If Supreme Court shifts right, may push surrogacy overseas

If the Trump administration regime pushes the U.S. Supreme Court further to the right, it is possible that we will see fewer surrogacy and fertility procedures performed domestically ? exacerbating a shift that's been underway for years as American surrogates seek out more politically accommodating countries such as Canada, France and the U.K.

This is one of the most blatant areas in which U.S. law is becoming further out of sync with our needs. As surrogacies and in vitro fertilization procedures become more commonplace, we're making it harder for women to access treatments such as selective reduction procedures, one of the most common surgeries associated with the implanting of embryos because of the high potential for multiple births. Any tightening of abortion laws is likely to further reduce the number of U.S. doctors available and willing to perform such procedures.

Infertility affects approximately 10 percent of the population, and is recognized as a disease by the World Health Organization. According the Centers for Disease Control and Prevention, about 6 percent of married American women ages 15-44 are unable to get pregnant after one year of unprotected sex. Yet insurance in the American marketplace, including the Affordable Care Act, provides little to no benefits addressing infertility.

Laws regarding fertility and assisted reproductive technologies vary widely between countries, with some having a formal legal framework and others relying on official guidelines. The International Federation of Fertility Societies Surveillance 2010 report explains in detail the different legislation in over 100 countries. The countries with laws and statutes covering the legal issues of fertility treatment include Canada, France, Finland, Germany and the U.K. Countries where legal issues around fertility treatment are left to official guidelines include Australia, Cyprus, India, Mexico, Poland and the U.S.

Legislation comes into play at almost every stage, from whether you will be allowed fertility treatment to how long frozen embryos may be stored. For example, many countries, such as Turkey, China and Indonesia, only permit IVF treatments for married couples. New Zealand insists on a stable nuclear family to raise the child. By contrast, Spain, Sweden and the U.S. allow IVF for single people and homosexual couples.

Other legal and ethical issues that are regulated include the use of donor sperm and eggs. For example, anonymity is guaranteed in law for donors in Greece, but no longer allowed in the U.K. The use and payment of surrogates is banned in many countries but completely legal in India ? the most desirable global medical tourism destination for the purposes of achieving successful IVF. Also, many countries have strict single embryo transfer policies, while others leave the number of embryos implanted to the discretion of the fertility specialist.

Cost is the single biggest factor driving women to seek infertility treatment in other countries. These costs can be less than half, even factoring in transportation and lodging. The International Federation of Fertility Societies reports that the cost of infertility treatment abroad varies from up to $8,000 (approximately £5,000 or ?6,000) per IVF cycle in the U.S. to as low as $2,500 (approximately £1,600 or ?2,000) in the Czech Republic and Latvia. On average, IVF treatment in the major infertility treatment destinations costs between $3,000 and $6,000 per cycle. It's important to note that cost can be influenced by political attitude: If your laws are more liberal, you'll have more doctors offering such procedures. Increased competition drives down prices.

The IFFS is concerned that more women are seeking infertility treatment outside their home countries due to: (a) the increased costs and stress that this poses; (b) the lack of uniformity of standards of practice; and (c) accountability for the management of complications arising from treatment. The success rate for infertility treatments, across all age groups, at best hovers below 50 percent.

Multi-fetal pregnancy reduction is a procedure used to reduce the number of fetuses in a multiple pregnancy, usually to two. When a pregnancy involves three or more fetuses (high-order pregnancy), the risks of miscarriage, stillbirth and lifelong disability increase with each additional fetus. Assisted reproductive technology and fertility drugs have greatly increased the number of multiple pregnancies.

Multi-fetal pregnancy reduction is usually done early in a pregnancy and is most often done when there are four or more fetuses present. It's known as "selective termination" when it involves a fetus with severe defects or one that is expected to die later in the pregnancy, which would threaten the life of the surviving fetus or fetuses.

For this procedure, the doctor inserts a needle through the woman's abdomen and into the uterus to the selected fetus. The doctor then injects the fetus with a potassium chloride solution (component of a table salt and a compound used in death penalty by lethal injection), which stops the fetal heart. In Christianity, termination is strictly prohibited under any circumstances.

This procedure, as well as the rest of the assisted reproductive technologies, have caused and will continue to cause major controversy across scientific and religious scholars.