Late one night, a young patient was admitted to the ER in terrible pain. She felt it in her abdomen and chest, and soon had difficulty breathing. She grew pale — then paler. Luckily, an ER doctor sounded the alarm. “We established 3 IVs, ran labs, sprinted a runner to blood bank, and started prepping the patient for emergency surgery,” they (@RndmStreetMedic on Twitter) wrote. Hours later, the patient lay in recovery very lucky to be alive. She’d had an ectopic pregnancy, where the fertilized egg implants and grows outside the uterus.

Ectopic pregnancies cannot succeed; there is no room and no means of supporting the fetus. In many cases — indeed, in this one — the tissues rupture and lead to life threatening bleeding. The patient’s pallor was more than skin deep; she’d been bleeding to death on the inside. The doctor and the other Emergency Department team members were her only hope, and the only reason she’s still with us today. And yet, were there to be a nationwide ban on abortion, this patient would either be dead or, as the doctors themselves know best, she would be alive, but “we’d all be criminals for saving her” and “there’s nothing Pro Life about that.”

Abortion in this country has become a political issue, and a divisive one at that. The leaked decision by the Supreme Court and the public intentions of GOP members makes it clear that we’re only at the beginning; in addition to overturning Roe vs. Wade, Mitch McConnell suggested a full nationwide ban on abortion might be possible. But these aren’t only political ramifications; such legislation would deeply impact scientific practice. Here are just a few ways the fallout could limit the progress of science and medicine.

Emergency Medicine

The story I relate at the opening of this essay isn’t the only one of its kind. A colleague and friend of mine also suffered an ectopic pregnancy in her youth. She hadn’t known she was pregnant, and had she not been rushed into surgery, she would have died. Instead, she lived to have two lovely children (now young adults).

Ectopic pregnancies aren’t the only ones that threaten the lives of mothers, however. Seven-hundred women die annually in the United States alone from pregnancy and birth complications. In some cases, saving the life of the woman means terminating the pregnancy — but in many of these, the fetus would not survive either way (ectopic or tubal as one example). If an abortion ban were to be enforced, it would — as @RndmStreetMedic rightly states — either mean the death of the woman or the criminalization of the doctors.

It also means no more babies. Many who have had abortive procedures go on to have healthy children. The ban could mean the death of mother, of fetus, and — in a way — the terminus of a future child.

Fertility Support and IVF

Until the birth of Louise Brown, the first “test tube” baby in 1978, it seemed highly unlikely that IVF could ever lead to healthy births. Louise’s delivery had been cloaked in secrecy; doctors worked in near darkness and under police escort, her identity protected from the papers and sometimes from the medical staff. She is now in her forties, and the number of babies born since through IVF or other reproductive technologies is over 8 million, globally. More than mainstream, it is now an entire industry.

It is estimated that 30% of Americans have either been directly affected by reproductive technology or know someone who has. But how exactly does it work? What is involved? First, eggs are collected from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) is transferred to a uterus. One full cycle takes three weeks — and one or both partners may be on fertility drugs and dealing with complications throughout the process. The trouble is, not all IVF procedures are successful. Sometimes the embryo does not develop. As a result, most treatments use multiple eggs at a time. According to California’s Stem Cell Agency, the four to five day-old embryos are “left over” from in vitro fertilization (IVF). Implanted into a human womb, they would (or could) survive and be born.

My twin nephews were a single egg, implanted by in vitro fertilization, that split in two. My niece was once a fertilized but unused egg. It might have been frozen as an extra, donated, or destroyed. This did not occur, primarily because my sister-in-law had long considered this egg as her ‘girl on ice’ to have implanted at a later date — and I’m happy to say it was a great success. But what would happen if a nationwide ban declared that a fertilized egg could not ever be destroyed?

For one thing, the failed egg embryos (and they do often fail) would be potentially legal matters. If that seems extreme, recall that women who miscarry are already being arrested in some states. Then consider the extra eggs. They can’t survive on their own. They can’t grow without a uterus. In Louisiana, a bill on the docket would grant constitutional rights to “all unborn children from the moment of fertilization,” removing language about “implantation.” Would the law be content with keeping them frozen forever? Who would be responsible for housing these unused eggs in perpetuity? Or would it be mandated that each egg be implanted and carried to term as law-enforced pregnancies?

The concerns are real and have raised the alarm among fertility specialists; an urgent bulletin from the American Society for Reproductive Medicine warns that “measures designed to restrict abortion could end up also curtailing access to the family building treatments upon which our infertility patients rely to build their families.” The ban on abortion could limit or halt IVF all together, preventing 300,000 people (per year) in the US from having a child. It also means new techniques in fertility — research and development — could lose funding and support. The progress made since the 1960s could be reversed almost overnight.

Stem Cells and Cloning Research

“They were such tiny dots” wrote Jose Cibelli, Robert Lanza, and Michael West (vice president of research, vice president of medical and scientific development, and president and CEO, respectively) of Advanced Cell Technology, a privately-held biotechnology company in Worcester, Massachusetts.

In October of 2001, they had cloned the very first human embryos, clusters of 100-celled blastocysts. They were not interested in reproduction, and had no plans to implant their cells into a human womb. They were instead growing “starter stock,” and we can create these from any human cells (it doesn’t have to be sperm and egg derived). Stem cells are pluripotent (that is, having the ability to become any type of tissue). Under the right conditions, they would develop into nerve or muscle. They might be able to correct inhibited immune systems. They may be used therapeutically, to treat damaged spinal cords. It’s a brilliant and noble thing to help people walk again — but it still relies on these lab-grown embryos. Under a ban, we could lose all of these incredible, life changing advances. We could lose life-saving ones, too, especially in the field of organ transplant.

Marilia Cascalho and Jeffrey L. Platt (of the Transplantation Biology Program and the Departments of Surgery, Immunology and Pediatrics, Mayo Clinic College of Medicine) say it might be time to stop harvesting organs and start growing them. Stem cells have the capacity to become any organ in the body when implanted into a blastocyst — that primitive stage of egg development right after fertilization. They would begin with the patient’s own cells, so the donor organ would be a perfect match: the DNA is already yours. What if we could grow a replacement organ, or even a replacement limb? What if we could regenerate a damaged spinal column or rebuild a failing body? If we can use hollow egg blastocysts and insert replacement cellular DNA, it has possibilities for IVF, too.

On February 6, 2021, Australia voted to legalize 3-parent babies — a method first approved in the UK in 2016 (it is home to Dolly, after all). Replacing mitochondrial DNA of an embryo that has a risk of mitochondrial disease with healthy DNA from a donor, or the “third parent” saves lives and makes healthy birth possible. The first parent’s egg is hollowed out, it’s defective mitochondria removed. New DNA is then placed into the mother’s egg, and this new creation is fertilized. A three-parent child is born. Where once the condition lead to miscarriage or death of the child shortly after birth, now parents have a chance to raise healthy children. The future is very much on our doorstep.

Or at least, it could be. But as with urgent care for life-threatening pregnancies, traditional IVF, and stem cell technology, this too may be banned along with abortion. So much will be lost, so many families impacted.

The reversal of Roe vs. Wade has raised a specter that will continue to haunt us. It threatens reproductive rights and justice; it does harm. And in the conservative political scramble to take advantage of the moment, we may lose even more. We must resist this retreat into the past —

There is just so much at stake.