At a meeting with his fertility-clinic partners and staff earlier this year, Dr. Carl Laskin was shocked to hear the latest figure.
Frozen in tanks of liquid nitrogen, he was told, the Lifequest office in downtown Toronto is holding 1,000 embryos belonging to in-vitro fertilization (IVF) patients who have essentially disappeared.
Across the country, in fact, fertility practices are storing thousands of such abandoned or “orphaned” embryos, while grappling with a moral and legal quandary: what to do with so many germs of potential human life when their owners are nowhere to be found.
Some are destroyed but most held indefinitely, partly out of a fear the patients will some day emerge from the woodwork, suddenly wanting to make another child.
Meanwhile, a bioethicist proposed a contentious solution at a conference last month — donate the stranded embryos to science rather than let them go to waste. Many clinics are unwilling to take that or any definitive action.
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“The issue is, you are dreading that phone call from the couple that says, ‘We’ve been out of the country and we’ve decided we want to use the embryos.… And [when told the material is no more] they say: ‘You threw them out? How could you?’, ” said Dr. Laskin. “It is a very difficult area. As clinic directors, we talk about it frequently.”
In fact, a University of Saskatchewan-based fertility scientist, Roger Pierson, said he knows of an ongoing case where the clinic donated a supposedly abandoned embryo to research, only to have the patient resurface — and be appalled at what had happened. The couple’s lawyer is now involved.
HandoutAcross the country, fertility practices are storing thousands of abandoned embryos.
Glenna Owen, a Vancouver woman whose two children, aged three and five, were born through IVF, said she is almost ready to allow her six surplus embryos in storage be destroyed, but admitted she feels a strong tie to them.
“It’s kind of akin to your parents selling your childhood home: You don’t want to live there yourself, but it is sad to see it go,” she said. “As humans, we just form these attachments.”
Part of the problem for the clinics is that, like so many aspects of the burgeoning field of fertility medicine, governments offer little guidance on the issue. A 2010 Supreme Court ruling left the area split between federal and provincial jurisdiction, but neither Ottawa nor most provinces have passed regulations on what to do with abandoned embryos.
“It is anywhere from disappointing to disgusting that we don’t have an ethical framework,” said Dr. Art Leader, another fertility physician. “Neither level of government really wants to touch this with a 10-foot pole.”
The embryos used in IVF are created by fertilizing eggs with sperm in a laboratory. The result is barely recognizable as human material — a collection of as few as six cells that cannot even be seen with the naked eye. But for some infertile couples, single women and same-sex partners, they are the only route to having a baby.
Those that are not needed are cryo-preserved, giving the patient the option trying to conceive again later, with clinics charging storage fees of up to about $300 a year.
Sometimes, the fees stop coming in and clinics lose contact with the patient, despite considerable efforts to find them. The search can include sending letters and making phone calls, contacting the family physician and even reaching out to relatives, said Dr. Laskin.
Until several years ago, consent forms did not even address what would happen if patients no longer wanted surplus embryos — or abandoned them. More recently, forms have given patients the option of having them destroyed, donated to other couples or used in research.
‘If it was me, I wouldn’t be able to do that. It’s worse than abortion’
Yet even when the consent document allows clinics to dispose of an orphaned embryo, many remain loath to act.
“What we spend all our time doing is creating embryos for people to help them have babies,” said Simon Phillips, laboratory director at Montreal’s Ovo Clinic. “It would be pretty difficult to have to allow them to perish.”
A minority of clinics are more determined. Dr. Leader’s Ottawa Fertility Centre, for instance, routinely destroys abandoned embryos, and has yet to receive any complaints.
Still, it is an emotional issue for the owners of those tiny collections of cells. Often the choice they made on lengthy consent forms in the tumultuous days leading up to IVF treatment changes when they are contacted much later, said Dr. Janet Takefman, director of psychology at Montreal’s MUHC Reproductive Centre.
Those who managed to have a baby from their treatment, for instance, can turn against the idea of left-over embryos going to research, she said. “They have this live child, and they can’t imagine experimenting on them.”
Another option is for embryos to be “adopted” to patients unable to create their own, but fertility specialists say it is crucial to involve the parents of the embryo in that process.
Philip Cheung for National PostDr. Carl Laskin (L) says fertility clinics make considerable efforts to track down patients they have lost contact with.
Unwanted embryos are now used in stem-cell experiments and other research, when the patients are reachable and directly consent to it. But there is nothing legally or morally preventing clinics from doing the same with embryos that have been “willfully” abandoned, especially if the alternative is to destroy them, argues Ryan Tonkens, a former research fellow with Dalhousie University’s Novel Tech Ethics unit.
For stem-cell research specifically, using abandoned embryos without direct consent may be inappropriate, as the life is in essence extended through the resulting stem-cell line, he said. But there is other science, such as developing more effective fertility treatments, that could benefit greatly from all those orphaned embryos, Mr. Tonkens said in a presentation to a Canadian Bioethics Society conference in June.
“Insofar as we expressly discard these abandoned embryos, we are wasting a valuable scientific and clinical resource,” he said in an interview.
Most fertility professionals say they would balk at donating an embryo for research unless the patient could be contacted for permission, or there was at least legislation allowing it.
‘It is anywhere from disappointing to disgusting that we don’t have an ethical framework’
Gloria Poirier, acting director of the Infertility Awareness Association of Canada, said she believes the choice should be in patients’ hands, but would personally be uncomfortable to see an abandoned embryo go to science.
“If it was me, I wouldn’t be able to do that,” she said. “It’s worse than abortion.”
The space requirements and cost of maintaining cryogenic equipment to store abandoned embryos is not a massive logistical or financial burden on clinics yet, but that will change, they say. IVF continues to build in popularity, and with it comes more and more embryos, noted Mr. Tonkens.
“It’s a significant problem and it’s a growing one … and we really don’t have anything in place to deal with it.”
National Post
tblackwell@nationalpost.com