Ohio abortion ‘trigger’ bill could outlaw in vitro fertilization; increase infant, maternal mortality rates, physicians say

COLUMBUS, Ohio — An Ohio House bill that would outlaw abortion in Ohio under most circumstances could also criminalize in vitro fertilization, a Cincinnati fertility physician told lawmakers Thursday morning.

The bill would also likely increase the state’s already-high infant and woman morbidity and mortality rates, intrude on the patient-physician relationship and possibly result in physicians fleeing the state, obstetricians and gynecologists said.

With the U.S. Supreme Court poised to overturn Roe v. Wade next month, House Bill 598, if it passes, could be “triggered” or go into effect after the court decision is released. Thursday was the third committee hearing for the bill, during which opponents testified. However, the Ohio Senate president has said he doesn’t want any trigger bill to pass until he can see the Supreme Court decision.

Under HB 598, physicians and others who perform abortions through medication or instruments would face charges of criminal abortion, a fourth-degree felony. The bill specifies prosecutors cannot bring charges against pregnant women, but the bill has no exceptions for abortion in the case of rape or incest.

The bill would allow doctors who perform abortions to preserve a woman’s life and health to use medical records as an affirmative defense if they’re prosecuted. Another physician not professionally related to the first would have to certify in writing that the abortion was necessary. When the abortion occurs, another doctor needs to be in the room to “take all reasonable steps to preserve the life and health of the unborn child,” the bill states.

Dr. Thomas Burwinkel, a Cincinnati obstetrician and gynecologist specializing in reproductive endocrinology, noted that House Bill 598 defines an “unborn child” as a Homosapien organism that has been fertilized. That definition could make IVF illegal, he said.

“HB 598 may erase the dreams of many patients of becoming parents through IVF or other reproductive technologies,” he said. “The bill defines an embryo created from IVF as an ‘unborn child,’ even though most of the embryo created from IVF will never survive to be implanted into a patient to have a chance to turn into a pregnancy.”

In addition to embryos before they’re implanted, HB 598 creates problems for fertility doctors and women after they’re implanted.

Sometimes, doctors perform selective reductions, a procedure to stop the heart of a fetus, which is usually reabsorbed into the woman when there is a multifetal pregnancy. That would have to end under HB 598, he said.

“This practice will result in triplet, quadruplet, quintuplet or more pregnancies,” Burwinkel said. “These patients would not have the option under this bill to make these very high-risk pregnancies safer through the use of selective reduction. This is a medical procedure used to reduce the number of embryos to a number that is safer for her and her fetuses.”

Tim Ginter, a Columbiana County Republican, asked Burwinkel the percentage of pregnancies that result in selective reduction in his practice.

Burwinkel said his practice helps over 2,000 pregnancies a year from in vitro and medication treatments. Selectively reductions tend to be very low since modern fertility treatments result in fewer multifetal pregnancies. The last selective reduction that he remembered was four years ago. He said that women with quintuplets, quadruplets and triplets are more likely to consider them.

He described one pregnant patient with triplets who didn’t have a complete uterus. He said it was about half the size of other women’s, and she opted for a selective reduction of two fetuses and delivered one baby at 33 weeks, which is still early.

“I’m fairly certain she would not have made it to term or viability with triplets,” Burwinkel said.

Dr. David Hackney, a Cleveland OBGYN specialist in maternal-fetal medicine, said the current Ohio law that bans abortions at 20 weeks already makes it difficult for doctors to practice. As a result, some lethal fetal genetic disorders and congenital disabilities are not diagnosed until past the gestational age limits.

“Today we are already having to tell many of these patients they must travel out of state as we are unable to provide their standard medical care in Ohio,” he said. “Those who do not have the means to do so are forced to continue. It is difficult to imagine what would happen if pregnancy discontinuation for fetal or obstetric indications is outlawed completely. Many patients will be unable to travel, and the proportion of those who have to suffer through entire pregnancies will certainly be disproportionate by class, income, ethnicity and race.”

Ohio University medical student Shivani Deshpande said that students wouldn’t be able to receive complete medical training under HB 598.

She plans to stay in the state because she grew up in Ohio, but that won’t be the case for all future doctors, she said.

“Others will leave Ohio to seek proper education and the ability to practice accurate medicine,” she said. “If abortion is banned, Ohio faces a future with undereducated, under-experienced healthcare professionals,” she said.

Rep. Andrea White, a Dayton-area Republican, asked Dr. Amy Burkett, a Northeast Ohio OGBYN hospitalist, about the broader needs of women who will have to carry pregnancies to term.

“I’m wondering, from your perspective, what prenatal supports and postnatal supports do the women of this state need that we are currently not providing?” White asked.

Burkett mentioned reversing the state’s maternal and infant morbidity and mortality problem and harmful social determinants of health that influence health and quality-of-life outcomes, such as economic stability, access to quality education, safe housing and a clean environment.

“We have a long list of social determinants of health that I won’t detail here that women need support for,” Burkett said. “A pregnancy in a person who is already struggling adds to all of that. And so, a woman who chooses to continue a pregnancy, she needs support not only through the pregnancy but beyond. Beyond to the 18 to 20 years that she will be taking care of that child, her own medical conditions and any medical conditions that that child may have.”