Event Review: The Impact of Dobbs on Emerging Reproductive Technologies

Focused on the widespread implications of the Dobbs ruling on the future of fertility treatment and related technologies, this ELSI Friday Forum presented an interesting and informative discussion brimming with clinical and legal insights.

Hosted by the Ethical, Legal and Social Issues (ELSI) Hub, the 'Friday Forum' is a monthly seminar series that enables experts to present on and discuss the implications of topics relating to genetics and genomics. Since the overturning of Roe v Wade in 2022, questions have been raised as to how this historical ruling might restrict future fertility treatment and accessibility in the USA (see BioNews 1147). Moderated by reproductive justice scholar Kimberly Mutcherson, the March ELSI Friday Forum featured reproductive endocrinologist Dr Sigal Klipstein of InVia Fertility Center in Chicago and professor of law Judith Daar who serves as dean of the Salmon P. Chase College of Law in Kentucky.

Dr Klipstein began the session by first reminding listeners that 'reproduction is not an exact science'. Whether or not a couple conceives naturally or via IVF, not every embryo becomes a child. For this reason, fertility clinics tend to collect more eggs and create more embryos than children an intended parent or parents plan to have. Dr Klipstein describes the use of excess embryos as a 'necessary and inextricable part of the process of IVF' that raises various ethical considerations in light of the Dobbs decision. If embryos were to be collectively regarded as persons, then what do clinics do with these embryos? Do clinicians compel intended parents to implant more embryos than children they desire? And what happens to frozen embryos that patients no longer intend to use?

The discussion then moved on to consider the potential impact on preimplantation genetic testing (PGT). Embryos are frequently tested for aneuploidy or monogenic disorders, meaning embryos that test positive for a certain chromosome abnormality or genetic condition may not be selected for implantation. Active screening of embryos prior to implantation begs the question - what do we do with affected embryos? Could these embryos be discarded, and if not, is there any use in testing in the first place?

Dr Klipstein closed her presentation by acknowledging the possible impact on surrogacy and the need to establish a legal landscape that accounts for bodily autonomy of surrogates, in addition to the rights of couples seeking fertility treatment more broadly. This seamlessly transitioned into Professor Daar's presentation which largely focused on the legal implications of a post-Dobbs era.

By overturning federal protection for abortion, the US Supreme Court has enabled states to independently regulate aspects of abortion not protected by federal statutory law. Fortunately, IVF and PGT have historically escaped prohibitive regulation. However, the recent Alabama Supreme Court's decision to equate embryos created through IVF with living children has introduced a newfound level of uncertainty surrounding the vulnerability of assisted reproductive technologies to restrictive regulation (see BioNews 1230). While the Dobbs decision does not explicitly discuss reproductive technologies, Professor Daar points out that this ruling likely will (and has already begun to) impact assisted reproduction. Despite having been initially doubtful that Congress would act to restrict IVF, Professor Daar admits a shift in her judgment since the more recent ruling in Alabama. As the clinical implications of the Dobbs decision begin to unfold and encroach on assisted reproductive technologies, Professor Daar predicts a new wave of restrictions as the country faces the 'next frontier in reproductive regulation'.

In the second half of the seminar, the session shifted to a Q&A comprised of varied questions from the session's moderator and audience members. Having touched on a wide range of clinical and legal implications, the discussion-based portion of the session was somewhat ambitious in its attempt to satisfactorily address diverse follow-ups to both speakers' talks. In the remaining thirty minutes, the conversation grazed the surface of important and intriguing themes including the delicate balance between preservation of clinicians' and patients' rights, as well as the need to educate lawmakers on assisted (and unassisted) reproduction.

As the discussion continued to oscillate between clinical and legal points, I was struck by the dichotomous yet harmonious contribution of both speakers' expertise. While just one perspective alone would have easily been sufficiently interesting and informative, the deliberate selection of two speakers that despite having different areas of work share a common area of interest, resulted in a well-rounded and complementary discussion. Different professions did however result in a fusion of medical and legal jargon. Having a more scientific background myself, I found the largely legal aspects of the session to be relatively dense.

Although this session could have benefitted from being twice as long, this ELSI Friday Forum presented a well-informed and insightful consideration of how a post-Dobbs era might impact reproductive technologies and reproductive decision-making in the future. As a US citizen myself, I listened to this session as an invested stakeholder in this discussion. Personally impacted or not, this seminar is bound to prompt an eye-opening consideration of the complex ethical and logistical questions wrapped up in this landmark decision.