Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Thursday, June 23, 2016

A Bioethical Conundrum

"They'll have all the embryos transferred, so they can die in the uterus."
"[The decision to discard unused embryos can be] gut-wrenching. They [couples attempting conception through in vitro fertilization] think of those embryos as related in some way to the children that they have."
"If we have this idea that embryos are something that need respect, we should have clarity about what to do with them in a long-term way."
"It might not be in the best interest of society to keep human embryos frozen in storage forever -- and ever and ever."
Alana Cattapan, post-doctoral fellow, faculty of medicine, Dalhousie University, Nova Scotia 

"None of us like dealing with the abandoned embryo issue — it’s difficult for us, it’s not an easy decision."
"The important thing is to define, right up front, what to do if the couple no longer wants to take care of the embryos. There has to be absolute clarity with the couple from the beginning — 'if you walk away from this and nobody can reach you, here is what we are forced into doing down the road'."Dr. Matt Gysler, past president, Canadian Fertility and Andrology Society
When fertility clinics end up with a build-up of unclaimed embryos, a dilemma has been ensuing: How do doctors ensure there's space for existing patients while balancing the ethics of 'disposing' of the building blocks of human life? One doctors' group's solution? Just let them thaw out.
Mauricio Lima/AFP/Getty Images   When fertility clinics end up with a build-up of unclaimed embryos, a dilemma has been ensuing: How do doctors ensure there's space for existing patients while balancing the ethics of 'disposing' of the building blocks of human life? One doctors' group's solution? Just let them thaw out.

Unused and stored embryos are not just any waste human tissue to be casually disposed of; they have risen well beyond the building blocks of human life, representing nascent human beings simply awaiting transplantation into a woman's uterus to be given the opportunity to grow into a foetus, to become a baby cherished by parents eager to welcome an infant into their hearts and their home. But in the process of producing these embryos meant for multiple transfer but for one reason or another considered to be redundant, they have been left in storage.

But is it for posterity, when the prospective parents decide for any number of reasons not to proceed with their  use? This is an issue troubling ethicists and the businesses of offering IVF (in vitro fertilization) services to a public which values the opportunity to conceive a child through methods that owe more to the laboratory and medical science than to nature's plan for conception, foetal maturation and birth.

Up to a third of patients undergoing cycles of IVF will end up in possession of excess embryos, which is to say more than can be safely transferred, leading to the recognition that more embryos are produced than are necessary for the process at hand. Two scholars out of Dalhousie University in Halifax have published their research findings with the recommendation that Canada take heed of how the United Kingdom, Denmark and New Zealand consider the legality of fertility clinics discarding embryos which no one claims after five or ten  years.

Reasonable effort should have been made in outreach in the absence of no clear written direction how to settle the existence and disposal of embryos whose use is no longer required for reproduction. They might be the possession of those who have completed fertility treatment, or abandoned their treatment, or simply stopped paying storage fees and cannot bring themselves to deciding what to do with the embryos. The opportunity to offer the embryos for transplant to another couple might be offered.

Without a clear legal mandate, clinics are placed in a position where the way forward is lacking; whether to legally be entitled to dispose of the frozen embryos which remain unclaimed, or whether to have to continue storing them on an indefinite basis. Clinics hesitate to act without precise instructions from the people who own the embryos. Sometimes they are loathe to act even when they are in possession of prior instructions on how to proceed.

Dalhousie University bioethicist Francoise Baylis and Alana Cattapan recently published their findings and recommendations in Reproduction Biomedicine & Society Online. "There is no governance of abandoned embryos at the federal, provincial and territorial levels [in Canada]" they wrote. According to Dr. Heather Shapiro, president of the Canadian Fertility and Andrology Society, precise figures are unknown. "I don't think we should assume it's an epidemic, nor should we assume it's a non-issue."

Estimates exist in the United States that 400,000 to 1.4-million embryos are in an abandoned state, but there are no reliable figures, let alone reasonable estimates for Canada, to indicate the number of abandoned embryos in existence. One 2003 study revealed 15,615 frozen embryos in Canada. Since that time, however, another ten fertility clinics have been in operation and logically a plenitude of additional embryos were created and frozen.

Clinics have been incorporating genetic testing of embryos to determine which are the healthiest to be selected for transfer; a process that eliminates large numbers of embryos frozen as 'spares' in case they're needed. And, in an effort to bring solace and closure to the issue of expendable embryo decision-making, some clinics in the United States offer to implant unused embryos into the IVF patient's uterus when there is little likelihood of it resulting in a successful pregnancy, as a method of disposal.

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