My interest in this topic was sparked by an article, “The Americans who ‘adopt’ other people’s embryos.’’ (1) Embryo adoption is increasingly being seen as an alternative to other methods of forming a family, such as the adoption of an existing child, using in vitro fertilisation (IVF) with the patient’s own eggs/ sperm or donor eggs/sperm, or using an altruistic or paid surrogate. Reproductive donation has become an option only since the onset of assisted reproductive technologies, so it has been an established practice for more than 25 years. Medical professionals consider embryo donation provides patients a way to conceive that may be less medically complex and cost effective then gamete donation. It also provides a sense of fulfillment for the donor. (9)
However, it remains controversial and raises passionate debate within the community.
For me, while I don’t know all the answers, these questions are important. Does using donor embryos or a surrogate mother objectify children to be bought, sold and used at will? Is the rights and interests of the child/ren born of embryo adoption of paramount importance? Is it a moral and ethical method of forming a family? Is it saving a life that is already in existence, rather than using IVF and producing more embryos to be left in frozen nitrogen in storage? What should be the ‘cut off’ age of the patient? As the majority of clinics who use embryo adoptions are Christian, should they be able to refuse treatment to non-Christian couples? Should it be available to single women and same sex couples? Will it reduce the number of adoptions of existing children waiting for their permanent families? Are clinics, including those overseas, regulated to ensure that there are no abusive practices?
Research shows that for many adult adoptees and adults born from donor sperm and/or eggs there is often deep and long lasting loss and grief issues, a desire to find their birth families, and a struggle to form an identity. Should embryo adoptions be ‘open’ to ensure that adults conceived this way can know their genetic roots? Or is it Ok for them to be anonymous? Is there relevant research to understand and predict how adults conceived by embryo adoptions will feel? What records are being kept to allow adults to search their origins? Is it important that they may have existing siblings?
A few days after I started researching this fascinating topic a 62-year-old woman gave birth at 34 weeks to a child by caesarean section at a Melbourne Hospital, making her the oldest woman to give birth in Australia. Her husband is aged 78 and after numerous attempts to achieve a pregnancy using IVF, they travelled to the USA to use a donor embryo. (10)
While opinions to the news varied, the vast majority of the general public and professionals considered the couple selfish and that IVF should be not allowed after a woman turns 50-51 years.
Australian IVF pioneer, Dr Gab Kovacs from Monash University labelled the procedure irresponsible, as there are significant health risks to mother and child. These include high blood pressure, birth complications and concerns with foetal development. Australian Medical Association president, Michael Ganon said the couple were selfish and that women were not designed to have children in their 60s.
While the procedure is not illegal, Dr Bernadette Richards, an expert in medical law and bioethics from the University of Adelaide says just because medical intervention enables a 62 years of woman to become pregnant doesn’t mean it is right. The driving principle of our laws, she says, should be is it in the child’s best interests to have parents of that age? (11)
The use of donated embryos is less common then the use of donor sperm and/or eggs, but the numbers in the USA have doubled in the last 10 years, driven by conservative Christian and pro-life groups. Mostly offered in Christian fertility clinics, many who use embryo adoption see it as a Christian duty to save a life ‘frozen in time’ and that IVF treatment adds to the many thousands of what are called left over, excess and unused embryos. (9)
Terminology and Its Importance
The use of terminology, such as donation and adoption, varies depending on several factors, including profession and religious beliefs.
The term embryo “adoption,” suggests the Centre for Human Reproduction, was coined by their group not because they wanted to suggest that the process is equal to the adoption of a child, rather that they intended to “personalise” the selection process of embryos produced by another couple through assisted reproductive technologies. (8)
Lawyers who assist couples who are trying to acquire an embryo state the term "embryo adoption" is a misnomer because the transfer of an embryo is handled as property transfer. (9)
Some use the terms synonymously because regardless of whether the arrangement is open or anonymous, the donation of embryos and a clinical assisted reproduction procedure is involved, and the recipient couple is preparing to raise a child not genetically related to them.
Abortion rights advocates, advocates of embryonic stem cell research, and members of the fertility industry object to referring to the transfer as an "adoption" because they feel it gives an embryo the same status as a child. (6)
In agreement, the Ethics Committee of the American Society for Reproductive Medicine, states that embryos have special significance compared to gametes because of their potential to become people, but they should not be given the same legal or moral status as persons. Therefore, application of the term adoption to embryos is inaccurate, misleading and should be avoided. (9)
Embryos are often referred as ‘snowflake babies’ by American agencies. (2)
What is Embryo Donation and Adoption?
However, for the purpose of this article, I suggest we define embryo donation as the giving of embryos remaining after one couple's in vitro fertilisation to either another person or couple for implantation (usually without compensation but some donors are reimbursed for costs) or to be used for research.
Where it is given for the purpose of implantation, and the donation is followed by the placement of those embryos into the recipient woman's uterus to facilitate pregnancy and child birth, I suggest we use the term “embryo adoption”. Do you agree?
If a pregnancy occurs, the child of the woman who carries it and gives birth, and not the child of the donor, as is the case in egg and sperm donation, is considered the ‘legal’ mother. (6)
Embryo donation can be handled on an anonymous basis (donor and recipient parties are not known to each other), or on an open basis (parties' identities are shared and the families agree to a relationship).
Occasionally, a "semi-open" arrangement is used in which the parties know family and other information about each other, but their real names and locating information are withheld, in order to provide a layer of privacy protection. (6)
Embryo Donor Options
In the treatment of IVF, doctors often create more embryos than a couple uses in their cycles. Most often, the embryos are donated after the woman for whom they were originally created has successfully carried one or more pregnancies to term.
This creates a dilemma! What to do with the embryos once a pregnancy/s is achieved?
According to a survey by the American Society for Reproductive Medicine, 54% of fertility patients want to preserve their remaining embryos for future use. Embryos can survive in frozen nitrogen for an indefinite period, and babies have been born after 20 years! (1)
Another 21% want to donate leftover embryos for research, and this number increases if patients are given honest, correct and clear information about research projects.
The remaining 7% of those surveyed are willing to donate leftover embryos to another couple. The rest were unsure.
Dr. Jeffrey Nelson is Director of the Huntington Reproductive Center, one of California's largest IVF clinics. He reports that just twenty-five per cent of patients want to donate their spare embryos, a number he wants to increase. Patients are reluctant to make a decision, and so his clinic has placed a fee for storage after a certain number of years. He estimates it costs US1200 a year to store frozen embryos, so it costs donor families in the USA about US72 million annually for storage fees. (6)
What Countries Practice Embryo Adoptions?
When I began researching embryo donation and adoption, I was curious to understand where it was practiced, current guidelines and regulations, and whose interests were being served! It was difficult to find reliable information, including the latest statistics. However, what is certain is that most governments play a more active role in the adoption of existing children then in embryo donation for family building. In some countries there are guidelines such as medical screening, psychological counselling, informed consent and the transfer of rights over the embryo from donor to recipient. (9)
USA- There are 600,000 embryos in frozen storage, most of them waiting to be used by the couple that created them. Those wishing to donate surplus embryos can choose parents based on criteria such as race, sexuality and religion, and whether there is any contact initially or ongoing. (1)
The average cost is US12,400 (adoption costs are from US20-40,000 or more!)
Since 2002, the US government has been giving between US1-4 million a year to organisations that promote awareness of embryo donation and adoption. Embryos are often referred to as ‘snowflake babies”. (2)
Many agencies that do embryo adoptions, such as the US based agency Nightlife, also process domestic and international adoptions. On their website they cite over 2000 domestic and 1700 international adoptions. Their Snowflakes Embryo Adoption Program has resulted in 555 embryo adoptions. (4)
United Kingdom- Again, embryo adoption is offered by the Nightlife agency. Equality laws mean that clinics have to treat all patients equally. (1)
Australia- The Embryo Donation Network cites its purpose of helping readers to make decisions about embryo donations, by giving information, sharing stories, and answering important questions. (3)
Embryo Donors is online community of people that are actively considering embryo donation. It has been designed to help facilitate connections between potential recipients and donors, and everyone who is considering donating undergoes a medical assessment, infections and genetic screening and counselling, to understand the legal and emotional consequences of embryo donation. (5)
An Australian branch of Nightlight advertises that it is possible to experience the miracle of giving birth to an adopted child and is available for people worldwide. The Snowflakes Program makes it possible as embryos are currently stored in fertility clinics and are waiting for a loving home. Prior to being matched with embryos, the recipient will have an adoption home study.
The adoptive parent receives autobiographical information, medical health history, and pictures from the donating family. All the embryos a family has are transferred. (4)
For Our Reflection!
Globally, in vitro fertilisation (IVF) has formed families for thousands of individuals and couples that would remain childless, and in this process the doctors often create more embryos than necessary to achieve a successful pregnancy/s.
As we have discussed, this creates a dilemma for many. What to do with the excess embryos? Does the couple choose to thaw them, donate them for research, or to others to allow them to achieve their dream of forming a family?
While two family building options in which children are genetically unrelated to the individuals raising them are the adoption of living children and the use of donated embryos, the latter is relatively new.
How do adult children conceived in this way feel about embryo donation? Studies are lacking. Is embryo donation a loving, caring and compassionate choice? Or is it a process that places adult’s rights over the child’s.
I will conclude with this quote from Ms. Wendy Francis, spokesperson for the Australian Christian Lobby (ACL). She writes, “Children risk missing out on forming important relationships with those who are the source of their biological origins. We must ask ourselves what kind of impact using donor embryos, eggs or surrogates might have on a child’s identity, and if the desire to have a child, no matter what the cost, is really more important than the needs of the child involved.”(11)
I look forward to your thoughts on the complex questions I have asked in this newsletter!
Taylor-Coleman, J., “The Americans who ‘adopt’ other people’s embryos”, BBC Magazine, 18th July 2016.
Spooner R., and Choahan, N., Channel 7, Australia
Australian Prayer Network Newsletter, Ethical Debate over 62 Year old Mum, August 2016.