On July 25th, 1978, the first “test tube baby” was born. Louise Brown, born through a Caesarian section in England was the result of what is known as in vitro fertilization (in vitro is Latin for “in glass”, referring to a petri dish).[1] The possibility of overcoming the age-old challenges of infertility came both as the answer to prayers for many, and were accompanied by words of caution from bioethicists. The advancement of technology in the field of medicine has created new frontiers for ethics. Each discovery of a cure, new surgical procedure or treatment comes loaded with the possibilities and hope for new levels of human flourishing.
IVF has since become a common option for many couples seeking to have their kids biologically, though it is conception by another means, it is still plagued with uncertainty and imperfection.[2] Between 1987 and 2015, approximately one million children were born through the use of IVF or other reproductive technologies[3] averaging about 62,000 children per year.[4] Seeking to fulfill the desire to have children is laudable impulse though the means have come into question. Aside from what could be crippling expenses, emotional tolls from failed attempts and a dubious past that pioneered the field of IVF, a pressing question and problem has arisen: now that we have our kids, what do we do with our leftover embryos? Thesis It's my argument that the leftover embryos should be regarded first as human persons made in the image and likeness of God. Consistency with this view should be accompanied by a change in the legal status of embryos from property to persons. Additionally, the only ethical and morally permissible options to do with leftover embryos is to freeze them in the hope and intention of implanting them for birth. As to the vast amount of currently frozen embryos, they should be adopted by parents willing to attempt the implantation procedure. To that end, this article will catalog and analyze the other options and provide an assessment as to why other options of what to do with leftover embryos must be abandoned. How IVF works Under the broad heading of IVF nest a few different distinct forms and methods that are often referred to collectively as IVF. But in general, IVF works by taking an egg or eggs from the mother that are extracted through a needle inserted into the woman’s vagina.[5] The sperm of the father is taken, usually through masturbation, while a medical professional joins the two in a laboratory setting in a petri dish. The fertilized egg or eggs are observed for the formation of the two pronuclei around the embryo, an indication the egg has been successfully fertilized.[6] The embryos are then screened, or “graded”, to see which would be best candidates for implantation and the remainder of frozen until they are implanted in the future, discarded, or face a different fate.[7] The fertilized eggs that are selected are implanted into the mother during the peak of her monthly cycle to increase the changes of pregnancy.[8] If the fertilized egg does not implant, the process is often repeated with the spare embryos until success is achieved or finances are depleted.[9] IVF does not necessarily involve the “shotgun” approach where multiple eggs are allowed to be fertilized in one dish by the male’s sperm. Sub-forms of IVF, such as Intracytoplasmic Sperm Injection (ICSI), will take a singular egg and singular sperm per round of fertilization.[10] The sperm, which is usually one that struggles with motility, is loaded into a hollow needle and injected directly into the egg. Because of the imperfect techniques, methods and science behind IVF, there is a greater level of embryos that do not successfully implant into the mother. This is why the majority of clinics create many embryos to maximize the chances of the woman becoming pregnant. What takes place after a pregnancy and successful birth diverges for many couples. Initially, nearly all embryos are frozen. On the backside of a birth then comes the question many couples are crippled with: what do we do with our leftover embryos? Before the options can be weighed, however, the identity of the embryo, pinpointing the moment of conception, as well as its legal and moral status be critically evaluated. Embryo and Conception An embryo is the medical and technical term for a fertilized egg.[11] Though it may sound and be used comparable to a euphemism, it is a bit more complex than just the result of a sperm fertilizing the egg. The importance of identifying and pinpointing when an egg and sperm cease to be their separate entities is at the heart of a parallel vein in the abortion debate. The modern Christian position is that life begins at conception. But what is conception, precisely? And more pointedly, what kind of life are we speaking of? These questions are necessary preconditions that must be answered because of the ethics that follow. When a sperm first reaches an egg, a series of bio-chemical processes are triggered. Best summarizes it in this way: "Cells in the human body have 46 chromosomes, made up of 23 pairs […] both the egg and the sperm carry half the usual number of chromosomes, so this union creates a single cell […] called a zygote. Both the sperm and egg cease to exists at this point […] All the genetic material required for full maturity of the human being is present in the single cell, and from this point on it will direct its own growth. From this point, development of the individual will be a continuum through pregnancy and childhood to adulthood. We therefore have in the human zygote a member of the species homo sapiens.[12]" Though disagreements of where to draw the line of when life begins differ, the most satisfying place is when the sperm joins with the egg. Technology may very well advance to a point in which it will be possible to become more precise in when the egg is fertilized. For example, if the capability became available to allow the sperm to reach the egg, but stop the process of development at that moment, even though it has reached it, then it would be morally permissible to allow the destruction of the egg since it was not an embryo and therefore not human life. But given this is not the reality, the most sensible position is to maintain a stubborn boundary of protecting the egg once the sperm reaches it because our knowledge and technology do not give us a sufficient warrant to destroy an egg at that point, even if the biochemical processes are only beginning. What is the status of an embryo? Embryos are tiny humans. Because they are human, they have a moral status of being made in the image and likeness of God (Genesis 1:27). They are deserving of dignity, respect, and because of their vulnerability, care and protection, as well. Though they are strangely different morphologically in his or her size and shape, they are merely at the earliest stages of development. Though embryos are humans, their current legal status is that of property. A host of debates abound in and around this topic because of their parallel consequences in other arenas. What is apparent, at this point, is that when parents opt for IVF, they often have leftover human embryos that raise the question, what do we do with them? What are the options? As of 2007, it was reported that there were at least 400,000 embryos in the United States alone that are frozen.[13] Though a significant amount of time has passed since then, it has been noted in an article appearing in NBC News: "It is not known precisely how many frozen embryos have been abandoned in the more than 500 fertility clinics in the United States. Clinics are not required by the Centers for Disease Control and Prevention, or the Society for Assisted Reproductive Technology, the nation’s primary organization dedicated to assisted reproductive technologies, to report those numbers."[14] An article appearing in the women’s magazine Elle estimates that over 1 million embryos remain frozen, though no source is given.[15] The concerns about this growing problem are not shared only in bioethics or niche evangelical circles, but resonate on a large scale as to the use of IVF. In the last few years a cascade of articles have appeared in magazines[16], family centered medical news[17], professionally medical blogs[18], as well as more recognizable and mainstream sources like NPR[19] and the New York Times.[20] One couple, while wrestling through what to do with their leftover embryos ever year, remarked, “Every time we read the ‘destroy’ option on the form, my stomach does a somersault. It feels as if our future children are showing up once a year to confront us.”[21] The status of the embryo, it would seem, appears to be a given for most parents. They agree that it is a human life. But the inability or unwillingness to implant the leftover children is outweighing the willingness or ability to do so. Whether it is crippling finances, or being overwhelmed with the prospect of multiple kids, embryo storage is growing into an epidemic ripe to be contended with. The options available for parents with leftover embryos include but are not excluded to: 1) Implant and raise, 2) Put them up for adoption, 3) Store them indefinitely, 4) Donate them to science, 5) Thaw, 6) Make a compassionate transfer, 7) Use them for an aesthetic purpose and finally, 8) Discard them. Each of these will be explained, evaluated and then categorized according to their moral permissibility. Option One: Implant and Raise As the label implies, this option is what parents intend to do with some of their embryos to begin with. What many simply do not realize or choose not to wrestle with if they have been informed, is what to do with all the extras. Implantation, as described previously, involves choosing the most opportune time to elevate the chances of a successful pregnancy. Success rates vary by source and as indicated by one fertility clinic, depend on the clinic chosen.[22] Regardless of what the actual percentage is, an attempt to implant the embryo is an option that raises the least moral concerns. Opponents at this juncture may disagree with the endeavor of IVF, but that is not the present concern. The first concern is what to do with what presently is the problem: having too many embryos leftover. Parents who have only a few embryos in storage face a less daunting challenge than those that have dozens. Option Two: Put them up for Adoption Parents who have more embryos than they are willing or able to implant have the option to put their children up for adoption. Because embryos are considered property, adoption agencies that specialize in embryo adoption are for profit. Furthermore, some suggest that adoption should only be a temporary contractual option to avoid long term storage and kicking the proverbial can down the road.[23] Though the option is a practical one, it is often not taken because of the familial complexities parents face. Many simply do not wish to have another parent raising their biological offspring.[24] Though there are over 400,000 embryos frozen, it is only a smaller subsection of these that are available to adopt. To further complicate matters, one study found that 24% of clinics do not desire to participate with embryo adoption.[25] If parents are unable to make attempts to implant their embryos, then adoption seems to be a sensible route. The option for other infertile couples to consider this form of adoption is now available, though, like non-foster adoption options, will remain expensive and carry with it the risks of a failed implantation (i.e. a miscarriage) and biological ups and downs along with many of the same emotional costs of longing for children. Because a child is not destroyed and will be treated as a child once is transferred to the mother’s womb, this is the second-best option for couples with leftover embryos. Option Three: Store them Indefinitely Far and away, this is the most common choice made my parents, though it is one made by indecision, more accurately. At one storage center, parents can store their embryos for a fee of $40 per month and have options all the way up to prepaying for 10-year storage for $2400.[26] Because there is a lack of finality or closure as to their fate, this indecision of indefinite storage is agonizing for many parents. These parents do not need to be convinced the embryo is life. They pursued IVF because there was already some level of agreement that life begins where it begins, and a baby is a baby, no matter how small. This likely feeds into the reason why so many are stored indefinitely, though moral questions are raised about this. The science is not clear how long an embryo can be stored before he or she dies. To date, the oldest embryo born after being frozen was stored for nearly 25 years to a mother only one year her elder from conception.[27] Freezing, though a science, relies on technology and maintenance to ensure their proper longevity. As accepted as the practice is becoming, it relies heavily on the dependability of technology to not fail, or accidents to happen to a clinic. If the power should fail or, as tragic as it might be, the storage facility should burn down, the loss of life would be disproportionate to the space that number of people occupy. In one such incident, over 4000 embryos were “affected” in a storage tank failure.[28] Because they are not being destroyed when they are stored but also not being implanted, this option is morally permissible in the short term and highly problematic in the long term. Option Four: Donate to Science A donation to science in the field of IVF sounds as though the embryo will be used for stem-cell research. The reality is that the leftover embryo has a much less noble sounding fate. The Reproductive Resources Center Kansas City IVF clinic says of this choice, “Now that the ban has been lifted on stem-cell research, you can choose to donate your embryos to university-based and other research clinics that use stem cells to advance medical research.”[29] This statement, however, makes it seem as every donation results with the same research. While couples can donate their embryos to places that do stem-cell research, their embryo donations will likely not consist of what sounds like life-saving work if the clinic is even accepting donations – many of whom are not.[30] Embryo donations could consist of training other embryologists and IVF techs so that they can be more proficient with fertilization and implantation of other IVF clients.[31] Donations of embryos are accompanied by another problem: lack of consent. Because embryos are humans they should not be treated, first, as commodities to be bought and sold. Secondly, because they are humans they should not be operated, experimented on or otherwise without their consistent since it will not benefit the unborn embryo. Proponents may appeal to a woman’s right to privacy in a similar fashion as they would to in the abortion arena, but this would be fallacious. Because the parents have chosen to do IVF, these arguments do not apply. Option Five: Thaw Thawing the embryo is as simple and problematic as it sounds. It is allowing an embryo to thaw, and then allowing it to die on its own. This process of thawing without the intention to implant into a mother is tantamount to allowing someone to die of exposure. Couples considering long-term storage need to realize this is how an embryo will die when there is a failure in the power resulting in a temperature change of the storage tank. Option Six: Make a Compassionate Transfer Though the adjective is applied to the word ‘transfer’, it is highly misleading and perhaps meant only to serve as conscience anesthetic. A “compassionate” transfer makes the attempt to implant the embryo into the mother at a time in her cycle when she is least likely to be get pregnant.[32] Though there is a highly miniscule chance the transfer could be successfully, both the doctors and the mother know the odds are extremely slim. The intention is known by both parties that the implantation is never meant to occur, and if it does, it is accidental and not incidental as IVF intends. It is hard to infer why this would be an option considered for many. Perhaps because when the most natural means of pregnancy are pursued, the mother often loses children though miscarriage that she is unaware of in the early stages of pregnancy. Because this is a death that occurs naturally, it might be reasoned that his makes a compassionate transfer a natural and therefore a morally permissible death. Though the reasoning is not stated, a transfer of this sort is an intentional death of a different variety. Option Seven: Use them for an Aesthetic Purpose Though this option is veiled in artistic language, what it refers to is using the deceased embryos to make and sell as jewelry for either keep sakes and/or profit. It is difficult to convey dispassionate words to describe what this is. Given the embryos are humans, to make jewelry that is to be displayed and contemplated as a form of beauty not only distorts the intention of art, but it mocks the dignity of the unborn. A Google search will yield many jewelers who offer this. One such mother accounts her choice to have her embryos turned into jewelry with these words: "We had been on a six-year journey of IVF. It was painful, tormenting, a strain on our marriage and just plain hard. Finding this has brought me so much comfort and joy. I finally at peace and my journey complete. My embryos were my babies - frozen in time. When we completed our family, it wasn't in my heart to destroy them. Now they are forever with me in a beautiful keepsake."[33] Whether the embryos are donated to someone to create jewelry to sell or whether they are created as keepsakes for the parents, this practice is morally wrong when held with the consistency of Christian Worldview. When held to the ultimate foundations (or lack thereof) of a secular humanistic worldview, it is schizophrenic, at best. To desire children, for presumedly the same reasons any other humans do, and then not want their others but to display their corpse reveals a level of incomprehensiveness that is a form of barbarism. Options Eight: Discard As the option states, the discarding of embryos is simply that. Ironically, many find that discarding the embryos is not as simple as they wanted and feel the obligation to hold some kind of ceremony.[34] Many of these cremations are offered in the IVF clinic itself. The urge to hold a ceremony seems to lend itself to the human ritual and liturgy of a funeral. The fact that this ceremony exists, like option seven, displays the natural human desire to dignify the deceased. The betrayal, though, is that the parents were both the ones who brought them into the world, and then chose to end their lives. [35] Conclusion There are only three morally acceptable options for parents with leftover embryos. They can 1) choose to implant and raise their children 2) put their embryos up for adoption or 3) store their embryos in the short-term while they decide which of the first two options are best. The remaining options do not contain within them any redeeming qualities that would warrant the destruction of human life. Many questions about leftover embryos exists because of the moral dilemma and ethical problems created upstream because of IVF. Those questions and problems deserve to be interrogated and critically engaged. I hope to be able to spend some time writing about IVF in that arena, as well. NOTES [1] Sister Regis Mary Dunne, “Issues Related to In Vitro Fertilization,” St. Mark’s Review (September 1982): 9. [2] Matthew Arbo, Walking Through Infertility: Biblical, Theological, and Moral Counsel for Those Who Are Struggling (Wheaton: Crossway, 2018), 77. [3] “2015 Assisted Reproductive Technology National Summary Report” (2015): 74. [4] Ibid. [5] Megan Best, Fearfully and Wonderfully Made: Ethics and the Beginning of Human Life (Kingsford, N.S.W.: Matthias Media, 2012), 331. [6] Ibid. [7] Scott B. Rae, Moral Choices: An Introduction to Ethics, Fourth edition. (Grand Rapids, Michigan: Zondervan, 2018), 181. [8] John S. Feinberg, “A Baby at Any Cost and by Any Means? The Morality of In Vitro Fertilization and Frozen Embryos,” Trinity Journal 14 (1993): 147. [9] Wayne A. Grudem, Christian Ethics: An Introduction to Biblical Moral Reasoning (Wheaton, Illinois: Crossway, 2018) 770. [10] “What Is Intracytoplasmic Sperm Injection (ICSI)?,” accessed August 14, 2020, https://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-intracytoplasmic-sperm-injection-icsi/. [11] Megan Best, Fearfully and Wonderfully Made: Ethics and the Beginning of Human Life (Kingsford, N.S.W.: Matthias Media, 2012), 29. [12] Ibid. 16-17. [13] Cited in John S. Feinberg, Paul D. Feinberg, and Aldous Huxley, Ethics for a Brave New World, 2nd ed. (Wheaton, Ill: Crossway, 2010) 430. [14] “‘We Were Not Prepared for Any of This’: Fertility Clinics Struggle with a Growing Number of Abandoned Embryos,” NBC News, accessed August 14, 2020, https://www.nbcnews.com/health/features/nation-s-fertility-clinics-struggle-growing-number-abandoned-embryos-n1040806.https://www.nbcnews.com/health/features/nation-s-fertility-clinics-struggle-growing-number-abandoned-embryos-n1040806 [15] Elissa Strauss, “The Leftover Embryo Crisis,” ELLE, last modified September 29, 2017, accessed August 14, 2020, https://www.elle.com/culture/a12445676/the-leftover-embryo-crisis/. [16] Ibid. [17] “Options for What to Do With Extra Frozen Embryos After IVF,” Very Well Family, accessed August 14, 2020, https://www.verywellfamily.com/extra-embryos-after-ivf-what-are-your-options-1960215. [18] Ellen S. Glazer LICSW, “Infertility: Extra Embryos –– Too Much of a Good Thing?,” Harvard Health Blog, last modified April 22, 2019, accessed August 14, 2020, https://www.health.harvard.edu/blog/infertility-extra-embryos-too-much-of-a-good-thing-2019042216476. [19] “After IVF, Some Struggle With What To Do With Leftover Embryos,” NPR.Org, accessed August 14, 2020, https://www.npr.org/sections/health-shots/2016/08/20/489232868/after-ivf-some-struggle-with-what-to-do-with-leftover-embryos. [20] Anna Hecker, “What Should I Do with My Unused Embryos?,” The New York Times, April 15, 2020, sec. Parenting, accessed August 14, 2020, https://www.nytimes.com/2020/04/15/parenting/fertility/ivf-unused-frozen-eggs.html. [21] “After IVF, Some Struggle With What To Do With Leftover Embryos,” NPR.Org [22] “Five Reasons IVF Has a Higher Success Rate than Natural Conception | Fertility Center in Utah,” accessed August 14, 2020, https://www.utahfertility.com/five-reasons-ivf-has-a-higher-success-rate-than-natural-conception/. [23] Timothy J. Murphy, “Adoption First? The Disposition of Human Embryos,” Journal of Medical Ethics 40, no. 6 (June 2014): 392. [24] Elizabeth F. S. Roberts, “The Ethics of Cryopreservation in Ecuador and Elsewhere,” American Ethnologist 34, no. 1 (February 2007): 195. [25] Andrea D. Gurmankin, Dominic Sisti, and Arthur L. Caplan, “Embryo Disposal Practices in IVF Clinics in the United States,” Cambridge University Press 22, no. 3 (September 2003): 4–8. [26] “Embryo Storage Costs | Fairfax Cryobank,” Fairfax Cryobank - Find a Sperm Donor, n.d., accessed August 14, 2020, https://fairfaxcryobank.com/embryo-storage-fees. [27] “‘Longest-Frozen’ Embryo Born 24 Years On,” BBC News, December 20, 2017, sec. US & Canada, accessed August 14, 2020, https://www.bbc.com/news/world-us-canada-42420864. [28] ABC News, “More than 4,000 Eggs, Embryos Affected in Storage Tank Failure, Hospital Says,” ABC News, accessed August 14, 2020, https://abcnews.go.com/US/4000-eggs-embryos-affected-storage-tank-failure-hospital/story?id=54039445. This comes just a month after another failure in California where about 600 embryos were lost. “Embryo Tank Maker Ducks Class Action over Failure at California Clinic,” Reuters, June 24, 2020, accessed August 14, 2020, https://www.reuters.com/article/products-fertility-idUSL1N2E11U1. [29] “What Happens to Stored Embryos If I Decide Not To Use Them?” Reproductive Resource Center Kansas City IVF, last modified January 13, 2015, accessed August 14, 2020, https://www.rrc.com/what-happens-to-stored-embryos-if-i-decide-not-to-use-them/. [30] “University of Michigan Stem Cell Research | Embryo Donation,” accessed August 14, 2020, http://www.stemcellresearch.umich.edu/donation/donors.html. [31] Chrissie Joy, “After Infertility: What to Do with Leftover Frozen Embryos When Your Family Is Complete,” One Hangry Mama, May 23, 2019, accessed August 14, 2020, https://onehangrymama.com/after-infertility-what-to-do-with-leftover-frozen-embryos-when-family-complete/. [32] “Compassionate Transfer: Patient Requests for Embryo Transfer for Nonreproductive Purposes,” Fertility and Sterility 113, no. 1 (January 1, 2020): 62–65. [33] Shauna Anderson, “Couples Are Turning Extra IVF Embryos into Jewelry,” accessed August 14, 2020, https://www.kidspot.com.au/parenting/real-life/in-the-news/couples-are-turning-extra-ivf-embryos-into-jewellery/news-story/ee4638f7227a1942be12a52de1742ddf. [34] Anne Drapkin Lyerly et al., “Fertility Patients’ Views about Frozen Embryo Disposition: Results of a Multi-Institutional U.S. Survey,” Fertility and sterility 93, no. 2 (February 2010): 499–509. [35] The format of this spectrum is adapted from formulation the American Medical and Dental Association used for their own ethical evaluation of IVF. See Garth D. Jones, “In Vitro Fertilization and the Destruction of Embryos,” Perspectives on Science and Christian Faith 67, no. 3 (September 2015): 170.
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