by Jane L. Frederick, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility
Couples going through infertility have many decisions to make. For couples who have gone through in-vitro fertilization (IVF) and have extra frozen embryos which they no longer need, the decision of what to do with their frozen embryos is difficult. They can choose to have the IVF clinic thaw and discard the embryos, donate them to research, or donate them to another infertile couple (embryo donation). Not all infertility practices have active embryo donation programs. Currently, HRC Fertility is not participating in embryo donation, but referrals to National Embryo Adoption or Snowflakes Agency are available upon request.
Recently, a 2002 SART-RAND survey was generated by the IVF clinics in the United States documenting the number of embryos stored and their current disposition. Nearly 400,000 embryos are stored, the majority of which (88.2%) are targeted for patient use. Patients are holding these embryos in storage for future use in helping them get pregnant. Less than 3% of couples are willing to donate to research, and just over 2% are in storage for embryo donation.
In addition, there is a lot of debate about human embryos in the media today. Embryos have stem cells, almost magical cells that can become any tissue in the human body. Researchers say stem cells might one day be used to save adult lives, and many academic centers are boosting their efforts to become a major center in this hot branch of biomedical science. In 2004, California voters agreed to pay for stem cell research when they approved Proposition 71.
According to the survey, only about 11,000 embryos have actually been designated for research. Although this is a seemingly large number, these embryos may not have the highest development potential for a variety of reasons. First, IVF clinics generally transfer the best quality embryos to the patient during the fresh treatment cycle. Consequently, the remaining embryos available to be frozen are not always the highest quality. Second, some of these frozen embryos may have been in storage for a number of years. At the time they were frozen, culture conditions used in IVF laboratories may not have been as optimized as they are today. Finally, some loss of embryos is inherent in the thawing process. For these reasons, the cryopreserved embryos are less likely to produce viable blastocysts than non frozen embryos.
Other couples may feel, through the process of parenting, that they have developed a deeper empathy with infertile couples and can now more easily donate their unused embryo to another couple. For these couples, the pain of the infertility experience is a vivid memory, and their wish to help others prompts them to donate their embryos. These couples believe that the uniqueness of each embryo, the different environment, and the difference in parenting distinguishes the couple’s children from the children potentially born from the embryo donation. As a result, they are able to psychologically detach from the embryo they wish to donate. Many of these couples also maintain the opinion that embryos should be “given a chance” for implantation based on moral or religious beliefs. Embryo adoption has attracted the attention of Congress, which passed a measure in 2003 earmarking nearly $1 million to boost public awareness of embryo adoption.
The Christian-run Snowflakes Embryo Adoption Program is one of a growing number of private programs that treat embryo donation like the adoption of a child. The Snowflakes program requires prospective adoptive parents to undergo financial and criminal background checks, as well as counseling with social workers for parental responsibilities. Potential recipients must also be aware of the legal status of donated embryos in their state, and their legal status as parents of the potential offspring. So far, the Snowflakes program has helped more than 81 couples have babies through embryo adoption. An unusual feature of the Snowflakes program allows the donors to choose the adoptive parents, and gives them the option of staying in touch if both parties agree, so they can follow their biological child’s progress.
The psychosocial impact of creating children through embryo donation is uncharted territory at this point. The guidance that mental help professionals can provide is based solely upon what is known through attachment and adoption literature, as well as what is understood thus far about children created through egg or sperm donation.
In-vitro fertilization is truly a wonderful solution for many couples seeking to build a family. In some cases, multiple embryos are left in storage and often without a plan for their future. It’s a difficult decision faced by many successful fertility patients, “What should we do with our frozen embryos?” For some patients, embryo donation may be acceptable. Others may believe that contributing to scientific advancement is noble and an action they can proudly embrace. Pre-treatment counseling can be helpful to explore the couple’s beliefs, values and to make a preliminary decision, before the embryos are made.