A quick primer on IVF to explain the Alabama Supreme Court decision:

In IVF we take eggs and sperm and put them together in a lab. This involves taking hormone shots to mature the eggs in the body, removing the eggs, and fertilizing the eggs with sperm in the lab.
1/10 Not all eggs will fertilize with sperm, on average 75% will. About 50% of these that fertilize will then grow to the stage of an embryo that can be implanted into the body - this stage is called a blastocyst stage, a day 5 or 6 embryo, and it is a few hundred cells.
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A year ago, Roe was overturned. As a fertility doctor, my patients have felt and lived the consequences of this.

The nonviable fetus after IVF. Delay in care because out of state terminations are full, resultant termination at a later gestation by 5 wks.

1/11 This made a relatively simple procedure life threatening. Blood transfusions, emergent D&C, and resultant uterine scarring. This may resultant in an inability to carry a child again. This would not had happened at an earlier gestational age.

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If you thought we were overreacting about the overturn of Roe let me present:

Abortion bills in Wyoming, Nebraska, Arkansas, Kansas. Some of these clearly prohibit IVF as we know it. All impact reproductive care and risk maternal life.

Your IVF docs have been warning of this. Each bills that attempts to restrict "all" abortions actually restricts proper medical care, miscarriage and pregnancy management, treatment of ectopic pregnancy, contraceptive access, and fertility treatment like IVF.

Maternal life is on the line. So is your future fertility.

Nobody wants to talk about abortion. I hear this daily.

And it’s true. And we shouldn’t have to talk about it - it should be medical care that is available when needed.

But it’s not.

1/ Let’s imagine for one minute that we let politics dictate who can have treatment for a heart attack.

I’m sorry - since you live in Texas we need to consult the legal team to see if your life is threatened enough to get a cardiac cath and a stent. Wait here and we will see.

2/

A nationwide abortion ban was introduced today by Senate Republicans - aiming to limit abortions across the US. This ban would prohibit abortions after 15 wks, but medically their argument is false.

1/ 1. The phrase “late term abortion” is used on purpose. This is not a medical term
2. 15 wks is not even midterm let alone late (pregnancies are 40 wks in length).
3. Most abortions that occur after 15 wks are for *lethal fetal anomalies* that CAN’T be diagnosed before.

2/

Limiting abortion has many consequences.

If your doctors can’t manage the complications that WE KNOW arise during pregnancy, maternal health will suffer. Life will be lost.

This is happening in Texas right now.

1/ A study in @AJOG_thegray looked at Texas this past year since SB8 was passed.

Just as every obgyn warned the world - we saw a significant increase in maternal complications without improvement in fetal survival.

2/

Welcome to Texas. Today abortion, a medical procedure, is now a felony. Punishable with up to life in prison. No exceptions for rape or incest. If you don’t think this will seriously impact medical care, you are wrong.

1/ Treatment of miscarriage. Treatment of ectopic pregnancy.
Treatment of previable pregnancy loss.
Access to contraception.
Access to fertility care.
And more.

2/

Emergency contraception PREVENTS pregnancy. These do not cause an abortion :
1. IUD
2. Plan B
3. Ella
4. Yuzpe method

*all must be used within 5 days of intercourse (sooner the better)

1/ IUD - most effective (99%)
Copper or progesterone (like Mirena), need an office office for placement

2/

In case you think abortion laws don’t matter: last week a pharmacist declined to fill a prescription for a patient of mine with an ectopic pregnancy citing SB8 restrictions.

The same medicine that saved my life in 2013 when I had my own ectopic pregnancy

1/4 I’ve also had pharmacists decline misoprostol (cytotec) lately which can be used for abortion, labor induction, helping a missed miscarriage (incomplete miscarriage) and more.

I like to use it before hysteroscopy in non pregnant patients to make surgery easy/safer.

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IVF requires utilization of technology to fertilize, grow, test, freeze and thaw embryos.

Limiting abortion access also limits all reproductive rights, including your ability to have a family with IVF.

1/6 Maybe you will be able to do IVF in your state but will you have limits of number of eggs fertilized? Ability to genetically test? Ability to freeze embryos? Ability to thaw & limit number of embryos transferred?

These advancements help IVF be safe and effective.

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Why are IVF and abortion tightly linked? IVF came into existence in a Roe world (Roe had been around almost 10 years before the first IVF baby). Roe allowed IVF - and maybe you’ve never thought of this.

1/10 When we protect reproductive rights we inherently say that embryos are not autonomous and can’t exist independently. This means that we don’t grant embryos rights. This means I am allowed to utilize reproductive technology to help people get pregnant.

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In 2013, I had an ectopic pregnancy. I was treated with methotrexate, terminating the pregnancy and saving my life.

Today in Texas, I could have been turned away and not treated.

A story about #SB8 A woman in South Texas was diagnosed with an ectopic pregnancy. Her doctor refused to treat her citing SB8 as the reason.

She went to the ER, who also sent her away. They would not do anything to end her pregnancy.
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The COVID vaccines do not cause infertility.

Your fertility doctors have been saying this since December, but we are now saying it louder.

1/4 @ReprodMed latest guideline reviews:

@CDCgov only 16.3% of pregnant people are vaccinated.

@JAMA_current COVID in pregnancy is associated with adverse maternal and fetal outcomes.

@AJOG_thegray COVID vaccination in pregnancy and lactation passes antibodies to the baby.

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