What can we do about all the frozen embryos slated for destruction?

Avoid cryopreservation of embryos – First, we need to avoid the waste of more embryos by counseling couples pursuing assisted reproductive technologies to limit the number of eggs fertilized to the number they’re committed to carry to term. With in vitro fertilization procedures, each mature egg is placed in a separate dish. So in the case of abundant eggs, embryologists can limit the number of eggs exposed to sperm. Generally when couples request this, clinics honor their ethical desires.

Perfect the egg-freezing process so that gametes – sperm and eggs – are frozen instead of embryos. Currently freezing sperm is commonly done, but scientists are still working to improve the egg-freezing process.

Encourage embryo adoption. At the moment, such a service costs about $6,000. However, some Internet services charge less than $100 to connect couples and let them work out the details.”

William Cutrer, M.D., and Sandra Glahn, “Of Ethics and Embryos,” Light, (Fall 2000), page 5

For more information:

Infertility Companion: Help and Hope for Couples Facing Infertility
Drawing on Glahn’s decade-long struggle with infertility treatment and Cutrer’s medical expertise, this book explores the spiritual, marital, emotional, medical, and ethic issues surrounding infertility. The authors bring their unique male/female, doctor/patient, and clinical/theological combination of perspectives.

When Heather Patterson hadn’t conceived after trying 18 months for a second child, she consulted her physician. At 32, she dropped her jaw when he told her she had begun early menopause. “I cry a lot now,” she said. “Especially when I receive baby shower invitations.”

When Heather Patterson hadn’t conceived after trying 18 months for a second child, she consulted her physician. At 32, she dropped her jaw when he told her she had begun early menopause. “I cry a lot now,” she said. “Especially when I receive baby shower invitations.”

In longing for a child, Heather has plenty of company, as researchers estimate that one in six couples of childbearing age experience infertility. Infertility is defined as the inability to conceive after a year of unprotected intercourse or to carry a child to term.

Of those seeking treatment, roughly half eventually conceive. For those who seek no medical intervention, only about 5 percent achieve pregnancy. So for many patients, the advice to “take a vacation” serves as an irritant.

The pain.

“Most patients describe infertility as a roller coaster of up-and-down emotions,” says Susan Claerhout of RESOLVE, a national infertility support organization. Susan experienced a miscarriage followed by years of trying to conceive. “Miscarriage is a compressed loss; failure to conceive is a drawn-out loss. You have hope during treatment followed by that monthly reminder that you’ve failed. You give up your privacy as you endure poking and prodding; you experience “love by the calendar,” which can destroy the greatest of romances; you loathe Mother’s Day; and with most couples, one partner feels more of a longing to have children. ‘Being at different places’ can be agonizing. People think stress causes infertility; actually, most of the time, infertility causes stress.”

Infertility rates sixth among 43 major life stresses, according to some psychologists who study infertility. “Yet the rest of the world doesn’t even acknowledge it,” says one of the Rutgers researchers who conducted the study.

Patients typically experience a “grief cycle” in which mentally healthy patients move from denial to sadness, anger and depression and then eventually to resolution. “Infertility was a grief cycle within a grief cycle for me,” says Mary McLaughlin, a patient treated for unexplained infertility. “The monthly cycle of despair followed by hope fell within the larger grief cycle, leaving me wondering if I’d ever be free.”

Mary eventually adopted. Afterwards her doctor discovered a minor infection that she and her husband kept giving each other. Following a round of antibiotics, she conceived. “I understand that only 5 percent of women conceive after adopting. That’s the same percentage as those who seek no treatment,” she says. “But I’m amazed at how many times people assume my adopted child served as a placebo. They used to say, ‘Adopt and then you’ll get pregnant.’ Part of me hurt that my story gave people ammunition for hurting my infertile friends.”

Even though modern technologies have improved the chances of having a baby, nearly half of those who undergo treatment remain childless. These couples ultimately face the question of when to stop.

“Often people accuse patients of ‘baby craving,’ as though couples believe their genetics are superior. They don’t understand the longing that drives couples to stay in treatment. How can you place a value on creating a child together?” says Susan, who stopped trying several years ago. “Nevertheless, it’s time to stop when it hurts more to go on than it does to quit.”

The causes.

Causes of infertility include immunological abnormalities, delayed childbearing, failure to ovulate, structural damage to the reproductive tract, low sperm count, and sexually transmitted diseases, to name a few.

Though many consider it a “women’s health issue,” men and women actually share medical diagnoses equally: roughly 30% of infertility’s causes are in the female, 30% in the male, 30% are shared by both partners, and 10% of cases remain unexplained. Uterine infection or scarring following childbirth can also create problems, and the odds of conceiving her cycle drop drastically in the upper 30s. So couples “trying again” may face increased difficulty.

The options.

Physicians encourage women under 30 to try for a year before seeking help. Those approaching their mid- to upper-30s may want to cut that time to six months. And though couples with multiple losses still have good odds of having a baby, after two or three miscarriages, they should seek medical evaluation.

Few health plans cover treatment unless doctors list specific diagnoses. For example, companies may cover tests for “endometriosis” or “polycystic ovarian disease,” but not “infertility.” Many insurance plans label infertility “elective,” lumping it in the same category as cosmetic surgery. One patient gave up a career in public relations with a company whose plan excluded infertility for a minimum-wage job with an organization offering the benefits she needed.

Women generally consult their OB-GYNs first. “Many physicians say they are experts in infertility when they are not,” says Theresa Venet Grant, co-founder and public information director for INCIID (International Council on Infertility Information Dissemination, Inc.). Samuel Marynick, M.D., an endocrinologist at the Baylor Center for Reproductive Health suggests that some OB-GYNs understand and can evaluate infertility well; some cannot. Most OB-GYNs know nothing of male infertility. He suggests, “If you have been with a physician six to twelve months and don’t have a diagnosis or a pregnancy, it seems reasonable to pursue another option.”

Reproductive endocrinologists now offer a growing number of treatments.

Fertility drugs. Doctors may prescribe fertility drugs when tests reveal a hormone imbalance in either male or female. And recently the odds of overcoming recurrent pregnancy loss have improved with medicines which treat immune disorders. Unfortunately, some medications come only in injectable form and require constant monitoring. And because some drugs “hyper-stimulate” ovaries to produce many eggs, they increase the risk of multiple pregnancies.

One cycle on the stronger medications can run into thousands of dollars. Some couples lacking insurance go to Mexico or France , where they can purchase medications legally for a fraction of the U.S. cost. Daily consultations, blood tests and sonograms add to the expense of drug treatment.

Some studies associate ovarian cancer with two commonly-used medications. In reality researchers found only one additional case of cancer in every 6,395 women treated for more than one year with Clomid. And many doctors suspect that the condition which caused these women to need drugs may have been the cancer link, rather than the drugs themselves.

Surgery. Diagnostic surgery can uncover hidden causes of infertility. And corrective surgery may not eliminate infertility, but it often helps. Surgeons may correct fallopian tube blockage or endometriosis, which affects the uterine lining. In men, they may repair structural damage and varicose veins in the testicles.

Intrauterine insemination (IUI). In this procedure, the doctor uses a catheter to place specially-prepared sperm directly into a woman’s uterus. Couples using a donor’s sperm run only an extremely low risk of AIDS, according to Gary Ackerman, M.D., a reproductive endocrinologist at UT Southwestern. The most careful programs freeze sperm for six months and then release it only after the donor has been re-tested for the virus. Each cycle of IUI costs several hundred dollars.

In vitro fertilization (IVF). IVF has become more common since the first “test tube baby,” in 1978. Louise Brown’s father’s sperm fertilized her mother’s egg in a tissue culture dish. Within 36 hours scientists transferred the fertilized egg to her mother’s womb, where it grew. This procedure offers hope for women with blocked tubes.

Today assisted reproductive techniques (ARTs) have many variations. For example specialists may mix sperm and eggs in the fallopian tubes to encourage fertilization in its natural environment. Or egg and sperm may “meet” in glass, and then be transferred to a healthy fallopian tube, where an embryo can travel to the uterus as it would in a normalconception. Various micromanipulation procedures are available for overcoming male factor fertility problems.

A woman who produces no eggs but who has an intact uterus can opt to use donor eggs. Because the process of freezing eggs is unperfected, this involves synchronizing her cycle with the donor’s, whose ovaries are stimulated with fertility drugs. Reproduction care givers then retrieve the eggs, expose them to sperm and transfer resulting embryos to the recipient’s uterus.

One relatively new technique involves injecting one sperm directly into the egg. This helps men with low sperm counts or with sperm that are too weak to penetrate the egg. Specialists generally recommend ARTs only after couples have exhausted other reasonable options. It can be expensive ($10,000+), and physicians recommending it for their patients usually point out the high odds of failure.

Surrogacy. This involves using another woman’s uterus and her egg (traditional surrogacy) or the couple’s embryo (gestational surrogacy). One clinic estimates the average cost at $50,000, and the legal headaches dominate media coverage.

Reproductive technologies continue to evolve, creating ethical mine fields while offering new hope.

“I appreciated the sensitivity of my friend who sent a note breaking the news to me that she was finally pregnant,” says Heather. “She wrote, ‘Infertility is so difficult. Call me when you feel like it. Believe me, I understand.’

“I’m glad she got out. I ran to make the call.”

This article first appeared in Dallas Family.

Hannah’s Prayer is an online Christian support organization for couples experiencing infertility, including pregnancy loss. Check out their web site at www.hannah.org.

For more on infertility and pregnancy loss, check out

Infertility Companion

When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility

We didn’t put much thought into the "right and wrong" of what we were doing. We wanted a baby and either of us probably would have sacrificed anything for success.

How many to fertilize, what to do with "leftover embryos," whether we’d consider using a donor, destroying embryos without thinking—answering those questions beforehand saved us lots of stress in the midst of IVF.

We didn’t put much thought into the "right and wrong" of what we were doing. We wanted a baby and either of us probably would have sacrificed anything for success.

How many to fertilize, what to do with "leftover embryos," whether we’d consider using a donor, destroying embryos without thinking—answering those questions beforehand saved us lots of stress in the midst of IVF.

Consider how the two Christian couples quoted above handled their fertility treatment quite differently. Some couples give no thought to the hidden landmines and charge ahead unprepared. Others, feeling the Lord’s leading to stay out of the "ethical minefield," end treatment when the doctor recommends fertility drugs. And then there are those who, armed with good maps drawn from scripture, pursue medical treatment and closely monitor their care in striving for the "safe" zone. It is to this last group that I’ll direct my comments.

How do we make God-honoring choices while staying in treatment? We begin by understanding that each unique individual is made in the image of God. It is wrong to take human life (Exodus 20:13)—and an embryo is a human life.

How do we know this? It’s really not too hard. Life begins at the single moment when egg and sperm unite, DNA aligns, and the resulting being begins to function as a coordinated organism. Some infertility specialists (those who have no problem discarding embryos) argue that if we’re so silly as to treat tiny embryos as persons, we should also treat tiny sperm as persons because they’re alive, too. Yet a sperm is not a human life—that is, it is not a being that functions as a coordinated organism. It has only half of the DNA necessary for human life, and it has not united with a human egg. As one expert explains it, "Human embryos are living human beings precisely because they possess the single defining feature of human life that is lost in the moment of death—the ability to function as a coordinated organism rather than merely as a group of living human cells…. Dead bodies may have plenty of live cells, but their cells no longer function together in a coordinated manner. We can take living organs and cells from dead people for transplant to patients without a breach of ethics precisely because corpses are no longer living human beings. Human life is defined by the ability to function as an integrated whole—not by the mere presence of living human cells."

An understanding of when life begins and a commitment to respect the dignity of all human life is essential when making decisions in the infertility lab. It impacts the choices we make relating to multiple follicles, multiple embryos, and multiple transfers. Following are some guidelines.

Stop if you get too many follicles in a non-IVF cycle. The whole point of taking ovulation-inducing drugs is to stimulate a woman’s follicles, those fluid-filled sacs that contain one ovum apiece. During an unassisted cycle, a woman’s body normally regulates the process such that only one follicle matures and releases its egg (ovulation). But fertility drugs override that regulatory mechanism, allowing maturation of up to forty follicles. Multiple follicles mean potential multiple embryos.

To avoid high-order multiples, as mid-cycle approaches, medical personnel must monitor follicles daily via ultrasound. A high number of follicles means a heightened risk of multiple births. If hyperstimulation occurs, the responsible move is for the couple to abstain from sexual intercourse (or IUI) and/or for the doctor to stop administering hormones for that month. (In the case of a patient on clomiphene citrate, the patient has already taken all the medication for that cycle, so abstinence is the only option, though it’s extremely rare for such hyperstimulation to happen on Clomid alone.)

If no sonograms are done, the couple has no idea how many follicles are present. That means they can have a positive pregnancy test before they even know they have the potential for multiple pregnancies—as happened in cases of both octuplets and septuplets. According to ABC News, "While only one or two multiple births have hit the headlines in recent years, more than 80 cases of multiple births of quintuplets or greater now occur in the United States each year. In fact, the country’s birth rate for triplets and higher multiples has nearly quadrupled since 1971." Why? More people are using ovulation induction medications, many of them unmonitored.

Bottom line: If you’re taking fertility drugs, make sure your doctor monitors you appropriately via ultrasound so you know the number of follicles you’re dealing with and can make decisions accordingly. If you end up with too many maturing follicles, despite the cost invested—sometimes in the thousands of dollars—patients need to give serious consideration to the heartbreaking choice of canceling the cycle.

Avoid the creation of multiple embryos. Let’s say you’ve taken clomiphene citrate during an unmonitored cycle, followed by a positive pregnancy test. Your HCG levels have skyrocketed. And when you go for your first ultrasound, the doctor visualizes seven embryos on the screen. Now you face an agonizing decision: should you abort some of the babies in hopes that the others will have a better chance of being born healthy (not to mention minimizing the risk to your own body)? That is what most medical teams would recommend.

Two couples who profess faith in Christ have faced similar situations—one the parents of octuplets (one of whom died) and the other the parents of septuplets. Their difficult choices to carry their children to term rather than taking human life in utero have demonstrated that "it can be done." Yet the best ethical solution here is to avoid getting into this situation! Don’t let the number of mature follicles come as a surprise after conception. And certainly avoid the mentality that says, "We’ll take the risk because we can always reduce later if we get too many."

Though about 37 percent of births using advanced reproductive technologies (ART) are multiples (31 percent twins, 6 percent triplets or more), in vitro fertilization actually allows for more precise management of the number of eggs fertilized. After the doctor aspirates the mature eggs from the follicles, each is placed in its own petri dish. Thus, it’s relatively easy to limit the number of embryos created by directing your medical team to expose only the number of eggs to sperm that you can safely carry to term in that cycle in the event that all embryos implant.

Couples may find themselves facing enormous dilemmas if they do not consider the ethical ramifications of their choices ahead of time and choose accordingly. Imagine being in the situation this patient described:

I was shocked when our doctor aspirated more than thirty eggs from my ovaries and exposed them all to sperm.

Avoid multiple embryo transfers. The couple suddenly faced with multiple embryos in the IVF lab (and this should never come as a surprise!) has little choice but to ask the doctor to transfer several embryos to the wife’s uterus and cryopreserve the rest. Yet it’s best to avoid cryopreservation. The freeze/thaw process is hard on sperm because many of them die; the same is true with eggs. Based on embryo survival rates, it appears that the freeze/thaw process is hard on embryos, too.

Depending on what you read, you’ll find that some clinics have a 50 percent thaw survival rate (half of the embryos survive). Others quote between 60 and 70 percent (at best three-quarters survive). Clinics with higher rates often freeze only the "higher quality embryos" in the first place and discard the rest. Thus the numbers can be deceptive as clinics with higher ethical standards (those that freeze even the "lesser quality" embryos rather than discarding) may have lower "success rates" as a result of their higher regard for human life. This poses a moral dilemma:

I met with my doctor about IVF. He wants to fertilize as many eggs as we can—transfer three and freeze the rest. I told him my concerns about freezing. He said the ones that make it through the thawing process are the ones that would most likely survive naturally anyway, but that it’d be unusual if we have any to freeze. He wants to start immediately, but I’m still uncomfortable. My husband wants to do it the way the doctor recommends. But why won’t my doctor respect what I am saying? I think, "Let’s just set our boundaries." At least I won’t have the moral regret.

Until thaw and conception rates improve following embryo freezing, couples should consider avoiding cryopreservation by having fewer eggs fertilized, even though the financial cost may be higher as a result. That is, they may have to try more IVF cycles with smaller numbers of embryos.

Several clinics in England now focus on natural cycle IVF. It’s less expensive without the ovulation induction medications, and while the odds of success in each cycle are lower, couples can try numerous times. Also, some overseas clinics now limit transfers to one embryo per IVF cycle. In Sweden, transferring a single embryo is the overriding rule, with only one in ten transfers allowing transfer of two embryos.* In the U.S., transferring three to five or more embryos is common, though we are seeing a trend toward transferring fewer embryos selected for their higher quality (read: discard or freeze those of "lower quality") with more cell divisions.

While cryopreservation has its problems, it’s still more ethical to freeze embryos (taking risks with human life) than to discard them (destroying human life). But sadly the common practice of cryopreservation has led to 400,000 embryos now sitting in liquid nitrogen. Consider the following true scenarios that have resulted from cryopreserving numerous embryos:

My husband and I had several embryos transferred to my uterus and a bunch frozen. I conceived twins from that original transfer, but then I had major medical problems during the delivery. That made it impossible for me to carry any more pregnancies. The cost of a gestational surrogate: fifty grand!

We’ve had six kids now through IVF, but we still have three more frozen embryos. So we’re going back for one more transfer...

We have three embryos still frozen after four IVF attempts. We long to quit treatment and we’re broke, but if we do embryo adoption, another couple could end up with our biological child while we’re still childless!

Couples with several frozen embryos can face some tough choices. Respecting the sanctity of human life means giving all embryos a chance to live rather than letting them thaw and die—eliminating the options of destruction and research. (Though it might sound noble to donate an embryo for the furtherance of science, it is unethical to take one life as a means of trying to improve the quality of another life.)

To give every cryopreserved embryo a chance means transferring thawed embryos to the genetic mother, entering into an "embryo adoption" agreement, or procuring the services of a gestational surrogate.

My co-author, William Cutrer, M.D., often notes that an embryo is not a potential life; it is a life with potential. Couples will find that some, if not all, members of their medical team will have this reversed. While sensitive to the fact that clinics are usually evaluated on the basis of their success rates (and our needs may impact those rates), we must also stand our ground as consumers needing to make decisions that line up with our belief systems. Forty years from now, when our doctors have all retired, we’re the ones who’ll still be living with our multiple choices.

© 2003 Sandra Glahn, Hannah's Prayer (HP) Advisory Board Member. This first appeared in HP's July 2003 newsletter.

For more information:

Infertility Companion .
Drawing on Sandra Glahn’s decade-long struggle with infertility treatment this coauthored book explores the spiritual, marital, emotional, medical, and ethic issues surrounding infertility. The authors bring their unique male/female, doctor/patient, and clinical/theological combination of perspectives.

When my daughter, Alexandra, arrived home from school today, she told me one of the girls in her class didn't "get" adoption. Apparently this fellow student looked down on Alexandra and asked, "Why don't you go back to your old parents?" Sadly, when Alexandra tried to explain, she didn't get far.

Almost ten years ago, Gary and I rejoiced over the arrival of the girl—an eight-month-old, dark-haired, blue-eyed baby—who came storming into our lives. (Alexandra does nothing subtly.) Her adoption is a fact of her life that we discuss openly and with enthusiasm. And we do so using positive language—adoption vocabulary chosen to assign the maximum dignity to the way our family has been built. It is language that has helped us to eliminate some of the emotional overcharging that for years has helped perpetuate the myth that being part of an adoption means that one has somehow missed out on a real (or, as in today's case, old) family experience.

Here’s how that looks in our house.

We avoid saying “our daughter is adopted.” Phrasing it in the present tense suggests that adoption is ongoing. When it is appropriate to refer to the fact of her adoption at all, we say, “Our daughter was adopted,” referring to the way in which she joined our family.

When people ask if she is our natural child, we affirm that she is—the alternative being that she is our unnatural child. As she describes it, “Mommy’s tummy was broken so I grew in her heart instead.” We refer to her genetic family as her birthparents. Everyone has birthparents, but not everyone lives in the custody of his or her birthparents.

People often want to know if we have ongoing contact with our daughter’s birthparents. The answer is yes, we have an open adoption. At this point people often shudder, confusing open adoption with shared parenting. I have never met our daughter’s birthmom, though my husband has. But we know her name and her health history and we exchange cards on Mother’s Day. We speak respectfully about our daughter’s birth parents as those in a unique group of fewer than one percent of the population who make such a loving choice.

Is our daughter “one of our own”? Certainly. We kiss her boo-boos when she hurts, we laugh when she’s funny, we pray with her. We drag ourselves out of bed in the night when she’s sick. We help her with her homework. We are her parents, and we love her as much as any parent could love a child. The very institution of marriage demonstrates that one can love as family a person to whom he or she is not genetically related. My sister, who is the biological mother of one daughter and the adoptive mother of another, insists that genetic ties are no stronger nor enduring than adoptive relationships.

Today’s birthparents do not surrender or release or relinquish or give up their child to adoption, except in rare cases of involuntary termination of parental rights due to abuse or neglect. Instead birthmoms and dads “make an adoption plan.” They recognize that they are incapable of giving their biological child all that is needed for his or her well being, so they proactively choose a life for that child which demonstrates selfless love.

Some prospective parents choose to adopt a child from another country. Formerly this was referred to as foreign adoption, but “foreign” often has negative connotations: “I got a foreign object in my eye”; “His thinking was foreign to me;” “Don’t possess foreign substances.” So the preferred label is international adoption. (In the same way, we now refer to students who come to the United States seeking education as “international students” not “foreign students.”)

We describe parents who have chosen to adopt sibling groups, older children, or kids facing unique challenges as parenting special-needs children. This is preferable to saying their children are hard to place.

We refer to our friends’ children who were adopted not as “their adopted children,” but simply “their children.” Adoption is a way children join a family, but the modifier “adopted” is unnecessary as an on-going label. (As adoption expert, Patricia Johnston, points out, we would never describe little Jimmy as Tom and Meg’s “birth-control-failure child.”)

We didn't rescue our daughter. If anyone was rescued, it was Gary and me... rescued, for example, from seeing dust particles in the sunlight as signs of filth when the child in our home perceived them as bubbles. So much beauty we were missing....

Speaking of missing beauty, that's what happened to Alexandra at school today--her classmate mistook beauty for loss. Fortunately, our daughter knew better.

Each year in the United States, more than 120,000 children join their families through adoption. In ancient history, Moses lived in an adoption arrangement, as did Esther. Paul says God has adopted us into His family.

If adoption is a metaphor for how God views us, perhaps we can find ways, dignified ways, to express that truth and, as Crosby, Stills, Nash & Young would say, teach our children well.