This is not a political blog and my intention is not to tell you how to vote. But personhood is a topic that may be on your state ballot this year and as a reproductive endocrinologist, I do have some insights into what happens to an embryo.
Personhood is an attempt by pro-life organizations to give legal rights to all life from the moment of fertilization of the egg by the sperm. This would criminalize all abortions because if fetuses are “persons” then abortion is homicide and punishable as such. This is the desired outcome of the personhood measures. But what are the repercussions of giving legal rights prior to birth?
IVF would change immediately. At present, some countries have similar laws in place and in those countries the clinic can only fertilize the number of eggs that the woman is willing to transfer. This number is capped by law and usually the maximum is 3 eggs. The upside of this is that these countries have made tremendous progress in the research of freezing unfertilized eggs. But the financial, emotional, and physical costs to the patient are increased, as it is not possible to determine which eggs are most likely to fertilize and result in a viable embryo. There would also be no possibility of freezing embryos, as this would violate the embryo’s rights under law.
Contraception would also change. Under personhood, most forms of contraception other than barrier methods and permanent sterilization would become illegal, because of the small chance that an egg could still fertilize in spite of the contraception and then the “back-up plan” of the contraceptive, inhibition of implantation, would be considered an abortion.
Once a woman is pregnant, most of the time what’s good for her is good for the embryo. But what if she is in a car accident and loses the pregnancy? What if the accident was her fault? Does this make her guilty of manslaughter? Do we add the distress of a trial to her grief over losing a pregnancy? Should she go to jail? What if she falls down the stairs and miscarries? Is she guilty of negligence? If she has a glass of wine during her pregnancy or drinks a cup of coffee is that child abuse?
Personhood advocates state that all frozen embryos would be transferred into women who will carry them and benefit from adopting these unborn children. George W. Bush was a strong advocate of this and during his presidency promoted the establishment of “Snowflake programs” to ensure the adoption of all embryos. While this is well-intentioned, and can be a good option for building a family in cases where eggs and sperm are both in short supply, the reality is that majority of patients who are interested in these programs are single women or lesbians and many of my own patients have been discriminated against by these very programs. And what about embryos that are from parents who have transmissible genetic or infectious diseases? Current FDA guidelines prevent the transfer of these embryos into any third party, meaning any person who is not the source of the egg. What if the couple who created the embryos has a completed family already and can’t raise more kids? What if they are already raising a sick child with a genetic disease? Should we force them to accept the transfer of another embryo affected with the same disease to avoid discarding it? Personhood advocates say that yes, we should.
Personhood states that life begins at conception. But when does conception begin? Personhood states that conception and fertilization are the same thing, but the science does not bear this out. The fact is that human reproduction is notoriously inefficient. Humans are big, and slow to mature, and we live a long, long time. As a species, we can only afford to gestate and give birth to the embryos most likely to live. A typical IVF cycle will generate 8-10 eggs. With our best technology, we can get about 80% of these to fertilize. Of these, about half continue to grow into embryos. If we transfer two into the patient, she has a 50% chance of one of the embryos implanting and in the most successful programs, maybe a 30% chance of both embryos implanting. About 33% of the time, at least one of her remaining embryos will be able to be frozen, where it has a 20% chance of achieving a pregnancy.
If the woman becomes pregnant, she has a 50% chance of losing the pregnancy before the first pregnancy test. Once the pregnancy test turns positive, she still has a 25% chance of miscarriage before development of a heart beat and the pregnancy loss rate can still be up to 20% even after a heartbeat is seen. Let’s look at these numbers in a simpler way:
FERTILIZED EGGS: 8
ONGOING PREGNANCY: 0.5
ONGOING PREGNANCY FROM FROZEN TRANSFER: 0.2
In short, it takes 10 eggs to get one baby. This is probably similar to what happens naturally. Normal pregnancy rates in healthy young couples are 20-25% per month. So if, out of 10 couples 2 conceive per month, one will miscarry, probably before she even misses a period. 1 out of 10. It takes 10 eggs to get one baby. Yet in IVF, 8 eggs of 10 will be fertilized. Do these all have souls? If so, why would God bother to put souls in something that is never born? What is the point of being born if a complete soul can exist in a fertilized egg? I realize I’m branching off into theological questions for which I have neither answers or expertise. My asking these questions will strike some as inappropriate as theologians telling us that every fertilized egg is a viable human life. The fact is that most aren’t. The problem is that we don’t know which ones are viable. But is personhood the solution?
You don’t have to be for personhood to be pro-life.
As a reproductive endocrinologist, my view is that life is precious and that the most basic activity of life is to reproduce. That is why I do what I do. Embryos have the potential to become viable humans and should be treated with respect and handled with care. But they are not yet separate human beings and to give them separate rights from the women carrying them does not make sense and degrades the rights of the mother. If you are pro-choice, if you are pro-life, is not at issue here. Either way, personhood is a dangerous and poorly-conceived idea that impacts the lives of all reproductive age women, making their actual lives less important than the potential lives they may be carrying.