Defining Life: How to Unpack the Frozen Embryo Debate

The first ever person born through IVF (in-vitro fertilization) turned 40 over the summer. Robert Edwards, the researcher who helped Louise Brown’s parents conceive her in a petri dish, won a Nobel Prize in 2010 for his work with medically-assisted conception. That same basic science that the he used in 1977 to help create the first “test-tube baby” has gone one to help generations of parents conceive when they would otherwise be unable. IVF has grown into an entire industry, with health practitioners who range from medical doctors to nutritionists and acupuncturists devoting their entire practices to help families to conceive.

Chrissy Teigen and John Legend have not been shy about sharing their experiences with IVF with Luna, and most recently with the birth of their son, Miles.

“I know IVF was used for Luna; was it used for baby brother also?” a commenter asked on the pic of Miles lying on a giraffe pillow in a giraffe onesie.

“Yep, he was on ice a smidge longer. Science and the human body are beautiful,” Teigen, 32, replied.

When other commenters started bashing the Instagram user who posted the question — with one person calling it cringe-worthy — Teigen defended the fan.

“I wasn’t offended by it — people are just curious and I think hearing success stories gives people hope. I’m all for talking about IVF,” Teigen responded.

Miraculous for many, IVF is a relatively new option, and the use of frozen embryos are an even more recent practice. Researchers continue to try to optimize the process behind IVF, seeking to ameliorate the burden of treatment on the mother as she prepares for the embryo transfer, the effect of the hormones on her body, and the difficulty and invasiveness of egg retrieval. In addition to the physical and emotional repercussions of IVF, families must also grapple with the high cost of the treatment.

A Closer Look at the Advances Made

Since the birth of the first frozen embryo baby 30 years ago, reproductive doctors have improved upon the technology, vastly increasing the transfer success rate. When once the freezing process itself put the embryo at risk both during thawing and freezing, now cryopreservation makes the process less fraught. Similarly, the ability to further develop a three-day-old embryo in the lab to the five or six day blastocyst point, makes these frozen embryos more resilient than frozen ones.  

The greater predictability that frozen embryos began to show under these new circumstances encouraged many more future parents to choose this option, revealing the full advantage of frozen embryo transfer. By harvesting a number of eggs at once, fertilizing, and preserving them, the woman’s body has time to recover from the harvesting procedure before the embryo is implanted, making for a less stressful experience.

Additionally, the ability to preserve embryos for a long period of time, allows families to opt to use subsequent embryos for future pregnancies and eliminates the need for additional retrieval and fertilization procedures. Both of these have the advantage of reducing the overall cost of the treatment, and for all of these reasons most fertility doctors and institutes have special programs and pricing, as described here.

The Conundrum of Decision Making

Much like the science of IVF had to develop its own protocols, the practice is still in the process of settling on it ethics. Picture the following situation: a couple who are perfect candidates for IVF using frozen embryos undergo treatment. They harvest and fertilize six eggs in one cycle, implanting two fresh embryos and freezing four for subsequent rounds. Say the first round does not take; this couple now has the option to wait some time to allow the mother’s body to recover and try again. Perhaps the next time they will attempt a single transfer and succeed. They now have a baby. Say they try once more, a few years down the road, and another baby arrives. This couple’s family now feels complete — they always wanted two children. But there are still two more embryos that have been preserved and are in storage. What are they to do with those?

I may have become aware of the first wave of the ethical questions that result from IVF sometime around 2008 or ’09, when the dizzy lethargy of my own pregnancy made me into captive audience for the spectacle that was Jon and Kate Plus 8 and the trials and tribulations of “octomom” Nadya Suleman. As I sat absentmindedly chewing on pretzel sticks, watching these families walk through the daily chaos of raising eight or fourteen children, wondering how I would even manage one, television audiences and I bore witness to the how such these extreme pregnancies wreaked havoc on the mother’s body, the parents’ lives and marriages, at likely exponential cost to the well-being of the kids.

Since then, much stricter guidelines and regulations exist to prevent the transfer of more than one or two embryos at a single time. In California, the stricter guidelines placed on doctors and clinics were a direct result of Nadya Suleman’s case. What is salient, though, is that Suleman was able to convince her doctor to transfer eight embryos at once (after he had helped her conceive six previous children) based on her preoccupation with leaving the leftover embryos from her prior cycle in storage. At that time, her doctor had no more options to give her other than storing them indefinitely or destroying them.

These safer guidelines have certainly alleviated the ethical dilemma of burdening a single family with more children than they are able to handle but, in turn, has produced more leftover embryos. Estimates show that there are over one million frozen embryos in storage currently in the United States, with thousands of families trying to make some difficult and personal decisions.

The good news is that there are more options now than before, as we continue to grapple with the effects of our own medical advancements. For many people, the option that the cryopreserved embryo offers — to remain frozen indefinitely — is the only one. They may know they do not want to have a child at the moment, or even know they want no more children, but they are not comfortable with affirmatively destroying or donating their embryos.

While this option defers the decision, it requires a monthly storage fee and the need to constantly reexamine the decision not to take a decision. And to the detriment of both those who have plans to implant the embryos in the future and those don’t plan on it, there is always a risk that the embryos could be accidentally thawed or damaged.

A Landscape of Options

Other parents realize that they will not themselves wish to have more children and also don’t want to prolong the storage of the embryos. These parents can choose to donate their leftover embryos in one of two different ways. A great resource on the frequently asked questions for both options can be found here.

The first option is for another person who wishes to have a child to essentially adopt long before birth, at the embryo stage. This form of third-party reproduction enables the adoptive parent to carry and birth the child she is bringing into her family. Though this resembles an ideal version of adoption, the process is not legally or formally such. The donating parents’ contribution is governed by contract law, not family law. But the term adoption is used because it is so much more fitting.

For parents who adopt an embryo, there may or may not be contact with the biological parents. Each case is unique. For some biological parents, though, especially those who would not wish to remain in contact with the adoptive family, the idea that they could one day turn around and see a child resembling them is too uncanny. They might also prefer not to prolong the preservation of the embryo and see fit to donate their genetic material, and they donate to research.

Donated embryos are used to advanced the science of fertility itself, as well as providing much needed resources for stem cell researchers and scientists. In both cases, there are emotional, psychological, and even legal issues to sort out, and couples making these difficult decisions are encouraged to seek out as much support as they need. Organizations like RESOLVE and the American Fertility Association have counselors on hand to help.

Anyone involved in making a decision about the fate of their embryos deserves and may need resources and support. For some families, this is a pragmatic decision that is just right for them. They still might need support coping and mourning. Some mental health care professionals have suggested a slightly different route: allowing the embryos to thaw and cease thriving on their own. Families are encouraged to take the time to memorialize of observe the expiration of the embryo in a helpful and meaningful way.

As the years go one and more and more families are blessed with the ability to increase their family size with some help from science and medicine, we are also getting better at managing the various problems that tend to arise even from solutions themselves. As more options become readily available for families who are left with frozen embryos they do not wish implanted, hopefully these will be communicated earlier and earlier in the IVF process, empowering patients to plan for their treatment from beginning to end.

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