Nine of Mary and Tim’s embryos are still at their Denver doctor’s office, frozen in liquid nitrogen, stored in a holding tank, suspended in time.
Fifteen of the Detroit area couple’s embryos were frozen by their specialist this summer during their latest attempt to conceive a child through in-vitro fertilization.
The hormone treatments caused Mary to produce 42 eggs–a start-lingly high number. As a result, her ovaries became hyperstimulated and none of the 15 embryos created from the fertilized eggs could be implanted immediately.
Her doctor took the typical route and froze the embryos.
Weeks later, Mary returned to Colorado. Six embryos were thawed, and the three that were viable were implanted. She is now pregnant with twins.
Mary and Tim already have a 3-year-old child. If this pregnancy succeeds, they may decide their family is complete. But no matter what happens, they could face a reproductive decision they never expected:
What should they do with any unused frozen embryos?
They could decide to have them destroyed. They could even donate them for scientific research. Most intriguing, perhaps, is a third option that’s gaining increased attention: releasing the embryos for adoption by another infertile couple.
About 5 million to 6 million people of childbearing age battle infertility annually in the United States. Unknown thousands of their embryos are frozen in the nation’s 335 or so fertility clinics. Slowly, in a smattering of clinics and through adoption agencies in the Detroit area and elsewhere, doctors are matching unwanted embryos with infertile couples who long for children.
And as has happened with many areas of medical advancement involving human reproduction, freeing the frozen embryos for adoption is raising concerns.
What happens, for instance, if the adopted embryo develops into a child with a disability? Could the adopting parents change their minds? Could the donating couple be held financially responsible?
Could genetic siblings raised in different families date–even marry–each other and not know it?
And what about custom ordering? Will some couples try to design a child by matching characteristics from donors to create an ideal embryo?
As of now, frozen embryo adoptions are rare. A few infertility clinics and adoption agencies throughout the country have led the way by offering them to their clients.
Harper Hospital in Detroit and Oakwood Hospital in Dearborn, Mich., offer them only to their fertility patients. So far, William Beaumont Hospital in Royal Oak, the University of Michigan Hospitals in Ann Arbor and the Henry Ford Health System do not offer them.
Most of the infertility clinics and adoption agencies that avoid frozen embryo adoption do so because of sticky ethical or moral issues and the general absence of laws covering it.
“In our mind, it is a new legal, social and psychological situation that leaves so many questions unanswered,” says Bill Blacquiere, chief operating officer for Bethany Christian Services in Grand Rapids, Mich., an adoption agency with 70 offices in 30 states.
It’s also an option that has immense–and apparently growing–appeal.
Elizabeth and Mark have struggled with infertility nine of their 11 years of marriage. The Michigan couple tried adoption. A 41/2-week-old girl was placed in their care, only to be taken away nearly 3 weeks later when the birth mother changed her mind.
They tried sperm implantation after doctors traced their infertility to Mark’s low sperm count. Elizabeth was implanted unsuccessfully three times with sperm from a donor before deciding that was enough.
Then last year, when their assistant pastor and his wife told them about frozen embryo adoption, they investigated and found someone with 14 unneeded embryos.
Everything seemed to fall into place.
“I liked that. … I would be able to physically have the child,” says Elizabeth, 32. She and Mark, 35, also were happy that it would allow them to be with their baby from the very beginning.
Doctors and adoption agencies vary in how they handle embryo adoptions. Some agencies require home studies and treat the case like any other adoption. Many doctors, however, handle it as they would a donation to a sperm bank. In either case, donating couples are not paid for giving away their embryos.
Because they found the embryos on their own, Elizabeth and Mark went through their doctor, who treated the embryos as a donation.
The last of the embryos was implanted in Elizabeth in September. It was the couple’s third attempt and, like the others, it failed to lead to pregnancy.
Elizabeth and Mark are now pursuing a foreign adoption, but they have no regrets about trying embryo adoption.
“I would definitely do it again,” says Elizabeth. “An embryo is tissue, but it’s also a human being. … I still think for those people it could work for, it’s the right thing to do.”
The world’s first test-tube baby was born in the late `70s. It wasn’t until the mid-`80s that doctors began freezing the extra embryos produced by this method.
The hormones used cause a woman’s ovaries to produce multiple eggs. Doctors remove the eggs, mix them with sperm in a laboratory dish and, after 3-5 days, put two to four embryos back into the woman’s uterus.
Before freezing became an option, the whole process had to be completed, start to finish, during each in-vitro attempt. That put the woman at risk of hormone-induced ovary hyperstimulation, which makes implantation difficult or impossible until the condition subsides. Also in the mid-1980s, the eggs were retrieved through a surgical procedure, which introduced another risk. Now eggs are retrieved non-surgically through the cervix.
“One of the options that came up is, if we could freeze the embryos, you could avoid another surgical procedure, you could avoid the risk of the fertility drugs and hyperstimulation,” says Dr. Michael Diamond, director of Wayne State University Medical School’s reproductive endocrinology and infertility division.
Freezing also allowed embryos to be saved, and it significantly reduced the overall cost, which insurance generally does not cover. Each in-vitro procedure with fresh embryos costs from $8,000 to $15,000. Additional attempts using frozen embryos cost $1,000 to $3,000 each.
But with freezing came new issues, including what to do if the couple doesn’t need or no longer wants the embryos.
Sometimes that happens if the couple is successful on the first in-vitro try, though in-vitro generally results in a baby only once in every three tries. But sometimes the marriage breaks down, as was the case in a recent frozen embryo custody lawsuit in Livingston County, Mich. There, the couple froze extra embryos in 1994 and divorced a few years later. The ex-wife wanted the embryos implanted, but the ex-husband did not. The man prevailed in court when the judge ordered the embryos to be kept frozen until the couple can agree on what to do with them.
“Most programs … have extra embryos,” says Dr. Lori-Linell Hall, division head for reproductive endocrinology for the Henry Ford Health System, which has had frozen embryos for seven years.
“Basically,” says Hall, “these embryos are just sitting there.”
Most clinics charge for embryo storage, typically about $250 to $500 a year or more. But even if couples aren’t paying and can’t be found, some clinics are uncomfortable destroying the embryos without clear directions from them.
No one knows how many frozen embryos are stored at the nation’s fertility clinics and no one tracks how many are given to other couples each year for adoption. And sometimes the woman doesn’t produce enough eggs for there to be extra embryos. But according to figures kept by the American Society for Reproductive Medicine, a professional association of fertility specialists, 73,069 women used in-vitro-like techniques resulting in 25,059 babies in 1997, the most recent year for which statistics are available.
That means the number of frozen embryos stored throughout the country could be in the hundreds of thousands.
Although Michigan has no laws regulating frozen embryos, other states and countries do.
In Louisiana, it is illegal to destroy an embryo, and in Pennsylvania, it is illegal to use an embryo for research, says Sean Tipton, spokesman for the reproductive medicine society.
Florida and Texas have statutes recognizing embryo donations and making the recipient couple the parents, says Dr. Brad Van Voorhis, director of reproductive endocrinology and infertility at the University of Iowa in Iowa City.
So far, there has been no scientific limit set on how long an embryo can be frozen.
One of the reasons writing laws about frozen embryos is so sensitive is how the statutes might affect abortion laws. For instance, most abortions are performed when the fetus is 13 weeks or less. If a state outlawed embryo destruction, it could set up a situation in which it would be illegal to destroy a 3- to 5-day-old embryo but legal to abort a fetus that is several months old.
Van Voorhis’ clinic in Iowa is among those in the United States with the most experience with embryo adoption and has set its own guidelines. His practice started offering embryo adoption in the mid-1990s in response to a need from couples who felt uncomfortable destroying their embryos. The donated embryos are offered only to other infertile patients. Preference is given to couples who have never had a baby, and about 15 couples are on the clinic’s year-plus waiting list to receive embryos.
Van Voorhis says some couples who say they are willing to give away their embryos change their minds when it comes to signing on the line.
Van Voorhis said that as long as in-vitro fertilization continues, the number of frozen embryos will only grow.
“Something will have to be done with them,” he said.
