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Embryo Adoption – A Life-Affirming Parenthood Choice

 

by Reginald Finger, MD, MPH

 

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, 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 many more couples wanting to adopt embryos than 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 seven participating programs have reported 702 adopted embryo transfers, resulting in 314 pregnancies (44.7%) and 249 deliveries of one or more live infants (35.5%). Using the individual embryo as the unit of analysis, the programs experienced an implantation rate (gestational sacs per embryo transferred) of 19.7%, an implantation potential (gestational sacs per embryo thawed) of 11.7%, and a live birth rate per embryo transferred of 15.1%. 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. However, adoption attorneys have found that though 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 to come out as opposed to embryo adoption, much of the support for the practice as a pro-life solution to the “frozen human lives” would be lost.

 

The Vatican has not taken a formal position on the issue. Currently, Catholic scholars have lined up about 2 to 1 in favor of embryo adoption (41-45). 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, that is, that embryo adoption may violate the sanctity of a couple’s marriage or constitute complicity with the practice of IVF, continue to be debated.    

 

Dr. Dobson, Dr. David Stevens of Christian Medical and Dental Associations (46), 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):

 

  1. Compared to IVF: The cost is lower, because the woman does not have to undergo egg harvesting; for some couples, IVF will not work because either the male or female partner cannot produce gametes; and for some Catholic couples or others, embryo adoption is morally acceptable whereas IVF is not. The disadvantage, important for some, is that the offspring will have no genetic relation to either parent. In addition, data are beginning to emerge showing that at least in some centers, pregnancy rates are higher for embryo adoption than for ordinary IVF.

     

     

  2. Compared to gamete donation: The cost is lower than for egg donation (because many expenses associated with the use of an egg donor must be covered). In addition, Catholics and many others see gamete donation as something like adultery because in contrast to either IVF or embryo adoption, the creators of the embryo are not necessarily a couple at all. One disadvantage is that the cost is higher than for sperm donation. A disadvantage in the eyes of some is that the offspring of embryo adoption will have no genetic relation to either parent, whereas with gamete donation the offspring most often is genetically related to one parent or the other.

     

  3. Compared to traditional adoption: With embryo adoption, the agreements are signed beforehand, so there is no chance that the genetic mother will back out during the pregnancy or after the birth, such as often happens with traditional adoption; in addition, the embryo adoption mother experiences pregnancy, delivery, and possibly breastfeeding for herself. These are important aspects for some women. In addition, she can control the prenatal environment by not smoking, etc. The cost of embryo adoption is usually much lower than for either domestic or international post-birth adoption. The disadvantage of embryo adoption in this comparison is the risk that the procedure may fail to result in a pregnancy. In addition, the parents do not have the privilege of choosing an infant they have already seen. Sometimes, birth defects or other problems occur which cannot be predicted beforehand.

 

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 (47-50) 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.

 

Strategies for encouraging embryo adoption

 

I suggest seven possible strategies for encouraging embryo adoption:

 

  1. Increase public and professional awareness

    Compared to other great public policy issues of our time – the HIV epidemic, abortion, human trafficking, terrorism, global warming, and the rapidly increasing average age of the global population – the plight of the frozen embryos is still a relatively little-known problem. The published literature on this subject is not vast. The medical, legal, adoption advocacy, and faith communities can all play parts in bringing the issue to the attention of the public. Personal stories, such as that of the Strege family, are likely to have a greater impact on the general public than facts and statistics. The stories can be passed on by advocacy groups and informally by word of mouth.

     

  2. Offer open embryo adoption in preference to anonymous embryo adoption

    Clearly, both options must be offered to couples, given that some will participate either as donors or adopting families only if their favored approach is offered. It does seem that open embryo adoption has the potential of attracting more families, given the prevailing sentiment toward open adoptions among counseling and adoption professionals and advocates in recent years.

     

  3. Get the pro-life community on board

    Most pro-life advocates, understandably, are better acquainted around pregnancy resource centers than around infertility clinics, but each community has something to offer the other. The message of embryo adoption as a life-affirming option to become parents surely resonates with the message of the sanctity of human life generally. Also, there are enough prospective parents so that embryo adoption will rarely, if ever, result in a scenario where a birth mother wants to place a child but cannot find a willing adoptive family.

     

    It is even possible that some activist couples may choose to adopt and bring an embryo to birth though they are not themselves infertile. This degree of self-sacrifice has certainly been seen with traditional adoption.

     

  4. Market embryo adoption to IVF patients through their physicians

    If convincing couples to let go of their remaining embryos is the rate-limiting step, then the relatively small group of people who have remaining embryos must be encouraged to give this opportunity for parenthood to another couple. These people can be best reached through their physicians, with whom they already have trusting relationships. Physicians can help the couples sort through the issues and determine whether helping another couple in this way will work for them.

     

  5. Resolve the bioethical dilemma for Roman Catholic communicants

    Hopefully, the leadership of the Roman Catholic Church will follow the bioethical reasoning of the majority group of its scholars and conclude that embryo adoption neither violates the sanctity of marriage nor constitutes complicity with IVF practice per se. If the Vatican publishes a sensitive but definitive statement in favor of embryo adoption, a difficult hurdle will have been surmounted.

     

  6. Articulate clearly that with today’s population dynamics, any increase in the birth rate resulting from not destroying embryos will be a positive rather than a negative.

    In a previous article, I have discussed the declining global birth rate, and the adverse economic circumstances that a birth dearth is having in many world regions, in the face of accumulating numbers of elderly persons (51). There was a time when pro-abortion policy fed off the perception that the world faced a serious population explosion, with attendant food shortage and environmental consequences. Though the problems with the environment have not gone away, it is clear now that human well-being in most countries will be better served by more births rather than fewer. Making these facts clear to the public and policymakers should resolve any concerns about overpopulation.

     

  7. Logistically, make embryo adoption easy to accomplish by getting the four functions – matching donor with adopting couples, clinical transfers of the embryos, adoption counseling, and legal assistance – under one roof.

    Nightlight Christian Adoptions (California) and the National Embryo Donation Center (Tennessee) have taken steps in this direction. Both have close relationships with agencies for the functions that are not available in-house. However, I believe a model that offers them all in one place would certainly be worth piloting.

 

In conclusion, embryo adoption can accomplish two important things: first, it gives frozen human lives a chance to be born – and second, it helps infertile couples to become parents by a means that is preferable to other strategies in many ways. Unlike many bioethical, human rights, and public policy issues facing humanity, the dilemma of the embryos has a reasonable solution that can be implemented in our lifetimes. I encourage clinicians, scholars, and families on all sides of this issue to join forces to that end.

 

References

 

1)  Syrop CH. Embryo Donation: A Simple Phrase – A Complex Issue. SARTimes 2003 Winter;7(1):3-6

 

2)  Katz KD. Snowflake Adoptions and Orphan Embryos: The Legal Response to Embryo Transfer. Wisconsin Women’s Law J 2003 fall; 18(2): 179 – 231

 

3)  Kindregan CP Jr., McBrien M. Embryo Donation: Unresolved Legal Issues in the Transfer of Surplus Cryopreserved Embryos. Villanova Law Review 2004;49:169-206

 

4)  Amoroso K. Frozen Embryo Adoption and the United States Government. APA Newsl Philos Med 2005 Fall;5(1)3-5

 

5)  Johnson ND. Excess embryos: is embryo adoption a new solution or a temporary fix? Brooklyn Law Rev 2003 Spring;68(3):853-83

 

6)  Sauer MV, Paulson RJ. Human Oocyte and Preembryo Donation: an Evolving Method for the Treatment of Infertility. Am J Obstet Gynecol 1990 Nov;163(5 Pt 1):1421-1424

    

7)  Van Steirteghem AC, Van den Abbeel E, Braeckmans P, et al. Pregnancy With a Frozen-thawed Embryo in a Woman With Primary Ovarian Failure. NEJM 1987; 317:113

 

8)  Devroey P, Braeckmans P, Camus M, et al. Pregnancies After Replacement of Fresh and Frozen-thawed Embryos in a Donation Program. In Feichtinger W, Kemeter P (eds) Future Aspects of Human In Vitro Fertilization, Springer-Verlag, Berlin, 1987, pp. 133-137

 

9)  Marcus SF. Embryo Donation. In: A Textbook of In Vitro Fertilization and Assisted Reproduction, Brindsen PR, ed. The Parthenon Publishing Group, New York / London

 

10)  Crockin SL. Embryo “Adoption”: a Limited Option. Reprod Biomed Online 2001;3(2):162-163       

   

11)  Domar AD, Zuttermeister PC, Friedman R. The Psychological Impact of Infertility: a Comparison with Patients with Other Medical Conditions.
J Psychosom Obstet Gynaecol 1993;14 Suppl:45-52    

 

12)  NHS National Institute for Clinical Excellence. Fertility Assessment and Treatment for People With Fertility Problems. http://www.nice.org.uk/nicemedia/pdf/CG011algorithm.pdf

 

13)  Steptoe PC, Edwards RG. Birth After the Reimplantation of a Human Embryo.
Lancet 1978 Aug 12;2(8085):366

 

14)  Trounson A, Freemann L. The use of embryo cryopreservation in human IVF programmes. Clin Obstet Gynaecol 1985 Dec;12(4):825-33

 

15)  Downing BG, Mohr LR, Trounson AO, Freemann LE, Wood C. Birth After Transfer of Cryopreserved Embryos. Med J Aust 1985 Apr 1;142(7):409-11

 

16)  Trounson A, Leeton J, Besanko M, Wood C, Conti A. Pregnancy Established in an Infertile Patient After Transfer of a Donated Embryo Fertilized in Vitro. British Medical J 1983 Mar 12;286:835-838

 

17)  Robertson JA. Embryos, Families, and Procreative Liberty: the Legal Structure of the New Reproduction. Southern California Law Review. 1986. 59: 939-1041

 

18)  Wurmbrand MJ. Frozen embryos: moral, social, and legal implications. South Calif Law Rev 1986 Jul;59(5):1079-1100

 

19)  Devroey P, Camus M, van den Abbeel E, van Waesberghe L, Wisanto A, van Steirteghem AC. Establishment of 22 Pregnancies After Oocyte and Embryo Donation. Br J Obstet Gynaecol 1989 Aug;96(8):900-906

 

20)  Personal communication, Maria Bustillo, MD, January, 2007

 

21)  Personal communication, Howard W. Jones, MD, January, 2007

 

22)  Focus on the Family: Breaking New Ground (Panel) (on CD), 1999

 

23)  Focus on the Family: A Closer Look at Stem Cell Research (Panel) (on CD), 2005

 

24)  Christian Medical and Dental Associations. Testimony of Marlene Strege Before the U.S. United States House of Representatives Committee on Governmental Reform, July 17, 2001. http://www.cmda.org/AM/Template.cfm?Section=Search&template=/CM/HTMLDisplay.cfm&ContentID=3922

 

25)  The White House. President Discusses Stem Cell Research. Office of the Press Secretary, August 9, 2001. http://www.whitehouse.gov/news/releases/2001/08/20010809-2.html

 

26)  The White House. President Discusses Embryo Adoption and Ethical Stem Cell Research. Office of the Press Secretary, May 24, 2005. http://www.whitehouse.gov/news/releases/2005/05/20050524-12.html

 

27)  Hoffman DI, Zellman GL, Fair CC, et al. Cryopreserved Embryos in the United States and their Availability for Research. Fertility and Sterility 2003 May;79(5):1063-1069

 

28)  See http://www.nightlight.org/Snowflakesfacts.pdf

 

29)  de Lacey S. Parent Identity and “Virtual” Children: Why Patients Discard Rather Than Donate Unused Embryos. Human Reproduction 2005; 20(6):1661-1669

 

30)  Personal communication, Jeffrey Keenan, MD, March, 2007

 

31)  Keenan JK, Finger RF, Check JH, Dodds W, Daly D, Stoddart R. Favorable Pregnancy, Birth, and Implantation Rates Experienced in Embryo Donation Programs in the United States. Fertility and Sterility, in press.

 

32)  Puskar JM. "Prenatal adoption": the Vatican's proposal to the in vitro fertilization disposition dilemma. N Y Law Sch J Hum Rights 1998 Spring;14(3):757-93

 

33)  Jones HW Jr, Veeck L. What Is an Embryo? Fertility and Sterility 2002 Apr;77(4):658-659

 

34)  Crockin SL. The “Embryo” Wars: at the Epicenter of Science, Law, Religion, and Politics. Family Law Quarterly 2005;39(3):599-632

 

35)  Muller C. The status of the extracorporeal embryo in German law (part II). Law Hum Genome Rev 2005 Jul-Dec;(23):139-65

 

36)  York v. Jones, 717 F. Supp 421 (E.D. Va 1989)

 

37)  Davis v. Davis, 842 SW 2nd 588 (Tenn. 1992)

 

38)  Redman PC II, Redman LF. Seeking a Better Solution for the Disposition of Frozen Embryos: Is Embryo Adoption the Answer? Tulsa Law Journal 2000;35:583-598

 

39)  Robertson JA. Early Embryos. Virginia Law Review 1990; 76:437-517

 

40)  Louisiana Revised Statutes, 6:126 - 133. http://www.legis.state.la.us/lss/lss.asp?doc=108443

 

41)  Iozzio MJ. It Is Time to Support Embryo Adoption. National Catholic Bioethics Quarterly2002 Winter; Vol. 2 (4), pp. 585-93

 

42)  Tonti-Filippini N. The Embryo Rescue Debate: Impregnating Women, Ectogenesis, and Restoration From Suspended Animation. National Catholic Bioethics Quarterly2003 Spring; Vol. 3 (1), pp. 111-37

 

43)  Berkman J. Gestating the Embryos of Others: Surrogacy? Adoption? Rescue? Natl Cathol Bioeth Q 2003 Summer

 

44)  May WE. The Embryo Rescue Debate. National Catholic Bioethics Quarterly2004 Spring; Vol. 4 (1), pp. 9-14

 

45)  May WE. On "Rescuing" Frozen Embryos: Why the Decision to Do So Is Moral. National Catholic Bioethics Quarterly2005 Spring; Vol. 5 (1), pp. 51-7

           

46)  Christian Doctor: Embryo Center Offers Ethical Alternative to Life-Honoring Couples. Christian Medical and Dental Associations, November 17, 2003.   http://www.cmda.org/AM/Template.cfm?Section=Search&template=/CM/HTMLDisplay.cfm&ContentID=7196

 

47)  Laruelle C, Englert Y. Psychological Study of In Vitro Fertilization-Embryo Transfer Participants’ Attitudes Toward the Destiny of Their Supernumerary Embryos. Fertility and Sterility 1995 May;63(5):1047-1050

 

48)  Cooper S. The Destiny of Supernumerary Embryos. Fertility and Sterility 1996; 65:205

 

49)  Klock SC, Sheinin S, Kazer RR. The Disposition of Unused Frozen Embryos. NEJM 2001 Jul 5;345(1):69-70

 

50)  Fuscaldo G, Savulescu J. Spare Embryos: 3000 Reasons to Rethink the Significance of Genetic Relatedness. Reproductive Biomedicine Online 2005;10(2):164-168

 

51)  Finger RF. The Earth’s Population: What is the Real Problem? (Available from author, reg.finger@hotmail.com)

 

 

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