Determining the Fate of Frozen Embryos

SOURCE:  by Paul Ford, www.elle.com

March 24, 2014 - When my wife and I did in vitro fertilization, the doctor put two blastocysts in her because that bettered the odds that one would take. He handed my wife a picture, two lumpy circles in black-and-white on slippery thermal paper. They looked like rice cakes. Blastocysts are early embryos. These had been fertilized five days prior -- which, because we'd actually fertilized four of them, left two embryos for later.

So in one of the surprises of my married life, my wife and I became custodians of about 200 cells that reside in a freezer at a clinic in New York City, not far from Times Square. They were bathed in a special solution and slow-frozen, with care taken to avoid the formation of ice crystals. This is called cryopreservation. They are surrounded by liquid nitrogen. We pay $100 a month, $50 per embryo, to store them. We don't have pictures of them, but I imagine they look much like the first two. Around a tenth of a millimeter in diameter. Kind of big, actually.

The doctor who did the implantation was handsome. I thought it was insensitive of the clinic to insert him into the situation. My wife, filled with hormones, was puffy and tired. I had been abusing myself into a plastic cup with sharp edges. We'd been trying for three years. Did the doctor have to be a beautiful man?

He moved so smoothly. He came into the room as if he were on an invisible Segway. He fiddled with a plastic tube, and on the ultrasound two points of light appeared on the gray, pixelated screen that apparently showed the wall of my wife's uterus. When he was done, he drifted away in silence, leaving us there: two people oscillating between despair and hope, my wife in her gown with her knees up, and me petting her hand.

Some time passed and then we got up and went home. Everything is so anticlimactic.

A few weeks later I was leaving a meeting in Manhattan amid thousands of people headed in their respective directions and my cell phone rang. "My beta is good," my wife said, meaning the levels of human chorionic gonadotropin in her blood. The world stopped then. We were too confused to write down that number, but two days later the level was a very good 739, and my wife entered the number into her fertility spreadsheet (she likes detail). We were out of the middle of something and back to a beginning.

The first option we considered with our remaining embryos was to do nothing. Just leave them on ice and make a decision later. They can stay frozen for a long time -- in 2005, a child was born from an embryo frozen 13 years earlier -- though our clinic recommends waiting no more than seven years. We asked, "What happens if we don't pay?" The doctor shrugged. "Would you destroy them?" The doctor shook her head. In my experience fertility doctors shrug a lot. There's a lot of guesswork. Of course they keep billing you.

No one knows exactly how many embryos are out there, in liquid nitrogen. The low-end estimate is hundreds of thousands in the United States, but some people say as many as a million. It's a pretty good business; think of the $1,200 a year we pay. So it could come to something like $600 million a year in freezing.

Six weeks into the pregnancy came an awful and graphic night. I sat in the empty tub while my wife sat on the toilet, too exhausted to cry. We guessed she was miscarrying. "It's okay," she said as we walked into the clinic early the next morning. "We know I can get pregnant. We've got the others. We can do this again."

The three most judgmental places on earth are (1) the Vatican, (2) Park Slope, Brooklyn, and (3) Facebook. My wife and I live near Park Slope and spend too much time on Facebook. So we get hit twice.

I have never seen judgment like this. Not so much from the fathers. The fathers come later, screaming at soccer games. But the mothers...breast-milk absolutists, attachment theorists, potty trainers of four-month-olds, advocates of teaching kids to read from birth, advocates of bi- or trilingual education, sleep trainers (but also those who believe sleep training turns children into serial killers), passionate fans of baby sign language, mothers who disdain nannies but like day care. Being a mother means that you are always doing something that someone thinks is horrible. It's like wearing sweatpants to a wake.

Those judgmental people were there all through the fertility process, telling my wife that she should never drink, or that she should calm down and have a few drinks, that we should just have more sex, that we needed to try harder, that we should adopt. We researched it: Adoption is so grueling and ethically fraught that it makes fertility treatments look like a frolicsome dance in a wooded glen. "What about foster care?" asked people who had no idea about the foster-care system. The people who knew the least were generally the most willing to offer counsel. (Some unsolicited advice: You can best help someone struggling with her fertility by being quiet. "Ah, but what are you doing about gluten?" you might ask. No. Not gluten. Quiet.)

Those years when I was required to be a man, a grunting, stupid man, saying positive, hopeful things to my increasingly insane wife, I saw babies everywhere. Since we've had twins, I see even more babies. I know from babies now. I know from uteruses and fertility technologies and kids running in circles. God, I love babies. Their soft little feet and their perplexed faces. Breast-fed or not. Sleep trained or not. The babies are fine. It's the parents who are another story.

Destruction is the second option. It sounds dramatic, but when we asked the doctor what would happen, she shrugged again, as if to say: They just thaw. You take them out of the freezer, throw them out with the medical waste. That's that.

This presents a terrible problem if you believe life begins the moment sperm and egg meet. I don't know when life begins. If you think the picture of the rice cake is a picture of a baby, I'm not going to dissuade you now.

People do complex things to deal with this issue. Some women have the embryos implanted during an off time in their cycle, so that they don't attach and instead pass out of the body "naturally." Some take them away from the clinic and have a ceremony. I've only read about these options. They aren't explicitly offered by our clinic.

One day I went to pick up my kids from day care and loaded them into their giant stroller, the size of a French car. Suddenly I looked at my daughter and was convinced that she was some other child. What if the day care had switched her with a similar-looking girl? What if I'd had some kind of stroke that kept me from recognizing my daughter? I couldn't sort it out, even as I walked home with full knowledge that I was both tired and crazy. She was too young to talk, so I couldn't ask her.

I solved the problem by taking a picture of her with my phone and comparing it to other pictures of her. She was indeed my daughter. She looks quite a bit like me.

A paternity-testing clinic a few blocks from where I live has a sign showing a happy blue-eyed baby under the words: Does he really have his father's eyes?

The third option is to use the fertilized eggs to try to have more children. We already have twins. Soon we'll be 40. Twins are more than enough. "Wouldn't it be a blessing to have another?" we joked during their first year. Then we traveled by air from New York to California with them, just before their first birthdays. Turns out we were good on blessings.

When I first moved to New York City I was 21, and I worked with a woman in her early thirties who was trying to conceive. She was my first example of a woman who wanted a baby with every fiber of her being. She scared me.

She told me she was adopting a child from China. She and her husband interviewed with officials and transferred funds, until basically all of their money was gone. (A thing you learn about adoption: They don't give you your baby until you have given over all of your money.) One day they got a call saying that their daughter was waiting for them at an orphanage. She was just a few months old.

"My God," she told me, "I'm sobbing. There's my daughter in some orphanage, and I'm here. And now I have to wait a week to fly to China. I'm going out of my mind." I thought this was the craziest thing I'd ever heard. How could you freak out over a child you hadn't met? What was the source of this insanity? That's what I thought back then. Now I understand. The child whom she'd been dreaming of had just become a legal part of her family, but she had to count out time and thousands of miles until she could get on a plane and fly to her little girl. It must have been excruciating.

One day I was exhausted and I picked up my tiny, screaming son, and he sobbed into my shoulder. I thought, I will never be able to unlove you. If he turned out to be the son of, say, a handsome doctor, I would be confused and hurt. But the love would be the same.

A fourth possibility: We could donate the fertilized eggs for research. Perhaps they could be used to find cures for diseases like Alzheimer's. This thought led us down paths papered over with documents. There are so many guidelines, so many rules that researchers must follow. As the American Academy of Pediatrics dryly notes, there is a "unique developmental relationship between embryos and human persons." It's touchy.

It also turns out there isn't a huge need for embryo donations. According to researchers, there are more than 1,000 stem-cell lines in play in the medical-research community. They don't need that many more. Disposal might make the most sense. "Donors may be disappointed by this fact," blogged one researcher at the California Institute for Regenerative Medicine, "but details matter."

The final option would be to give them away. Let someone who has reached the end of her rope, fertility wise, but for whom the experience of having a child is paramount, have these tiny cell groupings dropped into her uterus in the hope that they will implant and grow.

Our clinic had an embryo-donation program, but it was new and no one responded to our phone calls. Meanwhile the clinic kept charging us for freezing. So we looked around and found that there are clinics that will accept donated embryos. Many of these places have a religious intent. The National Fertility Support Center in Kentwood, Michigan, which was started as part of Bethany Christian Services, says on its website that donating embryos "offers the chance for life, hope, and a family for the embryo." There's also Nightlight Christian Adoptions, with offices around the country and the "Snowflakes® Frozen Embryo Adoption Program."

The focus on religion, and the words life and adoption, didn't sit right with us. The registered-trademark symbol bugged us too. The websites made us uncomfortable. I'm sure many happy families are started in those clinics. And people are welcome to their beliefs. Just not to our embryos.

My wife and I discussed the options. We decided: We don't want them to be destroyed; we went through all that trouble to make this happen. So we gave our clinic another try. It was strange to go back as parents. The clinic had become a less mysterious place. I realized that when we were going through treatment I'd always felt like a child; always being told to go somewhere, do something. There was a sense of dread and hope and a constant fear. Now the place was just a waiting room.

The doctor gave us the phone number for the woman in charge of the donation program. The clinic charged us a $50 co-pay for that consultation, but finally we knew who to talk to.

The woman was very nice. It's a new program for women who want to carry a child but can't do so without both donated egg and sperm. We'd be the first to donate, which seems very odd -- it's a big clinic in New York -- but there it is.

To participate we'll need to become retroactive sperm and egg donors. (I'm married with young twins. All sex is retroactive.) This means filling out forms, giving up all rights to the embryos, and giving blood. And it means we will know nothing: We will not know when the eggs are implanted, if they are, or if they take, or if children are born.

We are allowed to insert a notarized letter into our file, so that if a baby arrives and the rules change, that child could look us up sometime in the distant future. But it's most likely we'll never know what happens. I imagine it will be something we talk about every now and then, when something jogs our memory. "I wonder if...." Maybe someday I'll get an e-mail from a stranger.

I do worry that the person who gets our cells will be one of the mean, judgmental parents, critical of other mothers, critical of the child. Of course my wife and I are raising our children by rules of our own. I'm sure people sneer at us for sleep training our children, and yet they go happily to bed at 6:30 every night and wake up at seven every morning. Maybe once a week one cries at night. It has been that way from month three.

Do we feel superior? Yes. Do we wish to share our wisdom? Absolutely. Do people make cruel comments about our selfish, insular little twin universe? Of course they do. It's the way of parents to mock other parents. It doesn't mean the other parents don't love their children. If some woman is willing to allow the fertilized eggs of strangers to be transferred to her body, then she's made it clear that she wants to love. Which is all we can ask. If we can make a little more love, well, isn't that the right thing to do?

The embryos are our responsibility, but not our possessions. Fatherhood and motherhood happen in the space, the gaps, between these children and me. I mean this literally: The motion of a spoon from bowl to mouth and back again; pushing toy cars around on the floor; saying no and snatching a small hand away from a cat's tail; saying no and pulling a child back from the other child she's hitting; saying no and listening to sobs of protest as I close the dishwasher; but most of all, saying yes. That is how they got here, these children. Because we kept saying yes.

Just as I worry that we are handing the embryos over to weird parents, I worry that we are giving someone children with problems. The first two are in great health, but what if the other two aren't? Will the mother feel cheated?

You meet kids with developmental issues, or kids with serious illnesses. The parents have gone a little off, exhausted by the stress. They are tired and often curt. Whatever they're doing is the best they can do, and you think, I can't imagine. But of course you do imagine. When you see the kid with the extra chromosome, you see that it's the same exact love that you know. It's all the same love.

We are handing over to providence, to some mother now or years from now, or maybe never, possible brothers or sisters to our twins. We release them via paperwork and blood samples. Someone else can fill that beautiful gap.

She was always saying things like this, things that broke my heart while reminding me of how insanely privileged we were to live in an era when this sort of science exists, and to be able to afford access to it. I felt both sad and selfish.

The doctor we saw that morning was a small woman in expensive leather boots. I knew how she could afford them. My wife climbed onto the table and the doctor inserted an ultrasound wand. I inhaled, expecting to learn that we were back to the beginning.

"There's the heartbeat," said the doctor, pointing to a tiny white set of throbbing pixels. A heart. She fiddled a little more, moving the wand. Over to the left, she found another group of pulsating pixels. With a slight lilt in her voice, she said, "You have twins."