It had to come to this.

Abortion is just one facet of the procreation die (singular for dice).

Infertility is another. And for many, mostly women, procreation does become a dicey endeavor.

So now, with a righteous Alabama Supreme Court opinion, this discussion might actually come into the open.

Us medical professionals have found living in the gray area of personhood profitable. Some, though truthfully, it was just a few practitioners, made money performing abortions. Some might have found some moral duty therein, even though the Hippocratic oath forbids abortion.

The line for abortion used to be “quickening”. Read The Cider House Rules, and you’ll learn the meaning of the question asked of the young pregnant woman, “Are you quick?”

For when the growing fetus’ movement was felt, and that was the line called “quickening”, an abortion was not considered proper. Before becoming quick, it was her decision, mainly.

The law didn’t enter into it in colonial times. There was community shame and derision and family pressure, but the law stayed out of this realm.

But in the mid 1800’s the medical profession lobbied state legislatures to make abortion illegal. You see, midwives, lay health providers did this procedure, since medical professionals were forbidden by oath. And doctors got paid to deliver babies. Maybe I’m cynical, but “follow the money” is good advice when considering what laws get passed.

So, most states outlawed abortion. Then the US Supreme Court handed down the Roe Decision. The line drawn by those justices was “viability”. When the fetus can survive outside of the mother, it is no longer her choice. Before, it is.

Viability comes at about 24 weeks of gestation.

Quickening comes usually about 16-20 weeks. These lines when the control of the decision shifts was very similar.

But now that Roe is no longer the law, and we’re back to state legislatures arbitrating, not only ending a pregnancy, but the decision to try to start one might move into the hands of lawmakers, not mothers, or families.

Because there are some real issues with infertility care that might make one cringe. Might make one consider passing legislation.

Say a woman is young and not ovulating. She and her partner want to conceive. The medical and pharmaceutical industries have wonderful drugs that can stimulate ovulation. They are inexpensive and convenient, though often unpleasant.

And now she gets pregnant. But she has a multiple.

The best chance for having a viable, healthy pregnancy is to deliver just one baby. The odds go down a bit with twins and drop off rapidly thereafter.

If she has five growing embryos, the odds are against any surviving. And the risk to the mother, should she choose to continue the pregnancy also goes up.

Selective reduction is the term used for this medical procedure. Some of the multiples are “reduced” so that some might survive.

A family wanted a baby. The doctor’s advice about the best odds for getting one might come down to sacrificing others.

Before Roe was overturned, the medical profession, mainly infertility specialists, had the freedom to discuss these very painful decisions with their patients. Not now. Especially under Idaho law. I’ll bet a lot of those OB Gyns fleeing our state practiced infertility care.

Where will Idaho infertility be treated?

And we haven’t even started talking about in vitro fertilization (IVF). That’s what got the Alabama Supreme Court going.

I could try to explain IVF in twenty words or less here, but let it just be said that technology may be miraculous. But with such power comes the need for wisdom.

Every medical and pharmaceutical intervention has odds of risk and cost or benefit. Do you want to roll the dice? If it’s an infertility gamble, you might have to leave Idaho.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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