The Dobbs decision left a broad mark on reproductive medicine

N:AND ORLEANS The annual meeting of the American Society for Reproductive Medicine is usually a lively, glittering parade of new science, fresh technological products, and the promise that together they will give more people more options than ever to control how, when, and if they have children.

This year’s event still carried the familiar 8-foot-tall images of hopeful parents cradling newborns bathed in sunlight, a verdant wishing wall adorned with crepe-paper flowers crumpled around wishes made on behalf of infertility patients. But as thousands of leading reproductive health researchers and doctors from around the world descended on The Big Easy, they couldn’t escape the big, dark, Dobbs-decision-shaped cloud that hung over it.

The United States now finds itself with countries we don’t normally think of as role models when it comes to health policy, namely Poland, Nicaragua and El Salvador, Anita Allen, a professor of law and philosophy at the University of Pennsylvania, said in a plenary address that opened the conference Monday morning.

That’s thanks to the US Supreme Court’s Dobbs decision last June, ending 50 years of constitutional protections for abortion. Since then, more than 20 states have enacted bans or legal restrictions, creating a patchwork of access to the surgical procedure, which is also used to treat other health conditions such as miscarriage and ectopic pregnancy. It’s also changing the fertility industry.

In her talk, Allen described conversations she had with fertility doctors who noticed patients asking for preimplantation genetic testing an expensive but unproven screening tool being marketed as a way to improve the odds of having a healthy baby. Expectant parents take such measures in the hope that it minimizes the chance of a fetal abnormality that could put them in a position where they must decide whether or not to have an abortion.

Can you imagine being afraid of getting pregnant? Allen asked the audience. So scared that you’re investing thousands of dollars in pre-implantation testing to avoid getting caught up in the abortion ban mess?

It’s not just jokes. Data presented at ASRM this week underscored how wide and deep that decision is now affecting the field of reproductive medicine, from changing where the next generation of doctors chooses to train and practice to costly decisions that patients are forced to make, to a minimum. to deliver the risk they need. seek care that is no longer legal where they live.

One theme that came up repeatedly was the effect of states restricting abortion in terms of the doctors they can attract to residency and fellowship programs.

You want to get as much training experience as possible so you can then provide the best care possible to patients, said Marissa Gigg, who was a resident at Tulane University when Dobbs’ decision was made. She knew she would not have the opportunity to learn and practice procedures vital to managing miscarriages and other threats to pregnant women’s health. He reassessed his options and chose a scholarship at the University of Southern California where he could.

When you’re taking care of a patient that you’re helping to conceive, if there’s something that’s wrong or that’s putting their health at risk, being able to help them get out of a situation that you’ve made it easy for them to get into is important to me, he said. he. . And I was wondering if anyone else felt the same way.

When Gigg asked doctors who had applied for the same OB/GYN fellowship the following year, he found he wasn’t alone. More than two-thirds of respondents said they either canceled interviews in states with restrictive abortion laws or changed the ratings of programs they applied to as a result of the Dobbs decision. For some of the doctors it was about training, but for many the reason for avoiding these conditions was more personal, they wanted more control over their ability to make family planning decisions for themselves and their partners.

The new data also shows that the new legal landscape isn’t just affecting women’s health. Researchers at Rutgers and the University of Washington surveyed male and female applicants for urology fellowships in 2023. They found that a quarter of respondents indicated that access to abortion was an important factor in their decisions about where to seek training. One in five said they would completely eliminate any programs in abortion-restricted states.

It appears to be the early stages of a troubling brain drain, said Chloe Peters, who led the study, which adds to a recently published study that found similar trends among female urology doctors. We know that more than half of residents stay in the state they live in, he said. If they change where they apply, it changes where they train, and down the road, affecting where they work.

America already faces a significant shortage of urologists, with 60% of US counties lacking one. And the counties with the fewest doctors also have the strictest abortion laws. Additionally, 1/3 of practicing urologists are over age 65, and access challenges will only worsen over the next decade.

Who will do your prostate biopsy if you live in Alabama and there is no urologist within 100 miles? Peters said: You’re kind of screwed.

One way people respond to this reduction in care is to take precautionary and permanent measures to prevent pregnancy in the first place.

University of Utah researchers analyzed a national database of medical procedures for more than 183 million undiagnosed patients, comparing rates of permanent birth control surgeries between July and December 2021 with the same period in 2022. After Dobbs, all states saw significant increases in the number of people undergoing vasectomies, with the sharpest increase among single patients under 30 living in states with hostile abortion laws. They observed similar trends for patients undergoing tubal sterilization, but not as dramatically.

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