A personal commentary on the relationship between ART/IVF and abortions
By Norbert Gleicher, MD, Medical Director and Chief Scientist, at The Center for Human Reproduction in New York City. He can be contacted though The Reproductive Times or directly at either ngleicher@thechr.com or ngleicher@rockefeller.edu
In reaction to a recent mailing from the ASRM, Dr. Gleicher argues that – especially considering recent political events in the U.S. - linking assisted reproductive technologies/in vitro fertilization (ART/IVF) automatically with the much more controversial abortion issue, represents a tactical as well as ethical/moral mistake for the reproductive medicine community. Recent political events, indeed, offer a unique opportunity to separate ART/IVF once and forever from the abortion issue, - a false link initially made in the early days of IVF when anti-abortion and anti-IVF opinions mostly overlapped. With the very obvious success of IVF (almost 10 million births worldwide), both medical interventions, however, are no longer overlapping, as even increasing percentages of still stringent anti-abortion voices have come to appreciate the importance of ART/IVF. Continuing the automatic linkage between abortions and ART/IVF appears, therefore, non-sensical and self-defeating and the correct argument should be that abortions and ART/IVF have nothing to do with each other. To the contrary, with one striving to end pregnancies and the other to produce pregnancies, they each stand on exactly opposite moral as well as practical grounds from each other.
Everyone in the fertility field is, of course, accustomed to the steady stream of written communications from our "mother ship"—the American Society for Reproductive Medicine (ASRM). However, we recently received something new: a formal mailing (or perhaps better called a document) that summarized “Oversight Lessons for Assisted Reproductive Technology (ART) for the U.S. from Abroad” (1). In simpler terms, ASRM is suggesting that the way IVF oversight is conducted in other countries may hold some lessons for the U.S.
More specifically, ASRM emphasizes that “any attempt to compare U.S. regulation of medicine in general, and ART in particular, should reflect a comprehensive understanding of the specifics and nuances of each nation’s healthcare and regulatory landscape.” In other words, after more than 40 years, IVF has gained unprecedented ethical, moral, financial, and political support—support that professional organizations should use to definitively de-link IVF from the abortion issue. If someone still tries to draw that connection, the only appropriate response should be: What are you talking about?
In describing the current state of ART in the U.S., the ASRM document accurately characterizes it as “highly regulated healthcare.” However, it ventures onto somewhat thinner ice by stating that in post-Dobbs America (referring to Dobbs v. Jackson Women’s Health Organization, the 2022 Supreme Court case that returned abortion rights decisions to state control), “access to reproductive healthcare, including ART (including IVF), is increasingly caught in the political crosshairs.”
What concerns us about this and similar statements from other professional organizations—understandably concerned about reproductive rights—is that they implicitly accept the conceptual link between ART and abortion. This link was purposefully created by the right-to-life movement during the early days of IVF, when anti-abortion and anti-IVF sentiments often went hand in hand.
But things have changed. Nothing demonstrated this more clearly than the last presidential campaign, when President Trump and his campaign made it known that they not only supported unrestricted access to IVF, but also advocated for even broader availability of IVF services.
Perhaps an even clearer indication of the need to sever the ART/abortion connection came from Alabama, after the bizarre state Supreme Court decision granting personhood to embryos (2). Understandably, all Alabama-based IVF clinics immediately shut down. But in what was likely the fastest legislative response in the state’s history, lawmakers passed a bill indemnifying IVF clinics from legal liability stemming from the decision (3). In other words, one of the most conservative states—strongly opposed to abortion—made it clear that it holds very different views on IVF.
Continuing to link ART/IVF with abortion, therefore, makes little sense for advocates of reproductive rights and medical self-determination. Not only does this link no longer exist—if it ever truly did—but IVF and abortion actually pursue opposite goals: abortion ends pregnancies, while ART aims to create them. Maintaining this outdated connection is not only misleading but politically self-defeating.
Recent political developments, in fact, offer an opportunity to highlight this divergence and accelerate the separation. The ASRM document specifically cited legal changes imposed by the Italian Supreme Court, noting that IVF births rose from just 1.22% of all Italian births in 2005 to 4.25% by 2022. Given Italy’s extremely low birth rate—far below replacement levels—this development highlights the growing importance of IVF (and ART in general) to national birthrates, especially in a world where many countries, including the U.S., are experiencing declining fertility.
Falling birth rates are not unique to the Western world. Countries such as Japan, South Korea, and even China are now grappling with the economic consequences of population decline. This presents a powerful new economic argument for supporting IVF more aggressively.
No country has understood this better than Israel, which has the world’s highest per capita use of IVF (4). The government covers almost unlimited IVF cycles until a family has at least three children. This stands in stark contrast to other developed nations—surprisingly, even those with socially progressive healthcare systems. For example, Scandinavian countries, often hailed for their liberal politics, impose surprisingly low age limits on IVF coverage. In Sweden, IVF access for women typically ends between ages 37 and 41, while for men it continues until age 54 to 56 (5).
In other words, after more than 40 years, IVF practice has garnered unprecedented ethical, moral, financial, and political support—support that professional organizations should leverage to fully de-link IVF from the abortion issue. If anyone still attempts to make that connection, the only appropriate response should be: What are you talking about?
References
1. ASRM. Advocacy resources. https://www.asrm.org/advocacy-and-policy/fact-sheets-and-one-pagers/art-oversight-lessons-for-the-us-from-abroad/
2. John Hopkins Bloomberg School of Public Health. February 27, 2024. https://publichealth.jhu.edu/2024/the-alabama-supreme-courts-ruling-on-frozen
3. Mulvihill G. AP. March 6, 2024. https://apnews.com/article/alabama-ivf-clinic-lawsuit-immunity-things-know-0d16d3be139f42c96bc3ab35c4467f55
4. Birenbaum-Carmeli D. Reprod Biomed Soc. Online;216-23. doi: 10.1016/j.rbms.2016.05.004
5. The Swedish National Council for Medical Ethics. February 2013. https://smer.se/wp-content/uploads/2013/03/Slutversion-sammanfattning-eng-Assisted-reproduction.pdf