Spring, 2005
Sarah-Vaughan Brakman, PhD
Director, Ethics Program Villanova University
Couples who have used in-vitro fertilization (IVF) may choose to give their no longer needed (frozen) embryos to other couples wishing to bear and raise children. The name given to this process (based on one’s frame of reference and/or ideological commitments) is embryo donation, embryo adoption, embryo rescue or human embryo transfer. This practice has been around for over 20 years1 but has only gained widespread attention recently. Why is this?
Four reasons may account in part for the current interest in embryo adoption. First, with estimates of over 400,000 embryos currently frozen in the United States and significant numbers in other countries, the question of what to do with them has become urgent.2 Storage is an issue in terms of space and cost as well as the “shelf-life” of frozen embryos, which will become nonviable over time. Interestingly, one option, relinquishing the embryos for research, is not chosen by significant numbers of couples for psychological and moral reasons.3 Embryo adoption offers those couples an alternative that they may find morally more palatable than donating their embryos to research.
Second, proponents of human embryonic stem cell research (which entails the destruction of embryos) argue for the moral permissibility of stem cell research on the grounds that only “excess” embryos from reproductive medicine will be used (i.e., no new embryos will be created for research purposes). Furthermore, since frozen embryos will expire eventually, using them for stem cell research is not depriving them of a better fate. Consequently, many believe the growing interest in embryo adoption is largely politically motivated by the stem cell debate.
As evidence for this claim, some bioethicists point to the Department of Health and Human Services 2001 announcement of close to one million dollars in grants for “Public Awareness Campaigns for embryo adoption.”4 These bioethicists claim that even calling the practice embryo adoption instead of donation implies that embryos are children. Elsewhere, I have argued the error of this claim.5 Data show that couples “considering the embryo as a child choose destruction as frequently as donation but refuse experimentation on the embryo.”6
Third, a significant number of couples with fertility problems or hereditary disorders are seeking embryo adoption.7 Some couples are attracted by the lower costs of embryo adoption in relation to traditional IVF. 8 For example, embryo adoption programs currently list costs of $3,600 to $10,000 per cycle, regardless of outcome and not including the expenses of pregnancy and delivery. These expenses include: the identification of a match; the cost of thawing; screening and testing of donors, embryos and possibly recipients; the hormonal preparation of the prospective mother, and the embryo transfer. Costs per cycle for IVF, using fresh embryos, range from $12,000 to $20,000, also exclusive of outcome. Costs are lower for embryo adoption, because the original couple has paid for the harvesting of gametes and fertilization of the ovums. The success rate using embryo adoption is slightly less than that of IVF using fresh embryos; however, it currently appears comparable to IVF with one’s own frozen embryos.9
Finally, embryo adoption is also on average less expensive than traditional newborn adoption (for example, in the US, domestic adoption fees vary from $9,000 to more than $35,000). However, each cycle of embryo adoption, just like traditional IVF, includes a greater than 60 percent chance of failure; whereas, traditional adoption fees are paid in relation to the placement of a child. Even so, embryo adoption may appeal to people in this country who have been waiting (sometimes years) to adopt newborns and has the added advantage of prospective parental control of the prenatal environment and the chance to experience the birth of the child.10 Embryo adoption may also afford older women, who are often not chosen by birth mothers in domestic adoptions, a chance to become mothers—a practice that raises ethical considerations in itself.
Yet despite long waiting lists for embryo adoption, it is rarely done, because people with frozen embryos are reluctant to donate. The most common reasons given are: having unknown children, the possibility of sibling marriage and legal ramifications.11 Some studies identified willingness to donate “was associated with greater comfort about disclosing personal information, a desire to know the outcome of donation and willingness to have future contact with a child, but not with current family size.”12 Seventysix percent of fertility clinics do not allow donors any control over who receives their embryos and further stipulate anonymous donation with no knowledge of outcome.13
In my view, embryo adoption is conceptually different than gamete donation, with which it is often compared. With embryo adoption, couples view the embryos as their once possible and perhaps future children. Decisions about giving the embryos to others more closely resemble adoption decisions than decisions about “donating” sperm or egg.14 Fertility centers ought to change their policies concerning donating couples’ choices to better respect the reality of this activity, to respect couples’ views and finally to increase the supply of embryos available for embryo adoption. Some agencies, like Snowflakes, and clinics, like the National Embryo Donation Center, in fact, have policies that allow for greater choice of involvement for couples with embryos.
Other ethical issues raised by embryo adoption have been raised by other forms of assisted reproductive technology and by traditional infant adoption. These include: permissibility of the practice; payment for the embryos; who decides which embryos are given to which couples and on what basis; screening of donors, embryos and recipients; genetic disclosure to recipient couples; privacy and disclosure to children; anonymous recordkeeping, and future relationships between genetic and rearing families.
Consensus seems to exist for one of these issues—the impermissibility of paying the donor couple for the embryo itself (though reimbursement for some specific expenses is permissible).15 This is based on views about gift giving, solidarity and the risk of commodification of human life. The policy is consonant with other practices in medicine, such as forbidding payment for organs and for babies.
Some major religious traditions have difficulties with the permissibility of embryo adoption, even those most associated with prolife positions. For example, controversy regarding embryo adoption exists among scholars who accept Roman Catholic official teachings. Arguments in favor of it include the appeal to rescuing innocent human lives, for embryos are viewed as persons with inherent dignity. Arguments against embryo adoption hold that condoning embryo adoption is not acceptable, because it is too closely associated with practices considered inherently immoral, such as IVF and the freezing of embryos. Reasons of this type do not seem particularly persuasive since traditional adoption is not denounced as condoning acts (i.e., extramarital intercourse) that have, in most cases, led to the availability of children for adoption.
A second type of argument against embryo adoption from Catholic scholars is that the ends do not justify the means. It is wrong for a woman to intentionally become pregnant with a child that is not the fruit of marital intercourse. Just as surrogacy and the use of donor gametes is impermissible, so is embryo adoption, despite the seemingly “good” intentions in this case. This set of arguments is currently at the heart of the debate among Catholic scholars. 16
A separate set of ethical issues arises once embryo adoption successfully has been accomplished. I will discuss just one of these here—parental privacy. With embryo adoption, no one, including the child, will know that a baby born into a family is not genetically related to that family, unless the couple chooses to share that information. I hold that children’s best interests are served by knowing about their origins as early as possible. Counter-arguments about the privacy of the couples, the liberty of parents to decide for children and the privacy of the genetic parents are weaker claims. Moreover, secrets of this magnitude, if discovered, are usually very damaging to the parent-child relationship and will be more difficult to keep as genetic testing becomes more comprehensive and routine.17 The obligation of parents to inform their children about the use of embryo adoption is founded on philosophical views about the rights of individuals and the obligations of the parents. It is also based, in part, on outcome data from the literature on traditional adoption concerning disclosure to children. Telling those other than their children entails different considerations, including that of the children’s privacy. Centers and agencies offering embryo adoption should counsel, if not require, couples to agree to disclose the use of embryo adoption to their future children.
Footnotes
1Eisenberg VH, Schenker JG. Pre-embryo donation: ethical and legal aspects. Int J Gynaecol Obstet. 1998;60:51–57.
2Eydoux P, et. al. How can the genetic risks of embryo donation be minimized? Hum Reprod. 2004;19(8):1685–1688.
3Lee J, Yap C. Embryo donation: a review. Acta
4Obstet Gynecol Scand. 2003;82:991–996. 4Caplan A. “The problem with ‘embryo adoption’: why is the government giving money to ‘Snowflakes?’ http://www.msnbc.com/id/3076556/print/1/displaymode/1098/
5Brakman S-V. “Ethics and ‘Embryo Adoption’: a rose by any other name…” Presentation at the annual meeting of the American Society of Bioethics and Humanities; October 2004.
6Laruelle C, Englert Y. Psychological study of in vitro fertilization-embryo transfer participants’ attitudes toward the destiny of their supernumerary embryos. Fertil Steril. 1995;63(5): 1047–1050.
7Eisenberg, Schenker, 1998; Lee, Yap, 2003.
8Robertson JA. Ethical and legal issues in human embryo donation. Fertil Steril. 1995;64(5): 885-894; Van Voorhis BJ, et al. Establishment of a successful donor embryo program: medical, ethical, and policy issues. Fertil Steril. 1999;71(4):604–608. See also Eisenberg, Schenker, 1998; Lee, Yap, 2003.
9Kovas GT, Breheny SA, Dear MJ. Embryo donation at an Australian university in-vitro fertilization clinic: issues and outcomes. Med J Aust. 2003;178(3):127–129.
10Robertson, 1995; Lee, Yap, 2003.
11Burton PJ, Sanders K. Patient attitudes to donation of embryos for research in Western Australia. Med J Aust. 2004;180(11):559–561.
12Newton CR, et al. Embryo donation: attitudes toward donation procedures and factors predicting willingness to donate. Hum Reprod. 2003;18(4):878–884.
13Kingsberg, et al. 2003.
14Brakman, 2004.
15The American Society for Reproductive Medicine. Guidelines for cryopreserved embryo donation. Fertil Steril. 2004;82(supplement 1):S16–S17.
16For more, see Natl Cathol Bioeth Q, Spring 2005 issue.
17McGee G, Brakman S-V, Gurmankin A. Debate: disclosure to children conceived with donor gametes. Hum Reprod. 2001;16(10):2033–6.
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belong to the individual contributors and do not represent the institutional position
of Lahey Clinic on any subject matters discussed.
