Red Clocks, author Leni Zumas’ most recent novel, imagines a reality in which abortion and in vitro fertilization (IVF) are illegal in the United States. A recent review pointed out that the book’s focus is not surprising since dystopian literature is popular right now, as it allows us to foresee “a terrible and dark timeline, albeit one in which the seeds of possibility are already visible.”
One such seed: A new bill in Arizona would allow divorcing couples to transfer sole ownership of frozen embryos to “the spouse that wants them for the purpose of having children.” Though the bill assumes that embryos are property that can be transferred like cars or homes, the wording of the bill implies that embryos are people deserving of a chance at life. The argument that life begins at conception, or at the creation of an embryo, was also prominently featured in the recent 18th District U.S. Congress special election in Pennsylvania and the 2018 Personhood Act in South Carolina.
Disagreements about when life begins are, and have long been, at the heart of the legal debate about abortion. Numerous bills have sought to ban abortion by assigning personhood to fetuses and, as a result, give them the same legal rights as, for example, the people who conceived them. However, these same bills are applicable to IVF as some anti-choice advocates believe that life begins at the creation of embryos in an IVF laboratory.
In short, as legislation regarding at what week of pregnancy an abortion can be performed potentially changes, such laws affect IVF. The assignment of personhood to embryos will mean that IVF clinics will no longer be able to create, freeze, or dispose of them. It would also prevent the retrieval of eggs for fertility preservation because those eggs would be used in the future to create embryos, thus creating “life” in the lab.
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As a clinical psychologist in the Division of Reproductive Endocrinology and Infertility at Northwestern University, I have had the privilege of counseling countless patients pursuing fertility treatment. Whether due to infertility or cancer, patients who pursue IVF frequently share with me their feelings of anxiety and grief that they were unable to conceive on their own. I have witnessed my patients’ resulting joys and sorrows as they pursue either successful or unsuccessful treatment. Regardless of outcome, nearly all patients report that they would feel intense regret if they had not been able to attempt IVF.
During IVF, sperm and eggs combine to create embryos, develop in a laboratory, and then are either transferred into a woman’s uterus or frozen for future use. Only small portions of these embryos result in viable pregnancies. Depending on a woman’s age, a 2017 study found that 35 to 90 percent of embryos may be chromosomally abnormal and result in a miscarriage or failed implantation. Even when chromosomally normal embryos are transferred, many fail to produce a viable pregnancy.
Given that so few embryos will result in viable pregnancies, assigning personhood to something that is already unlikely to become a human being is unwarranted. Without IVF, more than 7 million people would not exist today. Assigning personhood to embryos and restricting IVF would rob couples of a real chance to try to build their families. This is almost unfathomable.
Still, other legislation may affect IVF as well. Despite the fact that few embryos will become a “live-born” human baby, the recent U.S. tax plan included language to confer college savings benefits at the point of conception. In some states, fetal burial laws could require that patients pay for burials for unused nonviable embryos. Destroyed and buried embryos would need a government-issued death certificate and thus a birth certificate and Social Security number. If we follow personhood measures to the extreme, parents could take out life insurance policies for embryos that fail to produce a viable pregnancy, or freezing genetic material deemed a live human being could be considered a crime.
To be sure, limiting IVF to the creation of only one embryo at a time for a couple would prevent excess embryos from being frozen or destroyed. It would also serve as a barrier to accessing IVF, given that generally, multiple embryos are needed to allow for high rates of chromosomal abnormality in embryos, particularly in older women who pursue treatment. The repeated creation and transfer of individual embryos required to facilitate a viable pregnancy would require a great deal of time, money, and emotional resources not available to many couples.
Even if the creation and freezing of embryos was permissible, personhood laws could be used to require that parents utilize all embryos or donate them to another person. Very few of my patients elect to donate their excess embryos to another couple as they, understandably, want control over the fate of their genetic material. Rather than be forced to donate excess embryos, couples who pursue IVF may engage in medically riskier decision-making, such as the transfer of excess embryos resulting in multifetal pregnancy.
It is inappropriate to deem the donation of excess embryos to another couple as similar to an adoption of a child with the associated required adoption home studies and other adoption requirements. Adoption can be a beautiful yet emotionally, financially, and time-consuming experience.
The term “embryo adoption” has been used by some embryo donation agencies and patients. However, patients donate or use excess embryos; they do not adopt them like infants or older children.
Certainly some may disagree and believe that embryos are babies who are available for adoption. Rather than seeing embryos as cells with the possibility of a viable pregnancy, they may believe that the destruction of embryos is tantamount to murder. Indeed, some patients do view their embryos as babies. Most do not and choose to have excess embryos destroyed or donated to research. For the wife involved in the lawsuit at the heart of the Arizona bill, her embryos represent her only chance to have a biological child. Although understandably distressed by her potential genetic loss, forcing her soon-to-be ex-husband to give her his genetic material against his will may be equally psychologically destructive to him.
Perhaps most concerning, but least discussed, is how a child might experience a forced donation arrangement. Unless lied to, such a child could be keenly aware and potentially psychologically harmed by the knowledge that they were actively unwanted by one of their known genetic donors. This differs from the generally positive reaction of children conceived via voluntary egg or sperm donation.
One in eight couples experiences infertility. Infertility crosses all political, religious, racial, and economic boundaries. Whether infertility directly affects us personally, it is likely that it will affect our loved ones.
Embryo personhood will restrict family building. Beliefs around family building as well as abortion are indeed personal decisions. Let us be careful not to allow anti-choice legislation to close a door to building families.