Deep freeze, deeper debate

Thousands of embryos left over from IVF go into cryopreservation as couples consider their options: to discard them, donate them to research or give them to childless couples

Thousands of embryos left over from IVF go into cryopreservation as couples consider their options: to discard them, donate them to research or give them to childless couples
Six years of frustration and heartbreak. That8217;s how Gina Rathan recalls her attempts to become pregnant. Finally, she and her husband, Cheddi, conceived a daughter, now 3, through in vitro fertilisation. About a year later, she became pregnant with a second child, naturally. Their family was complete.

Then, a year ago, the Fountain Valley couple received a bill reminding them that their infertility journey wasn8217;t quite over. They owed 750 to preserve three frozen embryos they8217;d created but hadn8217;t used.
8220;I don8217;t see them as not being life yet,8221; says Gina Rathan, 42, a pharmaceutical sales representative. 8220;I thought, 8216;How can I discard them when I have a beautiful child from that IVF cycle?8217; 8221;

Many other former infertility patients also appear to be grappling over the fate of embryos they have no plans to use: an estimated 500,000 embryos are in cryopreservation in the US.
As with the Rathans, this unexpected conundrum often arises well after the infertility crisis has passed, triggering impassioned and highly personal debates about the science and ethics of human life. The discussion boils down to a fundamental question: what is this icy clump of cells smaller than a grain of sand? Across the country, people with less personal stakes in the matter are asking that question as well.

Couples with leftover frozen embryos have three choices: discard them, donate to research or donate to another couple for pregnancy. The default option is to leave the embryos in a vat of minus-310-degree liquid nitrogen, paying for the storage and deferring the decision. Embryo-protection legislation could ultimately winnow those options and possibly limit future infertility treatments.

Freezing excess embryos is a common strategy for in vitro fertilisation. To make embryos, a doctor injects a woman with potent hormones to produce eggs. These are then harvested in a surgical procedure. The eggs are mixed with sperm in the laboratory, and some of the developing embryos are transferred into the uterus. A single cycle with fresh embryos costs more than 15,000.

Subsequent attempts at pregnancy are less costly if frozen embryos are on hand. About half the people who undergo in vitro fertilisation end up with one or more frozen embryos. No one can predict how many embryos will be produced and used. As the success of the treatment has improved over the last two decades, doctors are now transferring fewer embryos to avoid multiple births.

Meanwhile, the glut of stored embryos grows and more families find themselves in a position some liken to playing God. 8220;They are wrestling with how to think of embryos. A person? Nothing? Something in between?8221; says Dawn Davenport, an adoption researcher who has an online radio show and a website called Creating a Family.

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Infertility clinics report that they lose contact with about 15 per cent to 25 per cent of families with frozen embryos. According to the American Society for Reproductive Medicine8217;s guidelines, a clinic can consider embryos abandoned and dispose of them if five years have passed without contact with the couple and if significant efforts have been made to reach the couple. But few doctors dispose of the embryos, says Dr. Richard J. Paulson, chief of reproductive endocrinology and infertility at the University of Southern California Keck School of Medicine.

The federal government supports, via funding, only one option: adoption to another couple for pregnancy. About 1,000 babies have been born in the U.S. from embryo adoption since it became available 10 years ago, said Ron Stoddart, who founded the Snowflakes Embryo Adoption Program, based in Fullerton, California. However, research by Anne Drapkin Lyerly, an associate professor of obstetrics and gynaecology at Duke University, as well as other surveys, have found that most families prefer not to donate embryos for adoption.

Human embryos are the primary source of stem cells, and the uptick in stem cell research has fostered a growing demand for donated embryos. Although such research destroys the embryos, the broader effort is aimed at curing disease. This goal resonates with couples who have endured reproductive health problems, says Lee Rubin Collins, co-chairwoman of Resolve8217;s national advocacy committee.

Some couples who want to donate to science find that researchers are not nearby, that their infertility clinic isn8217;t associated with a research programme and thus can8217;t facilitate donations, or that their state prohibits research on embryos.

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In a survey of 1,003 adults in the US published in the spring issue of the New Atlantis, about half the respondents said destroying embryos is unethical because they8217;re humans, but 41 per cent8212;some of the very same people8212;said it was ethical to destroy human embryos in the course of research if the research can help people.

As for the Rathans, the couple paid for three more years of cryopreservation. 8220;I think about the embryos every day,8221; Rathan says. 8220;I am their mother. I see them as my own children. It8217;s something I worry about, especially when the three years are over and I have to make a decision again.8221;
_Shari Roan,LATWP