Unintended consequences of the anti-abortion movement and its effect on fertility counseling and recommendations: a national survey of fertility specialists

The aim of this study is to explore whether fertility specialists have changed patient counseling and recommendations on topics such as in vitro fertilization (IVF), preimplantation genetic testing (PGT), and embryo cryopreservation in response to the changing legal and political climate surrounding abortion. An anonymous cross-sectional survey was sent to Society for Reproductive Endocrinology and Infertility (SREI) members. The 15-item survey included multiple-choice and open-ended questions. Topics included changes in counseling patterns in IVF, PGT, and cryopreservation related to recent changes in abortion legislation. This study was submitted for IRB approval and deemed exempt. Statistical analyses, including bivariate logistic regression, were performed using SAS® 9.4. The survey and analysis were reviewed and approved by the SREI research committee. A total of 285 (34%) SREI members responded to the survey, 59% practiced in abortion-accessible states, defined as states with laws protecting abortion rights beyond 12 weeks gestation, and 41% in abortion-restrictive states defined as states that impose medically unnecessary requirements on abortion before 12 weeks gestation in 2022. A higher proportion of younger participants (25-54 years) practiced in abortion restrictive states (OR: 1.79, 95% CI: 1.10, 2.90). No difference was seen in professional status or practice type. There were no differences in anticipated counseling practice surrounding IVF (p=0.63), PGT (p=0.22), and embryo cryopreservation (p=0.84) due to anti-abortion legislation or potential abortion restrictions in provider state. Similarly, no significant differences in practice recommendations regarding IVF (p=0.08), PGT (p=0.22), embryo cryopreservation (p=0.17), fertilizing fewer oocytes (p=0.89), increased oocyte vs. embryo cryopreservation (p=0.54) or donating supernumerary embryos to a donor embryo program (p=0.42) across states was observed. This study highlights the changing legal landscape surrounding abortion has not yet significantly impacted the counseling practices of fertility specialists regarding IVF, PGT, and embryo cryopreservation in abortion-restrictive vs. abortion-accessible states. Further research is needed to monitor the ongoing effects of restrictive abortion legislation on counseling patterns provided by fertility specialists.