Chris Charbonneau: My name is Chris Charbonneau and I'm the host of the Fall of Roe podcast. I'm a 40-year veteran of the pro-choice movement. I have been the CEO of Planned Parenthoods in seven different states, and have decades of experience in the pro-choice realm.
This is an unapologetically pro-choice podcast. We are going to talk about the disaster that is the unfolding dismantling of the Roe standard across the United States creating 50 states' worth of patchwork laws, the danger that that poses to anyone of reproductive age, and all of us who love them.
We need to figure out how we as a collective are going to get through this, change this situation, give ourselves some hope and get back to sanity in this country.
Welcome, friends! This is Chris Charbonneau and this is the Fall of Roe podcast. It is my great pleasure to welcome Dr. Lora Shahine to the show this morning to talk about the most planned of family planning, fertility treatment, and in vitro fertilization and what the fall of Roe means to people who've been attempting to plan their families. And the giant monkey wrench, the fall of Roe throws into all of that for people who desperately want to have children and are not able to.
So, we often think of abortion around the finger-wagging and teenagers, and all of that. This is so much a bigger issue. And here to talk with us about this is Dr. Lora Shahine. Dr. Lora Shahine has her own YouTube channel. I urge everyone to run over there and consume what she has to say. Dr. Shahine, welcome to the show!
Dr. Lora Shahine: Thank you, Chris. I am excited to be here. I've just absolutely loved your podcast and what you're doing and it's a real honor to be here.
Chris Charbonneau: Thank you very much. Tell us, because I don't want to put words in your mouth, what the fall of Roe means to you as a doctor who attempts to put families together all day long. And I think a lot of people and I know I hadn't, given all the aspects of what you do the same kind of weight as we give to people who are experiencing an unintended pregnancy. What about intended pregnancy?
Dr. Lora Shahine: Absolutely. I think that being a reproductive endocrinologist, which means that I've studied and helped deliver babies as an OB-GYN, but then now really focus on people building their families with IVF. I'm fortunate enough to work at Pacific Northwest fertility in Seattle, Washington, which is a blue state. I don't foresee an immediate impact to me, but I think I can provide a really important perspective that people have not thought of yet how these trigger laws and laws that are focused on protecting life at every stage could impact people who are trying to build their family with IVF.
Chris Charbonneau: Well, walk us through that process.
Dr. Lora Shahine: Absolutely. So, as soon as Roe v. Wade was overturned, there are several trigger laws that went into effect trying to ban abortion and criminalize it, of course. But a lot of the language in these personhood bills - which are not law yet, but are very close – these personhood bills that define life at fertilization and want to protect life at every stage can really impact how we practice IVF because defining life and protecting life at fertilization means protecting it at an embryo and as an IVF doctor, we are working with embryos every single day as a way to build a family.
So, what this could mean is if those personhood bills do go into effect, someone else gets to decide whether we're hurting embryos. It's basically giving rights to embryos, like people.
And so, someone else can decide that it's not okay to freeze embryos, someone else can decide it's not okay to do genetic screening on embryos, because the way that we do that, is we biopsy cells away from an embryo, and someone could decide that biopsying cells is harming the embryo.
Though if this goes into effect, we could be limited on how many eggs we can fertilize. So, we saw this in Italy from 2004 through 2009, when the government decided that doctors helping people build their families with IVF couldn't fertilize more than three eggs. And the patients had to transfer any embryos that were created from that IVF cycle.
Chris Charbonneau: Wow! So, every potential child through an embryo would need to be transferred into someone otherwise you couldn't create it.
Dr. Lora Shahine: Exactly. And so, it’s dramatic how much this changes the way that we do IVF. The way that we practice has dramatically increased the chances of success, dramatically decreased risky pregnancies from multiple gestations, and testing embryos for genetic issues has decreased disease – cystic fibrosis, sickle cell disease, muscular dystrophy - it's amazing what we can test for.
And if all of those things are changed with the feeling that you're protecting the embryos, you are really harming the people that are trying to get access to care. IVF is already limited, it's already so expensive, and it's hard for people to get access to it. And all of these changes could only increase costs and increase limits to something that is already far too limited.
Chris Charbonneau: So, here's a way in which the fall of Roe impacts the wealthy, not just low-income people and people who have been medically underserved over the years. This is all of us in the world that are attempting to become parents, so, watch what you're willing to let go in your political environment.
It is not surprising to me that this has become an issue because back in the day, the anti-choice movement began what they called a snowflake campaign. And that is what they called embryos in freezers that they believed had the same rights as walking around living people. And therefore, you were very limited with what you should do with the embryos and the snowflakes – snowflake is not my term, it’s theirs.
But we all had Roe and we thought, well, that's going to be that. But in today's dystopian world, it isn't far-fetched to wonder what they're going to want to have happen with all the embryos already in freezers, right?
Dr. Lora Shahine: Well, Louisiana has had a law in place since 1986, that does not allow people to dispose of embryos. And that is another thing that could absolutely be controlled if embryos are given rights.
Chris Charbonneau: Yeah. So, you might have embryos in freezers that maybe are required to be implanted into somebody or something.
Dr. Lora Shahine: Yeah, or indefinitely paying storage, which can increase costs. Right now, my patients have the option of either transferring the embryos, but if their family is complete, they can discard the embryos, they can donate them to science or in the lab to improve success and learning, or they can donate embryos, of course, to other couples. And embryo donation is a wonderful way of building a family and I've helped lots of families build this way.
But one thing that's really important that I've learned is that language is extremely important. So, this process is called embryo donation, not embryo adoption. But you'll see the term embryo adoption in the literature or journalists, and that's tenuous because that word adaption gives inherently just the way that we feel about that word rights to the embryo that right now they don't have, but we have to be careful.
Chris Charbonneau: Right. Well, then you can imagine these embryos lasting a lot. How long do they last in the freezer?
Dr. Lora Shahine: Indefinitely, there's a great story out of the UK several years ago, an embryo that was frozen for 29 years, was transferred to a different couple, and the embryo donation process resulted in a beautiful baby. So, there's no freezer date or freezer burn for embryos, they really can last forever.
Chris Charbonneau: I don't successfully keep a steak for more than X [amount of time], and we can do this, it’s pretty amazing technology, and also a technology that is apparently coming back, maybe, to bite us as we deal with this shifting landscape.
I am really familiar with the issue of embryos becoming issues in divorce cases and a variety of things like that. I mean, imagine these embryos going on for decades after one thought that they might use them and that those now have personhood rights that we have not yet conferred on anything before.
Dr. Lora Shahine: Absolutely. I can't remember the actress's name right now. But the beautiful actress from the show Modern Family, created embryos with a partner, they were not married, I think they were engaged and then broke up and he wanted to transfer these embryos and she didn't and it just turned into a really messy court case.
I do talk to my patients about really thinking through meeting with a reproductive lawyer before they create embryos to kind of think through what could happen if you break up in the future. Chris, I think that something that people just really don't understand is just how inefficient human reproduction is.
Chris Charbonneau: I've often thought the same thing. Mother Nature takes a hand a lot of the time.
Dr. Lora Shahine: Exactly! I just want to explain that it might take 15 or 20 eggs for you to create a baby. And so, even if you want to protect embryos or things like that, people, I just don't think to realize that especially let's say, for example, a woman with ovaries and eggs is 40 years old, it might honestly take 20 eggs turning into maybe five to six embryos to test. And she might find one normal embryo that she could transfer and have even then 70% chance of live birth, nothing is 100%.
And so, if that person is told that she can only fertilize three eggs at a time, that is a dramatically huge increase in cost to that person to have a baby.
Chris Charbonneau: And they may decide you're not allowed to fertilize anything outside your body.
Dr. Lora Shahine: Oh, boy! Yeah, that's taking us back to fertility treatment 50 years ago where you did have to do laparoscopy, so the camera in the belly button and take eggs and sperm, and it's something called GIFT, where you actually put gametes into the fallopian tube, so they can fertilize there.
Oh my gosh! So, I have been helping people build families for over 15 years. I've never even seen that procedure before. It's so outdated because it's so inefficient and it's increasing risk to the patient because they're having to go through surgery to do that. So, yeah, just the fact that you brought that up, I'm like, my gosh, here's something else for me to worry about.
Chris Charbonneau: Sorry about that. I didn't mean to traumatize you but I mean, there's nothing that says anyone would permit any kind of embryo creation?
Dr. Lora Shahine: Oh, absolutely. And think about the lack of access to medical care. I mean, there are so few people graduating from this field. And where are they going to want to practice? They're going to want to practice in states where they're able to practice medicine that's the best for their patients. And there's going to be a mass exodus of doctors from states that are really limiting them.
Chris Charbonneau: True, a red state, blue state divide. I think this will actually come to haunt corporate America as well. It's one thing to say we're going to ship our current people into another state where they can get the abortion care that they need.
It's quite another for A-level talent to say, ‘I'm going to move myself or my family or my family with young daughters into a state where they get treated like this.’ And so, all the talent and all of the professionals end up in the blue states where you can make your own decisions.
I mean, why would you pick some sort of second-rate state if you could go somewhere where you can live your life? Yeah, absolutely. I don't think corporate America has really gotten its arms around how devastating it is to make half the population less free than it was, and it has expected to be throughout their entire lives.
Dr. Lora Shahine: Yeah, I think we're all still processing. I mean, I'm not surprised that this happened. It's been under threat for 50 years, but I’m just shocked and trying to figure out how to process and move forward.
Chris Charbonneau: Right. Well, there were so many ways we could tell ourselves that the Supreme Court weren't really the hacks we thought they were, and look how wrong we were and with this as a cost.
One of the things I was fascinated to hear you talk about in your YouTube videos - which, once again, I'll say everybody needs to go watch - is the way in which it prevents you from would prevent you if you were in a red state from giving the best care to the people that you're seeing in a variety of circumstances, quite apart from some of these technologies and how they might slice and dice that for your profession, that it would require sort of, well, you described a little bit, the much more invasive ways that one might have to go about things. But what other ways would care be compromised from today's standards?
Dr. Lora Shahine: Sure, a huge part of my practice is caring for people in the first trimester of their pregnancy. And so, I'm helping people through miscarriage and failed pregnancies and anomalies and multiple gestations and trying to navigate how to care for the patient in a compassionate but also medically appropriate way.
And so, again, this has not impacted my personal practice in Washington State, but I have talked to colleagues who are trying to help people with ectopic pregnancies that are scared to go to the emergency room or they prescribed the medication misoprostol, which is a medication that can help expel contents of the uterus out of the uterus. It can also be used to soften the cervix before a medical procedure called a hysteroscopy where you're just looking inside the uterus to treat things like fibroids and scarring. And their patients are having to go to multiple pharmacies or being treated like criminals just trying to fill the prescription. And these people are already under so much grief. These are highly desired pregnancies that they have stopped developing and they want to use the medication in order to move on and try again for this family and they're being just re-traumatized by just trying to get medical care.
Chris Charbonneau: Right! Misoprostol is the second pill in the abortion regimen, RU46, and then, usually, misoprostol to help the uterus evacuate. And actually, misoprostol is an abortifacient on its own, used in certain kinds of ways. And therefore, it's going to be a targeted drug.
Misoprostol, according to the World Health Organization, is one of the wonder drugs of the last 40 years, they have a list of drugs that have been the most life-saving on the planet. And misoprostol is one of those listed because of its life-saving properties in the care of women. Also, it can be kind of good for ulcers and arthritis, and a couple of other things.
Lora Shaine: Absolutely! Methotrexate is a medication used to treat ectopic pregnancies, a pregnancy that's developing in the fallopian tube that if it's not treated quickly enough could result in a rupture of that fallopian tube and bleeding and hemorrhaging. And so, this medication can stop the development and the rupture of that ectopic pregnancy and can be life-saving, and can avoid surgery. But people are having a difficult time getting it dispensed. And this is affecting people who use that medication for other reasons like rheumatoid arthritis. There are people that can't get medication to help them with pain because it's a confusing time and people are worried about dispensing this medication and then getting prosecuted.
Chris Charbonneau: Did you read in Louisiana that they first attempted to make it illegal to treat an ectopic pregnancy? And then, somebody had to explain to them that that would result in lots of dead women.
It seems to me that if you don't really have a handle on this kind of thing. I'm struck by the differences between the gun conversation and arming people and abortion. I mean, people will yell at you, if you don't understand the technical term for some piece of an automatic weapon and tell you that you really don't have any business regulating anything about guns if you can't take that apart in 20 seconds, clean it and put it back together and name all the parts according to what they think they ought to be named. And yet, they'll say things like, let's not treat ectopic pregnancies. Talk to me about what happens in your head, when you hear a story like that?
Dr. Lora Shahine: Well, they just don't understand the medicine. Just last week, I had a patient diagnosed with an ectopic pregnancy and was talking about how sorry I was and just such a highly desired pregnancy. She was like, ‘Please, Dr. Shahine save it. Save the pregnancy. Can't you take it out of the tube and implant it into the uterus?’ It was because she read that online. I had to explain to her, ‘No, once it's implanted, you can't. If I could, I would. I want this pregnancy to continue just as much as you do.’ She honestly, I mean, we came together, we have a wonderful relationship built in trust. And she got the treatment that she needed.
But what about the women who go to the ER, don't understand, and they're mad at their providers because they're worried that the providers are trying to take away this desired pregnancy, and then it's just a mess. It's an absolute mess. It's people making decisions that don't have the full story and haven't cared for women in all reproductive stages.
Chris Charbonneau: It's pretty shocking, really. It's shocking how very impactful all of these decisions are to so many people, and how very little thought is given by politicians who are making names for themselves.
What's your biggest fear about this new thing? I mean, I realize you and I are sitting here in Washington State, and we not only are protected, but we have shield laws protecting us, as many of the blue states are beginning to do from things you do for other people. But what's your big fear for your colleagues in your profession? What does it mean going forward to have half the country shut down for what you do?
Dr. Lora Shahine: I worry about medical training. I mean already, residency programs and fellowship programs that are in really restrictive states are trying to find training for their medical doctors that are going to be taking care of women. Maternal mortality is already at an all-time high in developed countries around the world – the United States is only going to get worse.
I do really worry about the medical deserts, right? Places in the country where women just can't get reproductive care because nobody wants to practice there. I worry about my colleagues having to fight in order to provide good medical care – whether they're fighting administrative people in their hospital, or they're fighting lawyers, or they're even fighting misinformed patients, not fighting but sort of trying to explain like, “No, I can't save an ectopic pregnancy, even though your senator said it last week on the news.”
So, I worry about mental health. I worry about emotional frustration. I worry about burnout already kind of coming out of the pandemic. And I just think it's bigger than anybody has really thought through and kind of all in the name of power or trying to push yourself forward or bowing to a minority of people, honestly. I have a question for you, Chris.
Chris Charbonneau: Yes.
Dr. Lora Shahine: So, when we're talking, we're very like-minded. I love how you introduce yourself on the podcast, like, 'I am an unapologetic pro-choice'. I mean, we can go through all the logical explanations and the downstream effect. And I think the people that are already like-minded, like us, are like, ‘Yeah, see how hard this is?’
But how do you “argue”, and I put argue in air quotes, how do you talk to someone that just absolutely equates abortion with murder, and can never look at these really difficult medical decisions than any other way, just with your experience, and doing this over 40 years and talking to people and practicing, or being involved, like even pre-Roe, you know, any advice on that?
Chris Charbonneau: Well, I have found that being anti-choice is less a matter of religion or theory or any of that. It's almost exclusively in my experience, a failure of imagination. People cannot put themselves into other people's shoes, or even their own shoes in the future. And that, often, it's because there has not been deep thought given to these things.
When you put hypotheticals like this in front of people, “Do you really want to prevent your sister from building her family using infertility treatment because you have made a set of rules that don't allow it to work anymore?”
People start to question themselves. A group of people always go back to this doctrinaire place. They totally want some external person with so little information, they're willing to say women need to die because I don't want to see them have ectopic pregnancy treatment.
You can get people to go to those very doctrinaire places. But I think that's why Lora, the vast majority of Americans didn't want to see a change to Roe, they may have said, “I'm anti-choice”, but they also realized that Roe was already a compromise decision. And that it has been an equilibrium that was struck over many, many years of people trying to figure out how to deal with abortion in America, and that it didn't give people everything they might want.
There are some real limits to the Roe standard. In my counseling, I ended up telling many women that they were too far to have an abortion anywhere in America and that we were all going to need to wrap our arms around her and help her get her head around planning for a child and then figuring out what to do with that in any way there was.
But we would end up with young people who denied the pregnancy so long that they were going to be over 24 weeks and there wasn't going to be any solution to that. And so, thankfully, those are relatively rare cases. But it was my experience that people who got very doctrinaire believe that abortion was okay in three circumstances: rape, incest, and me.
And so, I can't tell you how many people picketing outside the clinic that then brought their daughters in. And one guy said to me, ‘Well, she's only 14.’ And I said, ‘Well, a lot of them are only 14.’ – “Well, I talked to God.” “Like, yeah that's the cell plan I want to have, right?”
So, people find ways to justify what they do. And that's why you'll find some anti-choice people that have had a bunch of abortions themselves, that “theirs are different”. I think that what's called on is this kindness and openness and empathy for everybody in these terrible positions. And that we tried to help people do what it is they need to do to lead a life that works.
And many of these are folks that already have children to take care of and don't really want to compromise how three other kids get their lives organized because we're going to force somebody into a fourth pregnancy that they can absolutely not manage.
It's very facile for people to say, ‘Well, just give them up.’ I mean, Amy Coney Barrett did this and I was just like, ‘What a monster.’ You think, “Well, this is really suboptimal.”
So it isn't that we have to convince the majority of Americans - we already have. It's that the majority of Americans need to go vote and make sure that their elected representatives represent a compassionate view of what's happening. In your field, I mean, I cannot imagine the stress of people trying their hardest to build their families. And then you add this on to it. Are they going to let vigilantes go after people in states where they are trying IVF treatments, and somehow, you're discarding some embryos along the way? Are they really going to do that? Is that worth 10 grand apiece to anyone who rats them out? I mean, is this the America that we want? You know, you wonder.
Dr. Lora Shahine: I appreciate that. You reminded me as I was listening, my patients, people who are struggling with infertility and with recurrent miscarriage, are already feeling marginalized. They'll have a cocktail conversation, like, ‘When are you going to have kids or when you're going to add to your family. It's so selfish not to have siblings.’
And they're trying or they just had a miscarriage last week, and then, if something happens, the comforting words in air quotes that come are, “Everything's meant to be. It's in God's plans.”
So, I just see if I'm arguing that politicians should stay out of my counseling and my IVF lab because I'm helping people build families, people can push back and say, “Well, it's in God's plan.” If these people were meant to be parents, they should just be able to get pregnant naturally – because it's very easy to stand back and sort of judge. Or another thing is “Just adopt”, like it's so easy and straightforward.
And so, yeah, it’s so many different viewpoints. And just like abortion people could say, “Well, if you can't get pregnant without intervention then you aren't meant to be parents anyway.” Right? It's just incredible.
Chris Charbonneau: Yeah, I mean, the ways in which we can cut each other to the quick in a few short sentences that we can even pretend to ourselves are compassionate. It’s pretty phenomenal and for many people, I'm guessing, that have thought about themselves as becoming parents at some point in their lives, all their lives, every time you succeed in pregnancy is a dream, and every time something fails in your vast attempts to help, I'm sure it feels like a failure to the people involved.
And what is a trauma to go through, to begin with, let alone have the eyes of the world watching you in some judgy kind of horrific way. And then, to sort of say, ‘Well, you can do it, Dr. Shahine, if you can do it without 70% of the tools in your tray.’
Dr. Lora Shahine: Exactly. At increased cost to patients and harder access and already something that is limited to too many people. It's just gonna even make that divide even further, quite honestly.
Chris Charbonneau: Well, I can’t imagine that the insurance companies would be covering something in states that wasn't legal, right? I mean, much of it's probably not covered by insurance today, and even less of it would be.
Dr. Lora Shahine: I am fortunate in Washington state that there are a lot of tech companies – Microsoft, Amazon, Facebook, Google, that really do cover it and so a lot more people where I am, have access to care, but it's not enough. I mean, it's by a company in the state of Washington, not mandated coverage.
Chris Charbonneau: Right. So, how do rural women go about getting care from you for infertility? It seems to me the kind of thing that would require a whole lot of face time.
Dr. Lora Shahine: Yeah, well, we do have telemedicine. We have a lot of patients from Alaska and from different parts of the country. We can do a lot of talking through telemedicine and education, and they can sometimes get some of the early ultrasound and early medication at home and then just fly to Seattle for the rest of their care.
So, that is possible. But I just worry that we're already having a little bit of issues meeting the current demand of our patients in the state of Washington. So, if IVF is limited around the country, I don't know how we could possibly accommodate so many more people, right?
People are even saying, ‘Well, I'm worried about maybe what I can do with my embryos in the state of blank. Maybe I'll just ship my embryos to Washington.’
But embryo storage is limited and it's really expensive, and just moving the embryos, there's a risk in transport. And so, the answer is not to make the divide even more. I also don't want to wait until these laws are in effect to react to them, sort of like the overturn of Roe v. Wade, I want to get out ahead of them and make sure that IVF access is protected.
Chris Charbonneau: Yeah, I would just like to say that anyone who thinks Dr. Shahine is being hysterical, which is a favorite thing people like to say when we raise real issues, I host a podcast called the Fall of Roe because Roe fell, people.
At what point are we going to say the things we're imagining are because we're being strategic, not because we are fearful. So, absolutely, all the doctors that work in your profession in half the states are in the wrong profession in the wrong place all of a sudden, and not able to use a lot of the tools at their disposal, or they do so at professional risk to themselves.
So, probably a good many of your colleagues, unlike the folks that provide abortion as a career, probably didn't imagine themselves quite in the eyes of this target.
Dr. Lora Shahine: Absolutely, we do feel that way.
Chris Charbonneau: So, what are you talking about in professional circles?
Dr. Lora Shahine: Well, we're paying very close attention to our professional medical societies, the American Society of Reproductive Medicine, and the American College of OB-GYN, and both professional societies have put out very strong support for the profession and against government interference in the medical doctor-patient relationship.
But there are limitations to what professional medical societies can do. And so, we have a grassroots effort that, it's going to launch officially, next week. It's called Doctors for Fertility. It's some reproductive endocrinologists, just like me, trying to come together, form a pack, try to get ahead of this, and really support our colleagues in different states that are not protected like I am.
Chris Charbonneau: Well, that's fascinating – Doctors for Fertility. Is it raising funds? Or is it lobbying for legislation? What's it doing?
Dr. Lora Shahine: Yes, yes, and education. So, trying to help people understand how IVF is currently practiced, and keeping it the way that it is now in order to increase access and take the best care of our patients.
Chris Charbonneau: Well, I think that that's an important effort and for education, hopefully, your YouTube channel and my podcast can go some way to putting out there the framework of why this is problematic.
Do you think that there will be exceptions, and people will say, “Fertility is for good women who want to have babies and abortion is for bad women who don't?” Are you worried about that kind of dichotomy being created in the law?
Dr. Lora Shahine: Of course, I mean, the whole narrative around abortion, that word has been – I talked about how important language is. I'm actually a writer, so I think deeply about that. The word 'abortion' is a medical term.
Stop making the narrative abortion is a promiscuous woman who doesn't care if she gets pregnant or not, because she can fall back on abortion as a way to make sure she doesn't have a baby. Abortion is a pregnancy that stops developing and needs to come out of the body in order for the woman to maybe try again if she's actively trying to build her family.
So, you get your medical records or your insurance bill and you had a miscarriage, it'll say 'this patient had a spontaneous abortion'. And my patients call me and say, “Why did you put the word abortion in my medical record?”
That's awful. I’m like, “No, no, no, that is a medical term. It just means termination of pregnancy.’ So, trying to just re-educate and absolutely trying to, I mean, it's almost like the Madonna versus prostitute, right?
Chris Charbonneau: Right.
Dr. Lora Shahine: Like, women either fall into one of these two categories. So, maybe, like you said, small minded people can rally around like, “Well trying to build your family is for good people that are trying to get kids on this earth”, and abortion, which again, it's a medical term, but the way most people are using it these days is for bad women that aren't being careful, are being frivolous.
Chris Charbonneau: Or are unnatural, and don't want to be parents when all women should want to be parents. I had this conversation with insurance executives when we were trying to get contraception covered. And I said, “Well, now that you're covering Viagra, surely it's clear to you why you'd need to cover contraception as well.” And they were like, “Well, Viagra solves a medical problem and pregnancy is not a medical problem.” It's like, “Pregnancy can kill you and not having an erection almost never kills you. I'm going to make you hear it in your heart, but you will not die from this.” So, it's like, “What are you talking about?”
Dr. Lora Shahine: Absolutely.
Chris Charbonneau: This odd way of framing and when people say “All women want to become mothers”, and all that, they're almost never women because most women know that there are times in your life that that might be the most optimal possible choice. And there are vastly more times in your life when you would never want to be pregnant and it needs to be possible for that to be the case.
Dr. Lora Shahine: Absolutely. Well, contraception is used for so many medical conditions, not just for preventing pregnancy. It’s for helping heavy periods, PCOS, and pain with endometriosis. Like, that is so small-minded to try to put it into this little tiny box, just like we were talking about the different uses of misoprostol and methotrexate. It's just not looking at something through a medical lens. It's trying to make legislation from some moral perspective, but it really impacts medical care and lives.
Chris Charbonneau: Well, back in the day, it was possible to get birth control paid for as long as you weren't using it as contraception. And once you're using it as contraception, well, all bets are off, “We're not covering that.”
It was just the most exasperating conversation of my tenure because it was so dumb. It was just like, how to be effective when you think the person, you're talking to is so dumb. It ultimately came to be, thank heavens, through a lot of people's very good works. But we spent decades convincing people that contraception was important. I would like to think that there's something deep down that says to people that infertility treatment is a gift to people who really, really desire having their families built biologically. And for a lot of people that are in non-standard kinds of families – and by standard, the 1950 standard. So, talk to me a little bit about parents who want to be parents that are not in sort of cis-gendered man-woman households?
Dr. Lora Shahine: Absolutely. Well, so my patients who are in the LGBTQ+ community are terrified like with the overturn of Roe v. Wade, what are they coming after? Next, is it going to be same-sex marriage? Honestly, the use of IVF and assisted reproduction for that community could make IVF even more of a target because they can make people with two uteruses, all they need is sperm, and they can help build these, air quotes, “non-normative” families, and that makes us even more of a target.
Chris Charbonneau: Yeah, tools of the devil there, Dr. Shahine. I mean, I think it's, it's been wonderful. Some of the most fabulous parents on the planet are sort of unconventional families or unconventional in 1950s terms families, I think they're perfectly conventional, real families. But what a set of conundra. Is that plural for conundrums?
Dr. Lora Shahine: Sounds great.
Chris Charbonneau: Yeah! To put in front of people. Talk about sort of the mental weight that the fall of Roe has had on you.
Dr. Lora Shahine: Oh my gosh! Do you have another hour? I have only practiced in a sort of Roe era. But my mother and my family, growing up in North Carolina, certainly have told me horror stories of friends in the 60s that you've shared on your podcast, too. And so, I'm very grateful that I'm working in a protected state, but also very aware that the assumption that it's going to be this way forever, or that people working in blue states aren't going to be affected, that is absolutely not true and it is impacting all of us.
I also just feel it's the tip of the iceberg. So, when you talk about a weight, like, even though my personal focus and the work that I'm doing with Doctors for Fertility is really focused on my lane and access for fertility care for people that want to build their families. I am looking at it as an attack on human rights, and what are they coming for next.
And I really do wrestle with a sort of giggle, and I sort of laugh when you say the word 'dumb', and that it's very small-minded. But growing up in North Carolina, in a community that is sort of very religious forward, I can see the other side and I can see that balance. I want us to somehow continue the conversations. That's why I was asking you like, we're very like-minded, we have a conversation, we're agreeing with each other. That's so great. But just social media, states, laws, everything is just pulling people apart. And how do we somehow come back to the table and have a civilized conversation in a way? So, yeah, those have been my thoughts over the past week in between tears.
Chris Charbonneau: Yeah. What sort of outcomes do we want? Do we really want to force people who've been raped to carry those pregnancies? Do we really want incest victims to have that be their entire lives, not just their young lives? Do we really want people to struggle like this trying to build families? Do we really want teenagers to be having children that they can't support in any emotional, physical or financial way?
I think, in many cases, Americans agree on the outcomes we want. It's a little different figuring out what problem people think they're solving. So, with teenagers, it's been my experience that the problem that folks think they're solving is teenage sexuality. You have to bottle that up in some way and there can't be any kind of release for it. And having been in that field for a long time, it's like tilting against windmills. It's virtually completely normal for human animals to want to be sexually active sometime in their late teens. And other than kids in body casts, you can almost count on it.
And so, if you just look at the realities of the situation, and don't assume that one gender needs to overcome that to make up for the other genders entirely not ever needing to overcome that, you get yourself out of the sort of mix that they throw themselves into.
Yeah, I mean, I think that this is wildly traumatic for all the people going through it. Just being a person trying to build a family today and the people searching for abortion care today have a special trauma in that the world is in total turmoil about that, and that we're all just understanding the massive implications.
I think it's more than what the people who've wanted to make abortion illegal have ever bargained for. I don't think they have a real view of what that could be like.
Dr. Lora Shahine: Yep! And just focusing on the small group of people just really celebrating right now, it's hard to watch because I just don't think that they see the future fallout. And so, it's hard to see people celebrating a moment where human rights have been taken away from a lot of the population.
I know that we talk about and focus on women because it's people with uteruses that are getting pregnant, they're getting told what to do. It takes two people to get pregnant. What about the men that don't have access to their partners being able to make a decision together? This is everyone. This is not just people with uteruses.
Chris Charbonneau: It is everyone and some of the most outraged people that I've spoken to have been men who are both undone for the safety of the people they love. And know that this has an effect in 37 ways on every man in the United States. There is a research study going on at the University of California about the impact of abortion on men, and the economic downsides when you do things like this to the entire economy.
So, things aren't all about money, but you create difficult medical scenarios and you get a lot of absenteeism and you get a lot of expense and you get all kinds of insurance costs if people think that it's cheaper to pay for miscarriages after a Roe situation than before.
I don't know about you, Lora, but I'm hearing from colleagues all over the country that there are women with planned pregnancies that end up bleeding and various things, and people are terrified to take care of them.
Dr. Lora Shahine: Yeah, or ectopic pregnancies, trying, delaying care until they can talk to lawyers.
Chris Charbonneau: Yeah, and figuring out what side of what line they need to be on while she's bleeding out in the other room. I mean, I don't blame the doctors for being confused and for not wanting to open themselves up to litigation and 35 vigilantes coming after their entire life's fortune and all of that. This is crazy time.
Dr. Lora Shahine: But I want it to be an opportunity moving forward. I mean, I have learned so much in the last week, just how sort of faulty the very original decision of Roe v Wade was, even if ethically it's the right thing, just legally, it was so easy to sort of chip away. And so, this is going to wake us up and help us change with something more permanent.
Chris Charbonneau: Yeah. Well, I think that the way they went after Roe in this decision, was none of that clever stuff. It was like, “If they didn't bring it up in 1725, then it isn't in there.” I would remind everybody, as I have a couple of times, women are not mentioned in the Constitution by the original papers, and yet here we are.
And so, women and anyone who's born with a uterus, no matter how they identify today, there's no protection for you and that's why likely we are in for more with, if you use that rationale, a good many of the rights that we have held most dear that have kind of come to be in the last 100 years, don't really have a basis. So, yeah, I mean, what do you do to put together a new basis?
Tell me how people get in touch with Doctors for Fertility?
Dr. Lora Shahine: Website – doctorsforfertility.com. And then, we have social media, Instagram, Tik Tok, and Twitter. It is officially coming out in mid-July, but we've been working really hard on this for a few months and are excited about the official announcement.
Chris Charbonneau: That's fantastic. Dr. Lora Shahine, thank you for all that you do for all the people who are trying to deliberately build their families and for being thoughtful about what to do in this nexus we find ourselves in. Thank you for coming on to the Fall of Roe.
Dr. Lora Shahine: Thank you for this opportunity, Chris. It’s just a true honor.
Chris Charbonneau: I really enjoyed talking to you. Great information. Thank you all. Thanks for listening. Come back for our next episode for the Fall of Roe.
Thank you for listening, friends. This is Chris Charbonneau. It's been my pleasure to host this broadcast for you today. If you'd like to hear more, please subscribe to Apple podcasts or Google podcasts and give us a five-star review. If you'd like to connect with me in some way, please go to fallofroe.com for information. Thank you!