SGO Statement: Commitment to Patient Care and Member Wellness in the Wake of the State of Alabama’s Supreme Court IVF Ruling

On February 16, 2024, the Supreme Court of Alabama decided in LePage v. Mobile Infirmary Clinic that frozen embryos created and stored for in vitro fertilization (IVF) are children under state law. The implications of this decision for many patients and their families are uncertain. Healthcare providers may be reticent to continue providing IVF services, given liability for loss of frozen embryos. Not all embryos are viable after the freezing and thawing process. As such, some infertility clinics in Alabama are pausing IVF treatments, limiting access to fertility care in that region.

The Society of Gynecologic Oncology (SGO)* is deeply concerned that the impact of the Alabama Supreme Court decision may have long-term, negative health-related consequences for people at risk for, or diagnosed with, gynecologic cancer, as well as for our SGO members. Additionally, this ruling interferes with the sanctity of the patient-physician relationship and could lead to the replication of similar restrictive reproductive healthcare policies in other states.

Restricted access to IVF has the potential to negatively impact care for gynecologic cancer survivors and countless people with hereditary cancer syndromes (“previvors”). Approximately 20% of gynecologic cancer patients are less than 40 years of age.1 Given the frequency of delayed childbearing, patients may be diagnosed with a gynecologic malignancy before their first pregnancy. At least one in every 200 individuals in the United States has a diagnosis of Hereditary Breast and Ovarian Cancer Syndrome (HBOC), Lynch syndrome, or other hereditary cancer syndromes.2 In these situations, procedures to remove reproductive organs may be recommended before childbearing is complete to reduce the risk of ovarian, tubal, peritoneal, and uterine cancers. Access to assisted reproductive techniques may provide hope for fertility for cancer survivors and previvors, as well as flexibility regarding family planning for previvors. In addition, individuals with hereditary cancer syndromes may be interested in preimplantation genetic diagnosis and IVF to reduce the likelihood that their children will inherit the syndrome. Limited access to IVF will disproportionately and negatively impact gynecologic cancer care and prevention.

Moreover, the removal of fertility options may negatively impact our trainees and SGO members. A recent survey of female physicians identified that 75.6% delayed childbearing, and 36.8% experienced infertility.3 The findings are important as 62% of SGO members identify as female, and many may be adversely affected by this court decision. Factors influencing career development, childbearing, parenting, and medical decisions are multifactorial and complex. Advancements in assisted reproductive techniques, including IVF, may provide hope for those aspiring to have a family.

Limited or no access to IVF may have a devastating impact on people at risk for, or diagnosed with, gynecologic cancer, and our SGO members. SGO is committed to promoting the eradication of gynecologic cancers; fostering empathic, comprehensive, and high-value care to improve the lives of people with or at risk for gynecologic cancer; supporting our members’ professional development and wellness; and overall access to reproductive health. The decision of the Alabama Supreme Court makes all of these goals harder to achieve.

For questions or further guidance, please e-mail sgo@sgo.org.

* SGO acknowledges the perspective of other member organizations that have made organizational statements and commitments to date in response to this ruling, including the American College of Obstetricians and Gynecologists, the American Society for Reproductive Medicine, the Association of Physician Associates in Obstetrics and Gynecology, and the Society of Reproductive Biologists and Technologists.

References:

1. La Rosa, V. L., Garzon, S., Gullo, G., Fichera, M., Sisti, G., Gallo, P., Riemma, G., & Schiattarella, A. (2020). Fertility preservation in women affected by gynaecological cancer: the importance of an integrated gynaecological and psychological approach. Ecancermedicalscience, 14. https://doi.org/10.3332/ecancer.2020.1035
2. Mighton, C., Shickh, S., Aguda, V., Krishnapillai, S., Adi-Wauran, E., & Bombard, Y. (2022). From the patient to the population: Use of genomics for population screening. Frontiers in Genetics, 13. https://doi.org/10.3389/fgene.2022.893832
3. Bakkensen, J. B., Smith, K. S., Cheung, E. O., Moreno, P. I., Goldman, K. N., Lawson, A. K., & Feinberg, E. C. (2023). Childbearing, infertility, and career trajectories among women in medicine. JAMA Network Open, 6(7), e2326192. https://doi.org/10.1001/jamanetworkopen.2023.26192