Posted on July 21st, 2022by RMANY

Ep 94: How Roe Versus Wade Will Affect Fertility Care with Dr. Kimberley Thornton and Melissa Brisman

Fertility Forward 94:

Believe it or not, the new legislation surrounding abortion laws will have an impact on fertility care and IVF. Today on Fertility Forward, we are joined by hope counselor, Kimberly Thornton, and lawyer and owner of Reproductive Possibilities, Melissa Brisman, to discuss exactly how Wade vs. Roe will affect fertility care. Tuning in, you’ll hear how the reduction of multiples may be problematic under the new legislation, the differences in different states, how ectopic pregnancies will fit into abortion trigger laws, and the balancing act of deciphering laws when we aren’t able to determine when life begins, and how fertility companies and resources will be affected. We also discuss why we still have a voice and can advocate for change. To find out why hope is not lost, press play now!

Transcript of podcast episode

Rena: Hi everyone. We are Rena and Dara, and welcome to ertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice for medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Rena: I am so excited to welcome to Fertility Forward today two amazing women who I brought on to talk about the hot button topic of Roe and how that impacts IVF and fertility care. So we have two recurring guests today, Melissa Brisman, who is a reproductive lawyer, and Kimberly Thornton, who is a reproductive endocrinologist at RMA here in New York. So thank you ladies so much for being on - really excited to have this discussion with you.
Kimberley: Well, thank you for having us.
Melissa: Yes, it's, it's a pleasure to be here.
Rena: So let's start, maybe, Melissa, with you with the legal perspective and talk about how Roe being overturned, how that might or might not impact IVF and fertility care in a legal sense.
Melissa: Well, unfortunately it definitely is going to impact fertility care. It may not impact it as much depending on the state. So for instance, New York may have less of an impact than other states, but basically when you put in what we call abortion trigger laws, when those go into effect, the way they define the beginning of life affects fertility care. So, for instance, if you define the beginning of life as when an egg meets a sperm and creates a fertilized embryo, then you're defining life as starting in the lab, right? So you have to look at the criminal statutes and histories and think about what does that mean? So if we define a human being as an embryo, that's in a Petri dish, does that mean if you drop the dish, you are committing manslaughter murder? If you put the embryo in the freezer, is it child abuse? Can you destroy the embryo? What about if you do genetic tests on the embryo? Does that mean that you're mamming a human being because they're considering it a life? So it brings up all these questions and basically what we need to be doing as a community is making sure that legislators carve out exceptions for IVF and understand laws, how they're writing them and how they may impact fertility care.
Rena: Got it. Okay. And Kim, what about from your perspective as an RE, anything that's gonna happen to impact how you would treat patients?
Kimberley: So I, I think there, you know, a lot of the concerns, you know, for the overturn of Roe versus Wade, as far as it applies to infertility patients is definitely the impact this could potentially have on IVF. And unfortunately it really takes often a lot of eggs and embryos to really have good, high success rates. I think, you know, as a patient, people are often shocked at how many eggs we’ve retrieved and seeing what it funnels down embryo-wise. So, you know, you usually would say maybe somewhere between 10 and 15 eggs is a really high, great response from a cycle of IVF, but not every one of those eggs is gonna fertilize. Normally the ones that fertilize normally often stop growing or developing. It usually funnels down to a minimum of a half if not more, you know, I'd say 10 eggs, most patients I see is like two to five embryos. And then out of those embryos, depending on somebody's age, it can be 25% to over 90% of those embryos may be chromosomally abnormal. And so I think a concern would be is if there ends up being limits on how many eggs can be fertilized, because of concerns those are considered to be persons, that would make IVF very inefficient that could require multiple cycles of either discarding or freezing extra eggs to then have to do multiple thaws over time to be able to be successful. So that would drive up cost of the procedure and lower overall success rates. The other, you know, big thing I think they're all worried about is, well then what if we have extra embryos or are we forced in a situation where we have to transfer them back? And that's just, you know, not safe. We know that singleton pregnancies do better. They are lower risk for preterm delivery. So even twins on an average are born at least, you know, one month early so there is a risk of NICU, you know, and complications and problems. And then like triplets are higher, incredibly high risk pregnancies. And so overall, the, the safety of the procedure could, you know, be affected by having to transfer back more than one embryo. So I think that as a physician, those are our kind of biggest concerns.
Rena: Well, what about, and I think that leads into, okay, if you have to transfer more than one embryo, and then you have the, I don't wanna say risk, but you have the higher chance then of a multiple pregnancy, then that goes into the question I think of then selective termination or reduction, you know, whether by choice or if one of the fetuses, I guess at that point had, you know, some sort of developmental or gene deletions, chromosomal deletions, you know, any sort of abnormalities?
Kimberley: You're right. So, you know, from a medical point of view, if a pregnancy is like a higher order, multiple, like, you know, we consider more than two pregnancies, three or higher, you know, incredibly rare situations well under 1%. Nowadays, you know, the American Society of Reproductive Medicine designates that everyone under age 38 should only have one embryo transferred back and all age groups of women, no matter what your age is, if you've tested and we know that embryo is healthy chromosomally, that we should only be putting one in. So these scenarios right now are incredibly rare, but when they do have 'em from a medical point of view, it's actually advisable to selectively terminate or reduce down some of the other pregnancies for the safety and health of the other babies. And so obviously that would open up a whole other window in these states where termination is not legal.
Rena: From a legal standpoint, then is that, you know, then it, I guess it chips into abortion?
Melissa: Well, I think what's gonna happen is you're gonna see that people like Dr. Thorton are gonna get patients from other states. So this will affect the way people obtain services in their state, right? So if they have the IVF in Oklahoma and Oklahoma is not gonna allow a selective reduction, they're gonna come to New York to have that selective reduction, right? Or they're going to just carry a fetus, maybe in an unsafe way or a fetus that maybe isn’t compatible with life. But the other issue that I think in the way that it will affect Dr. Thornton's practice, that we all have to think about is that we're gonna get an abnormally large number of patients who are seeking third party services, who are gonna come to states like New York, like New Jersey, like Massachusetts, because for instance, Texas, which is one of our largest states that I see for using gestational surrogates, right? Texas now has a very, very strict abortion law. After six weeks, I think there's no terminations. So a lot of times people might have ectopic pregnancies. They may have reasons why they need to use terminations. They're not going to maybe want a surrogate in the state of Texas where their fertility care is going to be dictated by terminations that really need to be done, but are not in our mind considerd terminations. Right? If someone comes to you with an ectopic pregnancy, you need to clean out their tubes or whatever you do to help them become safe. You don't really think of that as a termination, right? That person has a dangerous pregnancy. In my mind, that's not really an abortion. But the way these laws are written that can be interpreted to be a termination and people who are using third party services are now maybe gonna wanna use surrogates in New York state rather than Texas, because of these risks.
Kimberley: Yeah. And to touch on what you're saying, 100% percent, atopic pregnancy, they are not viable pregnancies. We would not consider as a medical professional as an abortion. That is a life saving procedure, you know, cause it can kill somebody if it's gone untreated.
Rena: Does that cover though under the trigger laws because the trigger laws say termination is okay if it is a threat to the mother, but then everything I read says DNCs or taking methotrexate is not going to be allowed.
Kimberley: I think as a doctor in like speaking to, you know, I have friends that live in other states and physicians in other states, I think that a lot of the problem with having like an exception for a life-threatening situation is some of these actually require that you have to have like two physicians approve that it's life-threatening or that you need like some sort of legal approval. And a lot of times in life-threatening situations like a topic pregnancy, if someone has a ruptured, atopic pregnancy they're coming in, they're losing blood, they're bleeding in their abdomen. You don't necessarily half time. Time's not on your side. And if you take that time, you're risking that person's life. I know that is why so many physicians are against having any sort of regulation in those scenarios.
Rena: Yeah. I mean, my concern as a mental health professional, when I was reading the trigger laws, is, are people then going to try and cause harm to themselves to terminate?
Melissa: Well, I think that's gonna be a risk. I think that this law is really only gonna impact people who are maybe very young, so they don't have access to transportation and like rape victim or an incest victim who's young and maybe just doesn't have the means or the education to go to another state. But it's really only gonna disproportionately impact our poorer patients and our patients who are seeking IVF services, who are already spending, you know, their whole life savings to have a baby, right? Because if you are a very well off person seeking IVF services, maybe you just don't seek them in a state that has these issues. And I think we're causing a lot of unintended consequences. So there was an article that I read yesterday about a patient who had rheumatoid arthritis and she was having difficulty obtaining her methotrexate because I guess methotrexate can cause a miscarriage. And the doctor wanted her to prove that she wasn't pregnant even though she was past childbearing years to get the methotrexate. And once she proved that she wasn't pregnant, he then continued and said that he felt that under the law, he couldn't prescribe this medication anymore because it causes an abortion. And obviously she's not pregnant so causing a, a miscarriage, isn't really an issue from a medical perspective. But I think it's more that the laws aren't written clearly, so physicians aren't lawyers, right? They shouldn't be put in the political arena. They shouldn't have to make these kinds of interpretations. So I think that really what needs to be done is whatever you think about an abortion is that they need to be narrowly tailored to be talking about abortions and reductions in the scenarios that they were intended. Right? That talking about everybody has somebody who did IVF, right? Republican, Democrat. We know that one in eight couples have some sort of infertility problem and lots and lots of people need to use fertility. But what we don't want is we don't want doctors, patients to have to be thinking about the unintended consequences of a law, right? Whether it's taking their rheumatoid arthritis medicine, whether or not it's, if they have an ectopic pregnancy, if Dr. Thornton then has to think, am I willing to go to jail for this patient because I know she's gonna die if I don't do it right now, as opposed to having to testify in a court and have another person say she wasn't gonna die, there was plenty of time to get the notes. Right? Just silly.
Kimberley: Yeah. You know, I think no one wants to be in the situation of ever, you know, having to think about abortion. And, and I think a lot of what we see on TV, in media, or what a lot of politicians think is this kind of like picture of, oh, people are just needlessly terminating pregnancies. But the reality when you work in the medical field, is there are these situations like atopic pregnancies. I have patients who went through infertility, went through IVF, the most desired pregnancies to find out like on their anatomy scan. There's an, a lethal like birth defect where, I mean, I just think it's cruel to make that person carry that pregnancy to term, to watch their child die. You know, can you imagine being pregnant on the street? We have kids, you walk up random strangers, just talk to you when you're pregnant to then be like, oh, congratulations, when's your due date? To be like, well, you know, my baby's not viable. I've delivered some of those babies when I was a, a resident for women who didn't know who, you know, maybe came from other countries, didn't have ultrasounds. It's the most devastating thing. The risks for IVF are definitely there. The higher order multiples. I don't think right now the language is targeted at IVF, but it's getting dangerously close where it can start to impact IVF. And so I think being involved in advocacy over the years, the biggest thing that's always shocked me is like going to DC or speaking with legislators is how little medical background and knowledge they have. And it's just because this is not their area of expertise, but yet these are the people making laws and regulations that can potentially hurt us, whether it's intentional or unintentional, because they sometimes don't have this understanding. And so many regular people who, you know, aren't in healthcare, don't have this, you know, understanding or background either.
Rena: And that's a great point, right? I mean, who's in charge of this if you are making these decisions is people that they don't know, they don't have your job. And you know, how is that fair? You know, and as we've touched upon the ripple effect of this is huge.
Melissa: Unfortunately Roe versus Wade has a lot more impacts than people also really realize. So when it leaves the decision up to the states, it means that the states can outlaw other things that impact healthcare. Right? So they can decide, even though nobody will ever know when life begins, right? You can take it so far as some religious groups will say that if you don't try to have a baby, like for all of your reproductive years, when it's safe to do so, like have a baby every year, then that is not appropriate. You're supposed to be reproducing constantly. Right? And then you have some religions that will say it begins when the egg and sperm meet, right. And then others, when there's cardiac activity and then others, when it can be, live outside the womb. And then I believe, you know, certain religions also believe until the umbilical cord is cut, it's not a human, right? So you really don't want your laws to be dictated by various religions and you want it to be dictated by safety of the patient. And it's become extremely, extremely political now. And all of that is up in the air.
Rena: It's so crazy. I mean, I think all three of us have been involved with RESOLVE and working on the insurance reform. I mean, that was such a headache and going through, you know, all of the language there and how they set up insurance coverage and, you know, understanding from a medical perspective that a lot of it doesn't make sense and does force people to transfer multiple embryos or do things that wouldn't medically really be advised. And so we're already dealing with that and now we have this and it just seems, you know, very disheartening.
Melissa: Laws never makes sense. So that's part of a big education that probably doctors aren't used to because I get a calls all the time. Like this doesn't make any sense. It's taking like two years for someone to get divorced in, in New York. And this woman wants to have a baby with her new partner and she's still married and why doesn't the system just let her get divorced. Right.? And probably all of that's true, but there's a disconnect between people who enact the laws and knowing exactly. And it's not just for IVF. They enact the laws, but they're not experts in their field. So they need experts to come there. But when you actually get in the legislative process, which I've been involved in, it's all about trading favors. So sometimes laws end up not making any sense. Right? So a Democrat will say, okay, I'll vote for this law for you, but I want you to put this in there because so, and so wants it. Then they write this in there and it doesn't really make any sort of sense, right? Because they just plopped it in the middle of a law without actually having somebody who's educated, read it. So that's what you have with all these, these trigger laws, right? They say, okay, we don't want you to have an abortion at any time, for any reason after we detect cardiac activity. Right. But they don't know about all these other things that could possibly happen. Right? They don't know about pregnancies in the tubes. They don't know that they're a hundred percent never gonna produce a baby so that we should exclude them because that's not really a termination. Right? They don't know that rheumatoid arthritis patients are taking methotrexate and we need to make exceptions for that. So there are really reactions where people are enacting laws like overnight, and there's no process going on.
Rena: I feel like you just summed up right there why people have issues with politics.
Melissa: Yeah. Well, yeah. I mean, it's not the best, right? So to have somebody making a decision, who's only knowledge is based on, you know, what they Googled last night for five minutes, right? That's not the best way for someone to be educated. And also it's never a good thing to do things with emotion, right? So when you're treating a patient and they get all emotional and they say, I can't go through IVF, I can't do another cycle. It's just too hard on me. I can't do it. And they're crying. That's like an emotional reaction, right? That's why we send them to see you so they can work out their feelings and go through their grieving process and then see what they can handle. Right? So the political process is just a bunch of hot heads getting all emotional and then the facts are somewhere in that pot, but it's very hard to get at them.
Rena: I do think though it is important to note for people that are listening and feel really anxious and uncertain and out of control, which, you know, all the feelings that it is important to advocate and educate. And as you said, these people they're Googling things for five minutes. They don't know, but what we can do and what we have the power to do. And I know all three of us have done, is advocate, send letters, make phone calls, meet with legislation. We do have that power. And so for anyone out there feeling totally stripped of that, which I can say that, you know, since this happened, all my conversations, every single patient, this has dominated the conversation. I think especially as women, we've all felt like we've lost our voice, but we have that. No, one's taken that away from us. And so advocacy is very obtainable. You can do it. And so raise your voice. That's what we can do.
Kimberley: Yeah. I totally echo on what you're saying. I think, I think you feel helpless in these situations. It feels like there's nothing we can do, but you can, you can share your story and your story is so powerful. And that's one thing I would say that I have learned from advocating when you speak to these legislators, it's not that all of them don't care. A lot of them actually do care and they just didn't realize something was an issue or, or a problem. And then like, as a physician and I say the medical aspect of things, and I'm saying, this is why this isn't working. Some of them are like, oh wow, that I never even thought of that. Or as a patient, to be able to tell your story, that's how they get their information. And unless somebody's there, unless you're writing letters or you're doing calls or you're, you know, involved with the advocacy days, they're not necessarily getting that information or realizing the impact things are having. So it's, it's really powerful. It's honestly the thing that's always kept me involved in advocating because they realize if we're not out there doing it, it like, as some of my patients, aren't ready to share their story and that's fine, but I need to be there advocating for them. And then I've met so many patients who are willing to share their story that are at a point where they feel like they can talk about it. And that is so powerful as well.
Rena: Totally. And I think I learned this in an ASRM webinar that I've written letters, made calls, gone in person, but I didn't know that politicians actually, they now look at what issues are important to their constituents by hashtags on social media. So if you're a big social media user, post use the hashtags, tag your politician and they track that because as you said, I mean, look, they're faced with a million issues. And obviously this is so important to us because this is what we're involved in. This is what we care about, but it doesn't mean that they know or have the knowledge. And I've never had a meeting in Albany or DC where somebody didn't at least on the outside seem to care. Any meeting I've had, they were like, thank you so much for sharing. They got on it. And I think as you said, they don't know, you know, just this is our field. We can be responsible for knowing about everything else. And so that's what we can do is we can bring it to them.
Melissa: I also think that there's strength in numbers, too. So social media is definitely a good way if you can use a hashtag because people, but I remember a very long time ago, so it's probably gonna date me. It's about 20 years ago when I had a problem in Connecticut with some of our, the legislation and the bureau of vital statistics. And I had every pregnant surrogate mother that had come through my practice, which was approximately at that time about 300 that were in Connecticut, actually physically go to the senator's office and stand outside. And they called me and they said, Melissa, can you stop sending pregnant women to our office? Like we get it. We hear you now. So we're gonna take some action. So sometimes also just physically being present at something, in addition to social media will help. You really do wanna be an active participant.
Rena: Absolutely. And that's all up to us. That's our choice. You know, I think your time is the greatest gift that you can give.
Kimberley: And I think a lot of legislators don't even understand what IVF is. People sometimes think it's like just a medicine that gives you a healthy embryo or baby. They don't understand why you need to make multiple embryos. I, I think just hearing that. I have patients every day who tell me, I don't know anybody else with infertility. I'm the only person going through this. And it's one in eight couples. So they're not the only person that they know. It's just that no one's in their social circle is talking about it, but it is common. And so when people get letters and they realize how many of their constituents’ issues impact, then it starts to matter to them because at the end of the day, they're supposed to be representing. And, and if not, they'll get voted out of office. So I think we've all said it a lot, but RESOLVE, I think is one of the best advocacy groups for the infertility. And I know that they're really on top of these personhood bills that always encourage patients to go to, if they wanna figure out ways to be involved.
Rena: Yeah. Resolve is great. And they give you very easy ways to get involved. You can from home or in person, that's the best resource.
Kimberley: I think a lot of which I don't know, Melissa can touch on. I think there's just so much unknown for our infertility IVF patients right now on how this could impact with frozen embryos and what to do with them. And I mean, as far as like I can tell and the best thing I can tell patients is right now, it's not gonna impact anything. At least in New York, we're very protected on a national level. It doesn't seem like there's gonna be any immediate impact, but to be determined. I don't know if you have any insight from a legal point of view, if anything, you think that would happen in the near future or, you know, is it still a big question mark?
Melissa: I think legally in the near future that we have to really be cognizant of is number one, there may be limitations on the thawing of embryos. So right now in Louisiana, you can't destroy embryos. You're not allowed. Now, I don't know if that would be challenged, if that would be a constitutional problem or not.
Rena: Let me interject cause I've really been wondering though, is there a statute of limitations on that? I mean, is what happens when you pass though, then what happens to your embryos?
Melissa: It's not addressed right now, right? So the law is not clear. So what people have been doing is they have been shipping their embryos across state lines and letting them defrost there, which sort of is a problem, right? Because an expense that you shouldn't have to go through. Right. But I think people need to be cognizant of the laws the way they're changing and be very careful, especially when thinking about what could happen in the future, if they're pregnant and not planning, but just when you're in an emotional state, it's a lot harder to think, right? So let's just say you are going to need, or you need a, a gestational carrier. Do you wanna take the risk of being in a red state? Right? Do you want, if there has to be any sort of procedure done. If you need to get a reduction because you have a higher order, multiple, do you want to just plan out where you can go. Will your employer cover a lot of this a lot? I think there's a huge list now on social media that you can see where companies are saying, if you need reproductive care and your state isn't gonna do it. And that has like abortion, IVF. If you need some care, we're gonna pay for your travel expenses, your lost wages. So I do think that RMA of New York is not gonna see and is not gonna need the planning because New York is very liberal. But I do think that people in Oklahoma, people in the Dakotas, they may wanna just do a little more research and find out like, is it best if I do, if I can afford it, is it maybe better for me to do my IV up in New York? Like, do I wanna do it here? Is it worth it?
Rena: So I would wonder if doctors in those states are now concerned about their business, right? Are they then going to lose patients who are gonna say, I don't wanna do fertility treatment in a red state? You know, I'm gonna travel to New York, New Jersey, whatever.
Kimberley: I can speak on that. Knowing I have friends in other states and yes they are. I mean, and those states are often where these people are born, raised, they've built their practices. They have their relationships with their patients. And overnight now, you know, their job of being able to help people start their family may be taken away. And it's awful. I also would say, I feel like a lot of people I've talked to a lot of just friends have been like, oh, about the companies. My company will pay for me to go to another state. And a lot of people, I think, haven't been as concerned as they should be because that kind of giving a false reassurance. As a medical provider, if only half the states or less than half the states are providing these services, there's gonna be a huge bottleneck. I mean, people are not gonna be able to get these services in a timely manner. There's only so much resources to go around. B) That means for medical training, like I trained to be an OB GYN, a reproductive endocrinologist, currently there's training programs in all the states, all 50 states. So what happens when half those states are not able to even train physicians to do these procedures, that's in a few years down the road, it's gonna make even much less providers available. So there is gonna be a huge access problem. Even if you have the money and means to travel to another state does not mean that you're gonna be able to get an appointment in a timely manner, be able to see somebody. And if you are in any sort of emergent situation where let's say you do wanna terminate a pregnancy, there is a lethal anomaly. Those are not usually picked up until anatomy scans, which are closer to 16 to 18 weeks. Even in New York state, you can only terminate a pregnancy before 24 weeks cuz 24 weeks is when the first stage of viability meaning if the pregnancy were to deliver, that is the first chance of pregnancy has the ability the baby could survive outside the body. Before that any delivery that happens, a pregnancy would not have any chance of viability. So that's why we consider 24 weeks viability. And that's why that's New York State law. So somebody finds that out, even in New York, right now, they have only a couple weeks to make those decisions. So traveling to another state, it doesn't mean you're necessarily going to have that option anymore. And there are very few providers, even in New York state at this point that are actually OB GYNs trained to do those type of more complex procedures. I can tell you as an OB GYN physician, I have never even been trained to do a late termination like that. It's much more complicated. So this idea that we can all just shift around and cross state borders is probably not reality. Even IVF there's only so many patients a practice is able to take on.
Rena: I think those are all great points and also really sobering points too, I think right, people are just sort of, they're panicking, you know? Oh, okay. I'm just gonna move states. I'm gonna move my embryos. Okay. But it's not that simple. And then when you also look at this from a business standpoint and physicians that have dedicated their careers to helping family-build that, now this is gonna impact their business. There's so many people this is impacting.
Kimberley: I don't know what your guys' thoughts on this is. Everyone, you know, keeps talking well, you know, maybe we'll have some sort of national law. If you know, doesn't probably not happening anytime soon with Congress and Senate, if we could pass some legislation outside the courts to make abortion legal, that could be helpful. But the sobering thought is the reverse is also a possibility. What if there's some sort of national legislation that goes in that, you know, political shifts sway that nationally impacts and, and makes laws and regulations that can impact terminations that could impact IVF. And that's in my mind, not out of the realm of possibility anymore.
Melissa: When you think about it legally, nothing is completely out of the realm of possibility. But when you think about how many people access IVF or any type of fertility treatment that you're gonna see both Republicans and Democrats, once they're educated, want access to fertility treatment, right? That's different than terminations and abortions and whether or not someday it could be a national law. I think you're gonna be pretty hard pressed to find anybody who's gonna say, we don't wanna help you have a baby, right? So there may be a national implications to abortion someday that we don't know about. But even under the current climate, it's going to be incredibly, incredibly hard. The Supreme Court didn't realize, I think what it did. It's gonna be incredibly hard to enforce some aspects of this law because many terminations and not necessarily, or DNCs, they can occur when you take a pill. And I'm not sure, but I read, and maybe Dr. Thornton you can give us some information on this, that you can't really tell when someone comes to the hospital, whether they had a miscarriage because they're having a miscarriage or they had it because they took a pill.
Kimberley: That's absolutely correct. You cannot tell the difference. So, you know, a lot of OB GYNs, a lot of colleagues I have are, you know, in banned states are advising patients. If they ask, advise people before they ban the medication, stock up on these medicines in case you need them. And if you are going and you're bleeding very heavily, you need to go to the emergency room, go to the emergency room, just say, I am pregnant and I am bleeding and you don't have to give any other information. There's not a blood test or anything that can be done to distinguish the, the two. What we don't want is people to be like hemorrhaging, bleeding out at home, having some sort of complication and not seeking care out of fear.
Rena: I mean, there's so many ramifications for that. One is, okay, now we're creating a black market for this medication and it's not being monitored or prescribed by a physician. So people are now just, you know, taking it on their own with no guidance and then right, are people then not seeking treatment out of fear and then going to be harmed?
Melissa: I also think that one of the things the FDA said is that the medication can't be banned, it's FDA approved. It's a national law. The states don't have power to ban the medication yet. I don't know where that's gonna go, but I think that the pill is gonna be accessible for a little while at least. I don't blame people for stocking up on it, but the FDA said they can't ban it.
Kimberley: And a lot of the like Misoprostol we use for other things, besides just like you talked about methotrexate earlier, we use that to treat really atopic pregnancy is not typically for terminations, but like you said, a patient needed it for rheumatoid arthritis. We also use a lot of these other medications for other indications. So they can't go away completely. We need them outside of the realm of pregnancy termination.
Melissa: Yeah. No, I don't know what's going on with the rheumatoid arthritis at all. I've just noticed that it's on a national level that's particularly in North Carolina. People are having trouble getting it.
Rena: Well I think, is there anything else that you think people should know right now about this?
Melissa: I do. I think that we have had a very, very scary conversation. And as a lawyer, I have this tendency to scare people. So I think that I'd like to leave it as long as people are listening, that these are things to be aware of, but this is still America. There is still a legislative process. Things changed overnight, right? They can change back. And that this isn't a reason not to seek the appropriate care, not to be safe with your body and to not have a baby. We want people to find ways to achieve their goals and their dreams and access all of this care. And at the same time to educate the rest of the public about what you can do to help affect change. And yes, this is not the best thing in our country for IVF professionals and all of us who have been working in this area to help people have their families. But also we shouldn't, you know, bury our head in the sand. And I think that knowledge is power and we have to just keep fighting through
Rena: Great perspective. What about you, Kim? Anything else you think that people should know who are listening.
Kimberley: I actually think really similar cause I was like, I know it seems like such a like depressing, downing conversation and I can, I'll be honest. I've gotten wrapped up in it myself. Like I was in the office when I heard the news that Friday and I, like, I just went home and cried. I was as a healthcare professional, like dedicating your life to this. It was just awful. And then you get sucked into reading this. And after a while, like, you know, towards the end of last week, I was like, I can't be negative every day. You know, you see on social media, people are, like, boycotting 4th of July, this or that. I'm like, we can still turn this around. We just need to educate people on what the potential impacts are that are actually really negative with these laws, make people aware we can have our voices. I don't think all is lost, but I think it's really important to realize how scary these laws can get if we don't speak up. And if we don't make our, our voices heard. I actually, Rena, will credit you cuz you sent out an email like end of last week about like needing, you have to, I don't know exactly your words, but you were like, your cup is empty. You have nothing to pour from it. So you need to do self-care and I felt like that really resonated with me. I was like, okay, I need to take a step back, take a day of not reading the news or looking at this. And then it kind of gives you perspective. Okay, well, how am I gonna move forward? What am I gonna do to help, you know, educate and help fight against this and try to make people realize what we can do to, you know, keep the things that are important to us safe.
Rena: I think that's a, a great point. Yeah. And totally you can't pour from an empty cup. And I know, you know, the three of us are people who take care of other people and you know, the pandemic was hard enough and something I certainly learned, you know, after getting very burnt out was how to say no and how to shut off. And I recently put a timer on my phone so that my social media shuts off after five minutes. And it's been one of the most helpful things that I've done because I can sit there and get sucked into this and doom scroll and all of that. But that's not helpful. It's so important to shut off, you know, conserve your energy and then find other people like the three of us, you know, who connected, we all care about this. You know, one of the things that I always love about this field in this recent overturn of Roe has brought out even more is how many other women out there care and we're all aligned on this. And so it's not one person fighting this fight and we're all strong, smart women, obviously men as well. And so we have to band together, we have to create community and that's what we can do. And it's okay to ask for help. It's okay to say no to take care of yourself because otherwise we can't help. So I guess let's end it on that sort of positive note. I mean, some great information was shared and I so appreciate both of you sharing your time and coming on. And the way that I like to end these episodes is with each sharing a gratitude. So we can really end it on some positivity.
Melissa: So I'm happy for good weather. I would like some really nice days that it's not raining and foggy and it's been nice for the past week. So very thankful for that.
Rena: I like that.
Kimberley: I, I have, I guess, gratitude. I was able to have a nice weekend away at the beach last weekend. Went to a hotel with no TV, no air conditioning, it was up further north, so it wasn't hot, but it was a really great way to disconnect because there was no way I could, unless I sat on my phone the whole time. And so I'm really grateful. I feel like I came back really fresh and new and feeling a lot more positive.
Rena: Oh good. I love that. And I will say over the fourth, I got in a little cycling accident and broke my hand, but I'm very grateful, of all the limbs to break. It was my hand because I would choose that any day over a foot because I'm very functional. So I'm very grateful that it was that limb.
Kimberley: Oh my goodness.
Melissa: Well, I hope you heal safely and quickly.
Rena: Thank you. I mean, look of all the limbs, the hand is what I would choose every time, you know, I can still run, I can still cycle. So, you know, it's all about perspective. So thank you both so much for being on and sharing your time and your knowledge. I really appreciate it.
Melissa: Absolutely. Anytime. Hopefully we'll have a happier, cheerier topic next time. Right?
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself, and remember - you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at and tune in next week for more Fertility Forward.

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