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Tag: vitro fertilization

  • The People Rooting for the End of IVF

    The People Rooting for the End of IVF

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    Updated at 4:10 p.m. ET on March 11, 2024

    Chaos reigns in Alabama—or at least in the Alabama world of reproductive health. Three weeks ago, the state’s supreme court ruled that embryos should be treated as children, thrusting the future of in vitro fertilization, and of thousands of would-be Alabama parents, into uncertainty. Last week, state lawmakers scrambled to pass a legislative fix to protect the right of prospective parents to seek IVF, but they did so without addressing the court’s existential questions about personhood.

    Meanwhile, those in the wider anti-abortion movement who oppose IVF are feeling hopeful. Whatever the outcome in Alabama, the situation has yanked the issue “into the public consciousness” nationwide, Aaron Kheriaty, a fellow at the conservative Ethics and Public Policy Center, told me. He and his allies object to IVF for the same reason that they object to abortion: Both procedures result, they believe, in the destruction of innocent life. And in an America without federal abortion protections, in which states will continue to redefine and recategorize what qualifies as life, more citizens will soon encounter what Kheriaty considers the moral hazards of IVF.

    In his ideal world, the anti-abortion movement would make ending IVF its new goal—the next frontier in a post-Roe society. The problem, of course, is that crossing that frontier will be bumpy, to say the least. IVF is extremely popular, and banning it is not—something President Joe Biden made a point of highlighting in his State of the Union speech last week. (A full 86 percent of Americans support keeping it legal, according to the latest polling.) “Even a lot of pro-lifers don’t want to touch this issue,” Kheriaty acknowledged. “It’s almost easier to talk about abortion.” But he and his allies see the Alabama ruling as a chance to start a national conversation about the morality of IVF—even if, at first, Americans don’t want to listen.

    Read: The anti-abortion movement’s attack on unwanted pregnancies

    After all, their movement has already won another unpopular, decades-long fight: With patience and dedication, pro-life activists succeeded in transforming abortion rights from a niche issue in religious circles to a mainstream cause—eventually making opposition to Roe a litmus test for Republican candidates. Perhaps, the thinking goes, pro-lifers could achieve the same with IVF.

    The typical IVF procedure goes like this: A doctor retrieves a number of eggs from a woman’s ovaries—maybe eight to 10—and fertilizes them with sperm in laboratory conditions. The fertilized eggs will grow in the lab for a few days, before one or more embryos will be selected for transfer to the woman’s uterus. A patient using IVF to get pregnant will likely have several embryos left over, and it’s up to the patient whether those extras are discarded, frozen for future use, or donated, either to research or to another couple.

    In the Alabama case, three couples were storing frozen embryos at an IVF clinic, where they were mistakenly destroyed. When the couples sued the clinic in a civil trial for the wrongful death of a child, the state supreme court ruled that they were entitled to damages, declaring in a novel interpretation of Alabama law that embryos qualify as children. The public’s response to the ruling can perhaps best be described as panicked. Two of the state’s major in-vitro-fertilization clinics immediately paused operations, citing uncertain legal liability, which disrupted many couples’ medical treatments and forced some out of state for care. Lawmakers across the country raced to clarify their position.

    But the ruling shouldn’t have come as such a shock, at least to the pro-life community. After all, “it’s a very morally consistent outcome” with what anti-abortion advocates have long argued—that life begins at conception—Andrew T. Walker, an ethics and public-theology professor at the Southern Baptist Theological Seminary, told me: “It’s the culmination of other pro-life arguments about human dignity, brought to the IVF domain.”

    Read: The significance of Michelle Obama’s fertility story

    The central criticism of IVF from Walker and others who share his opinion concerns the destruction of extra embryos, which they view as fully human. For some people, a degree of cognitive dissociation is required to look at a tiny embryo and see a human baby, which is a point that IVF defenders commonly make. (“I would invite them to try to change the diaper of an in vitro–fertilized egg,” Sean Tipton, the chief advocacy and policy officer at the American Society for Reproductive Medicine, told me. More soberly, Kate Devine, the medical director of US Fertility, a network of reproduction-focused practices, told me that referring to an embryo as a baby “is unjust and inaccurate and threatens to withhold highly efficacious family-building treatments from people affected by the disease of infertility.”)

    To IVF critics, however, an embryo is just a very young person. “The only real difference between those frozen embryos and me sitting here having this conversation with you is time,” Katy Faust, the president of the anti-abortion nonprofit Them Before Us, told me. “If you believe that children have a right to life, and that life begins at conception, then ‘Big Fertility’ as an industry is responsible for more child deaths than the abortion industry.” Faust’s organization argues from a “children’s rights” perspective, meaning it also believes that IVF is wrong, in part, because it allows single women and homosexual couples to have babies, which deprives children of having both a mother and a father.

    This leads to the other major criticism of IVF: that the process itself is so unnatural that it devalues sex and treats children as a commodity. The argument to which many religious Americans subscribe is that having children is a “cooperative act among husband, wife, and God himself,” John M. Haas, a former president of the National Catholic Bioethics Center, has written. “Children, in the final analysis, should be begotten not made.” The secular version of that opinion is that IVF poses all kinds of thorny bioethical quandaries, including questions about the implications of preimplantation genetic testing and the selection for sex and other traits. When a doctor takes babies “out of the normal process of conception, lines them up in a row, and picks which is the best baby, that brings a eugenicist mindset into it that’s really destructive,” Leah Sargeant, a Catholic writer, told me. “There are big moral complications and red flags that aren’t being treated as such.”

    She and the others believe that now is the time to stop ignoring those red flags. The Alabama Supreme Court has offered a chance to teach people about IVF—and the implications they may not yet be aware of. Some couples who’ve undergone IVF don’t even consider the consequences “until they themselves have seven [extra] frozen embryos,” Faust said, “and now they go, ‘Oh, shit, what do we do?’” The more Americans learn about IVF, the less they’ll use it, opponents argue, just as Americans have broadly moved away from international adoption for ethical reasons. Walker would advise faith leaders to counsel couples against the process. “As I’ve talked with people, they’ve come around,” he said.

    The IVF opponents I interviewed all made clear that they sympathize with couples struggling with infertility. But they also believe that not all couples will be able to have biological children. “Not every way of pursuing children turns out to be a good way,” Sargeant said; people will have to accept that “you don’t have total control over whether you get one.”

    Read: The pro-life movement’s not-so-secret plan for Trump

    None of these arguments is going to be an applause line for anti-IVF campaigners in most parts of the country. “I know that my view is deeply unpopular,” Walker told me, with a laugh. The Alabama ruling left Republicans in disarray: Even some hard-line social conservatives in Congress, including House Speaker Mike Johnson, have tried to distance themselves from it, arguing that they oppose abortion but support IVF from a natalist position. Democrats, meanwhile, are already using the issue as a wedge: If, in the lead-up to the 2024 election, they can connect Republicans’ support for Dobbs to the possible end of IVF, they’ll have an even easier job painting the GOP as extreme on reproductive health and out of touch with the average American voter.

    Even so, the anti-IVF people I interviewed say, at least Americans would be talking about it. Talking, they believe, is the beginning of persuasion. And they’re prepared to be patient.

    Earlier this week, Kheriaty texted me with what he seems to take as evidence that his movement is already making progress. He sent a comment he’d gotten from a reader in response to his latest column about the perils of IVF. “This troubling dilemma wasn’t on top of mind when we embarked on our IVF path,” the reader had written. The clinic had explained what would happen to their unused embryos, the woman said, but she hadn’t realized the issue “would loom” so heavily over her afterward.

    This article originally identified John M. Haas as the president of the National Catholic Bioethics Center; in fact, he is a former president of the center.

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    Elaine Godfrey

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  • The Calendar of Human Fertility Is Changing

    The Calendar of Human Fertility Is Changing

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    As the chair of the department of obstetrics and gynecology at UT Southwestern Medicine, Catherine Spong is used to seeing a lot of baby bumps. But through her decades of practice, she’s been fascinated by a different kind of bump: Year after year after year, she and her colleagues deliver a deluge of babies from June through September, as much as a 10 percent increase in monthly rates over what they see from February through April. “We call it the summer surge,” Spong told me.

    Her hospital isn’t alone in this trend. For decades, demographers have documented a lift in American births in late summer, and a trough in the spring. I see it myself in my own corner of the world: In the past several weeks, the hospital across the street from me has become a revolving door of new parents and infants. When David Lam, an economist at the University of Michigan who helped pioneer several early U.S. studies on seasonal patterns of fertility, first analyzed his data decades ago, “we were kind of surprised how big it was,” he told me. Compare the peak of some years to their nadir, he said, and it was almost like looking at the Baby Boom squished down into 12 months.

    Birth seasonality has been documented since the 1820s, if not earlier. But despite generations of study, we still don’t fully understand the reasons it exists, or why it differs so drastically among even neighboring countries. Teasing apart the contributions of biology and behavior to seasonality is messy because of the many factors involved, says Micaela Martinez, the director of environmental health at the nonprofit WE ACT for Environmental Justice, who has been studying seasonality for years. And even while researchers try to track it, the calendar of human fertility has been changing. As our species has grown more industrialized, claimed more agency over reproduction, and reshaped the climate we are living in, seasonality, in many places, is shifting or weakening.

    Read: The pregnancy risk that doctors won’t mention

    There is no doubt that a big part of human birth seasonality is behavioral. People have more sex when they have more free time; they have less sex when they’re overworked or overheated or stressed. Certain holidays have long been known to carry this effect: In parts of the Western world with a heavy Christian presence, baby boomlets fall roughly nine months after Christmas; the same patterns have been spotted with Spring Festival and Lunar New Year in certain Chinese communities. (Why these holidays strike such a note, and not others, isn’t entirely clear, experts told me.)

    In addition to free time, family-focused celebrations probably help set the mood, Luis Rocha, a systems scientist at Binghamton University, told me. Cold weather might help people get snuggly around Christmastime, too, but it’s not necessary; Rocha’s studies and others have shown the so-called Christmas effect in southern-hemisphere countries as well. No matter whether Christmas falls in the winter or summer, around the end of December, Google searches for sex skyrocket and people report more sexual activity on health-tracking apps. In a few countries, including the U.S., condom sales rise too.

    But cultural norms have never been able to explain everything about the Homo sapiens birth calendar. “It’s pretty common for mammals to have a specific breeding season” dictated by all sorts of environmental cues, Martinez told me. Deer, for instance, mate in the fall, triggered by the shortening length of daylight, effectively scheduling their fawns to be born in the spring; horses, whose gestations are longer, breed as the days lengthen in the spring and into summer, so they can foal the following year.

    Humans, of course, aren’t horses or deer. Our closest relatives among primates “are much more flexible” about when they mate, Élise Huchard, a behavioral ecologist at the University of Montpellier, in France, told me. But those apes are not immune to their surroundings, and neither are we. All sorts of hormones in the human body, including reproductive ones, wax and wane with the seasons. Researchers in the United States and Australia have found that couples hoping to conceive via in vitro fertilization have a higher chance of success if the eggs are retrieved during the summer. At the same time, summer conceptions appear to be less common, or less successfully carried to term, in some countries, a trend that sharpens at lower latitudes and, Lam told me, during hotter years. The subsequent spring lulls may be explained in part by heat waves dissuading people from sex. But Alan Barreca, an economist at UCLA, suspects that ultrahigh temperatures may also physiologically compromise fertility, potentially by affecting factors such as sperm quantity and quality, ovulation success, or the likelihood of early fetal loss.

    Read: Life can’t get much hotter than this

    No matter its exact drivers, seasonality is clearly weakening in many countries, Martinez told me; in some parts of the world, it may be entirely gone. The change isn’t uniform or entirely understood, but it’s probably to some extent a product of just how much human lifestyles have changed. In many communities that have historically planted and harvested their own food, people may have been more disinclined to, and less physically able to, conceive a child when labor demands were high or when crops were scarce—trends that are still prominent in certain countries today. People in industrial and high-income areas of the modern world, though, are more shielded from those stressors and others, in ways that may even out the annual birth schedule, Kathryn Grace, a geographer at the University of Minnesota, told me. The heat-driven dip in America’s spring births, for instance, has softened substantially in recent decades, likely due in part to increased access to air-conditioning, Lam said. And as certain populations get more relaxed about religion, the cultural drivers of birth times may be easing up, too, several experts told me. Sweden, for example, appears to have lost the “Christmas effect” of December sex boosting September births.

    Advances in contraception and fertility treatments have also put much more of fertility under personal control. People in well-resourced parts of the world can now, to a decent degree, realize their preferences for when they want their babies to be born. In Sweden, parents seem to avoid November and December deliveries because that would make their child among the youngest in their grade (which carries a stereotype of potentially having major impacts on their behavioral health, social skills, academics, and athletic success). In the U.S., people have reported preferring to give birth in the spring; there’s also a tax incentive to deliver early-winter babies before January 1, says Neel Shah, the chief medical officer of Maven Clinic, a women’s health and fertility clinic in New York.

    Humans aren’t yet, and never will be, completely divorced from the influences of our surroundings. We are also constantly altering the environment in which we reproduce—which could, in turn, change the implications of being born during a particular season. Births are not only more common at certain times of the year; they can also be riskier, because of the seasonal perils posed to fetuses and newborns, Mary-Alice Doyle, a social-policy researcher at the London School of Economics, told me. Babies born during summer may be at higher risk of asthma, for instance—a trend that’s likely to get only stronger as heat waves, wildfires, and air pollution become more routine during the year’s hottest months.

    The way we manage infectious disease matters too. Being born shortly after the peak of flu season—typically winter, in temperate parts of the world—can also be dangerous: Infections during pregnancy have been linked to lower birth weight, preterm delivery, even an increased likelihood of the baby developing certain mental-health issues later on. Comparable concerns exist in the tropics, where mosquitoes, carrying birth-defect-causing viruses such as dengue or Zika, can wax and wane with the rainy season. The more humans allow pathogens to spill over from wildlife and spread, the bigger these effects are likely to be.

    Read: One more COVID summer?

    Children born in the spring—in many countries, a more sparsely populated group—tend to be healthier on several metrics, Barreca told me. It’s possible that they’re able to “thread the needle,” he said, between the perils of flu in winter and extreme heat in summer. But these infants might also thrive because they are born to families with more socioeconomic privilege, who could afford to beat the heat that might have compromised other conceptions. As heat waves become more intense and frequent, people without access to air-conditioning might have an even harder time getting pregnant in the summer.

    The point of all this isn’t that there is a right or wrong time of year to be born, Grace told me. If seasonality will continue to have any sway over when we conceive and give birth, health-care systems and public-health experts might be able to use that knowledge to improve outcomes, shuttling resources to maternity wards and childhood-vaccination clinics, for instance, during the months they might be in highest demand.

    Humans may never have had as strict a breeding season as horses and deer. But the fact that so many people can now deliver safely throughout the year is a testament to our ingenuity—and to our sometimes-inadvertent power to reshape the world we live in. We have, without always meaning to, altered a fundamental aspect of human reproduction. And we’re still not done changing it.

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    Katherine J. Wu

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