When science comes home
By Annie Cheney, My Generation, January-February,
After undergoing infertility treatments, couples face
an agonizing choice: what to do with the remaining embryos.
When Lana Rico*
gave birth to her baby girl at age 51, it was the end of
a long and harrowing journey for her and her husband, Tony.
In their eight years of marriage, they had spent close to
$100,000 on infertility treatments. Now Lana and Tony finally
had what they’d always wanted – a healthy, beautiful
baby. They named her Sara. But the anguish that marked their
quest to have a child lingered as they faced another challenge:
what to do with Sara’s 11 potential brothers and sisters,
the embryos left over from Lana’s in-vitro fertilization
treatments. Those embryos were sitting, frozen, in a tank
of liquid nitrogen at the fertility clinic.
The ice of life: Canisters store frozen embryos.
Frozen embryos, which
are microscopic clusters of cells (including stem
cells), have caused heated political debate. Americans,
including President Bush, have only recently begun
to ponder the ethical questions raised by the use
of stem cells in medical research.
But for years, infertile couples have been grappling
with a much more personal and equally complex set
of issues: what to do with their frozen embryos once
they no longer can, or want, to conceive.
Many couples are unprepared for the feelings they experience
after they have children when there are extra embryos in
the picture. Lana and Tony had originally agreed to destroy
their unused embryos if they completed their family. “But,
suddenly, after Sara was born, it was like those embryos
were part of our family,” Lana explains. “They
were part of Sara.” When it came time to tell the
clinic what she wanted to do with them, Lana couldn’t
bring herself to have them discarded. “It was too
painful,” she says. “We had tried through hell
and high water to have them.” And so they put the
It’s been two and a half years since Sara was born,
and the Ricos’ embryos remain frozen. Tony says he’s
ready to let them go now. “I feel we’ve got
what we wanted…why keep them hanging on?” he
says. “Let’s close the books.” But Lana
is still haunted by the idea that they would be destroying
their potential children. After much discussion, the Ricos
have decided to leave their embryos in the tank for another
two and a half years – until they turn five years
old – when Lana believes that their potential for
life will have diminished. There’s no scientific proof
that frozen embryos become less vigorous over time, but
Lana still maintains she’d rather let the embryos
“run out” on their own.
“Ultimately,” she says, “I’m not
having to make a decision about their future. It’s
being made for me.”
According to Dr. Alan Copperman, director of infertility
at Mt. Sinai Hospital in New York City, Lana’s reluctance
to make a decision is not unusual. In part, it explains
why left over embryos are piling up in fertility centers
around the country, some belonging to couples who have simply
disappeared. Experts estimate that there are tens of thousands
of frozen embryos In the U.S., many belonging to couples
now in their late 40s and 50s, who are far removed from
the time when they froze them.
Potential life, potential lawsuit
Each embryo is a tiny fertilized egg, created during fertility
procedures such as in-vitro fertilization, when doctors
combine a woman’s egg with sperm in a Petri dish.
As many as 20 embryos may be produced in each in-vitro cycle.
Depending on a woman’s age and condition, doctors
will transfer anywhere from two to 12 into her uterus.
Most couples choose to freeze the extra embryos as a back-up
plan, because only 20 to 50 percent of transfers of fresh
(not frozen) embryos result in pregnancies. Frozen embryo
transfers are typically less successful (only 10 to 25 percent
result in pregnancies), but cost around $3,000 – roughly
one-third of the cost of using fresh embryos. As most women
require an average of two in-vitro treatments, which aren’t
covered under most insurance plans, those embryos represent
a great deal of money and painstaking effort.
Frozen embryos are no bigger that the period at the end
of this sentence, and almost everything about them suggests
that they aren’t alive. They’re stored in laboratories,
inside canisters the size of small beer kegs. The canisters
are filled with liquid nitrogen to keep the embryos frozen
indefinitely at minus 198 F. But put a frozen embryo under
a microscope and you’ll see the tiny cluster of cells
that, under the right conditions, holds the potential for
human life. That potential is a source of great encouragement
for infertile couples – even those who have successfully
completed their families.
“The embryos represent a ray of hope,” Copperman
says, which is why man y couples are reluctant to make a
decision about their future. “Giving permission to
discard them is not something they find easy to do.”
In the meantime, they leave their embryos inside the cold
canisters in fertility centers around the country. Copperman
estimates that his office has more than a hundred of them,
some belonging to patients he hasn’t seen in as many
as 12 years.
For Copperman and other infertility doctors, these forgotten
embryos represent a legal nightmare. “The same people
who have not come forward in the last decade to tell us
what to do with their embryos would sue us for destruction
of their property if we destroyed them,” says Copperman.
In recent years, his center has started charging couples
a yearly fee of $1,000 to store their embryos. Other clinics
have also taken this tactic; Dr. Rifaat Salem, who runs
the Pacific Reproductive Centers in Torrance and Irvine,
California, sent all his patients who were storing embryos
last year bills for $650. “Everybody has started waking
up now,” says Salem.
But a financial penalty is not always enough to spur couples
into making a decision. Some, like Tony and Lana, decided
to simply keep paying the bill each year. Others ignore
the invoices; Copperman’s clinic has resorted to using
a collection agency. “If the decision about what to
do with the embryos were easy,” he says wearily, “these
couples would’ve made it years ago.”
Copperman and other infertility doctors have even gone so
far as to hire therapists to counsel couples about their
frozen embryos. But still, deciding the fate of these microscopic
potential human beings is not easy, since the few options
available have serious emotional, moral and even legal ramifications.
To avoid making the
conscious decision to destroy or relinquish their
embryos, says Salem, many couples decide to give them
a shot at life by undergoing one final round of in-vitro
fertilization – even if they don’t necessarily
want any more children or they’re long past
traditional child-bearing age. One couple is Joan
and Wayne Smith from Clarksville, Maryland. In 1997,
when Joan was 54 years old, the Smiths had a son,
Jake, through in-vitro fertilization using donor eggs.
They were left with five frozen embryos. When Jake
was born, Joan was already a grandmother and had a
34-year-old son from a previous marriage, and Wayne
had two grown daughters, but they both agreed to try
for yet another child to give Jake a sibling closer
to his age.
for broke: At age 56, Joan Smith decided to use the
embryos she and Wayne had frozen. Twins resulted.
3-year-old twins Jon (rubbing
nose) and Joe Smith (front), as well as their 4-year-old
brother Jake (background)
“We knew that we could pass
away before Jake turned thirty and then he might not
have a family, so we thought we should have another
child,” says Joan. The Smiths got more than
they bargained for when they transferred three of
their leftover embryos and Joan became pregnant with
twins. Joe and Jon were born in 1998 when Joan was
56 years old. “I think of having three teenagers
at the age of seventy,” Joan says laughing,
“and then I think I need to have my head examined.”
Most couples who don’t want additional children
eventually decide to destroy their embryos. The procedure
is a lot less violent than it sounds, Copperman emphasizes.
“It’s not like we line them up and shoot
them,” he says, his face serious.
Embryologists simply remove the embryos from the tank and
within minutes, the microscopic cells begin to fragment
and decompose. It’s an invisible process, but it holds
profound emotional significance for a great number of couples.
Some attend the procedure and hold makeshift funerals. One
couple took their thawed embryos home from the Helix Center
for Assisted Reproductive Technologies in Baltimore, Maryland,
to give them a proper burial.
As a third option, a very small percentage of people donate
their embryos to science. These are mostly earmarked for
stem-cell research, which scientists say could hold the
key to cures for many diseases such as diabetes and Alzheimer’s.
Donation is often a comforting option because couples fell
that their embryos are being used for a good cause. But,
taking this route became more difficult last August, after
President Bush decided to withhold federal funding for any
studies using new stem cells. Couples can still donate their
embryos to labs receiving private funding, but there are
only a handful around the country (see “Stem Cells,
Ethics and the Law,” page 34).
Finding solace in adoption
Some people, particularly those with strong religious convictions,
believe that frozen embryos are human lives, so donating
to science is not an option (since scientists must destroy
the fertilized eggs in order to extract stem cells from
them). For these couples, even holding a funeral or burying
their embryos wouldn’t ease the burden of feeling
responsible for the death of their own children.
That was the case for Miriam Vigil, 43, and her husband,
Ted, 38, from Torrance, California. In 1997, the Vigils
took out a $10,000 loan to pay for the in-vitro fertilization
treatments that gave them their twin daughters, born in
1998. Along the way, they froze five embryos. The couple,
like many undergoing infertility treatments, were so anxious
to become pregnant that they gave little thought to what
they would do with the unused embryos. They forgot the embryos
even existed until they received a storage bill for $650
a year after their twins were born.
“My life was complete,” Miriam says, “and
then all of a sudden my emotions started coming back. I
started to get so sad. I started feeling torn.” The
Vigils were already under a great financial strain because
of their loan payments, and they didn’t feel that
they could afford to have any more children. Still, neither
of them was comfortable with the idea of destroying their
frozen embryos. After much prayer, they decided to put their
embryos up for adoption.
Embryo adoption is still a relatively rare option and is
not offered at most fertility clinics. But some centers
– like the Pacific Reproductive Center where Miriam
had her treatment and where she and her husband stored their
embryos – do provide it. All the Vigils needed to
do was sign a form agreeing to release their embryos anonymously
to another couple selected by the clinic director. At first,
Miriam says, she was reluctant to go through with it.
“I felt like the embryos were part of me and my husband,”
she says sadly. “That they were my children. But we
really didn’t have any other option.” When the
Vigils heard there might be an interested couple, Miriam
knew it was the right thing to do. But that didn’t
make it an easy choice.
As she and Ted drove home from the clinic, after signing
away their embryos, “I felt like I had let a little
piece of my life go,” she says, her voice breaking.
“The embryos had our characteristics. They could look
like my daughters. And I thought, I’ll never know
where they’re going to be.”
To complicate matters, many medical and legal experts question
whether embryo adoption is really advisable, as it’s
a very new concept and involves several legal risks. Melissa
Brisman, a reproductive lawyer in New Jersey who counsels
couples undergoing infertility treatments, says even though
they are required to sign consent forms relinquishing control
of their embryos, couples who decide to donate them are
entering legally uncharted territory.
“People think of it as being akin to adoption,”
she says, “but really it’s not. With a regular
adoption, once the birth mother’s and father’s
rights are legally terminated, the birth mother can’t
come back and say I want the baby. But there aren’t
any laws out there for embryo adoptions.” That means
couples who adopt embryos could be blindsided by a lawsuit
if the donor parents change their minds years later. Miriam
says she often wonders what would happen if she recognized
a child resulting from her embryos on the street. “It
makes me want to cry,” she confides. “But I
don’t think I would pursue a relationship unless it
was really important to my husband.”
Microscopic time bombs
While it can be wrenching for couples to destroy their embryos
or put them up for adoption, letting them linger in storage
can have equally devastating consequences in cases where
one partner dies or a couple divorces. Most fertility clinics
require couples to sign consent forms before freezing their
embryos, but they often do not detail what will be done
with them in the event of death or divorce. As James Katz,
a constitutional litigation lawyer in New Jersey points
out, when couples sign these forms, “they often can’t
imagine at the time that a year down the road there could
be problems. My experience is that people suffering from
reproductive problems will do anything and sign anything
to have success.”
There can even be unforeseen difficulties for couples who
read their forms carefully. Ruth Miller, 45, a former actress
who .lives in Ohio, remembers her surprise when she and
her husband, Jim, discussed their consent form. “I
was extremely hurt when Jim said that in the event of our
divorce he’d want our embryos thawed and destroyed,”
she reveals. “I said, ‘Listen, these eggs are
all I have and I’m getting near the end of my supply.’
It got really volatile. But in the end, I had to acquiesce.
Ruth and her husband ended up using their embryos, and
they’re still married, but other couples haven’t
been as lucky. Embryo custody battles have been fought in
the state supreme courts in Tennessee, New York, Massachusetts
and New Jersey. Katz recently represented a New Jersey woman
who froze seven embryos with her husband. The couple signed
a form that was extremely ambiguous about what would happen
to the embryos if they divorced. When the marriage ended,
her husband insisted that she had orally agreed that they
could be used for reproductive purposes, including being
implanted in his future wife or another couple seeking adoption.
But she refused to release the embryos and a lawsuit ensued.
The problem, says Katz, is that issues involving personal
decisions – like becoming a parent- are not necessarily
subject to binding contractual law. Even if a couple agrees
that in case of divorce one partner will retain the right
to use the frozen embryos, it’s unlikely that this
agreement would be enforced. Hat was the decision reaffirmed
by the New Jersey Supreme Court in this particular case.
In other words, it’s doubtful that any court would
uphold a contract that could require a person to become
a parent against his or her will. A few states have already
addressed this issue, but it’s unclear if courts would
make exceptions for people whom the embryos offered the
only chance of having a child.
Holding on to youth
Despite the potential legal complications and costly storage
bills, some couples confess that keeping their leftover
embryos perpetually frozen is an attempt to postpone the
passage of time, to keep at least some part of themselves
– some piece of their fertile past – alive.
Trudy Ambler, 46, and her husband, Mike, 41, from Santa
Maria, California, have paid close to $2,000 to store their
embryos that they froze in 1999. They spent five years under-going
five exhausting in-vitro cycles before Trudy finally became
pregnant. Since their daughter, Mikayla Marie, was born
in 2000, the Amblers have struggled to make a decision about
there and I know that they’re there,”
Trudy says. “But to get rid of them is like
saying I’ll never have another child.”
An only child?
Trudy and Mike Ambler had Mikayla in 2000, but can’t
let go of their three remaining embryos.
The Amblers have considered using their embryos for another
cycle of in-vitro fertilization, but they haven’t
taken any action yet. Trudy, who has an adult son and daughter
from a previous marriage, is reluctant to undergo the physically
grueling procedure again. What’s more, she says, she’s
learning just how taxing it can be as an older parent. “I’m
in a play group with women who are younger than me and I
look at them and wonder how I ever did it, even when I was
their age,” she says. The Amblers have discussed donating
their embryos to science (neither feels comfortable donating
them to another couple), but so far, they haven’t
agreed on a resolution. “It takes a lot of though,”
Meanwhile, Mikayla is approaching her second birthday and
next year’s storage bill looms on the horizon.
Stem cell Ethics and the
Frozen embryos are at the
core of the stem-cell debate that started in 1998,
when scientists discovered that stem cells could be
isolated from embryos. Stem cells are the building
blocks for all human tissue and promise to be invaluable
in developing treatments for diseases such as Parkinson’s,
Alzheimer’s, and diabetes. But because research
involves destroying the embryos, it has fueled an
impassioned response from pro-life groups who believe
their embryos are human lives.
President Bush’s decision
to allow federal funding for research on already existing
stem-cell colonies – but not for the destruction
of new embryos – didn’t satisfy many scientists,
who argued that existing cells are inadequate. To
address this, a Senate provision may give the President
the discretion to fund research on new groups of stem
While donating frozen embryos
for privately funded stem-cell research remains controversial,
it is still legal. However, very few couples exercise
this option. Many fertility centers don’t even
mention this possibility. In 12 years, Dr. Rifaat
Salem of the Pacific Reproductive Center in California
hasn’t had one couple request to donate their
embryos to science.
Couple who are comfortable
with donating their remaining frozen embryos for stem-cell
research should discuss the option with their doctor,
as some centers have relationships with privately
*Some names of family members have been changed at their