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IVF, Frozen Embryos, Talked about on Campaign Trail
In the days leading up to the Florida primary, Republican Presidential candidate and former Speaker of the House Newt Gingrich called for a ban on embryonic stem cell research and the creation of a commission to study the ethics of in vitro fertilization.
According to the Washington Post, Gingrich was expressing concern about the excess embryos created in the IVF process and said, “I believe life begins at conception, and the question I was raising was what happens to embryos in fertility clinics, and I would favor a commission to look seriously at the ethics of how we manage fertility clinics. If you have in vitro fertilization, you are creating life; therefore, we should look seriously at what the rules should be for clinics that are doing that, because they are creating life.”
Barb Collura, executive director of RESOLVE, says the statements demonstrate a lack of understanding about the science and medicine behind IVF, as well as a lack of understanding about infertility. "He is not understanding this is a medical condition, this is a medical treatment, and now you're going to take one option that we have and say we're going to put this under the microscope and we may decide that there needs to be government intervention and government rules and government managing it," she says. "And that is really sad when we're looking at a private medical condition, a medical decision that people want to make, and now we're going to have government telling you what kind of care you should have, what the medical procedure should be.
"When we look at transferring embryos and freezing embryos, that's the standard of care," Collura continues. "How many embryos are you going to transfer, what are you going to freeze, what's the drug protocol you're gong to use to stimulate? Those are the standard of care questions."
Fertility Clinics Are Regulated
The fact is, fertility clinics and labs are already highly regulated. "Clinics are already monitored by the government," says Stephanie Moyers, marketing and public relations manager with the National Embryo Donation Center (NEDC).
State governments regulate the practice of medicine with physician licensure and requirements for laboratories, explains Eleanor Nicoll, public affairs officer for the American Society for Reproductive Medicine (ASRM). The federal government regulates through the Food and Drug Administration. "Any medications, devices, and donor tissues which are used in fertility treatments are regulated by the FDA. And federal law requires every ART clinic to report data to the CDC on all cycles performed and their outcomes."
In addition, the profession is very actively self-regulated. "Physicians practicing in the field seek additional specialized training and board certification in Reproductive Endocrinology," Nicoll continues. "ASRM and SART (Society for Assisted Reproductive Technology) have developed extensive ethical and practice guidelines. SART member labs, which perform about 95 percent of assisted reproductive technology cycles in the U.S., must be certified through ASRM/CAP, the Joint Commission, or New York State."
Making Decisions about Embryos
Creating excess embryos is a part of the in vitro fertilization process. A woman's ovaries are stimulated with fertility drugs to produce more than one egg. The eggs are retrieved and fertilized in the lab with sperm in order to create embryos. Then a woman and her fertility doctor decide how many of those embryos are transferred to the uterus with the hopes that one will implant and result in a healthy pregnancy and birth. ASRM guidelines now recommend single embryo transfer in patients with a good prognosis.
Typically, there are embryos left over, which are usually frozen. Currently, there are about 615,000 embryos in cryopreservation, according to Moyers. The majority of those are awaiting the decision by the genetic parents on whether to have more children. "Of those 615, 000, really only 2 to 3 percent are the ones that are kind of in limbo," she says. "So yes, we have all these human frozen embryos, but most of them are still being retained for future children."
Making decisions about embryos can be a difficult decision for individuals and couples undergoing fertility treatment. If an individual or couple is interested in growing their family, the options are:
- Keep the embryos frozen and stored for use in future IVF cycles.
- Freeze Indefinitely. This can be an expensive option, and decisions must be made at some point.
If the individual or couple is sure their family is complete, the options are:
- Donate embryos to another couple.
- Donate embryos to medical and scientific research. According to RESOLVE, surveys suggest that nearly half of infertile couples say they would like to see some good come from their biological tissue and feel that the use of their embryos for research that may help save lives is extremely important.
- Thaw and dispose of the embryos. The embryos are taken out of storage by the clinic and thawed in the lab. A patient may also take the embryos from the fertility clinic and dispose of them in the way they see fit, possibly achieving closure with some sort of ceremony.
- Talk to the fertility doctor about transferring the embryos during a time in the cycle when it is unlikely the patient will become pregnant, so that the body disposes of the embryos naturally.
"What we see as the best option would be to pay it forward, to donate them to another couple who is wanting to have a baby," Moyers says. She explains that many fertility clinics have their own in-house donation service. In addition, there are embryo adoption programs such as NEDC and Nightlight Christian Adoption's Snowflakes Frozen Embryo Adoption & Donation Program. Some of these programs are virtual and will match donors to couples who want to adopt. NEDC is a brick and mortar program, and the organization takes over preservation of the embryos until a couple is found to adopt them.
Embryo decisions are difficult, says Collura. "It is a tough, tough decision. As a community collectively, there isn't enough being done to talk about this and to help educate patients. It's really important that we let them know what their options are.
"Having said that," she continues, "if the government is going to start saying here's what you're going to do with your frozen embryos, we don't like that. And that's another thing that came out in the comments from Newt Gingrich. What does that mean? Does that mean you're going to start taking away options or does this mean you're going to start telling us what we can do? We don't know what that means, but we at RESOLVE firmly believe that if you've gone through an IVF cycle, you've created those embryos, and you and you alone should choose what to do with them."