January 28, 2013
Sen. David Hogue
Chair, Senate Judiciary Committee
North Dakota Senate
600 East Blvd
Bismarck, ND 58505
Dear Chairman Hogue:
I am Dr. Kristen Cain, and I am a reproductive endocrinologist practicing in Fargo. I am writing to urge you to oppose measures outlined in SCR 4009 and SB 2302, SB2303, and SB2305 which would endanger lives of women and fetuses in North Dakota and curtail reproductive freedom of North Dakota residents.
There are serious problems with measures SCR 4009, SB2302, SB 2303 and SB2305. Each of these measures threatens women’s health and curtails the ability of women to procure birth control, treatment for infertility, and fertility preservation for loss of fertility due to cancer treatment.
In particular, SCR4009 provides for the recognition and status of personhood for all human life at any stage of development. This would codify into law a status that does not exist currently. It is a narrow interpretation of personhood based on the religious beliefs of a few and is not backed by science, law or other religions. Codifying a religious belief about the beginning of life is akin to a Jehovah’s Witness attempting to make blood transfusions illegal for all North Dakotans because it is their belief that those who accept a blood transfusion cannot be saved. Clearly, most of us who do not share this belief would be appalled at a small group making such an important medical decision for us. How are reproductive decisions any different?
Not only that, but fully half of every woman’s life is spent in the time between ovulation and knowing for certain whether or not she is pregnant. Are we willing to hold all women hostage and prevent their physicians from providing care for half of women’s lives because we cannot be certain that they are not pregnant?
SB2302 is also a dangerous piece of legislation. It obscurely states that contraception that can kill a person should be outlawed. The fact is that every type of contraception has medical risks and a person using any type of birth control can die of complications from the method, including blood clots of the lung, stroke, and even anaphylaxis due to latex allergy from a condom. Contraception prevents conception. Thanks to the increased use of effective contraception, abortions are at the lowest rate since accurate numbers have become available. Eliminating contraception in the state of North Dakota will increase abortions and also increase maternal deaths from unintended pregnancies and from women seeking illegal abortions by unregulated, unlicensed, and untrained providers. Only 3 maternal deaths were recordedin North Dakota in the past year, and 2 of them were motor vehicle accidents. None were from legal abortion or infertility treatment. Right now, a woman dies every 8 minutes somewhere in the world due to an illegal abortion. Do we really want that here?
SB2302 does not specifically exempt abortion for pregnancies resulting from incest or rape. It does not exempt treatment of incomplete or inevitable spontaneous abortions and it does not allow for treatment of ectopic pregnancy. The so-called protective language in this bill is unclear and subject to broad interpretation. Medical providers who are not skilled in the reading and interpretation of legal documents will not be able to interpret subtleties in this bill. We are at risk for having a situation like the one recently in Ireland, where the hospital would not evacuate the uterus of a Hindu woman with sepsis and rupture of membranes at 17 weeks, because the fetus still had a heartbeat and the providers feared legal repercussions. She tragically died, to “save” a doomed fetus. Of course, the fetus also died, as it would have anyway. This will happen here, with a law like this in place.
SB2302 limits the number of eggs to be fertilized in IVF to only the number to be transferred. Because we currently only transfer 1 or 2 embryos in good prognosis IVF patients under 40, this would result in us only being able to inseminate 1 or 2 eggs. It prohibits freezing of embryos, although freezing preserves and protects embryos, and doesn’t harm them. . The fact is that only 1 of every 10 fertilized eggs has the capability of becoming a living, breathing human being. What happens to the other 9? They fail to grow in culture, or become fragmented, or fail to implant when placed in a woman’s uterus. 50% of all implanted embryos miscarry. Human reproduction is inefficient by nature. The ability to generate multiple eggs in a single cycle for IVF and to preserve the extra embryos for another attempt or even another baby in a few years is an important part of fertility treatment. Limiting IVF in this way would result in more multiple pregnancies, more spontaneous losses, more fetal reduction, and more babies born with complications of multiple birth and prematurity, not less. It would also increase the risk to the mother, as she is forced to undergo 5 or more cycles to conceive instead of one, with 5 or more exposures to medication, anesthesia, and surgical egg retrieval. Such limitations will make IVF veryrisky and unappealing to patients who will then opt for treatments using fertility drugs and intercourse, which do not allow any control over the number of fertilized eggs in the uterus. This will actually increase the rate of high order multiples and their attendant risks.
SB2302 prohibits “valuable consideration” for sperm and egg donors. The anticipated benefit to North Dakotans by this measure is unclear, and not stated in the bill. Sperm and egg donors are paid for their time, travel, and inconvenience in donating their tissue. Eliminating payment to anonymous donors restricts donation to known donors only. Donation is tightly regulated by the FDA and tissue banks are regularly inspected. To date, these measures have proved to be safe, and not a single case of HIV transmission has occurred due to donation of anonymous sperm or eggs. Eliminating the ability of anonymous persons to donate tissue would cause many problems for the people of North Dakota. First, those who have lost their fertility due to cancer treatment would not be allowed to benefit from this treatment. Second, every case of custody and child support disputes that has arisen from third party reproduction has come from a known donor cycle, in which no payment was made. Proper screening of donors for psychological, genetic and infectious disease would also be at risk, as patients bypass medical and legal assistance and disease transmission would increase. This section of the bill does nothing to protect or benefit the citizens of North Dakota, and inhibits viable family-building options for them.
SB2302 would prohibit all research in all humans because all medical procedures carry risk of death or injury. This would also eliminate the ability to investigate causes of spontaneous abortions by doing genetic and chromosomal testing. It would eliminate all stem cell research, which has been making huge strides in the areas of Type 1 diabetes, cancer, spinal cord injuries, and Parkinson’s disease. It would eliminate preimplantation genetic diagnosis, which allows testing of embryos for diseases such as Down syndrome, cystic fibrosis, and Tay Sachs. It is the nature of all research is that the benefit to the treatment is unknown and may not exist. That is why research is necessary, to sort out the useful and safe treatments from those that are dangerous and don’t work.
Finally, Section 8 of SB2302 regarding Judicial Standard gives greater rights to an unborn or even unconceived, unimplanted embryo than to the born human woman who is carrying it. This is not backed by any science and reduces all women of reproductive age to a legal status that is lower than a single-celled fertilized egg. Currently, the woman carrying the child has the primary rights, and in medicine she is the primary person who is treated. In most cases, what’s good for the mother is also good for the child, and this is not an issue. But again, this law will lead to maternal deaths in futile attempts to avoid aborting doomed fetuses.
Therefore, Senator Houge, I urge you and the committee to oppose this dangerous bill.
Kristen Cain, MD