Last week’s Alabama Superior Court ruling that even single-celled human embryos should be recognized as “children” triggered painful déjà vu for me.
These days, I’m a reproductive endocrinologist at Brigham and Women’s Hospital and teach at Harvard Medical School, but I have also practiced in my native Italy, including during the heartbreaking years of what was known as Law 40.
In the spring of 2004, under a coalition government led by populist media mogul Silvio Berlusconi, the Italian Parliament passed a shocking new law giving full personhood rights to the human embryo. In a Western republic with clear right-to-choice reproductive laws, a blatantly unconstitutional law was enacted.
It took 10 years, and over 40 rulings of Italy’s Constitutional Court, to tame the terms of Law 40. Tens of thousands of Italian patients suffered in silence for a decade because of it.
Memories of the clinical and moral disasters caused by IVF restrictions hound me to this day. I remember most vividly the office visits with patients expecting babies afflicted by deadly genetic disease that could have been screened and prevented by IVF.
I recall the bewildered expressions of young patients who were pregnant with triplets because the new law forced them to transfer all the eggs that had been fertilized. Now they were faced with deciding between the high risk of fetal and maternal complications or the horrible alternative: a fetal reduction procedure.
I also think of the expressions of restored hope in those patients who had made tremendous financial and personal efforts to travel abroad to access egg donation, or at least “real IVF” (that is, IVF with no limitations on eggs inseminated, embryos frozen, or genetic testing).
Over those years, I frequently traveled from Boston to Italy as a consultant trying to help fertility centers optimize care in this new and extremely challenging legal environment, and I learned a lot. I know that too many people will be hurt by the Alabama ruling. In particular:
Infertility patients cannot count on many loyal allies.
Italian public opinion vehemently supported a 1978 referendum for the right to abortion but remained completely silent in 2004. It can be expected that friends, siblings, parents, and grandparents of patients suffering with infertility will continue to vote along party lines and accept whatever practical damages that vote brings along.
The time it takes to mend the damage of these laws spans a generation.
It took 10 years to partially reverse Law 40 in Italy, where abortion was already legal. The United States should be ready for several American states to relinquish access to real IVF, possibly indefinitely. As of today, 14 states have near-total abortion bans; all of these states may potentially follow suit with restrictive IVF laws. Millions of people could find themselves living in states where access to IVF is restricted or absent.
Scientific lies will be spread.
False statements will spread on mainstream and social media to isolate patients needing access to IVF. I still recall the 2004 television interviews of politically aligned professors at Italian universities stating that IVF could be offered without ever discarding embryos. That will never be true, but repeated lies may succeed in gaslighting American public opinion.
Countless babies will suffer and die unnecessarily.
There will be an increase in twins, triplets, and higher-order multiple gestations (and the complications associated with them) because of the inability to freeze embryos and preferentially offer single embryo transfer. Moreover, the potential for the expansion of laws that prevent the genetic testing of embryos will make it impossible to eliminate severe and deadly genetic disease from families affected by them.
Skilled worker migration will happen.
Clinical embryologists and reproductive endocrinologists (professions already in short supply nationwide) may relocate within and outside the country on account of IVF limitations and patient volume shifts. As a corollary, there will be a direct threat to the advancement of human reproduction research in America, a research community that has contributed greatly to progress on safety and efficacy of IVF worldwide.
There will be a boost in reproductive tourism and a geographic shift in expertise.
People with means, probably including the families of those politicians and judges who are directly responsible for this inequity, will travel to states that can still offer IVF. Conversely, people with limited means will have no access to IVF or may have to subject themselves to a limited IVF technology that is more costly (due to lower efficacy) and more risky (due to the need to transfer more embryos). The boost of IVF travel to Spain during Italy’s Law 40 contributed to the accumulation of incredible wealth, knowledge, and research in that country. Nobody in Europe was ever able to close that advantage gap, which was the direct result of Italian senselessness and Spanish entrepreneurship. The same is likely to happen in US states that enact similar policies. Some people will build wealth on this Alabama ruling. Millions of people, however, will have their basic dreams of happiness shattered.
I’m no politician, I’m just an academic fertility specialist. But in the summer of 2004, I was invited by the Italian Radical Party to rally national public opinion to push for a referendum to strike down the law. Alas, my efforts and those of other colleagues were to no avail then. I hope the United States can learn from the tragic effects of that failure.
Dr. Antonio Gargiulo is a reproductive endocrinologist and medical director of Gynecologic Robotic Surgery at Brigham and Women’s Hospital and an associate professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School.