Friday, August 10, 2007

challenging decision for couples with leftover embryos

Couples with leftover embryos face ethical, legal dilemma-By Yonat ShimronMcClatchy NewspapersPublished on: 07/27/07

Yonat Shimron — A storage tank at a University of North Carolina fertility clinic holds five frozen embryos belonging to Tim and Kelly Jo Vancelette.
The Vancelettes had these embryos created in 2003 to start a family when they could not conceive on their own. In 2004, their twins, Abby and Alex, were conceived using in vitro fertilization. In 2006, Kylie was conceived naturally.

A storage sleeve holds small vials that contain embryos that are preserved in liquid nitrogen at the Duke Fertility Center in Durham, North Carolina.

Doug Raburn, an embryologist and lab director at the Duke Fertility Center, looks in on the lineup of vacuum flasks that contain embryos and sperm samples from clients.

Now the Vancelettes are faced with an increasingly common dilemma: what to do with their unused embryos.
Their choices are limited. With a ban on federal funding for embryonic stem cell research, they have few avenues for scientific donations. They could give the fertilized eggs to another couple, they could have the embryos destroyed, or they could freeze them.
For now, they're freezing them. The Vancelettes think they may want one more child, though they probably won't need five embryos for that. The couple frequently talks about their options, especially when they get the $250 storage bill each year. So far, they have not come up with a good solution.
Like thousands of other couples who go through in vitro fertilization each year, the Vancelettes have decided not to decide. They've reluctantly found themselves at the center of an explosive political and moral debate about the status of embryos — one that pits President Bush and two of the nation's largest religious groups against a majority of Americans who favor using human embryos to develop cures for diseases.
"You go into it thinking 'I want a baby,' not 'I will have all these moral and ethical issues,'" said Kelly Jo Vancelette, who added that she would seriously consider donating to science.500,000 embryos may be in limbo
A 2002 study by the RAND Corp. estimated that 400,000 frozen embryos are stored in the nation's fertility clinics. Given that thousands more in vitro procedures have been performed since then, the number is likely to top 500,000 now.
Most of these embryos are a consequence of in vitro fertilization — a process in which a dozen eggs are aspirated from a woman's ovaries and joined with sperm in a petri dish. Doctors harvest more eggs than needed for a single pregnancy because it may take several tries before an embryo implants in the uterus.
Remaining embryos are stored in liquid nitrogen at minus 321 degrees Fahrenheit as couples wrestle with the so-called "disposition decision." Increasingly, many couples choose to bank them.
"People have trouble letting go," said Dr. Stan Beyler, lab director at the University of North Carolina's Reproductive Endocrinology and Infertility Clinic. "They don't want to have any more kids. They don't want to have the embryos destroyed. They don't want to give them to anyone else. So they're in limbo."
A recent study by researchers from Duke University and Johns Hopkins University found that given a choice, 60 percent of patients who had undergone in vitro fertilization would like to donate unused embryos to stem cell research. Stem cells from embryos can form into any cell of the body, holding promise for combating Parkinson's disease, spinal cord injuries and stroke.Stem cell labs are few
But few places across the country do stem-cell research. In part, that's because there's no federal funding for it. Bush has twice vetoed legislation that would provide federal money for stem cell research on grounds that it would destroy the embryo, which he views as destroying human life.
While a handful of states went ahead and appropriated money for such research, actual lab studies on embryonic stem cells are scattered and few.
"No one really wants the embryos right now," said Dr. Sameh Toma, medical director at the North Carolina Center for Reproductive Medicine. "There's no one to donate them to."
Consent policies vary from clinic to clinic, but couples who want to donate their unused embryos toward such research often have to find a lab willing to take them and pay shipping costs.
At Toma's clinic, couples are not given the option to donate the embryos for research unless they specifically ask for it. Instead, the research option falls under the broader category of destroying the embryo, which is what scientific research ultimately does.
Arthur L. Caplan, a leading bioethicist at the University of Pennsylvania, decries the "howlingly obvious ethical inconsistency" surrounding embryonic stem cell research. On the one hand, clinics destroy embryos every day. On the other hand, scientists can't use those embryos destined for destruction for research.
"People who object to embryonic stem cell research have done nothing to shut down clinics that destroy embryos every day," he said.Politics at play
Most scientists look forward to an end to the federal funding embargo, and many think that it could happen after Bush leaves office in January 2009. Leading Democrats and Republicans running for president have expressed support for embryonic stem-cell research.
Even if federal funding becomes available, the demand for embryos may not be immediate. The science is still new, and it will take time before researchers are able to use embryonic stem cells in medical applications, some say.
"There isn't a great need for frozen embryos right now," said Brigid Hogan, chairwoman of Duke's Department of Cell Biology, who studies embryonic stem cells in mice.
Some clinics have been more successful with another kind of embryo donation — to another couple. At the North Carolina Center for Reproductive Medicine, a dozen babies have been born to women who received donated embryos in the 10 years since the center started the program.
Still, most couples are leery of donating their embryos to another couple.
"These will turn into our kids," said Kelly Jo Vancelette. "They may one day ask, 'Why didn't you keep us?'"
Federal legislation approved in 2005 further complicates embryo donation. The Food and Drug Administration views embryos as donated tissue, much like a kidney. As such, donors must undergo blood tests both before and after the egg is fertilized to rule out diseases such as hepatitis and AIDS. Many couples who have already gone through weeks of grueling hormone treatments don't want to undergo more medical screenings.
That leaves most couples with two options: destroy the embryos or keep them indefinitely. Into this mix fall moral considerations about the status of the embryo. The Roman Catholic Church and the Southern Baptist Convention — the nation's two largest religious groups — both view embryos as human life and therefore, oppose their destruction. Infertile Catholic couples are taught to shun assisted reproduction altogether and adopt a child instead.
Regardless of religion, most couples recognize that the embryo holds the promise of human life.
"I sort of consider them my kids, and I sort of don't," Kelly Jo Vancelette said. "They're our babies to be."
Some willing to donate to research
Another parent likened her five frozen embryos to a set of opportunities that would allow her and her husband to expand their family if they choose.
"I worked incredibly hard for those seven embryos," said Elisabeth Morray, 31, mother of newborn twins Julian and Isabelle, who were conceived after fertility treatment. "I feel like they're an investment in our future."
Morray said she did not consider the frozen embryos living entities but rather potentially living entities. As such, she said she would not hesitate to donate them to research.
These deeply personal views of the embryo are a major reason many couples struggle with their disposition decision. And those struggles are affecting more people. In 2005, there were 132,242 U.S. procedures using assisted reproductive technology, according to preliminary figures from the Centers for Disease Control. That's more than double the 59,142 procedures in 1995.
Doctors don't have any easy solutions.
"We know that when couples start down this path they're so focused on having a child," said Dr. David K. Walmer, director of the Duke Fertility Clinic. "You can give them all the counseling you want. They're not focused on it. They just want to make it work."
Kelly Jo Vancelette is proof of that.
"Once I got it into my head I wanted a baby, nothing was going to stop me," she said. "I will take all these moral and ethical dilemmas people throw at me." Having a baby, she added, is "worth it."
Researchers from Duke and Johns Hopkins universities asked 2,210 in vitro fertilization patients what they would like to do with their unused embryos. Of the 1,244 who responded:
• 49 percent said they preferred to donate them to science.
• 60 percent said they preferred to donate them for stem cell research.
• 63 percent of the women preferred stem cell donation.
• 51 percent of the men chose stem cell donation.
• 22 percent said they were somewhat or very likely to donate them to another couple.
• A similar percentage said they preferred to destroy the embryos.
What happens to unused embryos?
United Kingdom: They are destroyed five years after their creation, although exceptions are made.
Italy: Law passed in 2004 prohibits destruction of embryos. All embryos created during in vitro fertilization (to a legal maximum of three) must be transferred to the woman's womb.
Spain: It is legal to freeze embryos but illegal to destroy them or donate them to research. Because most couples prefer not to donate their embryos to other patients, 50,000 embryos now sit unused in frozen storage.
Germany: No more than three eggs can be collected from a patient for in vitro fertilization. All embryos created must be transferred to the patient.
Denmark: Allows embryos to be stored for 24 months. Recent legislation allows for stem cell research and treatment. Embryo donation to another couple is illegal.
Australia: Embryos may be frozen for up to 2 years, donated to another couple or destroyed.
Belgium: Embryos may be stored for no more than 5 years, donated to a couple or destroyed.
These states either encourage or support embryonic stem cell research:
• California
• Connecticut
• Maryland
• Massachusetts
• New Jersey
• Illinois
• Washington
• Wisconsin

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