Could IVF build a bridge between political parties?

About the expert

Serena Chen, MD

Director Reproductive Medicine, IRMS Institute for Reproductive Medicine

Dr. Serena Chen is a Founding Partner at the Institute for Reproductive Medicine and Science and serves as the Director of Advocacy there. She served as Director for the Division of Reproductive Medicine in the Department of Obstetrics and Gynecology at Cooperman Barnabas Medical Center for 21 years. She is also a Clinical Associate Professor at Rutgers University, UMDNJ Medical School, and St. George’s University School of Medicine, as well as an Executive Board Member of the nonprofit organization Doctors for Fertility.

Silvia

It has been over two years since the overturning of Roe v. Wade, yet reproductive rights, including access to abortion and artificial reproductive technologies, continue to dominate health policy discussions, particularly in light of the upcoming American presidential election. One group often overlooked in this conversation is physicians. How have gynecologists and reproductive endocrinologists reacted to the new legal landscape?

Serena

The reactions are mixed. OB-GYNs and REIs are acutely aware of how serious this situation is, especially in areas where there are maternal health care deserts. In these places, the burden often falls on ER physicians who aren’t equipped to handle complex pregnancy-related issues. They might have to manage a pregnant woman in distress without an OB-GYN on staff and with the nearest specialized hospital hours away. The legal uncertainties around the Emergency Medical Treatment and Labor Act EMTALA, are also a concern—some states are challenging its enforcement, leaving doctors unsure of what they can legally do to save their patients.

Young doctors and medical students are also very aware. Many are making decisions about where to train or practice based on the reproductive laws in those states. They want to ensure they can provide comprehensive care and receive the necessary training. We’ve even had requests from medical students and residents to come train in New Jersey, where the laws are less restrictive, so they can learn everything they need to know to care for their patients.

However, there are also doctors who are overwhelmed and burnt out. The healthcare system was already struggling before the Dobbs decision, and COVID made things worse. Now, with the additional legal and ethical challenges, some doctors are simply exhausted. They’re facing enormous pressure, longer waitlists, and increased demands, all while working under corporations that may not prioritize patient care in the way they’d like.

At the same time, some physicians are hesitant to get involved in what they see as political issues. We’ve been taught that medicine should be neutral, but that neutrality has contributed to the current situation. By staying out of politics, we’ve allowed people with little to no understanding of medical science to make laws that affect our ability to provide care.

By staying out of politics, we’ve allowed people with little to no understanding of medical science to make laws that affect our ability to provide care. Now, many of us are realizing that we have to be involved—we have to advocate for our patients’ rights and for sensible healthcare policies.

Silvia

At Doctors for Fertility, you train doctors on how to be politically involved. Can you explain your approach and what you’ve achieved so far?

Serena

Certainly. We launched this initiative shortly after the Dobbs decision was leaked in May 2022. The idea was to equip healthcare professionals with the tools and knowledge they need to talk about reproductive rights and healthcare in a safe and effective way. Initially, we were very ambitious, trying to organize hour-long training sessions, but we quickly realized that this wasn’t practical given everyone’s busy schedules.

Now, we focus on shorter, more accessible training. We offer to pop in during already scheduled meetings, even if it’s just for 15 minutes. The goal is to help healthcare providers understand how to talk about IVF and related issues within the context of current legal challenges. We’ve found that talking about IVF and family building is often a more effective way to engage people who might be turned off by discussions of abortion.

Everyone knows someone who has struggled with infertility or benefited from IVF, so it’s a topic that can bridge divides.

We’ve had some success with this approach. For example, in Nebraska, our board members were able to engage with a state senator who was against abortion. By framing the discussion around healthcare and the impact on his constituents, they convinced him not to support restrictive abortion legislation. In Kansas, a similar approach helped protect the constitutional right to abortion up to 15 weeks by a significant bipartisan margin. These victories show that focusing on healthcare and decision-making autonomy can resonate even with those who might be opposed to abortion.

Silvia

In your opinion, what key factors led to the Dobbs decision and the eventual overturning of Roe v. Wade?

Serena

I think it's a bit beyond my expertise, but as someone outside the political system, it seems very politically driven. It feels like to be successful in such a divided political landscape, politicians have to follow certain rules. For instance, I think about that terrible massacre at the grocery store in Buffalo, where automatic weapons were used, and many lives were lost. One of the representatives from that district, who was a rising Republican star, suggested something as simple as mental health screenings for those buying automatic weapons. Even though he wasn’t against guns, he was pulled back by the Republican Party. It seems like there's a platform that everyone has to adhere to if they want to succeed, and unfortunately, healthcare has become a part of that political agenda. In Alabama, there’s a law that was supposed to protect doctors from liability, but it also defines embryos as ‘minor children’. This creates a strange legal situation where IVF is allowed, but any mishandling of embryos could be considered killing a minor.

When it comes to abortion laws, they often involve granting rights to pregnancies, fetuses, or embryos before they’re born—this is known as ‘personhood’. The problem is that these laws are often written by people who don’t fully understand the complexities of pregnancy and reproduction. For example, in Oklahoma, the way the law is written creates confusion about whether it applies to embryos. While one sentence in the law specifies "pregnancy in the uterus," other parts could be interpreted to apply to embryos. This has left IVF programs in a precarious position, where they had to rewrite consent forms just to reassure patients that their treatments were legal under state law.

In Alabama, there’s a law that was supposed to protect doctors from liability, but embryos in Alabama are legally considered as ‘minor children’. This creates a strange legal situation where IVF is allowed, but any mishandling of embryos could be considered killing a minor.” At the same time, Alabama has one of the strictest abortion laws in the country, which complicates all pregnancy-related care. So, we’re in this weird space where we’re trying to help people conceive, but our hands are tied by these restrictive and unclear laws.

Silvia

That sounds like a legal minefield.

Serena

It is. And it’s why IVF is such a powerful issue in this debate. Although there are only about 2,200 board-certified reproductive endocrinologists in the U.S., infertility affects a significant portion of the population. This includes not just heterosexual couples, but also single individuals, LGBTQ+ people, and those with genetic conditions who might need IVF. It’s a broad issue that touches many lives, making it a potent way to engage in a conversation about healthcare without the intense divisiveness that often accompanies discussions about abortion.

IVF is something that resonates with a lot of people because it’s about building families, which is a positive and hopeful topic. It’s also less politically charged, allowing for a more productive discussion about healthcare access. We’re encouraging people to talk to their legislators about these issues, not to tell them how to vote, but to ensure that their representatives understand the importance of healthcare and reproductive rights.

Silvia

Speaking of voting, what do you see as the key stakes for reproductive care in the upcoming U.S. elections, and what do you make of the debate to make IVF free for all Americans?

Serena

There should be bipartisan support for IVF coverage for everyone who needs it. Until recently, this wasn’t the case—when IVF became illegal in Alabama, there was a massive bipartisan outcry, showing that the threat to IVF following the Dobbs decision is very real. IVF coverage should be routine, just as we expect treatment for conditions like diabetes or high blood pressure to be covered by insurance. Yet many Americans with good insurance don’t have access to IVF, even though it’s a safe, effective, and cost-efficient standard of care for infertility.

It’s shocking that the U.S. is the only nation where IVF isn’t routinely covered. Thankfully, IVF is now part of the national conversation. In the past, votes on IVF coverage fell along party lines, with Democrats supporting access and Republicans opposing it, as seen in the June 2024 Senate vote on the Right to IVF bill. But now, with HR 8821 on the table, we’re hopeful for bipartisan support to improve access to IVF. The fact that both presidential candidates are talking about IVF shows our voices are being heard.

It’s important that we continue pushing for access to IVF and for the ability of physicians to provide comprehensive reproductive care without fear of being criminalized. IVF is part of a larger spectrum of reproductive health that includes contraception, abortion care, and complex pregnancy management. As IVF physicians our goal is not to make embryos. Embryos and IVF are just a means to an end: a healthy mom, baby and family and that means full reproductive healthcare access. We need to make sure our politicians support all reproductive healthcare and the right of women to make these decisions with their physician without extreme government mandates that criminalize standard medical care.

To make IVF successful, the full spectrum of reproductive healthcare must be protected. Our politicians must stand up for women’s right to make healthcare decisions with their doctors, free from extreme government interference. We need to vote for candidates who will protect both IVF and broader reproductive rights.

Silvia

Are there any nonpartisan campaigns you are supporting?

Serena

Yes, there’s a wonderful campaign called Vote ER that I’ve been supporting. It’s endorsed by major medical organizations like the AMA, ACOG, ASRM, and the American Cancer Society. The goal is to increase voter registration among patients and healthcare providers because voting directly impacts public health and healthcare policy. I believe that people who use the healthcare system should have a say in how it’s run, and voting is a crucial part of that. We’re encouraging healthcare providers to see voting as a component of overall health—physical, mental, and civic health. This campaign is a powerful way to remind people that their vote can influence healthcare outcomes, and I encourage everyone to get involved, register to vote, and make their voices heard.

Silvia

Do you sometimes find it hard to explain to teenagers and young women why the Roe v Wade discussion is happening, and what kind of consequences it could have? How to make sense of what the presidential candidates stand for?

Serena

I think we need to give young women more credit than we sometimes do. They’re incredibly smart and aware of what’s happening. They care deeply about their own rights and the rights of others. I’ve been in conversations with young women all over the world, and I see a lot of hope in their understanding and passion. They know that these decisions about their bodies should be between them and their physicians, without interference from politicians or outdated laws.

This generation is much more informed about reproductive health than previous ones. They have access to so much information and are using it to empower themselves. They’re not just concerned with their own health; they’re also thinking about the broader implications for human rights. It’s inspiring, and it gives me a lot of hope that they’ll continue to push for change.

Silvia

Serena, thank you for your time!