rates in the real world as in the research. In particular, oocyte cryopreservation (egg freezing) is a promising development, but physicians aren’t always seeing optimal results in practice. As the recent ASRM guidelines on oocyte cryopreservation note, small research studies may find good results, but large-scale observational studies show that “implantation and pregnancy rates may be lower when frozen oocytes are used compared with fresh or frozen embryos”. Several doctors at the panel discussed that this has been their experience with oocyte cryopreservation, and that they are seeing lower rates of successful fertilization, embryo quality, and pregnancy in their patients.
Again, this is a basic conflict with personhood. If freezing oocytes makes it less likely that those oocytes will fertilize correctly, implant, and develop into persons, personhood would obligate us not to perform a procedure which meets the medical definitions of “destructive research”. While oocytes are not persons, they would become persons at the instant that ICSI is performed to fertilize them. Any medical technique which impedes their later development and causes them to die in larger numbers would still be a potential violation of those embryos’ personhood rights. If individual physicians are seeing worse results in practice with frozen oocytes than fresh, legal and ethical constraints would prevent them from continuing to perform oocyte cryopreservation, and leave them open to allegations of malpractice or negligence.
Other subjects under discussion by the panelists and audience during this panel included Day 3 vs Day 5 cell biopsy, traditional ovarian stimulation versus newer low-stimulation techniques, and stimulation with FSH alone versus FSH-LH combination medications. In all of these cases, the question is which technique produces higher pregnancy rates — in other words, which technique damages or destroys fewer embryos. In every case, one technique will eventually be found have a higher success rate than another, meaning that in every case, the techniques we are using now may potentially be injuring embryos. If all embryos are people with a personhood-based right to life, we’re obligated not to perform medicine which we suspect may be increasing their risk of death, however inadvertent.
Ultimately, I left the PCRS Meeting with a much improved understanding of the latest scientific developments in reproductive medicine. In turn, that new knowledge clarified my existing awareness that the legal problems with infertility treatment and personhood are wide-ranging and basically impossible to reconcile. This wasn’t a surprise, as it’s why personhood is universally opposed by the medical professionals, researchers, and medical organizations who understand reproductive and infertility medicine. Still, there’s nothing to bring it home like listening to a room full of world experts talk about the science.
As always, I urge you to trust the judgment of physicians and medical organizations, not pro-life advocacy groups whose primary interest is abortion politics and who have little understanding of or interest in infertility treatment. That’s why I formed Parents Against Personhood in 2011, to help people understand the medical facts about infertility and personhood, and to encourage voters and legislators to listen to doctors and medical professionals. I thank the Pacific Coast Reproductive Society for the opportunity to continue my education in infertility medicine, and I hope I’ll have more chances in the future to share the latest knowledge with you.