Embryo Adoption, Stem Cell Research, Partial Birth Abortion Oh My: Breaking News From DITM

When does human life begin and what is a human?  Fertility specialists wrestle with this question every day as embryos are created, frozen, thawed, implanted, and discarded.  Occasionally an embryo is even “adopted”.  Today I received the draft results of a US government Health and Human Services Research Project that I participated in on the potential for embryo adoption in the US.

In 2002, the U.S. Congress authorized the Secretary of Health and Human Services to conduct a public awareness campaign to educate Americans about the existence of frozen embryos available for adoption.   Today I received the research report of the commission’s results:

Between April 4, 2005 and July 27, 2005, the Social Science Research Center (SSRC) at California State University Fullerton contacted 481 Assisted Reproductive Technology (ART) Centers in the United States, including yours, soliciting participation in a survey study. Attached to this message, please find a copy of the final report based on the 254 ART clinics that participated in this study.  This document is being distributed in response to interest in the results of the study expressed by many ART clinics.

The report begins 

Embryo adoption is a relatively new process in which individuals who have their own frozen embryos agree to release them to a recipient couple. The intent is to transfer into the womb of the recipient mother the donated embryos so that she and her partner may bear a child and  be that child’s parents. The number of embryos currently in storage in the Untied States was estimated at approximately 400,000. Of this number 88% are still being used by the creating families for their own family building efforts. Still, the remaining 12% or 48,000 embryos cannot be overlooked. Assuming an embryo transfer success rate of 30%, these 48,000 embryos could result in the birth of more than 14,000 children to infertile couples.

Under Public Law 107-116 (the Fiscal Year 2002 Department of Labor, Health and  Human Services, Education and Related Agencies Appropriations Act), the U.S. Congress authorized the Secretary of Health and Human Services to conduct a public awareness campaign to educate Americans about the existence of frozen embryos available for adoption.

There are 126,160 Human Embryos In Storage In the USA:  The  mean number of embryos stored across the centers is 1,208.89, and the median is 531. Overall, 126,160 embryos were being stored.

How Common is Embryo Adoption in US IVF/ART Programs:   43% of the programs indicate that their fertility center had a functioning embryo donation/adoption program during the previous year. 44% report that their fertility center currently had such a program.  Considering clinics with a current embryo donation/ adoption program and those reporting plans to implement such a program, almost 60% of the ART centers in the survey sample are likely to sponsor a program by this time.

How is Embryo Adoption Done in the US Now?:  75.1% of  fertility centers refer patients to outside sources for information regarding embryo donation/ adoption. Centers that do not currently have embryo donation/ adoption programs are more likely to refer their patients to outside sources for information on this topic than centers that do. Even among fertility clinics that do currently have embryo donation/adoption programs, however, the proportion who make outside referrals is still substantial (64.5%).  The largest proportion (59.7%) of clinic managers who refer patients to outside sources, refer their patients to the Snowflakes program. 7.9% refer their patients to embryoadoption.org; and 5.4% each to the National Embryo Adoption Center and to the Cooper Clinic. Less than 1% refer to “Embryos Alive.

Don’t Call it Adoption: Preferences for naming the transfer of embryos between couples were

1. Embryo Donation (65.6%)
2. Embryo Adoption (24.9%)
3. Some Other Term (9.5%)       obviously the term adoption is value laden to equate an embryo with a living child

Where Are The Embryos Stored?:  The majority of center staff report that their fertility centers store their patients’ frozen embryos at their clinic location, while nearly 10% report subcontracting for embryo storage.

Most Clinics Don’t Know How Many Embryos They Have!  Of the center staff indicating that their fertility center tracks the number of embryos it has stored, an astonishing majority (63.4%) indicate that they don’t know how many frozen embryos are currently stored, and another nine refused to answer this question.

When Do the Clinics Belive Human Life Begins?  “How do you characterize your fertility center’s general approach or philosophy with regard to the point at which embryos are thought of as human lives?” Ninety-six (37.8%) centers replied, “Don’t Know” in response to this question, and 37 (14.6%) refused to answer, illustrating the highly sensitive nature of this issue. Of those who did respond, the largest proportion (39.8%) say that “Embryos are considered human lives at conception,” followed by 33.9% that report, “Embryos are considered to be human lives after viability of pregnancy” and 15.3% that answered, “Embryos are considered human lives after implantation into the uterine lining”

Chipping Away at Roe v Wade:  Lost Embryo is Wrongful Death.  An Illinois appellate court ruled that a couple could sue their fertility center for wrongful death when the fertility center inadvertently discarded the couple’s frozen embryos. many clinics expressed concern or policy changes as a result.

The Relation To Stem Cells and Partial Birth Abortion:  The Stem cell connection is clear with so many groups arguing for the use of these embryos in storage to create stem cells.  The recent partial birth abortion ban announcement is another step to equate the fetus with human life and rights.  It will be interesting to follow how the classification and rights of these embryos evolves and see how that plays into the political debate on when life begins.  The Bush administration is very clear in its drive to push embryo adoption.

My Perspective as a Fertility Doctor:  My personal experience is that almost no patients ever request that their spare embryos be donated to other couples.  The vast majority simply prefer to leave them in frozen limbo in storage indefinitely - avoiding having to make a final decision of what to do with them.  As a result of the enormous expense and liability this poses to the clinics, private companies are forming to store the embryos off-site.  Many also choose to thaw them and discard them letting them die in the laboratory dish.  Occasionally a couple will choose to donate the embryo to research.  Why don’t more couples choose to donate to other couples?  I believe it’s a mixture of fear of the unknown (who the parents will be, would they ever run into their donated child?)  and lack of information regarding the process.  The problem will only grow as more embryos are frozen and success rates increase (limiting the need to use the frozen embryos). 

European Disasters From Limiting Embryo Freezing Legislation: 

• Italy passed the Medically Assisted Reproduction Law in March 2004, which prohibits the destruction of embryos created outside the body. This means that all embryos created during IVF (to a legal maximum of three) must be transferred to the woman’s womb- and within months infertile women were becomming pregnant with triplets despite the unwanted risks.
• In Spain, it is legal to put embryos in frozen storage, but it is illegal to destroy embryos or to donate them to research, despite the fact that 74 per cent of Spanish patients with spare embryos in storage would like to donate them to research. Because most couples would prefer not to donate their embryos to other patients, there are currently 50,000 embryos sitting unused in frozen storage in Spain
• The Embryo Protection Act of 1990 in Germany states that no more than three eggs can be collected from a patient for fertilization in vitro. After that, all embryos created must be transferred to the patient in order to avoid any embryo freezing or destruction. The result has been lower pregnancy rates and higher multiple pregnancy rate