Embryo Adoption – A Life-Affirming Parenthood Choice

by Reginald Finger, MD, MPH

Original version December, 2007 -- Revised November, 2009

Embryo adoption: Embryo adoption? At first glance, these two words do not seem to belong together. Infants and children are adopted, right? Right. Here is the definition of embryo adoption: Embryo adoption is the transfer of a microscopic human embryo that was originally created by one couple for their own reproductive efforts but remains after infertility treatments have been completed, to the uterus of a different recipient female (single or married), who will become its mother. The term, like the practice it describes, has evoked much controversy. Some medical infertility specialists are uncomfortable saying “adoption” in this context because children are adopted, and if the embryo comes to be viewed as a child in the eyes of the law, couples might lose the choice of discarding the embryos or donating them to research. Infertility practices might also come under stricter regulation (1,2). Pro-choice activists dislike the term for similar reasons (3,4). Legal scholars point out that at least in the U.S., statutes define adoption as the placement of a child after birth. Thus, they reason, use of the term might mislead couples as to what has actually occurred in the eyes of the law when an embryo is transferred (2,5).

After some consideration, I have elected to use the term embryo adoption rather than embryo donation in this essay, to distinguish the practice from gamete and embryo donation. In the latter practice, an embryo is created from donor sperm and a donor oocyte (egg) specifically for transfer to the recipient couple. In this practice, egg donors are sometimes paid large fees for their services. In some of the infertility literature, it is difficult to determine what the authors mean by embryo donation. Distinguishing between these types of practice requires at least a very careful reading of the methods, and sometimes, inquiry with the authors (6-9).

Despite disagreement over definitions, most medical infertility specialists, legal scholars, bioethicists, journalists, and researchers are supportive of the practice of embryo adoption. Massachusetts adoption attorney Susan Crockin describes it as “a limited option” – good if a couple makes this choice for their remaining embryos – but predicts that few will (10). This is the majority viewpoint among scholars who have published on the subject.

The purposes of this essay are: 1) to outline the history of embryo adoption; 2) to describe the current status of embryo adoption from epidemiologic, legal, and bioethical perspectives; 3) to show why embryo adoption compares favorably to other parenthood options for infertile couples; and finally 4) to suggest a few effective ways to promote the practice of embryo adoption. Hopefully, those readers who share the sense of need to do something about the large and growing number of embryos in frozen storage, will see embryo adoption as a viable part of the solution, one worth encouraging.  

History of embryo adoption

To understand the importance of embryo adoption, one must first capture a sense of why infertility is such a big deal in the first place. Couples often spend tens, sometimes hundreds, of thousands of dollars on infertility treatments over periods of several years. One widely cited study has found the measured stress levels in women with infertility to be equivalent to those seen from cancer, HIV infection, and chronic pain (11) – though there is some question as to whether the stress contributed to the infertility as well as vice versa. Infertility has many causes, some attributable to the male partner, some to the female. In some cases, no cause is ever found (12).

In many cases, however, the female partner is found to produce viable oocytes (at least, when stimulated by medication), and the male partner has viable sperm. For these couples, successful treatment can be accomplished by harvesting oocytes from the woman using a long needle under sonographic guidance, uniting an egg with the man’s sperm in a laboratory dish, and then transferring the resulting embryo directly into the uterus with a tiny catheter. This procedure, called in vitro fertilization (IVF) was first successfully performed in humans in 1978 (13). Clinicians soon learned how to maintain (cryopreserve) embryos in frozen storage and thaw them once again for implantation later, thus, in some cases sparing the woman a second egg harvesting procedure (14,15).

At about the same time, clinicians reasoned that more couples could be helped toward parenthood by substituting donor sperm for men who have no viable sperm, or donor eggs for women who have no viable oocytes – or both. Thus, gamete and embryo donation, as described above, came into being. A careful reading of the 1983 clinical report often cited as the first instance of embryo donation (16) reveals that the donated embryo was actually created for the recipient at the same time that four embryos were made for the donor couple’s own use – if you will, a “make me one while you’re at it” proposition. The menstrual cycles of the donor and recipient women were synchronized using medications, and the transfers occurred on the same day. None of these embryos had been cryopreserved.

Soon thereafter, reports were published documenting successful pregnancies and births from cryopreserved donor embryos. Again, however, these were embryos made from donor gametes specifically for the recipients (6,7).

No one knows for sure when the first true embryo adoption occurred. The term was used as early as the mid-1980s (17,18) in the legal literature. Devroey et al. (19), Bustillo (20), and Jones (21) have reported embryo transfers occurring between 1986 and 1990 that clearly represented adoption of remaining embryos.

The personal story of John and Marlene Strege of California (22), however, brought the idea of embryo adoption to the national stage. Mr. and Mrs. Strege were initially identified as “Zach” and “Elizabeth” (after the parents of John the Baptist, see Luke chapter 1) in order to protect their privacy. Since that time, however, they have become activists for embryo adoption, have testified before Congress, and are identified by name in many news reports and public documents (23, 24). John and Marlene, having experienced failure with traditional infertility treatments for some years, learned about the possibility of embryo adoption from their physician. However, this doctor was unable to connect them with a source for a donor embryo. Subsequently, they contacted Focus on the Family for assistance, and as a result were linked with a prospective donor couple from the Midwest, underwent the embryo transfer, and became parents of a daughter, Hannah, on December 31, 1998. Hannah became known as the “first snowflake®” child. Meanwhile, FOTF President Dr. James Dobson, at the urging of his friend, leading pro-life gynecologist Dr. Joseph McIlhaney, came to strongly and publicly support embryo adoption as both a solution for infertility and an opportunity for life for frozen embryos (22). Nightlight Christian Adoptions, directed by adoption attorney Ron Stoddart, facilitated the adoption process for the Streges. Nightlight has since done so for more than two hundred other couples in what is now known as the “Snowflake® Program.”

The Strege story was followed by two other major developments that have kept embryo adoption in the public eye. In August 2001, President Bush was confronted with the need to set policy on federal funding for embryonic stem cell research. (Creating cell lines for this type of research results in the destruction of embryos). After much consideration, he decided that although federal dollars could be used for research on existing cell lines, he would not support funding any activity in which any more embryos would be destroyed (25). Soon, embryo adoption came to the President’s attention as an attractive alternative to stem cell research, refuting the argument that “these embryos are only going to be thrown away anyway.” In May 2005, as Congress was challenging the funding policy, the President dramatized the issue by inviting a group of “snowflake®” families to the White House (26).

The other development was the 2003 publication of an “embryo census” conducted by the Rand Corporation for the American Society for Reproductive Medicine (ASRM) (27). Although the primary purpose was to find out how many embryos might be available for stem cell research, it was the total number of embryos found to be in frozen storage (just under 400,000) that caught public attention. This was a conservative number, because a few infertility clinics did not respond to the survey. Nonetheless, the figure was more than double the informal estimates that had been made previously, and highlighted the accumulation of embryos as a difficult problem. To Stoddart and others, these embryos represent frozen lives (28); to infertility clinics, they represent a large expense for storage, tracking, and maintenance. The parents who created them face the often difficult dilemma of what to do with them (29).

Current Status of Embryo Adoption

Admittedly, the vast majority of embryos (88 percent, according to the Hoffman census) are being stored with some possibility that they will still be used by the couples who created them. Just over 2 percent have been earmarked for embryo adoption, and a roughly equal number for stem cell research. However, clinics and adoption agencies that facilitate embryo adoption report that there are at least as many couples wanting to adopt embryos as there are embryos available (30). It seems that there are clearly enough “cribs” to accommodate the resulting babies if all embryos currently intended either for adoption or stem cell research were actually implanted in adoptive mothers, that is, at currently published success rates for embryo transfers.

My colleagues and I have recently found (31) that in 2004 through 2006, at least 170 (roughly a third) of the infertility clinics in the United States performed at least one donated embryo transfer.  These clinics reported (to a nationally required reporting system) 2224 donated embryo transfers, resulting in 921 pregnancies (41.4%) and 753 deliveries of one or more live infants (33.9%). Using the individual embryo as the unit of analysis, the programs experienced an implantation rate (gestational sacs per embryo transferred) of 20.5%, an implantation potential (gestational sacs per embryo thawed) of 13.4%, and a live birth rate per embryo transferred of 16.6%. These rates equal or exceed most of those previously published.

Meanwhile, the legal status of the human embryo continues to be debated (32-35). If personhood begins at the time of conception, then the law should grant the embryo the rights of a person. The rights of the future child would be considered alongside the rights of the parents. If not, then embryos could be treated with what the courts call “special respect” – i.e., not to be bought and sold as commodities, but not as having rights of their own. Alternatively, the law could regard embryos as property and their disposition as property transfers. These issues have been argued in state supreme court cases (36, 37) and in law journal commentaries (38,39). The statutes in Louisiana regard the embryo as a person (40) while in other states they do not (34). As mentioned previously, adoption laws are written specifically to apply to children after birth.  A new statute in Georgia offers parents the option to confirm parentage through a court proceeding following embryo adoption (41).   However, adoption attorneys have found that when embryo adoption proceedings are handled according to contract law, there is no barrier to treating the transaction as an adoption in the eyes of the parents, complete with home studies and counseling (28).

On another level, debate as to whether embryo adoption is morally legitimate continues to occur among religious scholars, especially in Catholic circles. The Roman Catholic position on this issue is especially important because the Catholic community has for many years taken a leading role in pro-life issues generally. If the Catholic Church were rule that embryo adoption were not a permitted practice for their communicants, much of the support for the practice as a pro-life solution to the “frozen human lives” could be lost.

In articles written from 2001 through 2007, Catholic scholars have lined up about 2 to 1 in favor of embryo adoption (42-46). The majority hold that although IVF itself is considered illicit in the eyes of the Church, couples seeking to adopt embryos are helping to solve a problem they did not create, and thus are performing a rescue. The countervailing issues posed by the minority scholars were that embryo adoption may violate the sanctity of a couple’s marriage or constitute complicity with the practice of IVF. 

Subsequently, the Church addressed embryo adoption in two documents intended to clarify its position on several issues of reproductive bioethics, including embryo adoption (47,48).  In both, embryo adoption was identified as having “serious moral problems”, and thus both the Congregation for the Doctrine of the Faith, and the U.S. Conference of Catholic Bishops are now on record as discouraging the practice.  However, the Church has stopped short of forbidding communicants to participate in embryo adoption, and the debate continues.

Dr. Dobson, Dr. David Stevens of Christian Medical and Dental Associations (49), Dr. McIlhaney (22), and others have helped the evangelical community for the most part accept embryo adoption as a compassionate act. Other faith communities, have, in general, not objected to the practice.

Choices for Infertile Couples

 Couples who have not achieved a pregnancy either by natural means or by what are called “traditional” infertility treatments – such as hormonal medications, tubal surgery, or artificial insemination – have essentially four possible options for becoming parents: 1) IVF using their own oocytes and sperm; 2) IVF using donated oocytes or sperm; 3) traditional post-birth adoption; or 4) embryo adoption. Second-generation infertility treatments (ZIFT, GIFT, and others) are essentially variations on #1 or #2.

Embryo adoption has the following advantages and disadvantages compared to the other options (considering that for all options except traditional adoption, the woman has to have a working uterus):

Indeed, perceived advantages outweigh disadvantages for enough couples that the demand for embryos to adopt well outweighs the supply. Therefore, if embryo adoption is to become a significant factor in reducing the numbers of frozen embryos in storage, the “bottleneck” – that is, the “rate-limiting step” – is to find ways to encourage couples who are not going to use remaining embryos themselves, to release them for adoption to others.

So why do so many couples hesitate to let the embryos go? Interview studies (50-53) have elicited a wide variety of responses. Some couples dislike the idea that “their child” could be out there, being raised by someone else, perhaps in less than ideal circumstances. Others fear the possibility that a child born by embryo adoption could meet and marry his or her genetic sibling. The probability of either scenario can be minimized, if not eliminated altogether, by the practice of an open embryo adoption. In this instance the donor and the recipient couple select each other beforehand and may even form a relationship. This has been the case with several families served by the Snowflake ® program.

Next >>