July 19, 2001
By Laura Landro, a Journal senior editor
In the debate over federal funding for stem cell research, the facts about surplus frozen embryos have been obscured by polemics. The truth is that donating them to science may be the only way they will ever be used in the ultimate preservation of human life.
No one knows for sure how many embryos are now stored in fertility clinics, but estimates range between 100,000 and 200,000. Many will never be used by the couples who created them, either because they have already had a child, have divorced, or face issues relating to their own health such as cancer or advanced maternal age. Those, like me, who froze embryos and faced one or more of these issues, know that unless the embryos are donated to science the most likely outcome is their eventual destruction. And for those who have also received lifesaving treatments derived from cell biology, as I have, donating embryos to science seems like a way to give something in return.
All this hit home for me in 1991, when I was diagnosed with chronic myelogenous leukemia, a potentially fatal blood cancer. My only hope for a cure was a bone marrow transplant, a treatment that required near-lethal doses of chemotherapy and would permanently destroy my fertility. Though at the time it was not yet possible to freeze a woman's eggs, doctors were giving cancer patients hope by suggesting that freezing fertilized embryos would preserve the chance to have a biological child. With little time to spare before my transplant, I entered the in vitro fertilization clinic at the New York Hospital-Cornell Medical Center.
At Cornell, as in all such clinics, women take hormone injections for a couple of weeks, causing their bodies to generally produce five to 15 eggs during a monthly reproductive cycle instead of the usual one. The eggs are then removed surgically and mixed with the partner's sperm in a lab dish. With a 70% to 75% success rate, this procedure generally produces multiple viable embryos per cycle.
If the patient wants to attempt a pregnancy right away, doctors implant several embryos in hopes that one will survive. Sometimes none take. Sometimes they all do -- which is why folks end up with triplets. But usually there are embryos left over, which many couples choose to freeze for possible future use.
Patients planning to undergo cancer treatment, on the other hand, typically freeze all the embryos right away so these can be used if they regain their health. Though some experts contend that embryos can be kept frozen indefinitely, they make no promises of viability after prolonged freezing. And success rates with frozen embryos have always been much smaller than with fresh ones. In my case, nine embryos were frozen -- a long shot, but one that seemed worth taking.
In every clinic, couples sign consent forms that determine the fate of the embryos in the event of divorce or death. There have been several legal battles in which one spouse has attempted to gain custody of embryos in a divorce proceeding. The courts have generally ruled that no one should be forced into parenthood without consent, and that neither ex-spouse has the sole right to determine the fate of the embryos. Since this conditions the decision on the consent of both parties, the embryos can get stuck in limbo when couples fail to agree.
It isn't just divorce that leaves a surplus of frozen embryos. Many couples decide after a successful pregnancy not to pursue another, particularly if they've had a multiple birth. Age can also play a role in this decision. Many women seek in vitro fertilization after years of failing to get pregnant the natural way, and give birth for the first time in their late 30s or even 40s. The risks of a second pregnancy are sometimes too high to bear, leaving any extra embryos superfluous.
With certain kinds of cancer, the policy is often to wait five years before implanting frozen embryos, the amount of time doctors feel prudent to ensure there will be no relapse. But the risks don't necessarily end there. Because pregnancy has natural immunosuppressive properties, it could pose a special danger to those with immune systems weakened by the disease. My bone marrow transplant was successful, but I read in the medical literature of cases where leukemia patients had relapsed after becoming pregnant with their frozen embryos. Using a surrogate mother is a safe alternative, but that road is fraught with legal and financial hurdles.
For me, these complicated legal, ethical and medical issues came together to make the use of my embryos a moot question. In addition to the health risk for me, the marriage in which they were created ended in divorce. There was thus no chance of attempting a pregnancy, and a decision had to be made about the embryos' fate.
There have been a few cases of couples who agreed to donate unused embryos to other infertile couples, but they are exceptions to the rule. Most people don't want someone else bearing and raising their biological child. And because people often stop paying the annual cryopreservation and storage fees, which run into the thousands of dollars, embryos can end up literally wards of the fertility clinic. Because the law is unclear, most clinics do not destroy abandoned embryos.
The alternatives presented to couples include thawing (and effectively destroying) them, releasing them for potential donation to another couple, or donating them for approved scientific research. After careful consideration, the latter was the only viable choice for me.
I had survived cancer thanks to research in cell biology that made it possible for my brother's bone marrow to be injected into my body and fight off my leukemia. The continuation of that kind of research may save other people's lives as well. So when the letter came from Cornell with a check next to the box confirming the choice "released for approved research," I was able to say goodbye to my embryos in peace.
It's true that they will never create
a life, but they may help save one. In approaching the question of stem
cell research, that's a fact we should not forget.
Copyright © 2001 Dow Jones &
Copyright © 2001 Dow Jones & Company, Inc.