IVF stressful enough without Alabama court ruling on embryos

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The Alabama Supreme Court ruling that embryos created through in vitro fertilization (IVF) are legally children sent shock waves through the reproductive health community. The decision only applies in that state, for now, and the court has already been asked to reconsider it. However, this idea might well gain traction in other places. The ruling resulted in several clinics, including the large one at the University of Alabama at Birmingham, suspending IVF treatments for fear of legal liability.

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Some providers are resuming some services after the state’s Republican governor signed a bill into law on Thursday aimed at protecting IVF patients and providers. The new law does not address the issue of personhood at the heart of last month’s unprecedented ruling.

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This has put some Alabama couples in a terrible bind. They have started the invasive IVF protocol and now cannot complete it unless they travel out of state. We quite rightly focus on the impact of this on women, who must endure all the poking and prodding, hormone injections, and tense waiting to see if they will have a baby. However, I was struck by the thoughtful and very emotional comments of some of the male partners in Alabama who have been interviewed on this subject.

It would be easy to underestimate the man’s role in IVF. Physically it involves a few minutes in a locked room with a plastic vial and some well-thumbed magazines. Psychologically, however, the effects of IVF on both members of the couple can be profound. A meta-analysis by Polish researcher Alicja Malina found that “in the process of treating infertility, the satisfaction with a couple’s relationship deteriorates.” Also, putting the focus on the technical side of intercourse often “results in the weakening of emotional bonds which leads to the loss of pleasure, and diminishes the spontaneity and desire.”

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Being the reason for going to an IVF clinic puts further emotional burden on the male partner. According to the Urology Care Foundation, “In over a third of infertility cases, the problem is with the man.” Their website, urologyhealth.org, goes on to note that male issues can range from previous genital tract infections to cancer as well as emotional issues like anxiety and depression. Overindulging in alcohol, tobacco, marijuana, and other recreational drugs can also be factors.

IVF success rates have certainly improved since Louise Brown, the world’s first “test-tube baby” was born in 1978. According to the Better Outcomes Registry and Network, which is funded by the Government of Ontario, “The overall cumulative live birth rate for retrieval cycles with at least one embryo transfer was 37.1%.”  However, this means that many couples will be disappointed in their IVF journey.

In her review article, Malina notes that “although women appear to be at greater risk for negative psychological consequences of IVF than men, men also reported significant negative psychological response after a failed treatment cycle.” Even a successful IVF implantation can lead to greater than normal pregnancy-related anxiety and “negative feelings related to infertility may continue to affect self-image for the IVF couples after pregnancy and childbirth were achieved.”

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The cost adds to the stress of many couples seeking IVF in Canada. According to the non-profit organization Fertility Matters, “the cost for treatment is approximately $10,000 to $20,000 per cycle.” Their website notes that funding for IVF is uneven across the country and that “British Columbia, Alberta, Saskatchewan, and the territories – where 29% of our country’s residents live – do not cover the cost of procedures like IVF or IUI (Intrauterine insemination).”

The Alabama ruling came from a case where an unauthorized person dropped some vials and destroyed the embryos within them. It’s also worth noting the 1872 state law in question, the Wrongful Death of a Minor Act, carries civil penalties, not criminal ones. It certainly does not ban IVF treatment in the state.

Still, the unintended, though probably not unforeseen, consequence is that several clinics have paused IVF treatments. There is always a chance that an embryo may be destroyed in the normal handling related to IVF, and they didn’t want to open themselves up to legal risks. One might well argue they have a countervailing duty to help their patients, especially those already in the middle of the IVF process. The clinics didn’t see it that way.

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This case raises complex moral, philosophical, medical, and yes, political questions. I am reminded of a 1965 ballad by American folksinger Phil Ochs, written at the height of the civil rights movement. One verse talks about the schools of Alabama’s next-door neighbour, Mississippi, “Where they’re teaching all the children that they don’t have to care … and there’s nobody learning such a foreign word as fair.”

Just in case somebody thinks that it’s a good idea to add to the mountain of stress that IVF couples, women and men, already face, the last line of that song sums it up well, and Alabama might want to look in the mirror.

“Mississippi, find yourself another country to be part of.”

Dr. Tom Keenan is an award-winning journalist, public speaker, professor in the School of Architecture, Planning and Landscape at the University of Calgary, and author of the best-selling book, Technocreep: The Surrender of Privacy and the Capitalization of Intimacy.

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