Sunday, April 19, 2009

Second of two parts

Even though warm spring weather is here, the snowflakes on the necklace Cara Vest wears will not melt.

“Especially in the summer, people come up to me all the time and say, ‘Why are you wearing snowflakes?’” Mrs. Vest said.

She happily explains the silver snowflakes represent her two children, who were adopted as frozen embryos from another couple who had “extras” after having children via in vitro fertilization (IVF).

Welcome to family-building in the 21st century.

Embryo adoption recently celebrated its 11th birthday. The Vests’ 6-year-old son, Jonah, was the 13th “snowflake baby” to be born.

In just three years — 2004 to 2006 — 988 babies have been born by this process, says one medical researcher, citing federal data. The total number born since Snowflakes Frozen Embryo Adoption Program was founded in November 1997 might conservatively be closer to 3,000, says Ron Stoddart, executive director of Nightlight Christian Adoptions, the agency that pioneered the process.

With an estimated 500,000 cyropreserved embryos in storage, there soon could be a blizzard of babies born through embryo adoption.

Whether it takes off will depend on public awareness and acceptance, especially among couples who have “extra” embryos, observers say. The issue of embryonic stem-cell research is also a factor, as most people currently think “excess” embryos are best donated to laboratories.

In addition, questions remain over whether the transfer of frozen embryos should be termed an “adoption” or a “donation.”

And while some adoption agencies, such as Bethany Christian Services, embrace embryo adoption, others, including Catholic Charities, do not.


Part 1: Last days of adoption?

Despite the obstacles, embryo adoption is emerging just as domestic infant adoption is vanishing and international adoption is becoming more difficult. Embryo adoption may not be the right choice for everyone, but it has been a dream come true for hundreds of families.

‘I wanted to carry’

As infertility patients in the 1990s, Mrs. Vest and her husband, Gregg, found themselves frustrated and childless after three IVF treatments. They reluctantly began exploring traditional adoption, but still were not satisfied.

“I wanted to carry [a child],” Mrs. Vest said. “I wanted to be pregnant. I couldn’t understand why something like [embryo adoption] didn’t exist.”

She heard about embryo adoption when Hannah Strege, the world’s first snowflake baby, was featured on James Dobson’s Focus on the Family radio show. Mrs. Vest ran to the phone to call Focus on the Family and Nightlight Christian Adoptions agency.

“I dove right in and asked them to send me anything they had,” she said.

The Vests received an application to adopt an embryo, but Mrs. Vest ended up putting it aside.

“It just wasn’t time and, for some reason, I knew that,” she said. “I just kept saying, ‘It’s just not time.’ Then, we moved into our house and one day I knew I had to get it in the mail. So we dropped it in.”

It wasn’t long before the Loudoun County couple were notified they were the perfect match for a donor family in Atlanta. The connection was made, and the families met in Atlanta.

“We hit it off immediately,” Mrs. Vest said. “It was quite an experience, to be standing there, staring at these four kids who would look like my kids one day.”

The Atlanta couple donated their 23 excess embryos to the Vests. The first embryos transferred to Mrs. Vest’s uterus produced a pregnancy, but the baby’s heart stopped beating after nine weeks. The devastation was so great that Mrs. Vest’s family and friends urged her to stop the process.

She decided to continue.

“I just knew — with every ounce of my being — I knew that I was supposed to be doing this process, and whether or not I ended up with a child in my arms at the end, was not why I was doing it,” Mrs. Vest said. “I just felt it was something God had given me and I was doing it.”

Jonah, the Vests’ first child, was born in 2002 after three more embryos were transferred.

“When they handed him to me, I just said ‘I am so thankful you are here,’” Mrs. Vest said.

A few years later, the Vests tried again. This time, 11 embryos did not survive the thawing process, but three were transferred. Gabrielle was born in 2005.

Jonah and Gabrielle are a joy, but there are three embryos left — which leaves the Vests with a tough decision.

“All my friends keep saying, ‘Give them up, you are happy with your family,’” Mrs. Vest said. “But I don’t know if I’m done. My kids would love another sibling.

“The Lord obviously gave me kids at a later age, and I still don’t know the reason.”

A donor story

In 2005, Michelle and Chris Casteel’s struggle with infertility finally ended. Thanks to their first IVF treatment, they had two beautiful children — and two extra embryos.

The Yakima, Wash., couple already had decided to donate any remaining embryos to another couple — giving them to a laboratory for research was not a consideration, Mrs. Casteel said.

“In two weeks, you could see the hearts in these babies. So I knew right away, they are not going for research,” she said.

The couple was forced into action on their decision when they got a $600 bill for another year’s cryopreservation. The Casteels contacted the National Embryo Donation Center (NEDC) in Knoxville, Tenn. The NEDC carefully explained their options.

“People can choose to take part in the selection of the adoptive parents of their embryo, or choose not to know anything,” said Michelle Dicken, public relations manager at NEDC.

Donating couples can choose to have an open relationship, where they can be a part of the embryo’s life, or have an anonymous one, where they will never meet.

“Some donors are very open — where they vacation with their kids — but others are not and prefer not to have any contact with them,” Ms. Dicken said.

The NEDC sent the Casteels the profile of Joel and Holly Davis, a Nebraska couple who had twin boys but wanted to have another child.

The couples clicked, and soon the NEDC was paying to ship the Casteels’ embryos to Tennessee, where the Davises would have the embryos transferred into Mrs. Davis’ uterus. One of the embryos resulted in a successful pregnancy and the Davises joyfully welcomed their daughter, Karissa, in 2007.

Today, the two families have “a wonderful friendship,” Mrs. Casteel said. The children have met each other, and while the Casteel children may not yet fully understand how they came to have another biological sister, “we will again tell them when they are much older,” she said.

Unfamiliar term

The path to embryo adoption began in England, with the 1978 creation of “test-tube” babies using IVF. A woman’s eggs were successfully fertilized with sperm in a petri dish and the resulting embryos were transferred into the woman’s uterus. The cryopreservation of embryos began in 1984.

In the beginning, doctors focused on perfecting the IVF procedure and didn’t worry too much about the rising number of embryos in storage. When faced with couples who didn’t have any luck doing IVF with their own eggs and sperm, doctors began cautiously experimenting with IVF treatments with unrelated embryos.

In December 1998, Marlene and John Strege became the first couple in the world to have a baby using an adopted frozen embryo.

Their historic journey started in late 1997 when they asked Mr. Stoddart of Nightlight Christian Adoptions if they could adopt an embryo. While Mr. Stoddart explored the novel idea, the Streges took their moral questions to their pastors and Mr. Dobson, the Focus on the Family founder.

“Ultimately, everyone with whom we made contact confirmed what we already knew: that embryos are human lives and they need to be adopted in the event that families responsible for their creation are unable to use them,” Mrs. Strege wrote in 2008 in Clearly Caring magazine.

The Streges and Mr. Stoddart came up with the “snowflake” concept after attending a Christmas play in which an actress said, “In the intricate design of each flake of snow, we find the Creator reflecting the individual human heart,” Mrs. Strege wrote in the magazine article. These embryos are like snowflakes, they decided — “frozen, unique, never again to be re-created.”

Hannah, the Strege’s daughter, paid a visit to Congress at the age of 2. She also attended a 2006 White House event when President Bush announced the first veto of his presidency — there would be no further federal funding for embryonic stem-cell research.

The federal government began funding embryo adoption awareness in fiscal 2002, and more than $10 million has been spent so far.

Mr. Stoddart says his organization can document 1,200 babies who have been born via embryo adoption, but he estimates that the true number of births is closer to 3,000, thanks to myriad fertility clinics that have done embryo transfers on their own.

According to federal data, there were 2,224 donated-embryo transfer cycles between 2004 and 2006, resulting in 988 live births, said Dr. Reginald Finger, who conducts research for the NEDC and published his findings in an abstract in Fertility and Sterility.

Even so, Americans remain unfamiliar with the process, the NEDC found. About 49 percent of 966 adults surveyed in 2007 by Harris Interactive said they had ever heard of the term “embryo donation.”

Once Americans understand it, though, they seem to approve of it: Seventy percent agreed with the statement, “Embryo donation is a good way to use frozen embryos.”

Stem-cell research

With embryo adoption a relatively new concept and embryonic stem-cell research so well publicized, it’s not surprising that many people choose research as the destination for any excess embryos.

A Duke University Medical Center survey of 1,020 fertility patients, published in 2008, found that of people who were sure they had extra embryos, 41 percent said it was very likely they would donate them to science, while 16 percent favored embryo donation and 12 percent said they would let their embryos be discarded.

Infertility experts said there is a scrupulous effort not to make people’s decisions for them.

“We don’t tell people what to do,” says Barbara Collura, executive director of RESOLVE: The National Infertility Association, which has received around $700,000 in federal embryo-adoption awareness funds.

“We don’t persuade them. Some people come away saying, ‘I feel more informed and I can do this,’ and others come away saying, ‘I feel more informed and I do not think I can go forward.’ We are never up there saying, ‘You should do this, this is great’ and we’re never up there saying, ‘This is terrible.’ We are just presenting the information as best as we can,” Ms. Collura said.

In fact, Mrs. Vest said, the issue of stem-cell research comes up all the time when she explains embryo adoption.

“I understand the hope that [embryonic stem-cell research] gives people,” she said. “I don’t want to take that hope from people, but I think there are better options. … I can’t see taking the lives of these potential children for just a hope — and not a reality — at the moment.”

Adopt or donate

Another debate is whether the process of transferring embryos between couples is an adoption or a donation. Generally, embryos are not classified as people. Therefore, when couples transfer their embryos, the process is a legal transfer of property, not an adoption. Some specialists cater their vocabulary to the family they are talking to.

“I use the terms [adoption and donation] interchangeably in most contexts,” Mr. Stoddart said. “The donor family typically prefers to use ‘embryo donation,’ whereas the receiving family prefers ‘adoption.’”

However, others are specific about the words and argue that using “adoption” adds legal work to the process.

“I think people that use the term ‘embryo adoption’ are doing a disservice to those families,” said Sean Tipton, public affairs director for the American Society for Reproductive Medicine (ASRM).

“This is not an adoption process; an adoption is a legal procedure that transfers one child traditionally from one family to the other,” Mr. Tipton said. “All they do by using this term is create more hurdles for those that are considering this choice. It is clear that those that are using the term are doing so for political purposes and not for the benefit of the child.”

Fuzzy future

“We haven’t even touched the potential” of embryo adoption, said Maria Lancaster, who has a 5-year-old “snowflake” daughter and became so inspired about the process that last year she founded Embryo Adoption Services of Cedar Park in Bothell, Wash.

There isn’t a shortage of infertile couples, and with nearly 500,000 embryos in cyropreservation, “all they need is a womb,” she said.

Embryo adoption is also affordable, proponents said.

The average expense of embryo adoptions — including home studies, embryo shipping and transfer to the prospective mother — is between $7,000 and $10,000, said Mr. Stoddart. This is relatively low compared to the $12,000-a-session cost for IVF treatments, and traditional adoption, which can run between $10,000 and $20,000 domestically, and between $30,000 and $40,000 for international adoptions. “Adopting through the foster care system is the only less-expensive option,” said Mr. Stoddart.

However, many specialists believe that embryo adoption, though it does create another choice for families, will never truly replace traditional adoption.

“As far as the future, we don’t believe it will replace traditional domestic adoption,” said the NEDC’s Ms. Dicken. “There are all pros and cons to embryo adoption and all sorts of people for all different reasons choose to do something else.”

The ASRM supports embryo adoption as a personal choice for couples, but doesn’t see it as a primary goal for most couples.

“We think embryo donation for family-building is a terrific option for some donors and adopters,” Mr. Tipton said. But it has been offered for a long time, and “it does not look like it is going to become a real choice for families.”

“It is all a matter of what people want,” he said. “If they want to adopt, they go adopt a child, and if they want to have a genetic child, they go to infertility clinics.”

Even Mr. Stoddart sees embryo adoption phasing out as IVF regulations limit the number of embryos produced and IVF treatments become more successful.

“Although the number of embryos in frozen storage is likely to continue to grow for a while,” he said, “I believe it will grow at a slower rate as the techniques for creating embryos improve. … I would like to see freezing of embryos become the exception rather than the rule.”

People who have participated in the process, however, see this as the best option for these embryos.

Mrs. Vest knows that their story affected an old school friend who went through IVF and ended up with extra embryos.

“She said to me, ‘Because of you, my husband and I decided to put them up for adoption,’” Mrs. Vest said as her eyes filled with tears. “I just lost it. You get out there and you try to promote this, and you so hope that somebody is listening, and that somebody will see how it has touched our lives, and we are a normal happy family and we love our kids.

“To actually have it affect somebody, and see that they would put their embryos up for adoption and it would be OK. … This was unbelievable.”

Cheryl Wetzstein contributed to this report.

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