Issue Date: March 3, 2006
By TOM CARNEY
The acrimony that has characterized abortion politics is increasingly engulfing couples who use reproductive technology to have babies and the agencies that serve them.
Pamela Madsen of New York City, founder and executive director of the American Fertility Association, said she believes her organization was denied renewal of a federal grant, worth about $190,000, because the organizations application declined to use the term embryo adoption instead of the usual embryo donation.
Madsen, who recently wrote an article for The Boston Globe headlined, Dont tell me what to do with my embryos, said couples who are struggling with the question of what to do with leftover frozen embryos are being sucked into the abortion debate.
These issues are messy, she said, and we have to be careful about telling people what to do, using language to color perception. Referring to a White House meeting last May in which President Bush praised the adoption of frozen embryos, sometimes called snowflake babies, Madsen said its hard enough being a couple that has to make a decision on what to do with frozen embryos without outside noise.
Bush holds up a snowflake baby and uses it as a symbol of right to life. Thats really painful, she said.
The issue affects a substantial number of American couples. Of the approximately 62 million women of reproductive age in 2002 -- the latest year for which figures are available -- about 1.2 million, or 2 percent, had had an infertility-related medical appointment within the previous year, according to the federal Centers for Disease Control and Prevention. An additional 10 percent had received infertility services at some time in their lives.
Infertility services include medical tests to diagnose infertility, medical advice and treatments to help a woman become pregnant, and services other than routine prenatal care to prevent miscarriage.
The 122,872 ART cycles performed at the 399 fertility clinics that reported to the CDC in 2003 resulted in 35,785 live births (of one or more babies) and 48,756 infants. An ART cycle consists of several steps over a period of about two weeks, beginning when a woman starts taking drugs to stimulate egg production or starts ovarian monitoring.
The percentage of fresh embryo transfers to the mother that are her own and that result in live births vary greatly because of many factors. Among them is the age of the mother. Percentages range from 15 percent in mothers 41-42 years old to 43 percent in mothers under 35. For frozen embryos from non-donor eggs, the percentage that results in live births ranges from 17 percent in mothers 41-42 to 29 percent among mothers under 35.
The question of what to do with frozen embryos, and what to call it when one couple provides them to another couple, is at the heart of the current controversy.
Dr. Brad Van Voorhis, professor of obstetrics and gynecology and director of in vitro fertilization at the University of Iowa Hospitals and Clinics, said the university in the late 1990s polled 365 couples on what they wanted to do with embryos that had been frozen for at least two years. About 44 percent wanted to continue storage, 34 percent wanted to discard them, 10 percent wanted to donate them for research and 12 percent wanted to donate them to other couples.
Van Voorhis, who said embryos can be kept frozen indefinitely, added that upon the advice of the universitys ethics advisory committee, which engaged in prolonged deliberation, the clinic he runs has stuck with the term, embryo donation. However, he acknowledges that some patients have moral qualms about the embryo freezing process, and sometimes we can tailor treatment to their beliefs.
Everyone is entitled to their opinion, he said.
But Madsen of the American Fertility Association believes people are too free with those opinions.
Theres a whole lot of noise out there from everyone -- and I mean everyone -- about what ought to be done with frozen embryos, she wrote in The Boston Globe article. Im impressed that so many pundits, politicians, religious leaders, scientists and celebrities can be so confident about making the right choice for others when theyve never been up against reproductive difficulties themselves.
Madsen and her spouse have two nearly grown children resulting from in vitro fertilization. Four unused embryos were frozen. After their unused embryos had spent years in storage and the couple had engaged in many conversations on what should be done with them, they could not bring themselves to donate them to another couple, knowing that a biological child of theirs would be raised by people unknown to them if the procedure were successful. They decided to donate the embryos to research.
What I do with my embryos doesnt affect my neighbor, she said.
Furthermore, embryo adoption is not a legally recognized term, she said, and it assumes that the embryos are human.
Eleanor Nicoll, spokeswoman for the American Society for Reproductive Medicine, agreed, saying that the embryos are not human beings.
The embryo that has not been implanted in a womb hasnt instigated a pregnancy, she said. Its not viable. Ultimately, its the patients to whom the embryos belong who need to make the decisions.
Jesuit Fr. Kevin Fitzgerald, Dr. David P. Lauler chair in Catholic Health Care Ethics at Georgetown Universitys Center for Clinical Bioethics, does not agree, nor does Richard Doerflinger, deputy director of pro-life activities at the United States Conference of Catholic Bishops.
If having babies is only the business of a couple seeking such services, Fitzgerald asks, why are we raising the possibility of helping them have babies? Fitzgerald has PhDs in molecular genetics as well as bioethics.
As for the anguish couples go through in deciding what to do with frozen embryos, Fitzgerald asks, How much of this struggle was anticipated when couples are getting into the whole process of in vitro fertilization? Werent all these possibilities laid out when they first got into it? Its called informed consent.
Fitzgerald said there are an estimated 400,000 frozen embryos in storage in the United States, and its unknown how many of them are still alive and how many die in the process of thawing. If they survive that, some grow, some dont.
We have some human beings, he said, and arguments that no human life is present are arbitrary.
There are all kinds of arguments and positions, he said, and none are established with certainty even on a biological level. Since there is doubt, who gets the benefit? The benefit of the doubt should go to the human being, the embryo. If you cant prove to me otherwise, you have to treat it as such.
If youre out in the woods hunting and see the bushes move, do you shoot? Of course you dont, he said.
Regarding adoption of embryos, Fitzgerald said, It might make some people conclude the technologies arent as troublesome as we consider them to be morally.
Doerflinger, of the bishops conference, said the Catholic church opposes freezing embryos, as laid out in the papal instruction Donum Vitae.
Its a way of procreating a human being that is not worthy of human beings, he says. New life doesnt arise from the loving union of the couple. Its done by a third-party technician in a laboratory. And whether or not you call it embryo donation or embryo adoption, the church disapproves of the depersonalized nature of the techniques involved.
The baby would be conceived immorally, frozen immorally, and now abandoned by its genetic parents, he said. He said he recognizes that many loving couples are unable to have children without such help, but asked, Does the end justify the means? It doesnt. The means also have to be moral.
Leisa Brug Kline, who lives in Orange County, Calif., is spokeswoman for the National Embryo Adoption Awareness Campaign, which is affiliated with Nightlight Christian Adoptions agency and its Snowflakes Frozen Embryo Adoption program. They are the groups with whom President Bush met in May 2005, the meeting to which Madsen referred. Brug said the organizations with which she is affiliated agree that embryos shouldnt be destroyed or used for research, but promotes adoption of frozen embryos.
The legal framework for such adoptions is not in place in any state but Ohio, she said, but several other states are moving toward establishing one.
In California and other states, she said, embryo adoptions are legally handled as property transfers, but from the adoption agencys view, they are handled like other adoptions with screening of adoptive parents and other typical adoption procedures.
In April, Snowflakes will celebrate the planned adoption of its 100th embryo.
Theyre twins, she said, so theyll be numbers 100 and 101.
National Catholic Reporter, March 3, 2006
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