In Vitro Fertilization (IVF): Infertility, Environmental Toxins, Homo/Transphobia
By Alexandra Siebenhaar
From 1981 to 2017 over 1.2 million babies have been born thanks to the fertility treatment or the reproductive technology known as in vitro fertilization (IVF). [i] Infertility is one of the main reasons why patients wish to access IVF, and couples and individuals alike face many barriers when trying to access IVF treatment. According to the Maryland Insurance Administration, employees who work for religious organizations that employ more than fifty workers may be denied healthcare coverage for IVF. [ii] It’s a common misconception that cisgender women past child-bearing age only experience infertility; it affects people of all sexes, gender identities, sexual orientations, and ages. Infertility can cause mental distress for an individual and a couple committed to forming their families through child-bearing.
The IVF process consists of many steps in which the patient takes medications for several months to advance fertility.[iii] After the patient’s ovaries have produced an appropriate number of potentially viable eggs, the doctor will perform a surgical procedure (called egg retrieval) to remove the eggs from the patient’s body. [iv] The eggs are then inseminated and fertilized with either a partner’s or donor’s sperm cells in a lab. [v] Finally, the eggs become embryos and are inserted into the uterus of the individual willing to carry what will hopefully become a pregnancy to term. [vi] IVF may not work after the first try and, like all medical invasive procedures, it can come with some potentially serious side effects. [vii] Improvements in reproductive technology and more medical scientists furthering clinical research are needed to mitigate many of these problems.
During the 2020 Maryland General Assembly, House Bill 0781[viii] and Senate Bill 0988[ix]: Health Insurance — In Vitro Fertilization — Revisions, sponsored by Delegate Ariana Kelly and Senator Shelly Hettleman, passed into both chambers before the sudden adjournment due to the COVID-19 pandemic. The bills are now on the governor’s desk for signature, and if they pass into law, will take effect January 1, 2021. The legislation requires health insurance coverage for expenses arising from in vitro fertilization procedures. It extends the duration in which a married cisgender individual experiences infertility while engaging in unprotected intercourse or a same-sex couple must experience before being eligible for coverage, such as three attempts (not the previous law of six months) of failed artificial insemination over the course of one year (instead of the two years). [x] The legislation created a new right for single patients to qualify for insurance coverage for IVF. They must have experienced three attempts of failed artificial insemination and infertility associating with the following medical conditions: endometriosis, diethylstilbestrol (DES), blockage, or removal of one or both fallopian tubes, or due to abnormal male factors that contribute to infertility, such as oligospermia. [xi] However, infertility can be caused by many other factors, including uterine fibroids, the shape of one’s uterus, and untreated chlamydia or gonorrhea for both sexes. [xii] Everyone should have access to fertility treatment no matter what medical condition they may have.
It is important that we recognize the totality of circumstances in which infertility is experienced in some communities, and not in others. Racism and environmental toxins lead to a higher risk of infertility. Black mothers and children are affected more by lead poisoning than their white counterparts. [xiii] According to the World Health Organization, young children (particularly those who are malnourished and economically disadvantaged) are the most vulnerable to lead poisoning, because bodies absorb more lead when nutrients are lacking. [xiv] In addition, pregnant individuals who are exposed to lead risk experiencing “miscarriage, stillbirth, premature birth and low birth weight.” [xv] Baltimore City is notorious for having exceptionally high levels of lead poisoning, and although lead poisoning rates among children have decreased in Baltimore City over time, the city still has the highest number of cases of 2018. [xvi] Affordable, environmental-friendly homes are essential in lowering infertility rates.
The taboo of homosexuality can also play a role in one’s unfulfilled dream of parenthood. Until 2015, same-sex couples were not able to access healthcare that covered IVF in the State of Maryland. I wonder how many same-sex couples in Maryland were denied their right to parenthood because they couldn’t financially afford IVF. Research shows lesbian couples may choose IVF for the following reasons: preferring an unknown sperm donor in order to protect the motherhood of the non-birth mother, the inability to become pregnant using other methods of reproductive technology (like vaginal insemination), and clinical health safety. [xvii]
During the voting session on the house floor, Delegate Parrott questioned whether or not unmarried people should get coverage through state regulated health insurance plans. He suggested that perhaps the legislation should allow carriers to opt in. After the bill passed the House of Delegates (105–32), the Chair of Health & Government Operations Committee, Delegate Shane Pendergrass (D13), rose to her feet and asked the Speaker of the House to share why she voted in favor of the legislation.
“I just want to mention that all our health insurance premiums are paid by married people and paid by single people — they are paid by everyone. This is about giving people parity, this is about justice, this is about allowing people to have the same rights as everyone not based on marital status.”
In the future, all legislators, policymakers, and healthcare providers should think about how transgender and/or gender non-binary individuals are included in healthcare insurance plans. Transgender individuals may have to consider if they want to be parents before undergoing hormone replacement therapy. If transgender individuals are not covered for IVF and hormone replacement therapy, they may face a far greater financial burden after fertility preservation. [xviii] In addition, considering that some transgender individuals may be unable to find work due to workplace discrimination, they may not be able to afford healthcare. We need to address these issues to not only make healthcare more inclusive, but more humane.
Economic insecurity, healthcare inequities, environmental toxin exposure, homophobia, and transphobia are all systematic barriers in preventing people from being parents. In order for everyone to have a right to parenthood no matter their sex, gender, sexual orientation, race, and economic status, we must have inclusive legislation and policies. More affordable, advanced reproductive technology or fertility treatments are needed in ending infertility.
[i] “Does In Vitro Fertilization Work,” Society for Assisted Reproductive Technology, 2020. https://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/q07-does-in-vitro-fertilization-work/
[ii] “Health Insurance,” Maryland Insurance Administration, 2020.
[iii] “What’s IVF,” Planned Parenthood, 2020. https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments/what-ivf
[viii] “HB0781: Health Insurance- In Vitro Fertilization- Revisions,” Maryland General Assembly, 2020. http://mgaleg.maryland.gov/mgawebsite/Legislation/Details/hb0781?ys=2020RS
[ix] “SB0988: Health Insurance- In Vitro Fertilization- Revisions.” Maryland General Assembly, 2020. http://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0988
[x] “HB0781: Health Insurance- In Vitro Fertilization- Revisions,” Maryland General Assembly, 2020. http://mgaleg.maryland.gov/mgawebsite/Legislation/Details/hb0781?ys=2020RS
[xii] “Infertility,” Planned Parenthood, 2020. https://www.plannedparenthood.org/learn/pregnancy/infertility
[xiii] “Healthy People Objectives,” Center for Disease Control and Prevention, 2020. https://www.cdc.gov/nceh/lead/data/healthy-people-objectives.htm
[xiv] “Lead poisoning and health,” World Health Organization, 2019. https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health
[xvi] Land and Material Administration; Lead Poisoning Prevention Program. 2019. “Childhood Blood Lead Surveillance in Maryland: Annual Report,” Maryland Department of the Environment 1–34.
[xvii] Hayman, Brenda, Lesley Wilkes, Elizabeth Halcomb, and Debra Jackson. 2015. “Lesbian Women Choosing Motherhood: The Journey to Conception.” Journal of GLBT Family Studies 11 (4): 395–409.
[xviii] Jones, C. A., L. Reiter, and E. Greenblatt. 2016. “Fertility Preservation in Transgender Patients.” International Journal of Transgenderism 17 (2): 76–82.