Researchers ponder best use of 400,000 stored embryos

American Medical News ^ | 6/16/03 | Andis Robeznieks

[RJCogburn]

For the first time, it's now known how many frozen human embryos created for infertility treatments are being stored in the United States -- 400,000, twice as high as previous estimates.

Researchers with the Society for Assisted Reproductive Technology found that most are designated for further fertility treatments, though it's doubtful that all 349,830 embryos with this designation will be used for that purpose.

Many of the embryos will not survive the thawing process but, as the number of "leftovers" left in freezers continues to rise, there are calls to minimize embryo production, put limits on storage time, and to have couples donate the embryos for use in research or for the infertility treatment of other couples.

The last choice has been embraced by the federal government, which is spending $1 million to foster public awareness of the "embryo-adoption" option for infertile couples.

"This issue has been around since in vitro fertilization was new," said Timothy Murphy, PhD, professor of philosophy in the biomedical sciences at the University of Illinois College of Medicine at Chicago and a visiting scholar at the AMA Institute for Ethics. "But folks are paying more attention to it now in political ways rather than medical."

Lori A. Marshall, MD, head of reproductive endocrinology at Virginia Mason Medical Center in Seattle, said one point lost in the debate is how many of the embryos actually have the potential to develop into a child.

"I think that's a misperception: that 400,000 embryos means there could be 400,000 people out there," she said. "About 35% don't survive the thawing process."

Dr. Marshall said it might be unfair to press couples to donate or destroy embryos they have in storage.

"There is concern that there are embryos being stored because couples don't know what to do with them, but we don't know what's in the mind of couples who are continuing to pay storage fees," she said. "I think that the perception of some of the public is that couples who are infertile are selfish and they should be giving away their embryos to couples who want them, but it's a lot more complicated than meets the eye."

David I. Hoffman, MD, was part of the research team that calculated the number of embryos held in storage and was lead author of its report, published in the May 2003 issue of Fertility & Sterility.

Dr. Hoffman, past president of the Society for Assisted Reproductive Technology, said few couples donate their embryos to other couples.

The study found that 9,225 frozen embryos are available for other couples to use, but Dr. Hoffman said that during his 14 years with IVF Florida Reproductive Associates in Margate, Fla., only two couples had donated embryos for this purpose.

"I'm sure it's a viable alternative," he said. "But in my practice, it's the last thing people will do."

If donated embryos are chosen by another couple, Dr. Hoffman said, the donor couple must come back for genetic- and infectious-disease screening, so the cost and inconvenience of testing work against this option.

Nevertheless, the government and some Christian adoption groups are working to increase the use of donated embryos. Last year, the U.S. Dept. of Health and Human Services released $1 million in grants to launch embryo-adoption public awareness campaigns.

There is not much complaint about the program's goal, just its use of the word "adoption," which in some people's minds politicizes the process.

"The use of the term 'adoption' is loaded," Dr. Murphy said. "It suggests that there is a recognizable human being in ethics and law, and that's disputable."

Half of the federal grant money is going to Snowflakes Embryo Adoption Program, a branch of the Nightlight Christian Adoptions agency in Fullerton, Calif. Snowflakes maintains that each frozen embryo -- like a snowflake -- is unique.

Program spokeswoman JoAnn Eiman said the grant was being used to produce 11,000 embryo-adoption videos for distribution to the public, medical community and news media.

Started six years ago, Snowflakes is beginning to pick up steam.

The embryo-adoption program has resulted in 30 children being born, including 11 this year and eight last year, Eiman said, adding that at least four more babies are expected this year.

One aspect of Snowflakes that's different from clinic-run donation programs is that the donating couple choose the parents of their embryos.

"The process is a little different, but the goal is the same: Moving embryos from storage to a home," Eiman said. "We don't care what anyone calls it. Getting people aware that this exists is what we're focused on."

Dr. Murphy said using another couple's already created embryos is a proper solution for treating infertility, but he called the government grant program an "empty political gesture" because it was impractical to expect that tens of thousands of women would try this to have children.

[eccentric]

I'd carry a 'snowflake' to term for someone else. It cost to much to do myself, and I don't want more kids.