Friday, July 29, 2011

A Hypothetical Catholic EA Agency

As mentioned in my brief overview on embryo adoption, there is a range of ways that one can “participate” in embryo adoption.  Not all methods award the proper dignity and respect to each embryo or even to each marital relationship.  As of today there are at least nine self-proclaimed “embryo adoption agencies” (here is a list of eight EA agencies; here’s one more agency).  And there are over 500 fertility clinics nationwide that have some sort of embryo donation program (click here for a partial list by state).  Just as regular domestic adoption agencies vary in their services provided, so too do all of these programs in their services provided.

Unfortunately, since embryo adoption is not recognized as a legal form of adoption under federal law, there are no laws in place to regulate embryo adoption practices.  I think it’s worthwhile, then, to define what an ideal Catholic embryo adoption agency would look like.  Though this discussion is hypothetical at this point, it should provide some measure with which to compare existing agencies.

Please note, the absolute best scenario would be for the genetic parents to complete the embryo transfers themselves with their own remaining embryos and care for them for the duration of embryos’ lives (be it moments or decades).  However, I do realize this scenario cannot always be achieved either due to mental, physical, or financial reasons.  The decision to place embryos for adoption should not be (and I doubt it ever is) a decision lightly made.

I would like to propose several criteria for a hypothetical Catholic embryo adoption agency.  First, adoptive parents should complete an adoption home study at least in accordance with their home state guidelines.  Home studies are required for domestic and international adoption; they should likewise be required for embryo adoption.  As part of the home study process, adoptive parents should receive tips on how to share with their child(ren) their unique origin.

Second, all fees associated with the embryo adoption AND frozen embryo transfer should be kept to a minimum and be as affordable as possible.  I’ve seen it argued that the placing parents (aka genetic parents) should “foot the bill”.  Honestly, I don’t think this is a reasonable request.  This is not expected of traditional forms of adoption, why should it be for embryo adoption?  It goes without saying that genetic parents should not be reimbursed in any way for expenses they undertook in the creation of the embryos or in storage of the embryos up until they are relinquished to the care of the adoptive parents.

Third, all adoption legalese should be patterned as closely as possible off of current domestic adoption legalese.  If one day our federal government wakes up and decides to recognize the embryo as a person and to recognize embryo adoption as a legal form of adoption, then there’d be fewer questions on the validity of the contract.  I’m sure they’d be grandfathered in if such a situation were to happen, but you get the idea…

Fourth, there must be strict mandates in place.  Absolutely no surrogates.  Absolutely no selective reduction.  Thaw only the embryos you are healthfully prepared to carry to term, regardless of the statistics.  (Typically anywhere from one to three embryos are frozen in a straw; you cannot thaw a partial straw.)  Do not refreeze thawed embryos.  No genetic testing of any sort.

Fifth, as with normal infant adoption, the placing parents need to accept responsibility for the life/lives created.  They should participate in the matching process as much as reasonably possible.  I favor the idea of a mutual matching process (both placing/adoptive parties few each other’s profiles and say yea/nay), but recognize there may be some instances in which the placing parents have relinquished their rights to the agency.

Sixth, to truly honor and respect each embryo, the agency must keep track of every embryo that passes through its system.  Each adoptive couple should report back with thawing/transfer details along with pregnancy information should one occur.  Normal adoptive post-birth visits should be held by social workers.  Post birth records should be completed by the adoptive parents and filed by the agency. 

Embryo adoption is undoubtedly a unique form of adoption.  I would strongly suggest that all placing parents provide at least two generations of medical history to the adoptive parents to accommodate the special nature of embryo adoption.  However, I believe the adoption could follow normal open or closed communication arrangements as negotiated by the two families with the agency.

Based on my research up through 2008, Nightlight’s Snowflake program was the closest match to this hypothetical list, though there is no exact match in existence.  (Many of the nine agencies listed were just coming into existence when we did the bulk of our research and so were not reviewed.  I’m in the process of gathering more information now…)   I have three issues with Nightlight:  cost, they’ll work with surrogates on a case by case basis, and they don’t have any regulations regarding refreezing.  The majority of EA agencies in existence seem to be more affordable than Nightlight but also seem to offer less to both placing/adopting families.  Some agencies, like Miracles Waiting or Embryos Alive, seem to be just a forum for matches to take place.  Without more oversight, I fear that each embryo may not receive its due dignity in such an arrangement as Miracles Waiting or Embryos Alive. 

However, my thoughts continually are evolving on the formation of a Catholic embryo adoption agency.  What do you think?  Is there anything I have omitted?  Or should edit? 

Saturday, July 23, 2011

Common Misconceptions about Embryo Adoption

(I originally wrote this in April 2009 and posted it on my personal blog; I’ve edited it only slightly.)

I realize that most of you probably never had these questions.  However, Bryan and I have come across a large number of misinformed people (both in person and through blog-hopping) and I just want to clarify.  Perhaps, there is an off chance that some random person may have their burning EA questions answered by reading this.  :-)

First, we did not commission the creation of these embryos.  (Actually got that question from a Church friend).  EA, at least through Nightlight's Snowflake Adoption Program, is not a mail-order baby program.  There are not couples anxiously waiting to be chosen so they can then begin their IVF program and give us the "leftovers".  As a side note, our twins were created in January 2006; that alone should disprove the above theory.

Second, we did not contribute to the IVF industry.  The genetic parents were not compensated for anything they did.  The fertility clinic was paid only for our frozen embryo transfer.  Point seven elaborates on this too.

Third, the Catholic Church has not issued a definitive stance on embryo adoption.  The Catholic Church, in the fairly recent Dignitas Personae, is clearly negative towards EA.  However, she (the Church) refrained from using the same definitive language as has been used in discussing IVF and embryo stem cell research - gravely immoral.  We've since seen that even the great theologians within the Church are still divided on EA.  In theory, the majority of people find it admirable, if somewhat problematic.  In practice, as we have found, the fertility clinics are the weak link.  I don't think anyone could find Nightlight's Snowflake Adoption Program to be morally reprehensible.  However, the fertility clinics are like wolves in sheep's clothing (more on this in number ten).  Currently, we're being mindful of the theory of probabilism - when two moral routes exist from an undefined topic, it is acceptable to choose the route that is supported by the minority opinion. 

Fourth, we did not pursue EA in hopes that our own fertility would be miraculously restored.  To date, I don't believe there have been any documented cases of a sudden return of fertility following embryo adoption.  Furthermore, how would embryo adoption (me carrying a pregnancy) undo male infertility?  I’m not sure how any amount of hormonal shifts that I experienced could evoke a cure in my husband!

Fifth, embryo adoption does not involve my eggs or Bryan's sperm.  You'd be surprised how often we got asked this.  I'll explain more on this in number seven.  So for now, I'll just say that embryos are fertilized eggs, possessing a full unique set of DNA. 

Sixth, we did not choose embryo adoption in hopes of concealing our own infertility from the world.  We do not pretend that our future children are our own genetic offspring.  No, I don’t spill the beans every time someone asks if my daughter looks like her daddy; but I also don’t secret away their unique origin.  The grocery story check out is not generally the best time to discuss embryo adoption.  Our children are not going to feel inferior, by any means, but they will know that they were hand-picked by God to be OUR children and that we will love them indefinitely.  Adoption is not going to be a bad word in our household. 

Seventh, EA and IVF are not the same thing!  Let's talk basics.  In in vitro fertilization (IVF), eggs are harvested from the wife (or obtained from a donor) after several weeks of hormone injections.   Hormones are used so that the woman will produce far more follicles than normal.  Sperm are obtained either from the husband (or a donor).  After both gametes are collected, the lab will then fertilize some or all of the eggs.  Some labs will fertilize all the eggs and then choose only the "best" embryos to transfer, freezing the rest.  Other labs will only fertilize a few and then transfer all resulting embryos.  Some couples may have enough embryos to attempt several embryo transfers.  Some couples may have enough frozen gametes left for the lab to fertilize more later on for subsequent transfer attempts.  Some couples may have to repeat the entire harvesting process again, if not enough eggs were claimed the first time.   Some couples may use donors for both gametes.  As you can see, there's a lot of variation. 

The embryo transfer (ET) is the very last step in the IVF process.  At this point, the fertilized egg (the embryo), whether frozen or fresh, is transferred from the lab to the woman.  If Bryan and I were to contribute our own gametes, we would be contributing directly to the IVF process.  Instead, embryo adoption takes place years after all of the previous procedures take place.  The purpose of the medications I used was to pinpoint the best transfer date.  Frozen embryos are typically thawed and grown for up to several days before the ET is to take place.  For example, if we had transferred five day old embryos, then my meds would have stimulated my uterus to be five days past ovulation for the day of the transfer.

Eighth, we have no hopes of becoming "octomom" or one day gaining our own TLC special.  Most fertility clinics already subscribe to the recommendations set in place by the ASRM (American Society for Reproductive Medicine).  In addition to these recommendations, Nightlights' Snowflake Program firmly discourages transferring more than three embryos at a time.  This decision was made out of concern for both the health of the mother and any surviving babies.  (I said "surviving" because not all embryos may survive the thaw and not all embryos may survive the transfer.)  I guess it is possible that one of the embryos could split and we could hypothetically end up with quadruplets.  However, there have been no recorded cases of quadruplets during Snowflake Program and only a few cases of triplets.  As Nightlight strictly prohibits selective reduction and also keeps very careful records, I feel confident that their information is accurate. 

Ninth, we have not given up on traditional adoption.  Bryan and I still dream of a large family.  Embryo adoption appealed to us in many ways:  I can carry a pregnancy, it's faster, we're young, and these embryos are in high-need.  However, traditional adoption still appeals to us as well.  With news that the average domestic infant adoption is taking longer and longer (two to five years in certain parts of the country, without regard to racial distinctions), I’m leaning towards additional embryo adoption for the near future, but we’ll see where God takes us.

Tenth, embryo adoption is currently not THE perfect solution.  If one only had to solely deal with Nightlight's Snowflake Program, I would be much more confident that all decisions are being made for the good of each embryo.  However, fertility clinics perform the transfer.  And they are sneaky.  I think embryo adoption can be a good and moral option, but one has to be constantly vigilant and read every bit of information carefully.  Consider our "Consent to Transport the Embryos" contract.  The contract asked what the clinic is to do with the embryos if both of us died - the only two options given were terminate the embryos or donate them to research (which is terminating them!).  Another section asked what the clinic should do if we stopped paying our storage fees  - the only two options again were terminate or donate to research.  After I spoke with our case worker at Nightlight, I learned that every individual has the right to modify a contract.  So, we struck out every immoral option and replaced it with something acceptable.  In both of those scenarios, any remaining embryos would have been returned to Nighlight's Snowflake Program to be adoptable once more (which is what our case-worker recommended).

Another sneaky phrase the fertility clinics use a lot in their contracts is "medically acceptable".  For example, only those embryos which are determined to be viable and "medically acceptable" will be transferred.  We crossed out that phrase every time we came to it.  I'm pretty sure that the doctor's definition of "medically acceptable" and my definition would not have coincided. 

And then there’s the whole business of making “perfect babies”.  My children’s genetic father has polycystic kidney disease.  Each of his offspring has a 50% chance of developing pkd.  We read the disclosure statements written by the genetic family, researched the disease, and then made the decision to move forward.  Our transfer, however, nearly didn’t happen because our fertility doctor struggled with whether or not he could ethically perform the transfer.  He’s in the business of giving people perfect children – he had never been confronted by someone wanting to adopt the imperfect ones.

In summation, we know we navigated a very careful path and perhaps not all people would be willing or able to do such.