By Dr. David Ayers

The Dobbs decision striking down Roe v. Wade has led to shrill outcries by providers of in vitro fertilization (IVF) and surrogacy. Both are lucrative, high-growth commercial industries enjoying increasing demand, thanks in part to rising infertility and late pregnancy among folk in income brackets able to pay for these services. Many of those involved in this industry are alarmed that their “market growth” and profitability are threatened by abortion restrictions and are willing to publicly say so. Others have argued that state bans will likely exclude abortion restrictions that will significantly impact these industries.

The balance of the evidence suggests that at least some key aspects of IVF and surrogacy practices are threatened by abortion bans. In highlighting these threats, those who want to keep abortion spigots wide open to accommodate the “needs” of IVF and surrogacy providers may reveal to more of our populace the true nature of much of what they do. The attention on certain grim realities might undermine the significant public support they currently enjoy.

For example, a May 9, 2023, analysis in a blog sponsored by the Petrie Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School bluntly summarized common elements of IVF and surrogacy practices that are jeopardized by post-Dobbs abortion restrictions: “embryo discard, embryo cryopreservation, preimplantation genetic testing (PGT), and selective reduction of multiple pregnancy.” We could also add the practice, common in surrogacy, of intended parents ordering the abortion of babies they have rejected as undesirable for reasons other than multiple pregnancy. Do the IVF and surrogacy industries really want public discussion of these realities? Let’s dive deeper.

IVFs Are Multi-Billion-Dollar Industries

Purchasing and trading eggs and sperm, the creation of hundreds of thousands, if not millions, of frozen embryos, supplying and managing surrogates, and more are now multi-billion-dollar industries. Much of this is even a form of eugenics, as couples increasingly screen out sperm, eggs, embryos, and even fetuses in order to select babies with preferred features. For example, everyone in the fertility industry knows that the monetary value of eggs and sperm used in IVF varies enormously by the supposedly desired traits of donors. As one former fertility clinic employee quoted in Katy Faust and Stacy Manning’s excellent Them Before Us honestly admitted, “The intended parents are buying genes, and they wanted white, movie star beautiful and diplomas from the right university.”

As if there was any doubt about the eugenics hiding in the underbelly of the IVF industry, a July 18 Christian Post news story reported on a new artificial intelligence (AI) software product for performing preimplantation genetic testing, touted on the website of its company, AIVF, as “fully automated AI-based embryo evaluation.” As David Prentice of the Charlotte Lozier Institute, quoted in the Christian Post, dryly remarked, this “AI program is a tool used to pick and choose which embryos are higher quality; this means some human beings are looked at as lower quality, perhaps even discarded as lives not worth living.”

Then, as that May 9 analysis admitted, they are terminating normal fetuses in women pregnant with more than one baby. The common term for this, “multifetal pregnancy reduction” (MFPR), is an Orwellian linguistic sleight of hand designed to disguise an awful reality — killing the babies one doesn’t want when pregnant with more babies than one wants. Of course, multifetal pregnancies, and thus MFPR, often occur without the use of IVF. But IVF has increased the incidence of such pregnancies and MFPR due to women being implanted with more embryos than they would want to carry to term.

Multifetal Pregnancy Often Results in Forced Abortions

How often do women undergoing IVF have more than one embryo implanted? Quite often. One fertility clinic, relying on CDC data, gives these overall figures: “…half of the IVF procedures in the U.S. involved transferring two embryos, 23% involved three, and 10% involved four or five.” So, we aren’t surprised that, as of 2020, one in five IVF pregnancies were “multifetal” and that dramatic increases in such pregnancies have been driven by this “assisted reproductive technology.” Thankfully, the use of multiple embryo transfers is declining, but it is certainly still more common than most folk probably think.

Most surrogacy contracts specify the rights of intended parents to demand that their surrogates abort the babies they are carrying. A major reason for this is the risk of multifetal pregnancies. As one clearinghouse site for surrogacy information bluntly states:

In many surrogacy journeys, any decisions regarding pregnancy termination or selective reduction fall to the intended parents…. For many intended parents, this means terminating unhealthy pregnancies or selectively reducing pregnancies in which more than one egg implants.

These facts were bluntly stated in a Feb. 18, 2016 piece in the Atlantic entitled, “When Parents and Surrogates Disagree on Abortion.” After admitting that the “vast majority” of surrogacy contracts require the surrogates to abort babies if ordered by the intended parents to do so, the author lays out why this is viewed as necessary by most of these parents:

In surrogacy cases, the most common reason for abortion is multiple pregnancies. And of course, the likelihood of becoming pregnant with twins, triplets, and even four or five fetuses increases once IVF enters the picture—doctors will often implant multiple embryos at a time, to increase the chance that one will take. For various reasons—health, financial, or otherwise—parents whose surrogate ends up carrying multiple fetuses may request to “selectively reduce,” or abort one or more.

In some abortions forced on surrogates, abortion pills — which are easy to obtain even where they are legally restricted — could be used. But MFPR doesn’t work that way. The doctor has to kill one or some while keeping one or some. In fact, they need to let the fetuses develop for a while — typically 11 weeks or more — before performing MFPR. This is later than the recommended gestation period for abortion pills. Thus, standard abortion restrictions could significantly impact the industry, abortion pills or not.

Most Frozen Embryos Will Never Be Born

As that May 9 quote tacitly admits, IVF also leaves us with the nightmare of all those frozen embryos. Some facts from Them Before Us: about one million frozen embryos are in storage, less than 8 percent of these will ever be born alive, one-fifth or more are simply abandoned, and there are only three options for embryos that are not needed for future attempts at pregnancies: “thaw and discard,” “donate to research,” or “donate to other parents.” And how do we wrap our minds around the fact that parents with “excess” frozen embryos are more than two times more likely to donate them to research than to give them to other families?

Infertility is a heartbreaking reality for millions, with roughly 9 percent of men and 11 percent of women having suffered from this to some extent. Many who get into IVF and surrogacy are pushed in this direction by medical professionals who skim over unsavory details and, too often, don’t help couples understand all of the other fertility options available to them. And let me be clear — there are plenty of folks who use IVF and surrogates for whom abortion is not an option.

However, the reality is that much of the lucrative IVF and surrogacy industry thrives on commercially creating embryos to be used or destroyed as intended parents see fit. The stark reality of using abortion to get rid of babies intended parents don’t want, either because they don’t fit desired standards, because there are “too many fetuses,” or even other reasons, such as divorce or simply changing their minds, are very real things.

Can’t we address these hard truths without dismissing the very real suffering of those dealing with infertility? I think we can. Will the objections to post-Dobbs abortion restrictions raised by those in the IVF and surrogacy industries lead to increased public awareness and scrutiny of them? I sure hope so.

Dr. David J. Ayers is the Fellow for Marriage and Family with the Institute for Faith & Freedom. His latest book is “Christian Marriage: A Comprehensive Introduction.”