June 13, 2023

To: Chair Jim Wood and members of the CA Assembly Health Committee

We wish to submit our written testimony in opposition to SB 729 which requires insurance companies to cover a redefined definition of “infertility” to include “a person’s inability to reproduce either as an individual or with their partner without medical intervention.” Further, this bill requires insurance companies to cover in-vitro fertilization procedures (IVF) not just for couples with infertility issues, but also for same-sex couples, as well as single men and women; increasing the practices of both gamete donation and surrogacy.

Infertility can be a heartbreaking condition affecting those who desire to have children. Infertility can affect either the man, woman, or in some cases, both, preventing a couple from conceiving and carrying a child to term. However, changing the definition of “infertility” from a medical condition to allowing a person or couple with no infertility diagnosis or expanding medical care as a right for any human to utilize healthcare coverage does more harm than good. As an attempt to remove financial barriers for those that could not biologically reproduce (not because of infertility, but because of relationship status), this bill imposes health insurance coverage of medically dangerous services.

Fertility drugs used to stimulate oocyte production as well as the process of retrieving the oocytes (used in egg “donation” and IVF), carries risks such as Ovarian Hyperstimulation Syndrome (OHSS), an under-reported, life-threatening condition that can cause stroke, ovarian torsion, organ failure, and psychological distress.1 Not only are the drugs and procedures associated with IVF harmful to women, new studies are exploring the dangerous effects on the children born through this technology. A 2021 study found that “children conceived by assisted reproductive technology (ART) had statistically significantly worse outcomes in left ventricular function and structure.” The article further stated that “children conceived by ART had increased blood pressure and unfavorable changes in left ventricular structure and function compared with children who were naturally conceived.”2 Of the frozen embryos that are used for IVF, one study found that these babies conceived from frozen embryo transfer were more than twice as likely to develop childhood cancer, particularly leukemia and neuroblastoma, a type of brain cancer.3

Not only are there risks and complications to IVF, but it is a costly procedure with a high failure rate. From the CDC’s most recent data of 2020 we see that 326,468 IVF cycles were done which resulted in 75,023 live born infants. A single IVF cycle, defined as ovarian stimulation, egg retrieval and embryo transfer, can conservatively cost from $15,000 to $30,000.4

Nowhere does this bill address the needs of the child or safety concerns regarding the child either in IVF or in gestational surrogacy, where “donor” eggs are often used. Children produced in surrogacy contracts are quality-controlled: subject to sex-selection or abandonment for disability or simple change-of-mind. Most often, these commercially produced children experience the sudden and complete severance of the natural bond between their birth mother and are intentionally deprived of contact with and knowledge of one or both biological parents in direct violation of the U.N.’s Declaration of the Rights of the Child.

The 12 weeks immediately after delivery are a time where the baby adjusts to life outside of the womb, recognizing that a mother and newborn are critically connected, even if they are no longer physically linked. Further, the benefits of breastfeeding, to both an infant and the birth mother, are substantial and well-documented. Of course, the surrogate mother can pump and provide the breastmilk to the child she birthed, but it is well known that separating an infant from the birth mother has a negative effect on lactation and milk supply. We find it troubling and counterintuitive that California Health & Safety Code §123367 requires that, by 2025, all hospitals with a perinatal unit adopt the “Ten Steps to Successful Breastfeeding” per Baby Friendly USA’s Baby-Friendly Hospital Initiative, or an alternate process, but then considers changing laws that will increase the demand for commercial surrogacy preventing such success; failing to give infants and women the life-long health benefits of breast feeding.

Surrogacy, which utilizes IVF, is inherently risky to the mother and infant(s). Recent research has shown that there are serious medical and psychosocial risks that gestational surrogacy confers onto women who serve as surrogates and to the babies they carry for another person or couple and that these are high-risk pregnancies. Surrogate pregnancies are more likely to result in cesarean section, maternal gestational diabetes, hypertension or preeclampsia, antibiotic use during labor, placenta previa, and other life-threatening complications like postpartum depression.5 ,6 Children born from IVF have increased incidences of pre-term birth, low birth weight, cerebral palsy, and other conditions that result in NICU admissions and longer hospital stays.6 We in no way minimize the heartache that comes from infertility, but we must not harm others in our quest to help some.

Proponents of SB 729, would like to emphasize the financial burden often placed on those struggling with infertility. We can empathize that high-tech baby making comes with a hefty price tag, but these bills do not erase the cost of these often-unsuccessful technologies, but rather shift them to the policyholders and taxpayers by way of increasing insurance premiums for necessary healthcare and treatment. Legislation, as a matter of good public policy, should help and protect citizens. As we seek to assist those who long for a family, we must realize that some of these very costly solutions offered carry real risks to women and children.

Jennifer L ahl, R.N., B.S.N, M.A.
President, The Center for Bioethics and Culture

Kallie Fell, R.N., B.S.N., M.S.
Executive Director, The Center for Bioethics and Culture


1 https://nap.nationalacademies.org/catalog/11832/assessing-the-medical-risks-of-human-oocyte-donation-for-stem-cell-research


3 https://jamanetwork.com/journals/jama/fullarticle/2757228

4 https://www.cdc.gov/art/artdata/index.html