Changing Abortion Laws Cast Uncertainty on Future of Fertility Preservation

Implications for Patients and Providers

As the laws continue to change, patients seeking fertility treatment are grappling with the uncertainty. 

“We are actually spending a lot of time trying to reassure our patients that nothing has changed here and that we are continuing to proceed as usual with standard-of-care medical therapies, including IVF and fertility preservation,” Dr Constance said. 

The American Society of Clinical Oncology (ASCO) recommends that health care providers discuss the possibility of infertility with adult and pediatric cancer patients as early as possible before treatment initiation and refer patients who are interested in fertility preservation to reproductive specialists.¹⁵ 

Talking with patients about fertility preservation can reduce distress and improve quality of life, according to the ASCO guidelines. However, research suggests that many cancer patients may not have adequate information on fertility planning. A study of nearly 7000 cancer patients showed that only 44% received counseling about the risk of infertility associated with chemotherapy.¹⁶ 

“I certainly wouldn’t want to see the changing legal environment lessen [the use of fertility preservation services] more than it already is,” Dr Constance said. 

That is why it is critical for health care providers and patients to engage with policymakers, according to Don Dizon, MD, professor of medicine and surgery at Brown University in Providence, Rhode Island, and a member of Cancer Therapy Advisor’s editorial board. 

“Doctors need to be engaged in this conversation aggressively” because the next part of the conversation will be about how abortion restrictions may restrict reproductive endocrinology, Dr Dizon said. 

“We can’t sit back and assume that rights are not going to be taken away because I think so many of us assumed that Roe would not be overturned, and here we are,” he added. 

Dr Dizon noted that he has seen a lot of physicians speaking up and writing about the harm that abortion bans could have on patients with cancer. In particular, there are concerns that abortion bans could prevent optimal care for patients with cancer diagnosed during pregnancy — about 1000 people every year in the US — because the treatment might injure the fetus.¹⁷

Medical societies, including ASCO and the American College of Obstetricians and Gynecologists (ACOG), have issued statements saying that the Dobbs v Jackson Women’s Health Organization ruling threatens patient safety and the ability of patients and their doctors to determine the most appropriate care.^18,19

These statements are “a really large step,” Dr Dizon said. “If we speak with one voice, hopefully, they will listen to us.”

Disclosures: Dr Dizon reported consulting for Midi, a women’s health platform. Reinecke, Dr Constance, and Tipton reported no conflicts.

References

1. Duignan B. Dobbs v. Jackson Women’s Health Organization law case. Britannica. Updated August 5, 2022. Accessed September 1, 2022. 
2. American Society for Reproductive Medicine Center for Policy and Leadership. State abortion trigger laws: Potential implications for reproductive medicine. Updated July 1, 2022. Accessed September 1, 2022. 
3. Durkee A. As 3 more abortion trigger bans take effect, here’s where laws are being enforced — And where they’ve been blocked. Forbes. Published August 25, 2022. Accessed September 1, 2022. 
4. Miller J. Planned Parenthood of Utah files suit, asking court to declare state’s abortion ban unconstitutional. The Salt Lake Tribune. Published June 25, 2022. Accessed September 1, 2022. 
5. Miller S. Judge blocks Utah’s abortion trigger law. KUER Public Radio. Published July 11, 2022. Accessed September 1, 2022. 
6. Stern EA. What’s next for abortion in Utah? Published August 23, 2022. Accessed September 1, 2022. 
7. Hammel P. ‘Trigger’ abortion bill fails by two votes to overcome eight-hour filibuster. Nebraska Examiner. Published April 6, 2022. Accessed September 1, 2022. 
8. Tipton S, Robins J. Not just abortion: How the demise of Roe v Wade may impact fertility care. Contemporary OB/GYN Journal. 2022;67(7):9-11.
9. Beck MA. Nebraska won’t hold special legislative session on abortion. AP News. Published August 8, 2022. Accessed September 1, 2022.
10. Newkirk M. Why Alabama’s abortion law includes an exemption for infertility. Bloomberg News. Published May 29, 2019. Accessed September 1, 2022. 
11. Preimplantation Genetic Testing: ACOG Committee Opinion, Number 799. Obstet Gynecol. 2020;135(3):e133-e137. doi:10.1097/AOG.0000000000003714 
12. Catchings HC. A “modern family” issue: Recategorizing embryos in the 21st century. LA L Rev. 2020;80(4):1522-1556.
13. Glaser B. The fertility dilemma: Frozen embryos. KPLC News. Updated March 27, 2009. Accessed September 1, 2022. 
14. Bayefsky M. Who should regulate preimplantation genetic diagnosis in the United States? AMA J Ethics.2018;20(12):E1160-E1167. doi:10.1001/amajethics.2018.1160
15. Oktay K, Harvey BE, Partridge AH, et al. Fertility preservation in patients with cancer: ASCO Clinical Practice Guideline update summary. J Oncol Pract. 2018;14(6):381-385. doi:10.1200/JOP.18.00160
16. Patel P, Kohn TP, Cohen J, Shiff B, Kohn J, Ramasamy R. Evaluation of reported fertility preservation counseling before chemotherapy using the Quality Oncology Practice Initiative Survey. JAMA Netw Open. 2020;3(7):e2010806. doi:10.1001/jamanetworkopen.2020.10806
17. Harris LH. Navigating loss of abortion services – A large academic medical center prepares for the overturn of Roe v. Wade. N Engl J Med. 2022;386(22):2061-2064. doi:10.1056/NEJMp2206246 
18. The American Society of Clinical Oncology. ASCO statement on Supreme Court decision in Dobbs v. Jackson Women’s Health. Published June 27, 2022. Accessed September 1, 2022. 
19. The American College of Obstetricians and Gynecologists. ACOG Statement on the decision in Dobbs v. Jackson. Published June 24, 2022. Accessed September 1, 2022.

This article originally appeared on Cancer Therapy Advisor