Embryo matchmakers make it easier for potential donors and recipients to find each other.
A massive demographic shift is underway as more Americans attempt to have children well into their 30s and 40s. Most will succeed, but many collide with the brutality of biology: Infertility now affects 1 in 7 couples.
Adoption has long been an alternative option for infertile couples and singles. But in recent years, that process has gotten dramatically more competitive as demand has increased and tighter regulations have decreased the supply of domestic and international children available for adoption. Prospective parents today are looking at up to $50,000 in agency fees and waiting lists of up to five years to get a child.
Jennifer Daman, 32, of Houston, Texas, faced this exact dilemma. She had tried in vain to get pregnant with her first husband — first naturally, and then by trying in vitro fertilization (IVF), in which mature eggs were collected from her ovaries and then fertilized with sperm in a lab. Nothing worked. After Daman married her second husband, she began looking into adoption. When she realized it would come with the deal-breaking price tag of $40,000, she was devastated.
But then a social worker who heard Daman's saga told her about another unorthodox option: using someone else's frozen embryos to get pregnant.
While nowhere near as common as adoption or using one's own eggs or sperm in IVF, embryo donation is becoming an increasingly more accessible way to try and start a family. When it works, a donation can solve two problems at once. It helps people who ended up with extra embryos from IVF cycles to find a home for them, rather than discarding them altogether. And it gives people otherwise frustrated by child-bearing or adopting attempts another shot at parenthood. Both sides, if they choose to, can control the selection process.
Daman and her husband recently acquired a set of five frozen embryos through a fertility clinic in Reno, Nevada for just $7,000 — a relative bargain compared with adoption. They will never know the people whose genes are contained in the embryos, which were donated anonymously and have been frozen since 2011.
"We have our frozen kiddos out in Reno waiting on us," Daman tells me. "It's absolutely amazing how good having hope again feels. We will get to experience the first kicks and the heartbeats."
As embryo donation becomes more common, more and more people will grasp at this hope. Some are motivated not just by their own parental yearnings, but also by politics: embryo donation is a pet cause of the pro-life movement. But treating frozen embryos like babies available for adoption, as some pro-life embryo banks do, is ethically galling to fertility experts. And like all forms of assisted reproduction, embryo donation is a risky pursuit: there's no guarantee any embryo will become a kiddo.
How the pro-life movement made embryo donation popular
Since 1978, when the first "test tube" IVF baby was born, assisted reproductive technology — the term for IVF and related procedures — has taken off. In 2014, some 65,175 babies were born in the United States through these methods.
Embryos can last indefinitely in the freezer
Embryos may be just a tiny mass of cells, but they are surprisingly hardy, especially those frozen with a technique called vitrification, or "flash freezing." It's been the fertility industry's freezing method of choice since around 2000, and has dramatically increased the survival rate of embryos when they're thawed for implantation in a woman's uterus.
Embryos, along with sperm and eggs, can theoretically survive in liquid nitrogen -- a temperature of -321°F -- forever. The technology has only been available for three decades, but babies have been born from from embryos that were frozen as long as 20 years.
Yet not all embryos are created equal in terms of quality. Embryology laboratories typically give three quality scores for each blastocyst embryo that indicate the potential of the embryo become a healthy baby. They look at the number and size of the cells, the rate of development, and other factors when giving these grades. It's always a bit of a guessing game, though, and different clinics have different grading systems.
Over the years, doctors have found that their first attempts to transfer embryos to a woman's uterus during IVF often fail. So they now try to increase chances of success by preserving multiple embryos for future attempts.
Today, one-third of IVF cycles in the United States yield extra embryos that will be "cryopreserved." But only about half of those embryos are actually used for reproduction. The other half — an estimated 700,000 to 1 million embryos — are stored as surplus, frozen in tanks of liquid nitrogen around the country.
Their owners pay annual storage fees of up to $1,000 while they weigh what to do with these embryos. Ultimately, they have a few options: they can use them to try and make more children, discard them, donate them to science, or donate them to other people.
As embryos keep piling up, donation has become more popular — particularly among those pro-life Christians who see embryos as tiny lives, "orphans" stranded by IVF who need to be rescued from an interminable existence in the freezer. Russell Moore, an evangelical leader and head of the Ethics and Religious Liberty Commission of the Southern Baptist Convention noted this trend in 2012:
"These aren’t 'unused embryos' as though they were things or tools. These are image-bearing persons who are endowed by their Creator, not by their 'usefulness' with certain inalienable rights. Opening our hearts, and our homes, and sometimes our wombs, to the least of these is a Christ-like thing to do."
More recently, in 2015, the pro-life blogger Dustin Germain described embryo "adoption" as an opportunity to right the wrongs of IVF: "The IVF industry not only discourages adoption of already existing orphans, but is responsible for the creation of hundreds of thousands of new orphans; it is an orphan-making industry."
In 2002, the pro-life movement convinced President George W. Bush to outlaw embryonic stem-cell research and allocate millions of dollars to promote "embryo adoptions" — what Bush called the "life-affirming alternative" to donating the embryos for research purposes. Since then, the US government has spent between $1 million and $4.2 million per year "to educate Americans about the existence of frozen embryos (resulting from in-vitro fertilization), which may be available for donation/adoption for family building."
Central to this movement are several embryo adoption agencies, including the National Embryo Donation Center, which says 565 babies have been born as a result of its services, and Snowflakes Embryo Adoption, a program of Nightlight Christian Adoptions. It lays claim to 432 "snowflake" babies from frozen embryos. In 2005, President Bush invited some of the "snowflakes" to the White House. They wore t-shirts that read "former embryo."
Pro-lifers aren't the only ones promoting embryo donation, however. The other group passionate about expanding it are doctors who feel responsible for all the extra embryos they've created, especially in light of so many people suffering from infertility. (Unlike pro-lifers, reproductive-medicine experts define embryos as having "the potential to become persons," rather than being persons.)
Craig Sweet is a reproductive endocrinologist in Fort Myers, Florida, and the founder of Embryo Donation International, one of a handful of fertility clinics that coordinate embryo matches. He says he was shocked when he eventually realized after years of freezing embryos for patients that one-third of them nationwide are discarded or abandoned. "I was naive, and my field was naive," he says. "At that point in time, 2001, I started the embryo donation program."
EDI now receives embryos from 44 different facilities around the country. At last count it had 250 donated embryos available.
Embryo donations are growing fast — but still face major obstacles
According to the latest data from the Society of Assisted Reproductive Technology, there were 524 babies born from donated embryos in 2014, up from 258 in 2004.
One big obstacle is that the transactions are hard to arrange — and can be as tricky, in some ways, as child adoptions. Both sides have to agree on what the relationship — if any — the donor parents will have with the child once it's born. The laws also vary significantly from state to state: some states have no statutes on embryo donation, some actually prohibit it, and a few have specific guidance on how donors relinquish the property, their responsibilities to it, and how they should be paid.
To guide different parts of this complex process, then, more people are now getting into the business of embryo matchmaking — to make it easier for potential donors and recipients to find each other. Some fertility clinics do this matchmaking themselves, while other embryo banks or embryo adoption agencies have sprung up to provide the service.
"There's a significant number of people struggling with what to do with their embryos, and the ones struggling could be better served with the option to donate," says Dr. Eric Widra, medical director of the Shady Grove Fertility Center in the Washington, DC, area. This fertility clinic, the largest in the US, launched a donor embryo matching program this year called Embryo Options.
The idea is that fertility clinics that store leftover embryos but don't offer matching services will be able to use Embryo Options to help their patients find recipients for their embryos.
But there's a big difference in how fertility clinics like Widra's play matchmaker compared to how Christian groups like Snowflakes Embryo Adoption and the National Embryo Donation Center (which receive federal funding) do it. And it all comes down to whether they see themselves as facilitating "adoption" or not.
The tricky ethics of "adopting" embryos
Anyone who owns an embryo has the right to choose its fate — using the embryo, discarding it, donating it to science, or donating it to someone else.
If you see embryos as people, as pro-life groups do, then the only ethical thing to do is use or "adopt" them. As the theological ethicist Therese Lysaught put it, embryo adoption is "rescuing a child orphaned before birth."
Yet many in the medical community have a problem with the word "adoption" in the context of embryos. The American Society for Reproductive Medicine, which sets guidance for the entire fertility industry, says it's frankly unethical.
"They should not be afforded the same status as persons" and as such, "the use of the term 'adoption’ for embryos is inaccurate and should be avoided," the ASRM wrote in a recent committee opinion paper.
Sean Tipton of the ASRM, who co-authored the paper, says he worries potential embryo recipients will be deceived by the word adoption.
"If you’re trying to adopt a child ... you know it is real existing live human being. When you've got a set of fertilized eggs in the freezer, most of those are still not going to become living babies. Adoption implies a sense of certainty that is inappropriate for the procedure."
Using a donated embryo is indeed an uncertain endeavor: Several women I spoke to told me their attempts to use one to get pregnant had failed.
Using a donated embryo is still an IVF procedure (the transfer of the thawed embryo to the uterus), and while rates for IVF procedures overall have improved, they still aren't that great. In 2014, a woman 35 or under had a 49 percent chance per cycle of having a live birth via IVF, versus 4 percent for women older than 42, according to SART data. Success also depends on the quality of the embryo (or eggs) you're using. An estimated 70 percent of embryos fail to result in a live birth -- and donated embryos could be even riskier because many come from couples who already have a history of infertility issues.
Not everyone is willing to let their extra embryos go
Many women and couples who have extra embryos left over from IVF want to use them all themselves. An extreme case in point is Nadya Suleman, who gave birth to octuplets in 2009 despite already having six children, because she reportedly did not want her extra embryos destroyed.
In general, couples who create embryos through IVF with their own eggs and sperm are less likely to donate them — often, I learned in interviews, because they're more psychologically attached to them.
For example, Melissa Brisman is a lawyer in New Jersey who ended up with eight leftover embryos after having three children through IVF. She says she would prefer to keep paying storage fees on them than discard or donate them. "I couldn’t give them to someone else," she says. "If [someone else] had my baby, it would be mine."
By contrast, couples that use donated eggs or sperm to produce embryos through IVF are more likely to donate the leftover embryos in turn. "They understand and value the concept of donation," says Dr. Sweet of Embryo Donation International.
An example here would be Debbie Oberlander of New York City, who looked into adopting a child two years ago but found that at age 54, she had "aged out" of agencies' prerequisites. But she could still try and get pregnant with embryos made from donated and egg and sperm. Last year she gave birth to a baby boy who, she says, is "the greatest joy of my life."
Oberlander was lucky to get pregnant on her first try with the donor egg and sperm embryos. But she now has 11 frozen embryos leftover. She's decided she wants to donate them. "Now that I look at my child, I view these other embryos as potential to be another beautiful life," she says.
Still, there remains one more obstacle: like many donors, Oberlander has stipulations about donating — stipulations that may make it hard for her to find the right match.
Matching frozen embryos with prospective parents can be really hard
Even though there is plenty of demand for frozen embryos, making matches between individuals can be exceedingly difficult. Some donors are picky about who gets their embryos, and want to be deeply involved in the selection process. Others want total anonymity in donating and receiving.
According to Sweet, some married couples only want to donate to other married couples. "As a result it’s harder to find people willing to give to single women," he says. Sweet also allows donors to dictate the race, religion, education, or income of the recipients. He allows this in order to encourage donations. "We don't discriminate, but donors can discriminate," he says. "They have to feel comfortable and safe with the process or they won't donate."
Many of the pro-life, Christian "embryo adoption" agencies typically restrict donation only to heterosexual couples married a minimum of three years. They also often require home visits of prospective recipients. In this sense, the Christian agencies function a lot like child adoption agencies. And a lot of it comes back to the donors seeing the embryos as children rather than potential children.
To get a sense for how strict the requirements can be, here are two ads on the Crystal Angels Embryo Adoption program in Texas from donors:
"Half African American/half Caucasian embryos: The donor couple seeks fair skinned African American family or an African American/Caucasian couple, preferable with a green eyed or light-eyed) partner; college educated couple, preferably who attended an IVY-league school, six-digit annual income; flexible on openness level.
Full Indian embryos: The donor couple seeks a heterosexual Indian couple; financially stable; family prefers the ability for the child to be able to contact donor when older or for the adopting family to contact donor when desired."
"We have the adopting family go through same process [as they would if they were adopting a child]: they have to have home study; we're vetting these families on behalf of the donor," says Tyson of Snowflake Embryo Adoption.
That intensive process can deter many would-be embryo users. Daman says she talked to Snowflake but was uncomfortable with the home studies. "Snowflake felt like they were Match.com," she says. "I didn’t want to feel rejected going through the process." Instead, she opted for the Nevada Center for Reproductive Medicine, which offered an anonymous matching process.
Making things more complicated, many donors, like Oberlander, want to donate embryos to someone who lives near them so they can have a relationship with the children that may result from their embryos. "I had a couple who were interested in the embryos, but not in open fashion, so I declined," says Oberlander. "I wasn’t willing to do it closed way, but I struggled, here’s a family that needed them … it wasn’t easy making that decision, to turn away from that."
Oberlander got in touch with that couple through a lawyer who handles embryo donation cases, but now she says she's unsure of how to find someone else. The fertility clinic where her embryos are stored doesn't offer matching services.
People get in fights over frozen embryos
Once matches are made, there are more legal hurdles for donors and recipients. First, the property must be transferred. According to a woman named Rachel who received her new embryos from a friend (and asked that her last name not be used), "Accepting them was much more complicated than any of us thought — things like changing the name of who the embryos belonged to."
John Robertson, a professor of law at the University of Texas Austin who's studied the legality of embryo donation, says all parties should seek separate, independent legal representation and write an agreement addressing the issues surrounding the embryo donation. That way, they can make a series of critical decisions together about potential relationships with any children that come from the embryos.
According to Robertson, the most litigated issue is when a couple with frozen embryos gets divorced and then disagree about what to do with them. In the beginning of the process, anyone who creates a frozen embryo has to elect whether to use, discard, or donate them (though it's not binding and they can change their mind) if they don't get used. "The question is: if you've decided but then get a divorce, do you follow the advance agreement or not?" says Robertson.
He points to a number of legal cases that resulted from disagreements over what to do with frozen embryos. In Findley v. Lee, decided in November 2015, a couple froze several embryos because the woman had to be treated for breast cancer and wanted to preserve the option to get pregnant with them later. When the embryos were created the embryos, the couple signed an agreement to destroy them in the case of divorce. When they did divorce, the woman claimed the embryos were her only opportunity to have a biological child and sued her ex-husband for them. The court ultimately ruled in favor of the ex-husband.
"Parties don't really know what they’re doing when they sign these directives," says Robertson. "So that process needs to be made more explicit, and given more time."
The future of embryo donation
We are likely to see the number of babies born from embryo donation continue to rise. It will be thanks to the inexorable trends of people aging out of natural reproduction and the matchmakers getting better at what they do. More people may also strike out on their own in search of each other.
Helen McGrath, 45, of Lafayette, Colorado tried embryo donation through Sweet's EDI in Florida and didn't succeed. She's now on the hunt for another set of embryos and is hoping to find some locally in Colorado to cut down on travel costs. "There are so many variables and it's really overwhelming," she says.
Someone like her might be better served with a website, not unlike a dating site, where embryo donors and recipients willing to be open about it could post profiles. And in fact, many people have already begun thinking about a broader reproductive sharing economy — in which egg and sperm donors and surrogates and the people seeking them can more easily connect. Many of the inefficiencies of embryo donation plague these types of transactions, too.
Jake Anderson-Bialis is a former venture capitalist-turned-entrepreneur in Silicon Valley who recently co-founded FertilityIQ, a site that's like a Yelp for fertility, with his wife. He says he thinks a more robust marketplace — a sharing economy — for third-party reproduction is inevitable. "It is not easy for these people to find each other — it's not a walk in the park. I think the issue will get solved online. But like everything in fertility, nothing happens overnight."