Sometimes, Salon is pretty good, ya know? Sometimes they're a little inflammatory (fresh Ayelet Waldman, every two weeks!). And sometimes their in-house writers are just a little dumb, or a little ill-informed, or... well, why don't you, dear reader, count how many fudges and/or inaccuracies and/or authorial prejudices masquerading as common sense you can find in the following excerpt from their round-up on the stem cell/embryo "adoption" hoo-ha?
OK, but doesn't Bush say that he's got his own solution to the problem of unwanted embryos -- doesn't he say that parents should give them up for "adoption"?
Arthur Caplan, the University of Pennsylvania bioethicist, has this to say of Bush's idea that hundreds of thousands of extra embryos can become children to adoptive parents: "I've never heard a sillier, more inaccurate, more ideologically fueled claim about anything in all of biomedicine." And Caplan is right.
It's true that there have been some children -- about 80 -- born from spare embryos donated to couples who want to adopt and also experience pregnancy. But to present this as a way to prevent throwing away all embryos currently frozen is grossly misleading. For one thing, the vast majority of parents of embryos in freezers don't want to give them up for adoption. They're emotionally attached to those embryos, Caplan points out, and they don't like the idea of other people raising their genetic children. That's why, according to the RAND study of frozen IVF embryos, more patients have chosen to discard or donate embryos for research than to donate them to other couples.
Moreover, the embryos currently stored in IVF clinics are there for a reason: They didn't look right, and doctors chose to freeze them rather than implant them. Perhaps that's why, according to the Centers for Disease Control, the chances of a frozen embryo resulting in a live birth are significantly lower than those of a fresh embryo: Once transferred into a woman's uterus, only 24 percent of frozen embryos result in babies, compared to 34 percent for never-frozen embryos. And not only is there a strong chance that you won't get any children if you choose to "adopt" frozen embryos, there's also a chance that you'll have more kids than you wanted, since embryo implantation very rarely results in the birth of just one child.
We should note that, just as it is unclear whether all of the embryos in storage can become babies, it's also unclear whether the embryos could work for stem cell extraction. But ethicists say it's much more practical, and perhaps humane, to try to get stem cells from the embryos than to try to get babies from them. In fact, it's unreasonable to expect any large demand for embryo adoption. Does Bush really believe that hundreds of thousands of women and couples who want kids will opt for this route -- to choose a process that rarely produces children, that sometimes produces more than one child, and that is, to boot, physically taxing and expensive? Caplan calls that expectation absurd.
And rather than selling them on this crapshoot, wouldn't it be more "pro-life" of Bush to suggest that childless couples choose traditional adoption? "We have 500,000 kids in foster care in this country," Rep. DeGette told Salon. "If the ultra right wing is so concerned maybe they might want to look out for kids who are already born."
(And I don't even really count the "implant" vs. "transfer" issue: that one's squarely the fault of the fertility industry and their publicists having been a little too optimistic and a little too imprecise for too long.)
UPDATE: This being the interactive blogosphere and all, it looks like we have the piece's author stopping by. Please add your comments too!
There are waiting lists for these embryos at every clinic I have contacted, some waits up to a year or more. This guy obviously hasn't dealt with infertility on a personal level, or even known anyone who's gone through it. I really want to kick him. I also disagree with the "adoption" aspect of it. If couples would like to donate, great, I'll take a batch, but adoption should be left for actual babies instead of the hopes of a baby.
Posted by: Kate | Thursday, June 09, 2005 at 02:38 PM
Blargh. Farhad Manjoo must have been talking to the wrong "scientist" when he wrote that. One interesting tidbit that I came across when I read the article, however (okay, I only read about 3 pages), was this:
"Bioethicists note that if [a four-day embryo] does [have a soul], it's not an individual soul, since an embryo at this stage has not yet reached the point where it might split in two to become twins. An embryo can't be thought of as an individual person, some ethicists say, since it may actually become two different people."
Bioethicists. They make me consider things I wouldn't on my own.
Posted by: Louise | Thursday, June 09, 2005 at 06:50 PM
Just because there are waiting lists of people willing to "adopt" embryos doesn't mean that there's great demand. It just means that there's more demand than the number of embryos people are willing to donate at that clinic.
This is simply a function of there not being that many people willing to donate their embryos to other couples; as noted, surveys of IVF clinics shows that fewer people are willing to donate their embryos to other couples than the number who want to discard them or donate them for research.
Posted by: farhad manjoo | Thursday, June 09, 2005 at 08:32 PM
And Emma Jane -- can you point out the instances of "fudges and/or inaccuracies and/or authorial prejudices masquerading as common sense" so that I may respond?
Posted by: farhad manjoo | Thursday, June 09, 2005 at 08:34 PM
No time for full answer now, but the one clause that was most strikingly problematic: "embryo implantation very rarely results in the birth of just one child."
It is transfer (damnit), and the most frequent result by far is zero children per transfer. Transfers only result in the birth of a child at all about a third of the time, averaged nationally. Good clinics have twin (or higher) rates of about a third of pregnancies; sloppy clinics, that transfer too many embryos to make patients happy/improve success rates, get that up to about half of pregnancies. So that's between 1/9 and 1/6 of transfers leading to multiple births.
The CDC has excruciatingly detailed stats on almost all the clinics in the country posted, together with excellent yearly summaries: http://www.cdc.gov/reproductivehealth/ART/index.htm (I assume you must have consulted them for parts of your article.)
Yes, IVF pregnancies are much more likely -- like 30 times more likely -- to be multiple pregnancies. But one of the things IVF patients struggle with is the general belief that (a) this stuff works every single time and (b) it generates the freakishly large litters that make headlines. My path -- three cycles to get to a singleton pregnancy, with no embryos frozen from any cycle -- is far more typical, but that never makes it into the popular imagination, since neither the clinics (who want to appear successful) nor the press (who like to tell interesting stories) have any interest in putting it out.
Posted by: Emma Jane | Thursday, June 09, 2005 at 11:55 PM
I'm not sure if this is a quibble on Caplan or the Manjoo (or both?), but this also struck me as quite a leap:
"They're emotionally attached to those embryos, Caplan points out, and they don't like the idea of other people raising their genetic children. That's why, according to the RAND study of frozen IVF embryos, more patients have chosen to discard or donate embryos for research than to donate them to other couples."
The RAND study, so far as I could tell, said nothing about the motivations of couples for discarding vs. donating embryos. It simply counted the couples who made each choice.
And the statement that couples are "emotionally attached" to their embryos is a simplistic way of putting it at best, and a risky one at worst; it almost sounds like infertile couples agree with pro-lifers that embryos = children.
As Jody at Raising Weg said recently, "My feelings about an eight-cell embryo are radically different than my feelings about any children that might be born from that embryo's transfer and growth."
Posted by: persephone | Friday, June 10, 2005 at 01:07 AM
I can recall clients at our clinic using both donor egg and donor sperm, and I guess they would have been good candidates for embryo adoption. It would have been much cheaper even if they had to do a few cycles. Yet we never did anything like this; never even mention it (in Manhattan).
Tthe embryos available wouldn't bring the same "young egg" benefits that the usual donor process does. Instead, you'd be getting an embryo from someone who had to do IVF: you know, she's 42 and they needed ICSI.
Clients would want the entire genetic histories of the donating couple, and they would want to know whether the 2 first choice embryos that were implanted resulted in a live birth etc.
I can think of some "younger" clients--early 30's--who had no issues other than blocked tubes who had terrific yields and got pregnant on the first cycle. But then, the fact that they're younger means they're likely to consider siblings and not want to give up their embryos for a long time. And early 30's is on the edge of what women will accept for donor eggs.
Posted by: Shamhat | Friday, June 10, 2005 at 08:41 AM
I also take issue with this part of the excerpt:
"Moreover, the embryos currently stored in IVF clinics are there for a reason: They didn't look right, and doctors chose to freeze them rather than implant them."
Sort of true, but sort of not: when you have enough embryos to transfer a few and freeze the remainder, you're going to cherry pick the best ones to transfer fresh, of course. But many clinics won't freeze anything they think won't survive the thaw hence the phrase in my records, "Unsuitable for transfer, cryopreservation, or observation." In my case, those that "didn't look right" weren't frozen, even though they were still living and dividing at the time the decision was made.
Further, when you have a dozen beautiful embryos to choose from, of course you'll transfer the best-looking ones, again but it doesn't follow that the frozen leftovers are therefore flawed.
Sloppy conclusion.
Posted by: Julie | Friday, June 10, 2005 at 09:48 AM
Thanks, Julie. The frozen embryo quality stuff was probably next on my list to flame about, with the added (perhaps irrelevant) detail that there was no mention at all of an at least equally plausible explanation for the drop in success rate: damage from the freezing/thawing process itself.
I'm pulling this out of my butt (and my years of reading blogs and bulletin boards), but I'm guessing that the 24% success rate cited is per FET (just as the 34% is per fresh transfer). No mention of losses during thaw -- which, again judging from the anecdotal data I've slogged through, are often substantial.
Posted by: Emma Jane | Friday, June 10, 2005 at 11:46 AM
Yes, indeed. There's also attrition even among the embryos that do survive the thaw, and yet we can't really assume those embryos are duds, either; looking at the controversy surrounding day 3 transfers vs. blastocyst transfers, it's not at all clear to me that embryos that don't perform well in a dish can't be winners within the uterus.
Posted by: Julie | Friday, June 10, 2005 at 12:50 PM
Okay, it's Saturday morning, and I have a bit more time. Let me apologize in advance to any readers who might be pursuing one of the many paths I mention below, in case I say something horribly insensitive; it's hard for me to tell when I haven't been there myself.
Let me also point out that the big point of this excerpt -- that embryo "adoption" is not going to "solve" the "problem" of hundreds of thousands of embryos in LN2 tanks -- is clearly true. I'm just objecting to various statements that have been embroiders on top of that.
Lessee. For fudges/inaccuracies, we have so far:
--probability of multiples as a result of embryo transfer
--interpretation of per-transfer statistics as per-embryo statistics
And, for authorial assumptions, we have:
--couples' "emotional attachment" to their embryos is why they don't want to donate
--lower quality of embryos not implanted in fresh cycles is main reason for lower success rate for FET
I'd add:
--where does the "about 80" number come from? The Times article says Snowflakes is responsible for 81 babies, but I seriously doubt that every single donation in the U.S. has been through Snowflakes; see, e.g., the commenter above who mentions that her fertility clinic tries to run an embryo donation program.
I can believe the number is quite small, judging from blogo-anecdote -- PGD is pretty rare, but lots of people on line are doing it, or trying to, and I can't remember seeing anyone actually pregnant from donor embryos. (I have seen people using both donor egg and donor sperm.) But, 80 is really tiny.
--The sentence that put me over the line with respect to assumptions about the motivations of the infertile: "Does Bush really believe that hundreds of thousands of women and couples who want kids will opt for this route -- to choose a process that rarely produces children, that sometimes produces more than one child, and that is, to boot, physically taxing and expensive? Caplan calls that expectation absurd."
I agree that there's not going to be a huge demand fgor embryo adoption. But that explanation?! There are many good reasons why people might not want to accept donor embryos. But the ones you picked out are demonstrably not sufficient.
Hundreds of thousands of people are already opting for other forms of medical assistance that are unlikely to work, that risk multiples if they do work, and that are physically taxing and expensive. 'Cause normal IVF is just like that. Check out the IVF Connections Veterans or Cornell or over-40 boards: there are women going through IVF after IVF after IVF, and they know perfectly well that their personal success probability is under 10 percent per cycle, which means they have to keep trying and trying to have any hope of success. But they keep on going. Absurd? Perhaps. But they keep on going.
What the medical intervention gets you, but adoption doesn't, is genetic connection to your children. For most couples, even if one partner's problems prevent genetic connection, the other one can still contribute: mix with donor sperm or donor egg. (I have no known fertilty problems; my husband is missing crucial tubing, so sperm connot leave his body without surgical asistance. We could have used donor sperm, in classic turkey-baster style, far more cheaply and far more easily than IVF -- and if the third cycle had failed, we had a donor chosen and were ready to switch. But IVF meant that we could have my husband's child, and we cared. I cared. People do care.)
Many couples decide to forgo treatment and go straight to adoption. Some think that treatment is morally wrong. Some fear the medical intervention -- someone with a needle phobia isn't going to do well through IVF, and the drugs do have side effects. Some don't have enough money to gamble: adopting a baby is hella expensive, whether domestic or international, but you do know that if you just wait, there will be a baby. (Side note: Sherman Silber estimates U.S. demand for IVF would be 10 times higher, were it not for the costs involved.) Some really believe that nurture is what's most important. Some think that adoption is just the right thing to do.
And, of course, lots of people end up adopting after years of treatment have failed.
So what's stopping all those folks, who have already decided to forgo the genetic connection, from embryo donation? Well, if they already think treatment is wrong. Or don't want to go through the medical process. Or don't want to go through it again. Or if they honestly believe they'll be giving an extant human child a better life. Then, they're probably not going to be too interested in donor embryos.
But I'm just pulling all of that out of my butt. Like the original article did.
--Finally, `"wouldn't it be more "pro-life" of Bush to suggest that childless couples choose traditional adoption? "We have 500,000 kids in foster care in this country," Rep. DeGette told Salon. "If the ultra right wing is so concerned maybe they might want to look out for kids who are already born."'
I notice that your final quote is from some politician, not from a bioethicist or anyone connected with the adoption or fertility industries. It's just not easy to adopt, and letting this quote stand without comment as a last word on the subject seems very naive. Demand for infants in the U.S. way outstrips supply, and the peculiar patchwork of agencies, lawyers, and state laws controlling the process is horribly complex; other countries are (understandably) pretty cautious about letting Americans steal their babies. And adopting older children, often from troubled families, or with problems themselves, or not really as available for adoption as they might be, is something many couples are quite reluctant to do.
--Farhad, you didn't say anything that just about anyone might say, before they learning much about this world. The couples going through treatment, and the doctors treating them, are necessarily forging some applied ethics as they go -- the choices available aren't always what the philosphers assume they are, and in the real world, we have to work with the choices available.
I guess I was particularly struck by the contrast between (a) the authoritative headline Salon slapped on the piece and (b) the density of confusion/misinformation these few paragraphs contained. I'm not a stem cell expert, so I can't tell if your miss rate was similar in the rest of the piece.
Posted by: Emma Jane | Saturday, June 11, 2005 at 03:12 PM
I'm going to add another nitpick, one that derives from my (European) perspective of (American) success rates and multiple rates. It is not true that 24% of frozen embryos result in babies; that is the success rate of cycles in which (several) frozen embyos were transfered. The CDC also provides the average number of frozen embryos transferred per cycle in the U.S. -- 3 or 4, I think. About half of frozen embryos do not survive the thawing process, and the success rate per embryo is obviously far lower.
In the same vein, it is not embryo implantation that causes multiples; it is usually (in the case of IVF) the implantation of multiple embryos that causes multiples. In Europe -- and more specifically, in countries where IVF is regulated and subsidized as part of a national health system -- fewer embryos are transfered per cycle. Belgium, for example, now has one of the strictest laws concerning transfers. The law was introduced at the same time that Belgium decided to fund most of the IVF process as part of national health coverage, and the rate of multiples is now far lower than in the U.S. (although the pregnancy rate per cycle is apparently not much lower). So the multiples problem -- when people begin to see it as a problem -- is manageable.
Now that I've added my wee vituperation, I'd like to defend the author of the Salon piece. I also found the article riddled with assumptions and slippages, but -- hey -- it also seemed to be heading in the right overall direction, no? I was glad to see Manjoo argue with Bush's snowbrained scheme, and his argument contained fewer fudge's than the president's.
Posted by: swisschard | Saturday, June 11, 2005 at 04:57 PM
Emma Jane --
I'm definitely not trying to flame, but it seems to me there are some rather weird holes in your ennumeration of problems with the original article, above.
You deride Farhad's assessment of the motivations of infertile couples who might be candidates for embryo donation -- yet cite, to counter him, your own experience as someone who worked very specifically to carry a child genetically linked to both you and your husband. That's the point, it seems to me: while I don't have any quantitative research to back this up, I'd feel reasonably safe in stating that the major motivating factor for most people who seek some kind of medical intervention for pregnancy is that desire for a genetic connection with their infant (to quote you, "I cared. People do care"). If nothing else, that's what got the techniques developed.
It makes sense: not only is there a strong cultural bias towards biological children ("Aw, he looks just like his mother!"), but at a biological level, the desire to reproduce is strictly a desire to pass on our genes. Otherwise, why go to the trouble of raising a kid, let alone having one? (Note: this is strictly a sociobiological interpretation, not an attack on adoptive families).
So if someone can't/has decided not to try to reproduce via embryos created from her own eggs and the sperm of her choice, why would, in fact, a donated embryo be at all attractive? Sure, some research could be done on parent preference: would they rather deal with the bureaucratic hardships of adoption, or the medical hardships of embryo transfer? The answers might be surprising -- especially once you factor in the importance of prenatal care in a child's future health, and the control that carrying one's own pregnancy can give. But given that the entire infertility treatment industry has been built up out of the desire of parents for genetically-related offspring, it's a bit harsh to criticize Farhad's use of that as a reasonable basis for discussion.
Posted by: Ruth | Monday, June 13, 2005 at 09:36 AM
Ruth: you make excellent points. I think we agree about why people do fertility treatment; where we disagree is whether Farhad gets it! In this excerpt, I don't see genetic connection mentioned anywhere, by anyone. Except, perhaps, indirectly, when the the feelings of couples towards their own spare embryos are discussed. It's the elephant hiding behind the whole adoption/treatment treatment decision -- but this bit seems to be about couples who have already decided to forgo that connection. I think I just tried to enumerate some of the reasons why people might make that choice (one I didn't make myself) and how some of those reasons might interact with choosing donor embryo, rather than adopting a newborn, or older, child.
The Times article (which overall was more clued in) more or less said that using donor embryo can be cheaper and (currently) less bureaucratically unpleasant than traditional adoption -- and can provide prenatal environment control, which we are oh-so-obsessed with these days. But many of the couples will have already either tried, or considered and rejected, other forms of medical treatment -- and may be evaluating "convenience" in that context.
Posted by: Emma Jane | Monday, June 13, 2005 at 02:24 PM