A moral minefield
Couples going through IVF should be allowed to choose what happens to their unwanted embryos, says Helen Pilcher.
Who should decide what happens when an embryo created in a fertility clinic goes unused? You might hope, as the potential parent, that the decision would be yours. But you could be disappointed, and so could the researchers who hope to benefit from material that would otherwise go to waste.
Every year, hundreds of thousands of couples undergo expensive, emotionally difficult fertility treatments in the hope of becoming parents. Many opt for in vitro fertilization (IVF), where eggs are fertilized in the lab and implanted back into the mother. But clinics often prepare more embryos than are needed, because they only transfer the best and most couples need more than one treatment cycle. So the question is: what should be done with the 'spare' embryos?
In the United States, there are no laws governing this area. Each of the 400 or so fertility clinics registered with the Society for Assisted Reproductive Technology stands alone, creating and enforcing their own policies. But, according to a recent study1, their policies differ... a lot.
Reviewing the options
At its most simple, there are three options: give the embryos away, store them, or destroy them. The first includes the possibility of donating spare embryos to medical research, but, alarmingly, only 60% of surveyed clinics give couples this option.
Researchers are crying out for embryonic tissue to study and the potential benefits of donation are enormous. There could even be direct advantages for the donors, albeit a few years down the track: by studying how early embryos develop, scientists may be able to improve the success of fertility treatments. At present, the success rate for IVF is a measly one in four. Studying embryos could lead to better screening processes, which would make healthy embryos easier to spot and mean patients would need fewer rounds of treatment.
Unwanted embryos can also be cultured in the laboratory and used as a source of stem cells. But these controversial cells could be something of a Pandora's box, and may be the cause of clinics' reticence about use the embryos for medical research.
Researchers argue that stem cells, which can turn into any of the 300 or so different types of adult cell, could be used to replace and repair damaged tissue. Such therapeutic cloning could offer treatments for a range of so-far incurable diseases such as Parkinson's disease and stroke.
Critics argue that their ideas will never bear fruit and that harvesting stem cells from a human embryo compromises its moral status, even though it is an unrecognizable ball of a few hundred cells.
Out of the clinic
But whatever your ethical view, should the offer of donating embryos to medical research really be left to the individual fertility clinics? In Britain, for example, clinics are obliged, if possible, to give couples this option.
If this option is not offered and a couple does not want to store their embryos indefinitely or donate them to other couples with fertility problems, there is only one other choice: to destroy them.
If that happens, we all miss out. Infertile couples have one less option. Researchers miss out on a vital and precious pieces of tissue that could further our understanding of embryology and fertility. Scientific progress is stymied, and medical progress is slowed.
This rare commodity should not be thrown away, at least, not without careful, considered thought. Couples need to give informed consent for any decision made. How is this possible in clinics where only part of the picture is presented?
- Gurmankin A. D., Sisti D. & Caplan A. L. Politics and the Life Sciences, 22:2. 2 - 6 (2004).
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