31 January 2007

I'd like blue eyes, black hair and no whining

Anyone in the mood for a long one?

A friend recently sent me the following article about a woman in Texas (why is it always Texas?) who opened a clinic offering pre-made embryos. Basically, it sounds like you get to pick your future baby from a catalog.
'Embryo bank': new hope or too far?
A Texas fertility center's methods raise concerns about 'designing'babies. Some say they're not much different from the usual practice.
By Amanda Paulson Staff writer of The Christian Science Monitor
January 18, 2007

In an era when infertile couples often look to test tubes or surrogate mothers to create children, the notion of egg or sperm donors is hardly novel.

Yet a San Antonio woman's idea to bring the two together – creating complete embryos ready to be implanted into the womb – has drawn a raft of criticism, with bioethicists debating whether this is the commodification of children or just another – perhaps more effective – way to help people become parents.
My friend expressed her concerns about the ethics of this. In addition, she questioned the idea of "leftover" embryos, which is what prompted me to write a way-too long response.

Which I decided to share with you, my peeps. Forthwith, I offer my response. No research, no links, and I absolutely welcome responses - disagree, agree, don't care, I made major errors, you're starting your own clinic, etc.

"Leftover" embryos are a real issue. In most IVF situations, well over 15 eggs can be retrieved at one time, with any number of those being fertilized. If a standard IVF procedure is used, the sperm and the eggs are put together, and "nature" takes its course, which can result in most, all, some or none of the eggs being fertilized. In an ICSI (Intracytoplasmic sperm injection) procedure, the sperm is cleaned and injected manually directly into the egg. With ICSI, the number of eggs fertilized can be controlled, however, the doctor and patient will usually agree to fertilize as many as possible, allowing for the quality of eggs. The fertilized eggs are then allowed to develop to embryo stage. The more fertilized eggs, the better the chances of getting 2, 3 or 4 high quality embryos.

However, regardless of how many eggs actually fertilize, and then develop on to become high-quality embryos (only embryos of a certain quality will be transferred to uterus), very few actually get transferred. Depending on the woman's age, and number of previous cycles, the maximum number of embryos transferred is usually 4, but more frequently 2 or 3.

That leaves a lot of embryos behind. They will typically be frozen and stored for a future cycle for the patients. Many frozen embryos break down during the thawing process and are not viable. If the patients succeed in getting pregnant, many will save the frozen embryos for a second or third child. Sometimes, patients can only afford one cycle, or choose to only have child, leaving the question of what to do with the remaining embryos.

It's a difficult subject for everyone in the infertility world. Do you destroy them? Do you donate them to someone else who is having difficulty? Do you donate them to science for stem-cell research? (Oh yeah, I forgot - infertile couples can't do that. G-d forbid one should try to do something good from one's pain and suffering.) Destroying them is a crushing question for those who believe that life begins at conception (I don't). But you have to pay to store them. How long do you keep paying?

I disagree with what this woman is doing, but only her method, not her end result. IVF is so extremely expensive. The idea that money might be the only thing preventing someone from having children is devastating. If both parents are infertile, having a place to go where the sperm and egg will be donated and then an embryo is created is a blessing, just like a "normal" infertility clinic. Having them created and stored like shoeboxes in a storage room waiting to chosen by a future client, is, in my opinion, unethical. I also reject the ability to "pick and choose" the genetics of the embryo, however, if a patient where going out on their own to pick sperm and egg donors, they would have the choice of people, so why not be able to choose the sperm and egg donors at a clinic? Before the embryo is created. This woman provides a comparitively inexpensive procedure that allows infertiles to get pregnant and have children.

Also I totally reject the scare tactic implication in this article with the line, "No studies have been done, for instance, on the long-term health effects of in vitro, and tracking such children would be impossible since records aren't kept." That's bullshit. Many, many studies have been done, starting with the very first IVF baby, Louise Brown. She was tracked practically every minute of the day. Every clinic keeps records of results, and nearly every long-standing clinic has done or participated in some sort of study on the effects of IVF on children. IVF babies are not smaller, they are not proven to be less intelligent, they are indistinguishable from every other child on the planet.

I think regulating this industry is walking a fine line. So far, all the attempts at regulation have been from fundamentalists who think infertility treatments are all together wrong, and they try to legislate only one embryo being transferred. Or who can qualify for infertility treatment. Or how many eggs can get fertilized. Etc., etc. I understand the desire to regulate clinics like this one, but we have to be careful about how the industry is regulated. If a law is passed preventing embryos being created to be sold, then what happens when an infertile couple comes along, with a sperm donor and an egg donor. Where do they go? How do they get their child created? Does the fertile world get to decide who can and cannot have children? I agree there are ethical issues here, and the fact that this woman thinks it is okay to make embryos in advance to sell to discerning couples is wrong in my view. What happens if the resulting child doesn't look the way the genetic mapping suggested? Do the parents get a refund? Do they get to return the child?

The vast majority of infertiles just want a child. They don't care if the child is perfect, has Mom's eyes and Dad's nose. They don't care if the child is a genius, or has an affinity for music. They just want a child, and they will give anything for that. That's the most important consideration here.

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At 1/2/07 11:08 a.m., Blogger Thalia said...

I think the most important issue here is how the children will feel as they become teenagers and want to know where they came from. I think the UK legislation which puts an end to anonymous donation is a good thing for them. I know that's an easy thing for me to say as we didn't need a donor (so far), but I would want my child to have access to information about his/her biological parents if she wanted it. I also think that any kind of "we bought you from..." would be a very hard thing to explain to a child.

At 4/2/07 2:03 p.m., Blogger Natalie said...

See, I don't have a big problem with the embryos being created and stored. The sperm and the eggs would be stored otherwise, and to me in my head it's not a huge leap from sperm/egg to embryo.

I also don't necessarily disagree with allowing the infertile couple to choose their donors. I do think it could be taken too far. But I think it's pretty understandable that people want a baby who looks like them. I think most people would understand that there are no guarantees in life. (For the others who want something exact and would freak out later if it wasn't right - I think something is wrong with them, not necessarily the system, if that makes any sense.)

As for what the above commentor said about explaining it to your children.... I don't really see the big leap from using a sperm donor or even adoption. Either way it's a-typical and will be a bit awkward to explain how the baby ended up in your life. But the one thing all of that has going for it is that you CHOOSE the baby. You intentionall went out and paid a lot of money just for the opportunity to raise this child. And I think that's gotta count for a lot.

At 5/2/07 4:34 a.m., Blogger Bea said...

I have to side with you on this one. I have no problem with couples choosing a sperm donor and an egg donor and creating embryos they intend to use.

I do have a problem with someone creating embryos they *think* someone might want to use. No matter how right she usually gets her market research, it is commodification with all the usual inventory risks that come when someone tries to decide what other people might want and then makes it.

I don't believe a 2-day-old embryo is as important as an adult human being, but I do think it's more than merely the sum of its parts.


At 29/3/07 9:51 p.m., Blogger Lut C. said...

I agree with Thalia, that anonymous embryo donation is a thorny issue.
A number of countries have banned anonymous donation in the interest of the child. Usually the child gets a right to some information about the donor(s) when it reaches a certain age.
And indeed, anonymous sperm/egg donorship and untraceable adoption is the same.

A supermarket of embryo's does make me feel a bit uncomfortable, though I can't put my finger on why exactly. Perhaps because it is for profit? The difference with seeking out a sperm and egg donor on your own isn't that big.


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