The source of this article is the Chicago Tribune: http://tinyurl.com/4qmam

Fertility clinics face tough call
Crowded labs feel pressure to discard unwanted embryos

By Judith Graham
Tribune staff reporter
Published September 12, 2004

Nearly 500 embryos lie frozen in Thomas Pool's Texas fertility lab, abandoned by the men and women who created them.

For years, the scientist and his staff hoped in vain that the couples would come back to claim their potential progeny. Now, Pool said, he is considering doing what was previously unimaginable: removing the embryos from the cold and discarding them with his clinic's hazardous waste.

"We're to the point where we're out of room," said the embryologist, whose 1,000-square-foot lab in San Antonio is full to overflowing. "By all appearances, these embryos are unwanted. ... Something's got to give."

As the number of in-vitro fertilization procedures soars across the country, fertility clinics are feeling pressure to review the status of abandoned embryos--those whose parents have dropped out of touch and stopped paying fees for yearly storage. For the first time, a handful of clinics are suggesting they may dispose of these embryos.

Doctors and embryologists say it is one of the most difficult judgment calls they have to make. To many people, the embryos are alive--or at least potential life--and shouldn't be destroyed under any circumstances. To others, such as Pool, "these are not babies, they are not children. They're not even life forms that would survive without artificial intervention."

Although there is a growing movement to put frozen embryos up for adoption, that isn't possible for abandoned embryos because there is no one to sign away parental rights, lawyers said. Nor can clinics donate unwanted embryos to stem cell research, for the same reason.

Faced with the lack of clear guidelines, many centers--including those at Northwestern Memorial Hospital and Fertility Centers of Illinois--are preserving embryos indefinitely. But Pool's clinic in San Antonio and one at Rush University Medical Center in Chicago are among several now suggesting that they may discard abandoned embryos because of resource constraints.

This summer, Rush's in-vitro fertilization program in Chicago wrote to nearly 300 families, asking them what they wanted done with their potential offspring. The program expects that as many as 30 families will never answer, said director Richard Rawlins. Their abandoned embryos will probably be thawed because "we can't afford to keep them forever," he said.

The soaring number of in-vitro fertilization procedures, now about 100,000 a year, is the source of the dilemma. In these procedures, doctors harvest numerous eggs from a woman's ovaries and fertilize them with sperm. The resulting embryos--microscopic balls of hundreds of cells with no recognizable human characteristics--are carefully grown up to five to six days in petri dishes. At this point, some are implanted in women's wombs while others go into deep storage in liquid nitrogen tanks at minus 320.8 degrees Fahrenheit.

20,000 embryos left behind

Difficulties arise when fertility centers lose touch with patients who move or can't be found despite repeated efforts. As many as 20,000 frozen embryos--about 5 percent of the 400,000 embryos in storage nationwide--have been left behind by couples under these circumstances, according to a study last year by Rand Corp. researchers.

Dina Scolan, 33, of Naperville, who underwent fertility treatment for a year before giving birth to twins 23 months ago, thinks she can guess what some couples feel.

"I would imagine it's escaping responsibility. Not making a decision about what happens [to your embryos] means you don't have to bear the guilt. It leaves the onus on the lab technicians," she said.

Scolan and her husband, Paul, decided to have three frozen embryos thawed earlier this year.

The questions surrounding unwanted embryos are difficult, both ethically and practically. In the absence of direction, who defines what constitutes abandonment and decides what becomes of these embryos? What is the basis for deciding their fate? Who pays the price of continued maintenance and storage?

`Ethically acceptable'

Earlier this year, the American Society for Reproductive Medicine affirmed a policy stating it is "ethically acceptable" for fertility clinics to "consider embryos to have been abandoned if more than five years have passed since contact with a couple, diligent efforts have been made by telephone and registered mail to contact the couple ... and no written instruction from the couple exists concerning disposition."

Under these circumstances, clinics "may dispose of the embryos by removal from storage and thawing," the society concluded.

But with few exceptions, fertility centers aren't following the proposed guidelines. "We'll keep [abandoned embryos] forever," said Dr. Ralph Kazer, chief of the division of infertility at Northwestern Memorial. "I am very, very concerned about legal liability. It's not beyond imagining that a couple could show up after five years in Japan and say, `We're back; we want our embryos,' and what would we do then?"

At the Institute for Reproductive Medicine and Science at St. Barnabas Hospital in New Jersey, one of the country's largest IVF clinics, Dr. John Garrisi believes he has a custodial role.

"I'm an embryologist and my responsibility is to the embryos, even if my patients have lost contact," he said. But eventually, he added, his program will have to define when "we feel comfortable saying we've done all we can or should to protect them."

Storage firms spring up

No one is sure how long embryos can remain viable in deep storage. "Fourteen years is the current record for length of storage resulting in viable delivery," Garrisi said. "But theoretically, the limit could be on the order of 1,000 years."

That's a long time for a clump of cells to be maintained in constant deep freeze and protected from fire or intruders in special, secure facilities.

Indeed, a specialized line of business--long-term embryo storage--has cropped up to address the issue of what to do with excess frozen embryos. The concept is similar to the off-site facilities that house documents for law firms and corporations. ReproTech Ltd. of Roseville, Minn., helped pioneer this field, which also includes a handful of other companies, including California Cryobank in Los Angeles.

Rush's in-vitro fertilization program in Chicago is now offering patients the option of transferring frozen embryos to long-term storage off-site because of space constraints.

At a Chicago clinic that is part of the Fertility Centers of Illinois network, seven large liquid nitrogen tanks sit on the floor at the back of the laboratory, each holding about 200 frozen embryos stored in thin straws and marked with identifying number. At least once a week, staff members check on the levels of liquid nitrogen and make sure security systems are operating properly.

The centers' president, Dr. Aaron Lifchez, estimates that more than 100 of the frozen embryos have been abandoned by couples who moved, divorced or changed their minds about their future family plans. Many of the embryos left behind come from the earlier days of in-vitro fertilization, when scientists were less sophisticated about distinguishing the quality of embryos and were more likely to put all leftover embryos in deep storage.

"Who wants to take responsibility for discarding these?" Lifchez asked.

Although his clinics' contracts specify that officials have the right to dispose of frozen embryos if couples stop paying annual storage fees or cannot be found after repeated attempts, the doctor said "we've never done that, and don't plan to."

Uncharted legal waters

So far, no legal case involving abandoned embryos has reached the courts, said Bruce Wilder, co-chairman of the American Bar Association's committee on the law of genetics and assisted reproduction. But if a contract clearly spells out what will happen to embryos in case of abandonment, the clinic should prevail under contract law in a dispute, said Ami Jaeger, a lawyer specializing in reproductive medicine at the BioLaw Group of Santa Fe, N.M.

Although most clinics now use such contracts, clinic directors often don't feel comfortable destroying embryos without a newly signed consent form, just in case couples have changed their minds.

Only 10 states--Illinois is not among them--have laws related to the "use, storage and disposal" of frozen embryos, and none of these applies directly to abandoned embryos, according to materials supplied by the National Conference of State Legislatures.

More broadly, the question of an embryo's status--is it a person in the eyes of the law?--has not been the subject of an explicit legal ruling in the U.S., said John Robertson, a professor of law and bioethics at the University of Texas. "Generally in the U.S., [embryos] have not had legal standing, but this is based more on a set of assumptions than on actual cases," he said.

For Bonnie Steinbock, a philosopher at the University at Albany-SUNY who has just written a paper titled "Moral Status, Moral Value and Human Embryos," the notion that indefinite storage is preferable to thawing and discarding abandoned embryos is misguided.

"Is there a moral difference between destruction and leaving embryos perpetually frozen with no hope of being carried by a woman or born one day? I don't think so," she said.


Copyright © 2004, Chicago Tribune 

----------------------------------------------------------------------
To sign-off Parkinsn send a message to: mailto:[log in to unmask]
In the body of the message put: signoff parkinsn