Natalie Crawford, MD
@ncrawfordmd
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Fertility doctor. Board certified OBGYN/REI. Co-founder Fora Fertility, Host: As a Woman Podcast, IG, YouTube. @docs4fertility
Austin, TX
Joined April 2016
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Welcome to Texas. Today abortion, a medical procedure, is now a felony. Punishable with up to life in prison. No exceptions for rape or incest. If you don’t think this will seriously impact medical care, you are wrong.
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In case you think abortion laws don’t matter: last week a pharmacist declined to fill a prescription for a patient of mine with an ectopic pregnancy citing SB8 restrictions.
The same medicine that saved my life in 2013 when I had my own ectopic pregnancy
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I have friends who are fertility doctors in Louisiana and Nebraska contemplating leaving the state - leaving their home because they can’t practice fertility medicine there safely.
Listen to us.
Reproductive rights matter.
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As a fertility doctor, I’m scared about what this means for IVF. The definition of life will be defined at the state level and will change the scope of my field in many places.
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This is about more than just abortion, this is about all reproductive rights.
Contraception.
Medical treatment of miscarriage and ectopic pregnancies.
IVF.
We have so much at stake - including the safety of our patients.
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I’ve also had pharmacists decline misoprostol (cytotec) lately which can be used for abortion, labor induction, helping a missed miscarriage (incomplete miscarriage) and more.
I like to use it before hysteroscopy in non pregnant patients to make surgery easy/safer.
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Why are IVF and abortion tightly linked? IVF came into existence in a Roe world (Roe had been around almost 10 years before the first IVF baby). Roe allowed IVF - and maybe you’ve never thought of this.
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Treatment of miscarriage. Treatment of ectopic pregnancy.
Treatment of previable pregnancy loss.
Access to contraception.
Access to fertility care.
And more.
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Nothing about this is pro-life - this is forced birth.
A person should not be forced to risk their life to carry a pregnancy. Pregnancy inherently has risks in every case. And people seek abortion care for terrible circumstances that you could never imagine.
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The COVID vaccines do not cause infertility.
Your fertility doctors have been saying this since December, but we are now saying it louder.
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The decision to have an abortion should be personal. You should be allowed to follow your own core beliefs with input from your doctor and family.
Abortion is heath care. Politicians are making medical decisions without understanding the consequences.
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Abortion medications are used to treat incomplete miscarriage and ectopic.
When your water ruptured and the pregnancy is previable you need to induce labor even if the baby has a heartbeat or terminate the pregnancy - otherwise you can become septic and die.
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This is why
@docs4fertility
exists. Your doctors know what is coming. We know this is not safe. And we are not willing to have patient care compromised by politics without a fight.
We support access to the full spectrum of reproductive care for all. Join us.
8/8
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And when the consequence for providing essential medical care is a felony, you will see uncertainty and delay in care. Lawyers will get involved. Doctors will leave the state. Even getting care will become difficult. We must not allow this to happen silently.
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When life is defined as starting at fertilization, as in “personhood” bilks, it can limit the option to have full access to contraception and IVF care.
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A year ago, Roe was overturned. As a fertility doctor, my patients have felt and lived the consequences of this.
The nonviable fetus after IVF. Delay in care because out of state terminations are full, resultant termination at a later gestation by 5 wks.
1/11
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Today in IVF monitoring almost every patient asked how overturning Roe will impact their potential embryos or future fertility attempts.
Let that sink in.
Infertility patients, who strongly desire a pregnancy, may be limited in the ability to pursue IVF to grow their family.
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PSA from a fertility doctor.
Plan B won’t hurt your future fertility. Neither will birth control pills. Or an IUD.
Protect yourself.
Thanks for coming to my TED talk.
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If you thought we were overreacting about the overturn of Roe let me present:
Abortion bills in Wyoming, Nebraska, Arkansas, Kansas. Some of these clearly prohibit IVF as we know it. All impact reproductive care and risk maternal life.
Your IVF docs have been warning of this.
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The overturning of Roe today will lead to restrictions in IVF accessibility, safety, and success in some states. Now we must get ready for the fight.
As a fertility doctor, my patients are counting on me.
But what a sad day.
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IVF will be impacted. Fertilization, embryo freezing, genetic testing, thawing, and transfer are all at risk.
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Nobody wants to talk about abortion. I hear this daily.
And it’s true. And we shouldn’t have to talk about it - it should be medical care that is available when needed.
But it’s not.
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Roe predated IVF, so the truth is we don’t know what will happen. And if you have frozen embryos, you should be watching closely. But we also need your voice. We need you to share. We need you to vote.
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Because I can fertilize eggs, freeze embryos, test embryos, and transfer/discard embryos. This is essential for safe, accessible and effective IVF care.
IVF is a tool that allows so many babies to be born.
3/10
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When we protect reproductive rights we inherently say that embryos are not autonomous and can’t exist independently. This means that we don’t grant embryos rights. This means I am allowed to utilize reproductive technology to help people get pregnant.
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At this point, if your OBGYN or fertility doctor is not recommending the COVID vaccine - they are going against guidelines and the standard of care.
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We use IVF to treat infertility - but also think about fertility preservation, cancer, genetic diseases, need for gestational carriers, egg donation, recurrent miscarriage and more. So many people use IVF to have a child.
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This will not end at abortion. I strongly anticipate some states will define life at conception. What does this mean for fertilizing eggs? Testing embryos? Freezing embryos? Discarding embryos? Roe has protected our reproductive rights at many levels and our field is in danger.
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The fear is that when Roe is overturned states will then individually decide their stance on this matter / and personhood bills threaten this. If life begins legally at fertilization - then we are limited in the above technology.
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Limiting reproductive rights has consequences. And if a personhood bill was introduced to the Supreme Court - and the draft opinion language is upheld, then we as a nation are in trouble.
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And for reference, in the body - fertilization occurs in the fallopian tube, the embryo has to travel to the uterus for the next 5 days, then it implants, then you can get a positive pregnancy test.
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For example, I can limit fertilization and transfer all embryos if you don’t believe in freezing/thawing embryos - but IVF will take longer, cost more, and be less successful. It also starts to become more dangerous.
Similarly - should you be forced to birth all embryos?
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Since Roe was overturned, mothers in states with abortion bans are 3x more likely to die. Significant maternal morbidity is seen without appropriate medical intervention: we are risking maternal lives and their future family.
6/11
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Every day we talk to people who have their own personal beliefs about IVF - and we talk about changes we can make to the process for your goals. Everyone feels different. That is ok, we anticipate you have your own needs.
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Pregnancy is not health neutral. Any pregnancy has risks and it should be your decision to decide what to do in these terrible circumstances. But when we restrict medical care, we see an increase in poor outcomes. Medical decisions should not be made by politicians.
7/11
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AGAIN. The COVID vaccine does not hurt your fertility. You can (and should) get the vaccine - even if you are TTC, pregnant, or want kids in the future.
Love, a fertility doctor
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This made a relatively simple procedure life threatening. Blood transfusions, emergent D&C, and resultant uterine scarring. This may resultant in an inability to carry a child again. This would not had happened at an earlier gestational age.
2/11
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In Texas, maternal life is expendable. You are being used to further a political agenda. To impose religious views on a nation that was founded under the principal of freedom. Your physicians are not allowed to intervene (or even counsel you). This should scare you.
10/11
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These situations would have been different if these patients could have had intervention sooner. The delay in care because they reside in Texas risked their lives, did not result in a surviving child, and has led to likely irreparable uterine damage.
Studies confirm this.
5/11
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A nationwide abortion ban was introduced today by Senate Republicans - aiming to limit abortions across the US. This ban would prohibit abortions after 15 wks, but medically their argument is false.
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Another with previable rupture of membranes, with a heartbeat. These babies won't survive without amniotic fluid, it is critical to development, but in Texas, now we wait. Until labor, bleeding, or more commonly infection sets in. Now a septic abortion is life threatening.
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Abortion is a medical procedure, utilized in different scenarios, many of which you would never imagine could be possible. You don't think it will impact you - until it does. But when you live in Texas, you now know that our state does not care about you.
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We need your help. Speak up. Talk about hard issues. Use your vote. Challenge people around you to think about what these issues really mean and who should have the authority to make these decisions.
Join us
@docs4fertility
to learn more.
11/11
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Limiting abortion has many consequences.
If your doctors can’t manage the complications that WE KNOW arise during pregnancy, maternal health will suffer. Life will be lost.
This is happening in Texas right now.
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Not only does this require ICU care to try and save mom, now we are urgently intervening and also doing a procedure in the setting of a very high risk of scar tissue. Another patient who may not carry a child again.
4/11
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All people should get vaccinated to protect themselves and to protect others.
Even if you are trying to conceive.
Even if you want fertility in the future.
Even if you are going through fertility treatments.
Even if you are pregnant.
Even if you are breastfeeding.
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We have seen limitations on miscarriage management, ectopic pregnancies, PPROM, and termination. We see that IVF is being targeted by the groups that already "won" by getting Roe overturned.
Restricting medical autonomy is dangerous. The consequences are significant.
8/11
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Urgent data per the
@CDCgov
70% increased risk of death from COVID in pregnancy.
Only 31% of pregnant people are vaccinated.
Please get vaccinated.
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Emergency contraception PREVENTS pregnancy. These do not cause an abortion :
1. IUD
2. Plan B
3. Ella
4. Yuzpe method
*all must be used within 5 days of intercourse (sooner the better)
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Each bills that attempts to restrict "all" abortions actually restricts proper medical care, miscarriage and pregnancy management, treatment of ectopic pregnancy, contraceptive access, and fertility treatment like IVF.
Maternal life is on the line. So is your future fertility.
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Tonight we learned that pregnant people no longer have autonomy over their body. For 50 years this right has been protected, but no more. This is a sad day for those of us who have dedicated our lives to reproductive health. The past was scary - we know what is coming.
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@ReprodMed
latest guideline reviews:
@CDCgov
only 16.3% of pregnant people are vaccinated.
@JAMA_current
COVID in pregnancy is associated with adverse maternal and fetal outcomes.
@AJOG_thegray
COVID vaccination in pregnancy and lactation passes antibodies to the baby.
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Pregnancy is life threatening. Proper access to contraception, pregnancy care, and fertility treatments should be a right. But it is not in this country.
So happy National Women Physician Day. We have work to do
@docs4fertility
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Your belief on if abortion is right or wrong isn’t the point. The point is that you should have the freedom to make the choice for yourself.
People get abortions for reasons you may agree with or not. Some are rape, incest, anomalies, genetic diseases, multiples, maternal risks.
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@ReprodMed
continued:
@greenjrnl
COVID vaccination does not cause antibodies against the placenta.
@NEJM
COVID vaccination does not increase the risk of miscarriage.
@FertStert
and more: there is no impact of vaccination on male/female fertility or treatment outcomes.
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I’m OUTRAGED that
@texmedPAC
- the PAC representing *TX physicians* has endorsed
@GovAbbott
for reelection.
As physicians we know the harm he has done taking away reproductive rights and threatening doctors with felony charges.
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1. The phrase “late term abortion” is used on purpose. This is not a medical term
2. 15 wks is not even midterm let alone late (pregnancies are 40 wks in length).
3. Most abortions that occur after 15 wks are for *lethal fetal anomalies* that CAN’T be diagnosed before.
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Imagine a pregnancy you conceived with IVF. Your water breaks at 17wks but their is a heartbeat. The baby won't make it to viability (24 wks) but we can't intervene until your life is in danger. This will happen once your uterus is infected. You lose your baby and your uterus.
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Imagine a desired pregnancy. Life threatening fetal anomalies. You live in Texas. You travel out of state. You have a later procedure than desired because it took 4 weeks to arrange. You hemorrhage. Need blood. Your uterus is now scarred and you can't carry in the future.
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Imagine you have an ectopic pregnancy with a heartbeat. You sit for hours waiting for the hospital team to decide what is allowed in your state. In the interim your tube rupture, you bleed internally and you die because they don't get you to the operating room on time.
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We are allowing politicians to practice medicine without a license. They are proposing bills which dictate medical malpractice. They do not understand the medical terminology or the potential harm for what they are doing. And potentially, they don’t care.
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Imagine you are pregnant and get diagnosed with cancer. Your chance of survival is low without immediate chemo. Your doctors can't give you chemo while pregnant and you can't terminate because your state passed a heartbeat bill. You don't have money to travel, you and baby die.
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In 2013, I had an ectopic pregnancy. I was treated with methotrexate, terminating the pregnancy and saving my life.
Today in Texas, I could have been turned away and not treated.
A story about
#SB8
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Imagine being told the worst news on the worst day. Your doctor wants to help you but can't. Imagine not having the resources to get medical care bc you must miss work and travel. Imagine this is someone in your life who you love.
This is unacceptable.
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Imagine you have painful periods and endometriosis that destroyed your tubes and decreased your egg count. You need IVF. Your state decided life begins at fertilization so you can only fertilize 2 eggs per cycle and must transfer any embryo. Your chance of a child is now low.
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Pregnancy is not health neutral. Abortion care is pregnancy management. It is an essential medical intervention that saves maternal lives.
Abortion restrictions do not limit abortions, but makes them more dangerous. This has been consistently shown in studies.
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This is a sad time to be a woman in America. Guns have more rights than we do.
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The GOP is telling us EXACTLY what will come if they take control in November. If anyone on your life has a uterus - their life and medical autonomy is on the line.
We must VOTE. It has never been more important.
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Let’s imagine for one minute that we let politics dictate who can have treatment for a heart attack.
I’m sorry - since you live in Texas we need to consult the legal team to see if your life is threatened enough to get a cardiac cath and a stent. Wait here and we will see.
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4. Your anatomy scan is performed between 18-20 wks, well part the 15 wks cut off.
5. MOST abortions are early - 93% of abortions occur before 14 wks, 6% at 14-20wks, and 1% after 20 wks. But those after 15 wks are usually due to a devastating maternal/fetal situation.
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Also - I review all the studies in detail on YouTube.
Here is the latest: COVID vaccination and IVF & Fertility
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6. Arbitrary bans which limit medical care at a set gestational age, with no exceptions for fetal anomaly and vague exceptions for the life of the mother, universally harm pregnant people.
7. These bans harm those with fewer resources the most.
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Black women:
Have higher rates of infertility.
Have fewer infertility treatments, including IVF.
Have lower live birth rates.
Have higher miscarriage rates.
Have higher preterm birth rates.
Have higher fetal death rates.
Have higher maternal death rates.
We have work to do.
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Imagine you are in an abusive relationship. SA at home and your life threatened, you finally decide to leave with your 2 kids and go to a shelter. But your abuser gets you pregnant, you can't terminate in your state, you are stuck. A week after giving birth you commit suicide.
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We are going to ignore current advanced medical care. No more emergency care or life saving intervention.
And if you “caused” your heart attack by being overweight or having high cholesterol - that’s your fault. You should have prevented that.
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The decision to have an abortion is personal and should be made between a person and their health care team. Each case is different. Abortions happen in very desired pregnancies. They should be safe and accessible to all.
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The experts in reproductive care are united. Abortion is an essential part or healthcare. We are advocating for our patients and we need your help.
Join us
@docs4fertility
as we advocate, educate, and influence political change by speaking truth, facts, and science.
10/10
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If your heart attack kills you, it must have been God’s will. You should be thankful for the opportunity to try and survive. Maybe you will learn from this.
All the cardiologists, the experts who do this for a living are saying how dangerous this is. Nobody listens.
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Requiring people to cross state lines to receive appropriate medical care is dangerous. Uncertainty in state laws will result in delay of care. We are seeing this in Texas since SB8 went into effect - increase in maternal morbidity without an increase in fetal survival.
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This would never happen in other aspects of medicine - just reproductive health. It’s absurd to think about withholding life saving treatment for heart attacks **but this is exactly what is happening to pregnant people in this country***
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8. In addition - abortion bans limit medical counseling and medical training. The long term impact of this change in medical care will be substantial.
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So we must talk about abortion. What it is. How common it is. Why it is needed. We must challenge others to have hard conversations and share our stories. We must use our voice and vote. And we must do it together.
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You can also join us
@docs4fertility
where we (your physicians) are working to advocate and educate about the long term implications of abortion bans including pregnancy management, contraception, and IVF access.
7/7
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We must share these stories to show the world that politicians are practicing medicine. They are gambling with your life (or the life of your daughter, sister, friend, colleague) in order to fit their political agenda and uphold *their* personal views.
This is not safe.
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Support your doctors in supporting reproductive rights - including the right to contraception, pregnancy management and fertility care.
Reproductive rights are human rights.
Follow and donate to
@docs4fertility
7/7
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And in states which permit intervention to save maternal life: How close to death must one be? Immediate? How sick must you get before intervention is allowed?
And who does this benefit?? A pregnancy cannot survive if the person carrying it does not.
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These complications included: infection, placental abruption, ICU admission, blood transfusion, emergent D&C, postpartum admission.
There was no increase in fetal survival.
Forced birth is dangerous.
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In people who had pregnancy complications at 22 wks or earlier (pre-viable) the rate of maternal complications was 57% due to state required expectant manage as compared to 33% in states that allowed immediate pregnancy interruption.
This is scary.
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A study in
@AJOG_thegray
looked at Texas this past year since SB8 was passed.
Just as every obgyn warned the world - we saw a significant increase in maternal complications without improvement in fetal survival.
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Well this is 100% predictable.
@GovAbbott
does not care about maternal life in Texas. Vote him out.
Texas delays publication of maternal death data until after midterms, legislative session
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The misogyny expressed by other physicians toward women’s health never ceases to surprise me. As a fertility doctor who deeply cares for the rights of her patients, how can we expect politicians to understand when other physicians do not?
Ex: Phillip, oncologist
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1 in 4 women have had an abortion.
***You know someone who has had an abortion***
Abortion should not be political. It is a medical choice - it should be safe and available.
Abortions will still happen.
Now more people will die.
Thank you SB8 and a silent Supreme Court.
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Very desired pregnancies may end in abortion. Extremely religious people may choose abortion. Someone’s life may be saved by an abortion. The circumstances are so broad you can’t imagine. Limiting safe abortion access is not the answer.
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You can follow and support
@docs4fertility
to see what candidates we support who want to protect physicians and patients.
In TX -
@BetoORourke
for gov and
@RochelleMGarza
for AG.
3/3
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The COVID vaccine does not cause infertility.
No clinically significant difference after vaccination in:
AMH levels.
Menstrual cycle length.
Ovarian hormone function.
IVF response or outcomes.
Implantation rate.
Miscarriage rate.
Sperm counts.
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96% of republicans voted AGAINST making contraception legal by law.
This is very telling: they are not “pro-life” they are ANTI-CHOICE.
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It is Wednesday and the COVID vaccine still doesn’t cause infertility, that is all.
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It is now becoming clear that if helping women is my life calling that I made a huge mistake going into medicine. Personal medical decisions are no longer made between doctors and patients.
The court has spoken, 6-3.
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On the ballot: IVF.
NH senate candidate Bolduc and GA governor Kemp are ready to restrict IVF.
We’ve been watching as personhood bills are introduced in some states as a way to restrict abortion access as much as possible.
This will change IVF as we know it.
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This PAC claims to want to “protect the practice of medicine and do what we have been trained to do - take care of patients.”
Explain how you are helping me care for my patients with this endorsement?
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