I just read an interesting article in the Vancouver Sun on the ethics of embryo donation (also known as embryo adoption): “Embryo ethics: Finding a home for Canada’s frozen ‘orphans’ ” (article no longer online). While acknowledging that the growing numbers of frozen embryos that will not be used by the people who produced them via in vitro fertilization (IVF), the article raises questions about the ethics.
Ethical concerns surrounding embryo donation
- What rights do the children created have?
- Should children be raised by parents to whom they are not genetically related? (Duh, ever hear of adoption?!? Sorry, I couldn’t help that editorial comment.)
- Should the children have the right to know the identity of the people whose DNA created them?
- Should we even be producing more embryos than can be used at once?
- Some couples are finding one another on the web, raising concerns that despite a federal act outlawing the purchase of human sperm, eggs and embryos, money may still be changing hands.
- Should the biological parents be able to donate frozen embryos to their infertile children thus creating cross-generational donations?
- What are the psychological implications for the children born from donated embryos knowing that the people who created them did not choose to parent them?
Embryo donation can benefit from research on both adopted children and children conceived via donor sperm.
Embryo donation is both different from and similar to traditional adoption–hence why some believe that it should be called “embryo adoption”. Regardless where you fall on the labeling debate, I think most of us would agree that the 50+ years of research on adopted children and adults would at the very least shed some light on the psychological implications for the children.
There are also similarities to children conceived through donor sperm. The embryo donation field should look to the beginning research on kids conceived through donor sperm and to the various groups formed by parents and teens and adults born through donor sperm when deciding on what is in the best interest of the children and families formed through donated embryos.
Mainly though, I want to hear what you have to say about these ethical issues.
Image credit: Leo Reynolds
[I have edited this comment to remove offensive language.]
Dear Craig,
Upon reading Dawn’s reply, I was deeply grateful that she had managed to articulate what my mind could not put into an any more comprehensible form than “[you simply don’t understand what you are talking about]”
You have OBVIOUSLY *not* _HAD TO_ grow up without having ever known who even your most immediate ancestors are.
IT [messes] YOU UP!
It is absolutely ESSENTIAL that children receive genetic mirroring as they develop, as it constitutes a MASSIVE part of our identity.
Sants, H.J. (1964) Genealogical Bewilderment in Children with Substitute Parents. British Journal of Medical Psychology 37(?). pp.133-141
“In 1964, H.J. Sants … coined the phrase ‘genealogical bewilderment'”
O’Shaughnessy, T. (1994). Adoption, social work and social theory: Making the connections. Brookfield, VT: Ashgate Publishing. (p.119)
Adoption, blood kinship, stigma, and the Adoption Reform Movement: A historical perspective @ http://findarticles.com/p/articles/mi_qa3757/is_200201/ai_n9059070/pg_10/
Issues Facing Adult Adoptees
@ http://www.enotalone.com/article/10075.html
Trauma, Attachment, and Stress Disorders: Rethinking and Reworking Developmental Issues
@ http://www.healingresources.info/trauma_attachment_stress_disorders.htm
“Contrary to decades of claims that early experiences have no special influence on subsequent emotional well-being and personality, it is finally becoming apparent that negative experiences during the first five years do cause more damage than those in subsequent years. Many thousands of studies suggest this …
…
Studies of adoptees suggest that the older the child when adopted, the greater the damage. While intellectual deficits can often be largely reversed by stimulating adoptive environments, lasting psychopathology is found in significant proportions even where the adoptive nurture is first rate. Causal links have been demonstrated between adult personality disorder and maltreatment before the age of two; one study has shown this to be the strongest single predictor of dissociation at age nineteen, after allowing for quality of subsequent care and other factors. On top of this, it now seems clear that psychoanalyst John Bowlby was essentially correct in his claim that the period from six months to three years is a sensitive time for forming a secure pattern of attachment.”
*James, O. (2008) The Selfish Capitalist: Origins of Affluenza. London: Vermillion. (pp.18-20)
Adoptees and suicide?
@ http://answers.yahoo.com/question/index?qid=20100227185819AAHzL48
Former child welfare clients and suicide?
@ http://answers.yahoo.com/question/index?qid=20100227224313AAaMNGc
Adoption as a Risk Factor for Attempted Suicide During Adolescence
@ http://pediatrics.aappublications.org/cgi/content/full/108/2/e30
Adoption and Loss: The Hidden Grief – Evelyn Burns Robinson @ http://www.adoptioncrossroads.org/Adoption&Loss.html
Adoption Healing… the path to recovery for mothers who lost children to adoption – Joe Soll @ https://www.adoptionhealing.com/Moms/
Adoptees in Reunion: The Psychological Integration of Adoption, Motivations for Reunion, and the Reunion Relationship @ http://www.nla.gov.au/openpublish/index.php/aja/article/view/1447/1776 {.pdf format}
Adoption: Uncharted Waters – David Kirschner @ http://www.adoptionunchartedwaters.com/
Being Adopted: The Lifelong Search for Self – David Brodzinsky @ http://library.adoption.com/articles/being-adopted-the-lifelong-search-for-self.html
Journey of the Adopted Self: A Quest for Wholeness – Betty Jean Lifton @ http://www.bjlifton.com/books.htm & Lost and Found: the Adoption Experience – Betty Jean Lifton
The Adopted break Silence – Jean Paton @ http://www.uoregon.edu/~adoption/archive/PatonTABS.htm
The Girls Who Went Away – Ann Fessler @ http://www.thegirlswhowentaway.com/
Without a map – Meredith Hall @ http://meredithhall.org/
Statistics on the Effects of Adoption @ https://www.adoptionhealing.com/ginni.html
DO SOME [] RESEARCH!
Sadly the ethics of this industry as rather similar to those of the adoption industry.A Doictor managing a clinic in India has said that it is ‘agnostic on ethics’.
I don’t know where you got the idea that being raised by parents not genetically related is not problematic.There is much research to show otherwise.There is an enormous body of information available from adult adoptees to indicate otherwise.The ‘gestational products’ of ART are now becoming adults and able to say how they feel about their beginnings, lack of identity and information about their origins.Many are disgusted, bewildered and have an additional set of problems on top of those adoptees suffer.
Any industry that profits from manipulating lives needs to carefully exmine it’s ethics and often.
One of the things lacking in gamete donation is of course the court approved adoption process that protects minors from being trafficked and taken advantage of by their bio parents. Gamete donation is a loophole to allow black market adoption. If a person is not the offspring of the people named parents on their birth certificate and there was no court approved adoption then its black market adoption meaning off the record no record that they are actually the bio child of someone else. Adoption is bad enough with the revised birth certificates that should be just adoption certificates and nothing more, but to actually never record people as the parents of their own offspring is a public health risk and family health risk to everyone in the genetic and social family.
If embryo adoption results in the bio parents being named parents on the birth record then its a step in an honest direction. Hopefully the court approval process will vet any profiteering on the part of clinics or bio parents as the adopting party should pay absolutely nothing to assume parental responsibilities for someone who cannot or will not raise their own child.
As a mom to two wonderful boys who joined our family via embryo adoption, I wanted to comment on the choice of the title embryo adoption versus donation. I would never be offended to hear it referred to as embryo donation, but our family will always refer to our process as embryo adoption. My husband and I went through years in the “standard” adoption process, and our path eventually led to embryo adoption. We went through a homestudy and were matched in an open adoption manner. We feel it is important to communicate with our children about their biological family in a very similar way to how we would have with “standard” adoption. I can see how transferring embryos obtained from a fertility clinic in a closed manner may be referred to as embryo donation. I think it all depends on the individual situation, and the mindset of the embryo recipients. We are truly blessed that our sons’ biological parents chose to give them a chance at life.
I see some flaws in Dr Sweets argument:’First, embryo donation should really not be misconstrued as “embryo adoption”. …The FDA regulates embryo donation in the US whereas adoption is regulated by each of the states.’
What difference does it make who regulates it? I think it is still a form of adoption. The end result is parents raising children that are not genetically related to them, right?
On that same note, what does it matter what the different circumstances are in embryo adoption and traditional adoption; the end result is basically the same, isn’t it?
It is the same for the resulting child, I would think. And isn’t that what we should be concerned with? Whether you want to call it embryo ‘adoption’ or ‘donation,’ the kid still has a right to know where they come from, how they came into the world, and who they come from, otherwise you are betraying them on the deepest level of their being.
One of the problems we face when trying to develop a label for this practice is the greater ramifications of what we call it. Some are very concerned that if we label this as “adoption” it would give support to those who would like to legislate that some infertility treatment practices should be disallowed. Thus, it may seem that they are “overreacting” to a simple word choice, but in fact, they are concerned about the end result of such a word choice.
As you usually do, you give me a lot to think about. I love the show and now my family says I’ve become a Creating a Family addict. I appreciated the comments on the issue of whether to call this embryo donation or embryo adoption. We are in IVf and if it doesn’t work we may try to use another couple’s embryos. Does Dr. Sweet have a website that I can look at?
great post! I enjoy your blogs that give me something new to think about. This is one. I appreciated the doctor’s comments as well. I’ve never thought about these issues and his views were enlightening.
I can’t agree more with what the first commenter said. It’s a donation. Period. thank you for writing this!
Let me further clarify – for me fertility would have involved using donor sperm and I’m just not comfortable with the idea of using an anonymous donor to create half a child. I was also concerned with how a child might feel about being conceived that way. Obviously adoption has its pitfalls too, but it just felt like the right option for me.
Oh I understand why they try to produce the most embryos as possible. I’m just not sure I agree with science creating children. I chose not to do any fertility treatments and went right to adoption. For me – that was the right way to go.
The article written by Sharon Kirkey in Postmedia News, with additional discussion by Dawn, brings up some interesting questions regarding embryo donation. Understanding our practice has been performing embryo donation for ten years, I believe I can draw on a bit of experience to the discussion.
First, embryo donation should really not be misconstrued as “embryo adoption”. While seeming to be just splitting hairs, adoption is a legal term reserved for live children. The FDA regulates embryo donation in the US whereas adoption is regulated by each of the states. For a more detailed review, please visit http://www.embryodonation.com/donation-not-adoption.php. They simply are not the same.
Second, the circumstances that lead to embryo donation are very different than adoption. With embryo donation, most people are donating after they have completed building their families, divorced, have given up or if have moved onto to other family building options. Most adoptions occur because of the lack of desire or financial ability to raise the child or if parental rights have been stripped away. Embryo donors provide an amazing gift out of love and kindness remembering what it is like to be an infertile patient. The motivations are different in adoption where the live child may truly wonder why they were rejected by his/her genetic parents. While we can look to the adoption literature for guidance, embryo donation is simply a different set of circumstances.
The argument regarding “rights” is not a new one. The balance of the legal (contracted) rights of the donors and recipients who wanted anonymity must be balanced against the perceived rights of a child in finding their genetic origins. In anonymous embryo donation, a tremendous amount of medical information regarding the donors is given to the recipients without providing identifying information. Genetic issues are covered in these materials, so the argument regarding the lack of knowledge of possible future medical issues for the offspring is really a moot point. Besides, just because there is a family history of diabetes doesn’t mean the child-turned-adult has to follow in those same footsteps. We often can overwhelm many genetic predispositions though healthy lifestyle choices. Genetics is not everything.
I just received a positive pregnancy test on a patient who did not get pregnant on the fresh transfer but did with her frozen/thawed embryos. We freeze excess embryos to be used later in a cost-effective manner. The fact that there are excess embryos that may be donated to other patients, I believe, should be viewed as a tremendous plus and not a minus. It is our responsibility as reproductive endocrinologists to encourage patients to use or donate their embryos and never discard or abandon them. Regardless, the excess embryo dilemma will have to stay for a while.
I do feel that it is not a good idea to have embryos sold on the open market. It has an “ick” factor that one just can’t ignore. Reimbursement for reasonable expenses may be allowable, but one should never truly profit from the reimbursement process. Oversight by reproductive endocrine programs is needed to protect all participants understanding that some countries/states may forbid anything that could be misconstrued as a true payment.
The concern regarding cross-generational reproduction is theoretical and shouldn’t be over emphasized. The chances of an offspring who can’t get pregnant would want to give birth to their own sister or brother by using their parent’s cryopreserved embryos is extremely remote. It is simply very unlikely to ever happen.
Regarding the psychological implications of embryo donation, we are still just scratching the surface of this area of study. Understanding that embryo donation is not the same as adoption, we must look at the psychological well being of the donors, recipients and offspring with an open mind. That stated, when donors donate their embryos, rather than discard or abandon them, they are probably achieving emotional closure without guilt. Embryo recipients who are allowed to enjoy the trials and tribulations of parenthood will doubtfully suffer from significant psychological impairment any more than the raising of any adolescent would inflict. The fact that the embryo-turned-child is experiencing life can doubtfully ever be thought as a negative, even if the child struggles with identity issues.
I welcome the discourse understanding that we may not all agree. Respecting and understanding everyone’s opinions on this topic will be pivotal to begin to answer the questions posed here. There are also many other questions that we will need to answer before we are certain as to the benefits and risks regarding those that participate in the amazing world of embryo donation.
Craig R. Sweet, M.D.
Medical Director
Embryo Donation International
Dr. Sweet, thanks for sharing your experience. I do think we can rely on the multitudes of studies on adopted children to give assurance that being raised by parents that are not genetically related to you is not inherently problematic.
I am currently battling infertility. It is a long and exhausting road and at times feels completely isolating and lonely. Although I have many women I have “met” via support groups online, and their support is AMAZING, often I still find myself feeling ALONE in this. I have a husband who is also completely open and supportive, but late at night when my mind wanders and I think “What if?”
My “What ifs” are not only comprised of “What if I can’t have biological children?” “What if we need a sperm donor?” “What if IVF just doesn’t work for us?” but ALSO “What if MY journey, MY struggle can HELP someone else?” “What if the very reason I have to do IVF is to be the one to give another couple a chance at a family” “What if at the end of all of this, I have a child and SHE(Whomever she is that adopts our embryos) has children”
How can ANYTHING bad come of that? Why can’t it be treated as any other type of adoption? Why can’t the lines of communication be open with both parties. Why does it have to be made into an entirely BAD thing?
I would hope that any child born of embryos that we plan on placing for adoption would understand why we chose to do what we will. If personality is genetic, and let’s assume that some of it is, I have no doubts in my mind that my biological child would in fact understand.
I do not believe that blood and dna are what make a family, but rather bonding…and there is nothing wrong with extending that to someone who may never have the chance to have a child without embryo donation.
I cannot walk away from infertility, with children and have embryos sitting in storage, or destroyed when there are millions of couples longing for a family.
I truly believe that I have a greater purpose in all of this. Someday I will know what that purpose is…but I am pretty sure it has something to do with giving life to a couple who like my husband and I have all the desire and LOVE in the world to parent.
KellyAnne,
I love your attitude! Did you succeed in having children? I have gone through the journey and have ended it after losing my last baby, my last embryo from IVF.
I have considered embryo adoption/donation. I am still undecided. But I would love to hear how your story has progressed!
Best of luck to you!
I think in all of this – infertility treatments, embryo donation, adoption – we (collectively) think too little about what the child will think and feel. It seems to be all about wanting a child and not enough thinking about what may be best for that child.
Jennifer, I agree that the best interest of the child should be the standard that we apply in all things to do with infertility and adoption, but how do you interpret that standard in relation to the ethics of donor embryos?
•What rights do the children created have? Children or Embryos? I mean at the point of placement they may never even make it to implantation. I understand the arguments for personhood but I feel this is really stretching it.
•Should children be raised by parents to whom they are not genetically related? (Duh, ever hear of adoption?!? Sorry, I couldn’t help that editorial comment.)
I agree with your editorial comment.
•Should the children have the right to know the identity of the people whose DNA created them? Honestly YES. I do believe that a person should have the right to know the people whose DNA created them. This is why I personally prefer domestic adoption because of the availiability of open adoption. If I ever place embryos (if we have any left over) I would be more than willing to keep the lines of communication open or closed, but with the option of children to contact us at any time they choose.
•Should we even be producing more embryos than can be used at once?
Well, yes of course. IVF is a costly procedure. Compared with FET which can save couple’s thousands of dollars. More embryos offer a greater chance of pregnancies.
•Some couples are finding one another on the web, raising concerns that despite a federal act outlawing the purchase of human sperm, eggs and embryos, money may still be changing hands.
Purchasing sperm is illegal? I was unaware of this especially with countless sperm banks across the US.
•Should the biological parents be able to donate frozen embryos to their infertile children thus creating cross-generational donations? No. I feel this is a bit unethical in a sense that these children will be carrying their siblings and raising their siblings as their children. It is a bit “out there” for my taste.
•What are the psychological implications for the children born from donated embryos knowing that the people who created them did not choose to parent them?
I don’t see why it would be any different than any other child adopted.
KellyAnne: In an ideal world in the future, I do hope that we will be able to create just the embryos that we are going to transfer fresh. But that utopia requires that we are able to tell which egg and which sperm are going to join to form a viable embryo. Further it requires us to be able to tell which embryos are most likely to implant and grow for 9 months. Embryologists simply aren’t there yet. Also, and this is important, this future that I’m envisioning would have fertility treatment so affordable and covered by medical insurance that most people could afford multiple cycles in case the single embryo that they created on the first cycle did what the majority of embryos in nature do–not succeed. Human reproduction in nature if a very iffy process with more failures than successes. We seem to forget that when we start talking about fertility treatment.
Tough to answer – first there is the question of whether or not we should be creating embryos in the first place – particuarly “extra” embryos which end up in the freezer. I’m generally liberal – but I lean more to the right on these issues because I do believe life begins at conception. I had a miscarriage at 7 weeks and it sure felt like I lost a “life”.
I feel in some ways that fertility treatments have gone too far. The fact that we have freezers full of embryos speaks to that.
The next question of ethics is what to do with the extra embryos once they exist. Should they “dispose” of them. Or allow other families to gestate them… Its hard to me to even answer that – because I wish the extra embryos hadn’t been created in the first place. But – ideally a donated embryo/child should be able to know who its biological parents are and have contact with them.
I also feel that in the case of donated egg and/or sperm – that parental identity should not be anonymous. And that children should be told the whole story from the get go – such as we do with adoption.
I fear for the parents of these children who do not think these things through or work out their own feelings about the ethics of the situation. Because one day they will have to answer to their children.
Jennifer, I wanted to point out one major reason that extra embryos are created. Medical science in general, and embryology in specific, has not reached the point where they can determine which eggs will likely fertilize and which embryos that are created will likely implant and grow. In nature the odds are against any specific egg and any specific embryo. As Dr. Michael Tucker, a renowned embryologist, said on our Feb. 16 show (What Every Infertility patient MUST know About Eggs and Embryos): “Human reproduction is remarkably inefficient.” If a woman were to have only one egg fertilized per cycle, she would likely have to go through many many cycles before she ended up with one good embryo worthy of transferring. This approach is hard on her body (ovulatory stimulating drugs are powerful medications) and hard on her wallet. One cycle of IVF can cost between $10-15K and is seldom covered by medical insurance. I point this out, not to try to change your mind, but to help you understand the complexities many infertility patients face. There simply are no easy answers.
Dr. Sweet,
1. How valid is that medical information in 50 years after the biological family health history has expanded by diagnosis, deaths, birth of sibligs and at the same time more and more diseases genetic causes are identified? You cannot test for what has not yet happened, nor can you test for diseases genetic origins have not been identified. If you could there would be no reason for the Surgeon General and the NIH to call for families to update their family health histories YEARLY…
2. I believe that any transfer should have court records. Simply because how many clinics have already closed their doors and who knows what happened to their files or will be shredded or have mysterious floods or fires so common in adoption agencies and maternity homes. Having court records protects that individual being created. It also provides for some modicum of protection hopefully against unethical individuals out to make a ton of bucks…
3. Guaranteed many will want to know where they came, just like adoptees. Understanding the why is fine and dandy but it does not just make everything wonderful or the basic desire to know who you come from go away. People need to realize that the individual being created is the only one who should be thought of in this process, their future needs must be first and foremost. Certainly far above someones desire to be a parent.