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IVF embryos meet contrasting fates

August 27, 2004 By Emma Marris This article courtesy of Nature News.

Confusion reigns over how US fertility clinics deal with their 'waste'.

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What happens to the human embryos created during in vitro fertilization that do not get implanted? A study of IVF clinics in the United States has revealed that they meet incredibly varied fates.

The possibility of using stem cells from human embryos has sparked fierce debate over the moral status of these tiny balls of cells. Although the issue is causing problems worldwide, it has become particularly politicized in the United States. President George W. Bush, for example, is strongly opposed to the harvesting of stem cells from embryos created during IVF.

Yet a study has revealed that there is already a disturbing lack of consistency in the way in which such waste embryos are treated in the United States. Depending on the clinic, they can be frozen indefinitely, given a religious funeral, donated to scientific research or incinerated as biological waste.

Too many embryos

When a couple or individual struggling to conceive goes to an IVF clinic, the woman takes drugs to stimulate egg production. Her eggs are then extracted, and fertilized in a dish. Often, more eggs are successfully fertilized than it is desirable or safe to implant.

Some countries, including Britain and Canada, have rules about what happens to the spare embryos, and what level of consent is needed from the couple involved. But there is no such regulation in the United States.

Andrea Gurmankin of Rutgers, the State University of New Jersey, and colleagues sent anonymous questionnaires to the heads of almost 350 IVF clinics, asking what they did with the extra embryos. The results will appear in next month's Politics and the Life Sciences1.

A total of 217 clinics responded to the questionnaire, describing a hodge-podge of practices based on varying ethical frameworks.

About 3% of clinics managed to avoid creating superfluous embryos. Some 16% of the clinics that created extra embryos refused to dispose of them, often because of religious reasons, state laws, or from fear of being sued. These clinics kept the embryos frozen forever or donated them to other infertile couples.

Varied fates

The approaches of the 175 clinics that did dispose of extra embryos varied in the extreme. Some handed the tiny ball of cells over to the couple or individual to take home, whereas some incinerated them as biological waste. Of the clinics that incinerated the embryos, four required the presence of the couple while twenty-five clinics forbade it. Seven clinics even said a prayer during disposal in a quasi-funeral, according to Arthur Caplan, a co-author of the study from the Center for Bioethics at the University of Pennsylvania in Philadelphia.

The majority of clinics surveyed donate extra embryos to research institutions, with the permission of the couple or individual involved, although the clinics varied in the level of consent that was required and how this was obtained. Stem-cell lines derived from these embryos are ineligible for federal funding, however, under current US rules.

Informed consent?

Caplan says he was flabbergasted at the diversity of practices that the questionnaire uncovered: "It blew me away." He points out that it is not clear how much couples are told about the options available to them when they enrol at a particular clinic.

"Our results highlight the importance of fully disclosing disposal options when couples first consider enrolment," he says. "Little is known about how clinics deliver this information or about the proportion of couples who, in retrospect, feel they were not fully informed."

Richard Kennedy of the British Fertility Society agrees that the results underline the importance of treating such tissue in a standardized way. "The use of human embryos is a very sensitive area," he says. "They do represent a life. So it is important to have a regulatory framework in place that gives people clear guidelines."

References

  1. Gurmankin A., Sisti D. & Caplan A.Polit. Life. Sci., (in the press).

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