Mississippi Initiative 26 Would Limit Women’s and Men’s Fertility Options

I am originally from Jackson, Mississippi, so this issue is near and dear to my heart.

In a nutshell: The Mississippi Initiative 26 would take away a couple’s reproductive rights. For couples with infertility, the Initiative would hinder/inhibit them from using fertility treatments. Couples would not be allowed to make their own decisions regarding how to build their family.

Mississippi State Medical Association realizes there are strong feelings both for and against Proposal 26 that we recognize and appreciate. Our concern is not with those issues and

we do not in any way wish to take sides.
Our concern is how this amendment will affect the common practice of obstetrics and gynecology. We fear that it will place in jeopardy a physician who tries to save a mother’s life by performing procedures and employing techniques physicians have used for years.

The common procedures we use now could be interpreted as murder or wrongful death if Proposal 26 passes. This justifiably will limit the physician’s options and deter use of common lifesaving procedures.  It is for this reason only, the MSMA Board of Trustees cannot support Proposal 26.

~ MSMA Board of Trustees

Before I jump into explaining the details of Mississippi Initiative 26, allow me to give you a hypothetical scenario to put things into perspective.

Imagine you and your husband have been trying to have a child for three years with no results. You finally go to the doctor and get diagnosed with infertility. Maybe your husband has low sperm count and you have blocked fallopian tubes. After the heartbreaking news, you begin investigating Assisted Reproductive Technology (ART), knowing it may be the only way to have a biological child of your own. Because your fallopian tubes are blocked you decide to try a cycle of in vitro fertilization (IVF), giving you the best chances for conception.

During your IVF cycle, let’s suppose your doctor retrieves 16 follicles from your ovaries. From the 16 follicles, let’s say you get 8 good eggs. You’re excited that you have 8 good eggs, but you know not all of them are likely to become embryos once they are fertilized with your husband’s poor quality sperm. Nevertheless, you and your husband are hopeful because you’ve been praying to have children for a very long time.

Some of the questions you may ask yourself at this point are:

1. Should we fertilize all 8 eggs with my husband’s sperm? If not all 8, then how many?

2. What do we do with the eggs we don’t fertilize? Should we freeze them? If so, what is the viability of the eggs once they are thawed? How well will they fertilize with my husband’s sperm after being thawed?

If we initially only fertilize 3 (fresh) eggs (and freeze the other 5) and none of the 3 become embryos, then we’ve lost the opportunity to have fertilized the other 5 eggs. Hence, it would mean $18,000+ down the drain (for the one IVF cycle), and we’d have to start all over again with another IVF cycle to get more fresh eggs.

Egg Freezing
According to the San Diego Fertility Center, oocyte cryopreservation or egg freezing, is a relatively new procedure in the field of assisted reproductive technologies. Overall, this technology increases a woman’s potential to have children later in life.  Since the first successful pregnancy using egg freezing was reported in 1986, approximately 600 babies have been born.  Currently, pregnancy rates are between 30 and 40 percent in good prognosis patients.

Let me explain more about freezing your eggs:
Once the follicles are retrieved, there’s a small window of opportunity to fertilize the eggs. You can’t just put them in a Sub Zero refrigerator for a few days to make your decision. They don’t keep unless you freeze the eggs. Once frozen (using oocyte cryopreservation) and then thawed, the eggs’ success rate for proper fertilization decreases significantly. Again, pregnancy rates are between 30 and 40 percent in good prognosis patients.

A fresh egg is always the best for fertilization. Plus, the fertilization process in itself takes three to five days to see if an egg will properly unite with a sperm, be fertilized and become a zygote. Then, the zygote becomes a blastocyst that would then be transferred into the uterus for implantation.

Most couples would typically choose to fertilize all 8 eggs, hoping for at least 3 or 4 good embryos as a result. Please be aware that there are no guarantees. Just because the eggs are fertilized doesn’t mean they will all become viable embryos.

How’s it done?
So, after egg retrieval the 8 eggs are rinsed, counted, and placed in an incubator. Later that day, the 8 eggs are fertilized with your husband’s sperm. Because his sperm aren’t optimum, the doctor uses Intracytoplasmic sperm injection (ICSI), inserting the sperm directly into your egg.

Again, lets suppose that after four days you have 5 blastocysts that develop. The other 3 eggs and sperm didn’t fertilize for whatever reason. Now, you have 5 blastocysts that are viable.

What’s a blastocyst? After the sperm and egg unite to form the one-celled zygote, the zygote travels down the fallopian tube toward the uterus. At the same time, it will begin dividing rapidly to form a cluster of cells. By the time the zygote reaches the uterus, the rapidly dividing cluster of cells — now known as a blastocyst — has separated into two sections. The inner group of cells will become the embryo. The outer group of cells will become the membranes that nourish and protect it. On contact, it will burrow into the uterine wall for nourishment. This process is called implantation.

So, when does a blastocyst become an embryo? The third week after conception marks the beginning of the embryonic period. So, technically you don’t have an embryo until the blastocyst has implanted into the uterine wall, which is the third week after the one-celled zygote formed.

When does the embryo become a fetus? At the beginning of the ninth week after conception, the embryo is now officially described as a fetus.  (Source: MayoClinic.com)

Now that the technical speak is out of the way and we understand the process, let’s get back to the hypothetical situation.

Transfering the Blastocysts: Once you have 5 blastocysts (cluster of cells), you’ll have to decide how many to transfer into your uterus. If you transfer 2, then you’ll probably want to freeze the other 3 in case things don’t work out.

Later, the 3 frozen blastocysts will have to be thawed to transfer them into your uterus for a second chance. The viability of the blastocysts will have decreased because of the freezing and thawing process, but at least you have the blastocysts, which gives you another opportunity if your first transfer does not work out.

Your fertility specialist can give you the statistics on viability for your thawed blastocysts. Viability will depend upon your age at retrieval.

What does Mississippi Initiative 26 have to do with this?
The Mississippi Initiative 26 that Mississippians will vote on November 8^th is a “Personhood Amendment” that will change how a person is defined in the Mississippi Constitution.

Did you know?
Infertility affects at least 10-15 percent of couples in Mississippi (and in every state across the US) who desire pregnancy.  The Centers for Disease Control and Prevention estimates there are 7.3 million infertile couples in the U.S. For a number of those with infertility, Assisted Reproductive Technology, including in vitro fertilization (“IVF”), is necessary.

In IVF, multiple eggs are fertilized in a lab to increase the likelihood of pregnancy.  The microscopic fertilized eggs develop for three to five days, and then one or more are transferred to the woman’s uterus in the hope one will implant and develop to birth.

Sometimes extra fertilized eggs remain after a couple becomes pregnant, which is a benefit as many infertile couples require more than one attempt at implantation before a pregnancy occurs; many suffer from miscarriages; and many infertile couples plan on having additional children.  Thus, doctors often cryopreserve (freeze) the remaining microscopic embryos.

With Personhood Legislation, however, the legality of these effective pro-pregnancy fertility treatments would be called into question. If microscopic fertilized eggs/embryos are full humans, anything that puts an embryo at risk could be a criminal violation, even if its goal is the undeniable social good of helping someone have a baby.

The legal uncertainties stemming from the proposed amendment would make it difficult or impossible for reproductive endocrinologists to treat patients at all using ART.  Thus, the Personhood Legislation would prevent couples with infertility from being able to have families.

Again, as the Miss. State Medical Association pointed out: …”this amendment will affect the common practice of obstetrics and gynecology. We fear that it will place in jeopardy a physician who tries to save a mother’s life by performing procedures and employing techniques physicians have used for years.  The common procedures we use now could be interpreted as murder or wrongful death if Proposal 26 passes. This justifiably will limit the physician’s options and deter use of common lifesaving procedures.”

If you live in Mississippi, I urge you to vote NO on Mississippi Initiative 26 because it takes away a couples right to make their own reproductive decisions.

You can also visit RESOLVE’s website to learn more. LINK:  http://www.resolve.org/get-involved/mississippi-initiative-26.html

What can I do to fight Initiative 26?
Answer: If you live in MS, vote NO on November 8th and urge your friends and family to do the same. If you live in MS we need you to speak out – contact RESOLVE at info@resolve.org if you are willing to share your story with the media. We need the face of real people that will be impacted by this Amendment. We need accurate information conveyed to the citizens of Mississippi.

If you don’t live in MS, help spread the word about Initiative 26. If you have a blog, write about it; if you frequent online forums or communities, talk about it; and if you know anyone in MS, please contact them and urge them to Vote No on November 8.