Modeling IVF Access Post Repeal of Roe v. Wade Part 2: Including Potential Impacts of Upcoming Legislation

Abigail Sirus and David Sable MD

July 31, 2022

Our previous whitepaper “A New Challenge for Fertility Patients? Modeling IVF Access Post Repeal of Roe v. Wade” modeled the potential impact of Roe’s repeal on women and couples undergoing in vitro fertilization (IVF) treatment based on currently enacted legislation. Several states, however, are either debating further restrictive abortion legislation or have already passed or are close to passing personhood statutes (which attempt to legally establish that embryos have constitutional rights) that could significantly impact both access to and the practice of reproductive medicine. Given that Roe was overturned just over a month ago, the legal landscape remains uncertain and is changing day-by-day.

Kansas will be the first state to vote on banning abortion post Roe’s repeal in early August, and fetal personhood laws are either already passed or likely to be passed in Georgia, Iowa, Nebraska, Ohio and South Carolina. In this analysis, we expand on our previous analysis of the 18 states immediately impacted by Roe’s repeal to the 24 states that could be impacted in the coming months by adding Georgia, Iowa, Kansas, Nebraska, Ohio, and South Carolina.

What could IVF look like if just less than half of the states limit access to reproductive medicine?

· An additional 22,668 more IVF cycles would move from restrictive states, yielding a total of ~81,000, approximately 25% of total U.S. IVF cycles.[1]

· North Carolina and Virginia would be added to the list of states that will experience an inflow of cycles from neighboring states.

· Illinois would experience the largest cycle influx, with an incremental 18,319 cycles, bringing the state’s total to approximately 45,000 per year, a 2.4x increase over Illinois’ current ~19,000 cycles per year.

· Patients will have to travel ~8.7 million extra miles for care, with the average one-way trip increasing from 260 miles to 304.

[1] “Art Success Rates.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 14 June 2022, https://www.cdc.gov/art/artdata/index.html#preliminary.

In the United States, the following states would experience an outflow or inflow of cycles if patients move from restrictive states to the nearest clinic in a state without restrictions:*

*Highlighted text indicates a new addition compared to previous analysis.

Shifting to fertility preservation cycles (e.g., egg freezing), Illinois and Florida would experience the greatest influx of cycles per Table 2 below. Illinois’ portion of nationwide fertility preservation cycles would increase from 5.1% of all transfers to 9.2% while Florida would increase from 2.1% to 5.6%, respectively.

Illinois and Florida would also experience the greatest influx of frozen embryo transfers per Table 3 below. Illinois’ portion of nationwide transfers would increase from 4% of all transfers to 13% while Florida would increase from 3% to 12%, respectively.

Conclusion

If Kansas bans abortion with associated restrictions on IVF, and personhood laws take effect in Georgia, Iowa, Nebraska, Ohio, and South Carolina, almost half of all states will have restricted access to reproductive medicine. Illinois and Florida would experience a 2–4x influx of IVF cycles, fertility preservation cycles, and frozen embryo transfers compared to procedures performed in 2020. Patients who transfer care would face an incremental 8.7 million extra miles of travel for access to care.