It's a difficult reproductive question faced by hundreds of thousands of people and pretty much nobody is talking about it. Elissa Strauss writes on Elle about the million frozen embryos in the US, the two that are hers, and why nearly everyone has so much trouble figuring out what to do with them. Read on:
There are an estimated one million frozen embryos in the United States right now. If you're somebody who believes life begins at conception, you might see a potential tragedy. If you’re somebody who has long been struggling with infertility, you might wish that someone, somewhere, would send one your way. If you’re a clinic or storage facility, you might see a logistical struggle. And if you’re a former patient of IVF to whom one or more of those embryos belong, you might see indecision, an unyielding maybe that you can avoid dealing with for the not insignificant cost of approximately $750 per year.
Two of those million some embryos are mine, the byproduct of a successful course of treatment that resulted in the birth of a healthy child earlier this year. They’re currently residing in New York City, bundles of 120 cells suspended in cryoprotectant locked in a freezer set to negative 196 degrees celsius on the Upper East Side. We’re 3000 miles in our new home of Oakland CA, two parents, two kids, one dog. This was the plan, the dream even. Here we are.
What should we do with our two leftover embryos? The options, which include using them to try to have another child, donating them to research or another couple, or destroying them, are clear. Choosing one is not. Much of this struggle lies not so much in my indecisiveness, but my resentment about having to make this decision at all. Following a year of infertility treatments and another ten months of a highly monitored pregnancy, I’d prefer to retreat back to the illusion that creating life is more a matter of fate than human will. My son, the fullness of his thighs, the urgency of his coohs and cahs, affords me this fantasy. My embryos do not. Alive, but not quite, us, but not quite, they came into being by way a series of measured calculations designed to work as corrective to fate. Now we have to decide what’s next.
We are not unique in our ambivalence. A series of research projects led by Robert Nachtigall, a OB-Gyn at UC San Francisco, found that embryo disposition, the official term for getting rid of excess embryos, is rarely easy. A 2005 study called the decision “a significant and frequently unresolved issue for couples with stored frozen embryos,” one complicated by “their deeply personal conceptualizations of their embryos” which “contributes to their ambivalence, uncertainty, and difficulty in reaching a decision.” Another study found that “the majority of embryo-holding families choose to postpone ultimate decision-making about their embryos.” Some do this because they aren’t sure they are done having children, others because of an inability to make a decision, whether because of ambivalence or disagreement, and others because they lack the information and support to make a decision.
“This is one of the unintended consequences of IVF that doesn’t get a lot of attention,” said Barbara Collura, President and CEO of RESOLVE: The National Infertility Association. “But this is a huge challenge, and there is frankly not enough being done to help.”
Most reproductive health clinics, along with the patients they serve, operate with tunnel vision. They want to get you pregnant. When you are going through IVF, they require patients to sign a consent form about the fate of their potential extra embryos should a couple get divorced or someone dies. That tends to be it. Rarely does somebody sit you down and say, “you might end this process with excess embryos and here’s what you might do with them.” Even more rarely does somebody tell you that it might be hard. If they did, you might only laugh at the suggestion of such excessive fortune.
Outside the walls of the clinic it’s not much different. A byproduct of the ongoing fight for reproductive rights has been the self-censorship of stories that don’t follow the logic of either side of the debate. Regrets and mixed feelings about abortions, miscarriages and embryos can easily be interpreted as sympathy towards, or fodder for, the anti-abortion movement. So we hold back from talking about the messy middle in which embryos exist for many of us, compelled to contemplate their meaning and worth all on our own.
IF I DONATED MY EMBRYOS, I WORRIED I’D SPEND MY LIFE LOOKING FOR WHAT I STILL CONSIDERED MY CHILD.
The embryo disposition question surfaced about one month after my IVF baby was born. Having never received information about my options from my infertility clinic, I went searching for them on the internet. Google quickly directed me to RESOLVE’s website, where there is a list of seven options former IVF patients can choose from. Immediately, I ruled out four.
The easiest to dismiss was donating them to be used by someone else. This would involve giving the embryos to a clinic, or directly to a couple or individual who could implant it and, should it lead to a live birth, raise it. In order to create an embryo without any of their biological material, an infertile couple might have to pay for donor sperm and a donor egg, and then pay for a clinic to combine them and then transfer one or more resulting embryos to the womb, all of which can easily cost tens of thousands of dollars. While it is against the law to sell biological material, clinics are allowed to charge for the time and effort that goes into making sperm and eggs. Embryos, on the other hand, are generally a byproduct of a process done for another purpose and therefore can’t be assigned any monetary value. The cost of using a donated embryo includes only legal fees and the cost of transferring the embryo to the womb, which adds up to around $5000.
I could never donate my embryos because I’d be certain that I’d spend the rest of my life looking for what I would still consider my child. Most couples dealing with the disposition question feel the same. According to research done by Nachtigall and others, only a small number of couples—just 6% in one study—decide to donate their embryos.
However, some working in the industry say they see an uptick in couples being interested in donating their excess embryos, and a host of start-ups have arrived to help facilitate the process. One of these is Embryo Options, a new company that works with clinics to guide their patients through the whole embryo storage and disposition process, including donation. “We are like Match.com between embryo donors and recipients,” said co-founder Jim Knowles.
I WON’T OPT FOR THE SIMPLER, CHEAPER OPTION OF EMBRYO DESTRUCTION.
Knowles and his partner Andy Gairani said they started Embryo Options because they saw people trying to donate embryos by way of Facebook and determined they could use some help. Unlike many of the Christian groups helping facilitate embryo donation, or “adoption” as they often call it, Knowles and Gairani don’t put any moral premium on donation. “We just want to make sure [embryo disposition] is an educational process, and that there are tools out there to help place these embryos with recipients who want them.”
The rise in interest could be in part the effect of a federal program that spent tens of millions of dollars to raise awareness of embryo donation, or “snowflake adoption.” This began during the Bush administration, designed to protect what he considered “our society’s most vulnerable members,” and continued through the Obama years.
Even with the recent uptick, embryo donation as a large-scale answer to the excess embryo question has many skeptics. Arthur Caplan, a professor of bioethics at New York University, says he doesn’t believe that this will ever take off. “This is a completely ideological, moralistically driven solution. Meanwhile the fate of all these frozen embryos lies in the hands of utility companies.”
“Most people won’t feel comfortable with this,” he continued. “Could you ever feel comfortable with this?” “Never,” I replied.
Another non-option for me is the compassionate transfer, a procedure which involves placing the embryo in a woman during a time of her cycle when it has little chance of surviving. Before I went through IVF I neatly filed this away in the slightly ridiculous yet forgivable category. I considered it a waste of resources, financial and medical, and a product of the kind of knotty logic that often emerges when religious ethics butt heads with reproductive medicine.
Now that I’m on the other side of this process, I’ve become more sensitive to its appeal. Here’s a ritual, almost pagan in its mix of physicality and near absurdity, that might help women navigate through the liminality of frozen embryo possession. There’s a poetic cyclicality to having the cells reabsorbed into the mother’s body; a sense that the science experiment is over everything is back where it should be.
I won’t do that, nor will I opt for the simpler, cheaper option of embryo destruction in which they are thawed and discarded in the lab, or destroyed in a disposal ceremony of my own devising, because embryos are useful. They can be donated to research, either to be used in the lab or, less commonly, for stem cell research project. When choosing this option, I cut off any chance my embryos have to become life, but I guarantee that they will contribute to life; a fitting end to their confounding alive-but-not-life status. Studies show this feeling is common.
When I first heard of the research option, I imagined that meant that our embryos would head off to a stem cell lab, where they might play a crucial role in curing Alzheimer's or the creation of new organs for transplants. This scenario, I’ve since learned, is highly unlikely. Most embryos donated to research are destined for a less heroic and headline grabbing fate: they are used to help the infertility clinic maintain quality control. They might be used to train a young embryologist, or ensure that a new equipment is up to par. This is still contributing to life—that embryologist might gain skills that help her help other couples have babies—but it’s not what I had imagined.
According to Susan Fisher, the director of the Human Embryonic Stem Cell Program at University of California, San Francisco, this is largely because of federal laws limiting stem cell research. “The bar is so high to be able to do this work. You must work in non-federal lab, with non-federal equipment and non-federal fund,” she said. “This is such a shame to me, because people want them used for greater good, but there are all kinds of obstacles.”
While Obama undid some of the the second Bush’s restrictions, the field is still largely underfunded. Today, most research is done on stem cells created from adults, which are less politically controversial, but also, according to Fisher, less effective. “Embryonic stem cells are still what we would call the gold standard” and would provide far more insights into how our bodies work. “If we take the 30,000 feet perspective, we know nothing about human development. And the reason for this because, for a very long time, the United States government has not supported this work. In many ways they have prevented this work,” she said.
There isn’t a central organization where patients can go look for studies looking for embryos, no single entity that can walk them through research projects and facilitate donation. Doing it on one’s own is possible, but it’s a cumbersome process that requires an in-depth knowledge about how academic institutions work as well as a deep well of patience to wade through all the red tape. Individuals might also be responsible for setting up the transfer of their embryo, which can be complicated in and of itself. The infertility clinic that we used allows us to donate our embryos to stem cell research, but I was told that they embryos with such a designation often sit in the freezer for a long time. Hang in there long enough, she explained, and there’s a decent chance they will be be destroyed.
There is another option here, the one that all choices must ultimately be measured against. We could use the embryo to try to have a child. Ruling this out should be easy. We don’t want another child. But our present selves and future selves are rarely the same people and what’s obvious today might be a source of regret later on. What do I owe to person I will become in the next half decade? Some days I think the answer is clear: as much opportunity as I can give her and her family. Other days, most days, I think differently. Betting on change is foolish. It will cost our family many thousands of dollars, and, worse, serve as invitation for self-examination, even self-scrutiny, over the years about what kind of person doesn’t want more children. Especially when they are already in the works.
Finally there’s the last choice, the popular choice, the no-choice choice, of storing them for some undetermined amount of time. I understand its appeal and might consider it if I wasn’t constitutionally incapable of taking this path. This is because I’m an overly decisive type, the sort who moves swiftly and confidently through matters large and small and rarely second guesses herself afterward, occasionally to a fault. I do this in part because I’m terrible at avoidance, and lack the facility to redirect big questions, or tiny embryos, to the dark corners of mind where they can hibernate until I’m ready. I think of those maybe babies, and all that went into making them, and long for closure.
According to Dr. Nachtigall the no-choice choice is the most common one, and accounts for around two-thirds the people he has studied. “In order for couples to engage with disposition decision, they must first undergo a shift in conceptualization of embryos [away from potential children]. This shift is required before they can let them go. I don’t think it is easy,” he said.
____
Making a decision about embryos is complicated largely because we lack consensus on what they actually are. Bioethicists struggle to define them, trying to find a middle-ground between human tissue and a child. “Even if you don’t believe they are a person, they have moral status. You can’t minimize that; the genetic connection makes it really challenging to do so,” said Lisa Campo-Engelstein, an associate professor at the Alden March Bioethics Institute at Albany Medical College.
She believes one solution to the excess embryo question is for clinics to stop making so many embryos in the first place. They could instead freeze eggs and sperm and create embryos as needed, a process that is far less likely to create lower live birth rates than it would have in the past. This would avoid psychological strife on behalf of the possessors of embryos as well as prevent the number of excess embryos in the country from continuing to grow.
Another way to reduce the number of embryos sitting in freezers would be to have laws limiting how long they can be frozen for, which exist in other countries. In the United Kingdom, for example, most regions only allow individuals or couples to store embryos for ten years. In addition to the obvious effect of reducing the embryo glut, this legal framework might also change the way we think about embryos. If it becomes the norm to dispose of them at some point, then people might become more comfortable with letting go of them—at any point. It would also give the clinic the permission to destroy abandoned embryos after a certain predetermined period of time. As it stands now, most clinics never destroy embryos, even if storage fees haven’t been paid for years, out of fear that they might be sued should their patients or clients return years later and demand them.
“There has to be some endpoint,” Campo-Engelstein said. “I heard about a couple who was planning on bequeathing their embryos to their children. There should be safeguards in place.”
NYU’s Caplan has another suggestion for tweaking how we view embryos: change their name. He prefers calling those that have yet to enter the womb “pre-embryos,” a term some of in the reproductive medicine field have already adopted. “Clinics are responsible [for some of the confusion surrounding embryos] because they treat them like babies,” Caplan said. “There is a lot of politics, and even a little business, in what you call an embryo in a dish or tank.” In this largely for-profit field, the closer you get to promising someone a baby, the more likely your patients will opt for more, and more expensive, treatments.
When Caplan said “pre-embryo,” my mind quickly pivoted away from burden and towards relief. I’d always seen them as potential life, as opposed to life, and bristled at infertility discussion groups where they are lovingly named “embies,” and often attached to a gender descriptor. But this semantic tweak further emphases their potentiality, and detracts from any cuddly associations. When I think of my potential embryos, or the other million potential embryos, I see them less as a burden, or potential scientific plot, and more as a byproduct of a medical procedure. So much easier to say goodbye.
The law offers little in the way of clarity as to the status of embryos. Most lawyers and judges frame them as property, but “deserving of special respect for their potential to become a person,” as one much referenced court case put it. “You treat it respectfully, but it’s not a person. It doesn’t have all the rights of a person,” said Margaret E. Swain, the director of the American Academy of Assisted Reproductive Technology Attorneys.
But this definition is not federal law. Different states have different rules on the legal standing of embryos, mostly regarding what can be done to them while they are alive and whether or not their fate should be determined by a contract or what’s in the best interest of their parents. One state, Louisiana, gives embryos judicial standing, which is the reason why Sofia Vergara’s ex-fiancée Nick Loeb, headed east to file a lawsuit on behalf of their embryos in an attempt to use them. (A federal judge in Louisiana ultimately dismissed the case because neither parent lived there, nor were the embryos created there.)
About the closest we have ever gotten to a federal definition of embryos is when President Obama was sued by Mary Scott Doe, a “frozen embryo symbolizing all existing frozen embryos,” after lifting part of the ban on stem cell research 2009. A federal appeals court ruled against little Mary, claiming that the case had no standing because embryos are an “amorphous” class and nobody could prove any actual harm.
Politically speaking, the few attempts to articulate what embryos are have mostly happened in the context of the pro-life movement. There was the aforementioned program to encourage embryo donations, which was bereft of any information on other disposition options. Also, efforts to make IVF widely available to wounded veterans have been stymied by those on the right who don’t want to be a party to the creation of excess embryos that might later be destroyed.
Overall, however, the anti-abortion movement has largely stayed away from this issue. One rarely sees protests outside IVF clinics, or laws limiting the number of eggs that can be fertilized. Most reproductive advocates believe this is because of the bad optics. These embryos are for family-building, for creating life; the narratives fueling the anti-abortion movement claiming carelessness and disdain for life don’t work here. However, should personhood laws ever pass, the informal armistice could very well end.
____
My husband and I are lucky. The excess embryo question can create a lot of friction between couples, but we’re generally in agreement. Still, this agreement does not reflect an equal sharing of the burden of making this decision. He is also a journalist. He did not decide to research and write a 3500 plus word article on embryo disposition.
The whys are fairly obvious. Most of the physical labor involved in creating those embryos was on me, as would be the act of gestating them. Most of the emotional labor of family planning is on me, because I’m a woman and long ago the world decided women need to worry about such things. He didn’t cast judgement on all my ruminating. He was never an active participant in it either. He wanted to hear where I landed, and when I told him he was in swift agreement.
According to Jake Anderson, co-founder of the Fertility IQ, a website that offers data on doctors, clinic, and treatments in the field of reproductive medicine, women and men tend to approach the embryo disposition question differently.
“We often see a breakdown along gender lines among heterosexual couples. The guy often thinks ‘we got what we wanted, let’s call it a day.’ And the woman thinks that she never wants to revisit the whole process of going through IVF, so she would rather hold onto them,” he said. “This can be a meaningful pain point.”
We decided that we want to put this all behind us. We are going to donate our embryos to stem cell research, but request that if they aren’t used in a couple of years, then they should be donated to the reproductive lab. We concluded that should our tides shift and we decide we want to have another kid, we will try to have another kid. Even if that means going through IVF. That might not work, but so might not these two embryos we are saying goodbye to, or just about anything and everything else we do in a lifetime. We will be submitting ourselves to chance, which will, in turn, allow us to better commit to who we are now. To the children in front of us, to all the life we’ve already created.
There are an estimated one million frozen embryos in the United States right now. If you're somebody who believes life begins at conception, you might see a potential tragedy. If you’re somebody who has long been struggling with infertility, you might wish that someone, somewhere, would send one your way. If you’re a clinic or storage facility, you might see a logistical struggle. And if you’re a former patient of IVF to whom one or more of those embryos belong, you might see indecision, an unyielding maybe that you can avoid dealing with for the not insignificant cost of approximately $750 per year.
Two of those million some embryos are mine, the byproduct of a successful course of treatment that resulted in the birth of a healthy child earlier this year. They’re currently residing in New York City, bundles of 120 cells suspended in cryoprotectant locked in a freezer set to negative 196 degrees celsius on the Upper East Side. We’re 3000 miles in our new home of Oakland CA, two parents, two kids, one dog. This was the plan, the dream even. Here we are.
What should we do with our two leftover embryos? The options, which include using them to try to have another child, donating them to research or another couple, or destroying them, are clear. Choosing one is not. Much of this struggle lies not so much in my indecisiveness, but my resentment about having to make this decision at all. Following a year of infertility treatments and another ten months of a highly monitored pregnancy, I’d prefer to retreat back to the illusion that creating life is more a matter of fate than human will. My son, the fullness of his thighs, the urgency of his coohs and cahs, affords me this fantasy. My embryos do not. Alive, but not quite, us, but not quite, they came into being by way a series of measured calculations designed to work as corrective to fate. Now we have to decide what’s next.
We are not unique in our ambivalence. A series of research projects led by Robert Nachtigall, a OB-Gyn at UC San Francisco, found that embryo disposition, the official term for getting rid of excess embryos, is rarely easy. A 2005 study called the decision “a significant and frequently unresolved issue for couples with stored frozen embryos,” one complicated by “their deeply personal conceptualizations of their embryos” which “contributes to their ambivalence, uncertainty, and difficulty in reaching a decision.” Another study found that “the majority of embryo-holding families choose to postpone ultimate decision-making about their embryos.” Some do this because they aren’t sure they are done having children, others because of an inability to make a decision, whether because of ambivalence or disagreement, and others because they lack the information and support to make a decision.
“This is one of the unintended consequences of IVF that doesn’t get a lot of attention,” said Barbara Collura, President and CEO of RESOLVE: The National Infertility Association. “But this is a huge challenge, and there is frankly not enough being done to help.”
Most reproductive health clinics, along with the patients they serve, operate with tunnel vision. They want to get you pregnant. When you are going through IVF, they require patients to sign a consent form about the fate of their potential extra embryos should a couple get divorced or someone dies. That tends to be it. Rarely does somebody sit you down and say, “you might end this process with excess embryos and here’s what you might do with them.” Even more rarely does somebody tell you that it might be hard. If they did, you might only laugh at the suggestion of such excessive fortune.
Outside the walls of the clinic it’s not much different. A byproduct of the ongoing fight for reproductive rights has been the self-censorship of stories that don’t follow the logic of either side of the debate. Regrets and mixed feelings about abortions, miscarriages and embryos can easily be interpreted as sympathy towards, or fodder for, the anti-abortion movement. So we hold back from talking about the messy middle in which embryos exist for many of us, compelled to contemplate their meaning and worth all on our own.
IF I DONATED MY EMBRYOS, I WORRIED I’D SPEND MY LIFE LOOKING FOR WHAT I STILL CONSIDERED MY CHILD.
The embryo disposition question surfaced about one month after my IVF baby was born. Having never received information about my options from my infertility clinic, I went searching for them on the internet. Google quickly directed me to RESOLVE’s website, where there is a list of seven options former IVF patients can choose from. Immediately, I ruled out four.
The easiest to dismiss was donating them to be used by someone else. This would involve giving the embryos to a clinic, or directly to a couple or individual who could implant it and, should it lead to a live birth, raise it. In order to create an embryo without any of their biological material, an infertile couple might have to pay for donor sperm and a donor egg, and then pay for a clinic to combine them and then transfer one or more resulting embryos to the womb, all of which can easily cost tens of thousands of dollars. While it is against the law to sell biological material, clinics are allowed to charge for the time and effort that goes into making sperm and eggs. Embryos, on the other hand, are generally a byproduct of a process done for another purpose and therefore can’t be assigned any monetary value. The cost of using a donated embryo includes only legal fees and the cost of transferring the embryo to the womb, which adds up to around $5000.
I could never donate my embryos because I’d be certain that I’d spend the rest of my life looking for what I would still consider my child. Most couples dealing with the disposition question feel the same. According to research done by Nachtigall and others, only a small number of couples—just 6% in one study—decide to donate their embryos.
However, some working in the industry say they see an uptick in couples being interested in donating their excess embryos, and a host of start-ups have arrived to help facilitate the process. One of these is Embryo Options, a new company that works with clinics to guide their patients through the whole embryo storage and disposition process, including donation. “We are like Match.com between embryo donors and recipients,” said co-founder Jim Knowles.
I WON’T OPT FOR THE SIMPLER, CHEAPER OPTION OF EMBRYO DESTRUCTION.
Knowles and his partner Andy Gairani said they started Embryo Options because they saw people trying to donate embryos by way of Facebook and determined they could use some help. Unlike many of the Christian groups helping facilitate embryo donation, or “adoption” as they often call it, Knowles and Gairani don’t put any moral premium on donation. “We just want to make sure [embryo disposition] is an educational process, and that there are tools out there to help place these embryos with recipients who want them.”
The rise in interest could be in part the effect of a federal program that spent tens of millions of dollars to raise awareness of embryo donation, or “snowflake adoption.” This began during the Bush administration, designed to protect what he considered “our society’s most vulnerable members,” and continued through the Obama years.
Even with the recent uptick, embryo donation as a large-scale answer to the excess embryo question has many skeptics. Arthur Caplan, a professor of bioethics at New York University, says he doesn’t believe that this will ever take off. “This is a completely ideological, moralistically driven solution. Meanwhile the fate of all these frozen embryos lies in the hands of utility companies.”
“Most people won’t feel comfortable with this,” he continued. “Could you ever feel comfortable with this?” “Never,” I replied.
Another non-option for me is the compassionate transfer, a procedure which involves placing the embryo in a woman during a time of her cycle when it has little chance of surviving. Before I went through IVF I neatly filed this away in the slightly ridiculous yet forgivable category. I considered it a waste of resources, financial and medical, and a product of the kind of knotty logic that often emerges when religious ethics butt heads with reproductive medicine.
Now that I’m on the other side of this process, I’ve become more sensitive to its appeal. Here’s a ritual, almost pagan in its mix of physicality and near absurdity, that might help women navigate through the liminality of frozen embryo possession. There’s a poetic cyclicality to having the cells reabsorbed into the mother’s body; a sense that the science experiment is over everything is back where it should be.
I won’t do that, nor will I opt for the simpler, cheaper option of embryo destruction in which they are thawed and discarded in the lab, or destroyed in a disposal ceremony of my own devising, because embryos are useful. They can be donated to research, either to be used in the lab or, less commonly, for stem cell research project. When choosing this option, I cut off any chance my embryos have to become life, but I guarantee that they will contribute to life; a fitting end to their confounding alive-but-not-life status. Studies show this feeling is common.
When I first heard of the research option, I imagined that meant that our embryos would head off to a stem cell lab, where they might play a crucial role in curing Alzheimer's or the creation of new organs for transplants. This scenario, I’ve since learned, is highly unlikely. Most embryos donated to research are destined for a less heroic and headline grabbing fate: they are used to help the infertility clinic maintain quality control. They might be used to train a young embryologist, or ensure that a new equipment is up to par. This is still contributing to life—that embryologist might gain skills that help her help other couples have babies—but it’s not what I had imagined.
According to Susan Fisher, the director of the Human Embryonic Stem Cell Program at University of California, San Francisco, this is largely because of federal laws limiting stem cell research. “The bar is so high to be able to do this work. You must work in non-federal lab, with non-federal equipment and non-federal fund,” she said. “This is such a shame to me, because people want them used for greater good, but there are all kinds of obstacles.”
While Obama undid some of the the second Bush’s restrictions, the field is still largely underfunded. Today, most research is done on stem cells created from adults, which are less politically controversial, but also, according to Fisher, less effective. “Embryonic stem cells are still what we would call the gold standard” and would provide far more insights into how our bodies work. “If we take the 30,000 feet perspective, we know nothing about human development. And the reason for this because, for a very long time, the United States government has not supported this work. In many ways they have prevented this work,” she said.
There isn’t a central organization where patients can go look for studies looking for embryos, no single entity that can walk them through research projects and facilitate donation. Doing it on one’s own is possible, but it’s a cumbersome process that requires an in-depth knowledge about how academic institutions work as well as a deep well of patience to wade through all the red tape. Individuals might also be responsible for setting up the transfer of their embryo, which can be complicated in and of itself. The infertility clinic that we used allows us to donate our embryos to stem cell research, but I was told that they embryos with such a designation often sit in the freezer for a long time. Hang in there long enough, she explained, and there’s a decent chance they will be be destroyed.
There is another option here, the one that all choices must ultimately be measured against. We could use the embryo to try to have a child. Ruling this out should be easy. We don’t want another child. But our present selves and future selves are rarely the same people and what’s obvious today might be a source of regret later on. What do I owe to person I will become in the next half decade? Some days I think the answer is clear: as much opportunity as I can give her and her family. Other days, most days, I think differently. Betting on change is foolish. It will cost our family many thousands of dollars, and, worse, serve as invitation for self-examination, even self-scrutiny, over the years about what kind of person doesn’t want more children. Especially when they are already in the works.
Finally there’s the last choice, the popular choice, the no-choice choice, of storing them for some undetermined amount of time. I understand its appeal and might consider it if I wasn’t constitutionally incapable of taking this path. This is because I’m an overly decisive type, the sort who moves swiftly and confidently through matters large and small and rarely second guesses herself afterward, occasionally to a fault. I do this in part because I’m terrible at avoidance, and lack the facility to redirect big questions, or tiny embryos, to the dark corners of mind where they can hibernate until I’m ready. I think of those maybe babies, and all that went into making them, and long for closure.
According to Dr. Nachtigall the no-choice choice is the most common one, and accounts for around two-thirds the people he has studied. “In order for couples to engage with disposition decision, they must first undergo a shift in conceptualization of embryos [away from potential children]. This shift is required before they can let them go. I don’t think it is easy,” he said.
____
Making a decision about embryos is complicated largely because we lack consensus on what they actually are. Bioethicists struggle to define them, trying to find a middle-ground between human tissue and a child. “Even if you don’t believe they are a person, they have moral status. You can’t minimize that; the genetic connection makes it really challenging to do so,” said Lisa Campo-Engelstein, an associate professor at the Alden March Bioethics Institute at Albany Medical College.
She believes one solution to the excess embryo question is for clinics to stop making so many embryos in the first place. They could instead freeze eggs and sperm and create embryos as needed, a process that is far less likely to create lower live birth rates than it would have in the past. This would avoid psychological strife on behalf of the possessors of embryos as well as prevent the number of excess embryos in the country from continuing to grow.
Another way to reduce the number of embryos sitting in freezers would be to have laws limiting how long they can be frozen for, which exist in other countries. In the United Kingdom, for example, most regions only allow individuals or couples to store embryos for ten years. In addition to the obvious effect of reducing the embryo glut, this legal framework might also change the way we think about embryos. If it becomes the norm to dispose of them at some point, then people might become more comfortable with letting go of them—at any point. It would also give the clinic the permission to destroy abandoned embryos after a certain predetermined period of time. As it stands now, most clinics never destroy embryos, even if storage fees haven’t been paid for years, out of fear that they might be sued should their patients or clients return years later and demand them.
“There has to be some endpoint,” Campo-Engelstein said. “I heard about a couple who was planning on bequeathing their embryos to their children. There should be safeguards in place.”
NYU’s Caplan has another suggestion for tweaking how we view embryos: change their name. He prefers calling those that have yet to enter the womb “pre-embryos,” a term some of in the reproductive medicine field have already adopted. “Clinics are responsible [for some of the confusion surrounding embryos] because they treat them like babies,” Caplan said. “There is a lot of politics, and even a little business, in what you call an embryo in a dish or tank.” In this largely for-profit field, the closer you get to promising someone a baby, the more likely your patients will opt for more, and more expensive, treatments.
When Caplan said “pre-embryo,” my mind quickly pivoted away from burden and towards relief. I’d always seen them as potential life, as opposed to life, and bristled at infertility discussion groups where they are lovingly named “embies,” and often attached to a gender descriptor. But this semantic tweak further emphases their potentiality, and detracts from any cuddly associations. When I think of my potential embryos, or the other million potential embryos, I see them less as a burden, or potential scientific plot, and more as a byproduct of a medical procedure. So much easier to say goodbye.
The law offers little in the way of clarity as to the status of embryos. Most lawyers and judges frame them as property, but “deserving of special respect for their potential to become a person,” as one much referenced court case put it. “You treat it respectfully, but it’s not a person. It doesn’t have all the rights of a person,” said Margaret E. Swain, the director of the American Academy of Assisted Reproductive Technology Attorneys.
But this definition is not federal law. Different states have different rules on the legal standing of embryos, mostly regarding what can be done to them while they are alive and whether or not their fate should be determined by a contract or what’s in the best interest of their parents. One state, Louisiana, gives embryos judicial standing, which is the reason why Sofia Vergara’s ex-fiancée Nick Loeb, headed east to file a lawsuit on behalf of their embryos in an attempt to use them. (A federal judge in Louisiana ultimately dismissed the case because neither parent lived there, nor were the embryos created there.)
About the closest we have ever gotten to a federal definition of embryos is when President Obama was sued by Mary Scott Doe, a “frozen embryo symbolizing all existing frozen embryos,” after lifting part of the ban on stem cell research 2009. A federal appeals court ruled against little Mary, claiming that the case had no standing because embryos are an “amorphous” class and nobody could prove any actual harm.
Politically speaking, the few attempts to articulate what embryos are have mostly happened in the context of the pro-life movement. There was the aforementioned program to encourage embryo donations, which was bereft of any information on other disposition options. Also, efforts to make IVF widely available to wounded veterans have been stymied by those on the right who don’t want to be a party to the creation of excess embryos that might later be destroyed.
Overall, however, the anti-abortion movement has largely stayed away from this issue. One rarely sees protests outside IVF clinics, or laws limiting the number of eggs that can be fertilized. Most reproductive advocates believe this is because of the bad optics. These embryos are for family-building, for creating life; the narratives fueling the anti-abortion movement claiming carelessness and disdain for life don’t work here. However, should personhood laws ever pass, the informal armistice could very well end.
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My husband and I are lucky. The excess embryo question can create a lot of friction between couples, but we’re generally in agreement. Still, this agreement does not reflect an equal sharing of the burden of making this decision. He is also a journalist. He did not decide to research and write a 3500 plus word article on embryo disposition.
The whys are fairly obvious. Most of the physical labor involved in creating those embryos was on me, as would be the act of gestating them. Most of the emotional labor of family planning is on me, because I’m a woman and long ago the world decided women need to worry about such things. He didn’t cast judgement on all my ruminating. He was never an active participant in it either. He wanted to hear where I landed, and when I told him he was in swift agreement.
According to Jake Anderson, co-founder of the Fertility IQ, a website that offers data on doctors, clinic, and treatments in the field of reproductive medicine, women and men tend to approach the embryo disposition question differently.
“We often see a breakdown along gender lines among heterosexual couples. The guy often thinks ‘we got what we wanted, let’s call it a day.’ And the woman thinks that she never wants to revisit the whole process of going through IVF, so she would rather hold onto them,” he said. “This can be a meaningful pain point.”
We decided that we want to put this all behind us. We are going to donate our embryos to stem cell research, but request that if they aren’t used in a couple of years, then they should be donated to the reproductive lab. We concluded that should our tides shift and we decide we want to have another kid, we will try to have another kid. Even if that means going through IVF. That might not work, but so might not these two embryos we are saying goodbye to, or just about anything and everything else we do in a lifetime. We will be submitting ourselves to chance, which will, in turn, allow us to better commit to who we are now. To the children in front of us, to all the life we’ve already created.
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