Friday, July 21, 2006
IVF, frozen embryos, and research
Our Fearless Leader used his veto power for the very first time in six years of presidency this week to veto the legislation allowing federal funding for embryo stem cell research. To those without any experience with in-vitro fertilization, the estimated 500,000 embryos on ice are seen as guaran-damn-teed babies. To those who have experience, those 500,000 maybe...maybe...represent 25,000 babies. Maybe. Those embryos are a vast potential. But it's not a baby to anyone who has gone through IVF until it's a baby in your arms, kicking, squalling, and wanting to EAT. Too many of those of us who have done IVF know just how fragile and fleeting a thing the whole process can be. First you have to have follicles make real eggs. Lots of things that look like follicles on the ol' dildo-cam (vaginal ultrasound, great fun, folks--guys, just think high-level prostate exam, and you'll get an idea) end up being empty, fluid filled sacs that, when punctured by the nine-inch long needle deflate as rapidly as your hopes. Then your real eggs need to meet real, manly sperm. Strong sperm. Healthy swimmers. Sometimes, this requires a certain amount of help from yet another needle. Throw in a hope or two that the egg and sperm combo actually does the fertilization waltz. Now you've got an embryo. That embryo has to start dividing. It has to keep dividing in that warm, nurturing petri dish. Some embryos stop dead right there. Let's say it's dividing nicely. So your doc and embryologist take a peek at the embryos to decide which ones to transfer. (Note that word: TRANSFER. NOT "implant".) So if you've got a couple of nice-looking embryos--which is a sheer matter of judgement call--to pop inside the warm, nurturing uterus. If it's a first try, and you're young enough, they'll put two in. If you're older, or it's your third or fourth or fifth try, they'll put in more. Sometimes, if the embryos don't "look nice", they'll put more in, also. Now a miracle occurs. (Some of you may recall the cartoon with that phrase in it.) Hopefully, one of those embryos will IMPLANT in the uterine lining. "Implant" is a technical term, meaning a very specific thing, which is why I get all bent out of shape when people talk about doctors "implanting three embryos into the woman's womb". The docs don't "implant" anything. The embryo does it itself. If you're lucky, that implanted embryo will stick, and keep growing. Mine didn't; it hung around long enough to start producing pregnancy hormones, then went poof. This happens a lot. Then you've got to make it past the first trimester. Lots of those embryos don't. Now add in the question of how many frozen embryos actually thaw and stay alive (that is estimated at about 50%). I did some number crunching from the 2003 SART report, and came up with an overall figure of 11% of all embryos produced for IVF cycles result in a "take-home baby". In actuality, the number is probably somewhat lower, given the number of multiples that are actually identicals, in which case one embryo divided into two. This low number won't surprise anyone who has BTDT, but may come as a bit of a shock to people not in the know. When one does IVF, the docs give you a form to fill out to decide what to do with any leftover embryos if you're lucky enough to have extras. You have four options: freeze, donate to another couple, donate to research, or destroy. In my opinion, it's not anyone else's business what you decide to do with those extra embryos. It's a family decision, akin to deciding whether to pull the plug on a family member who is on life support. But one of those decisions is actually a chimera, because there is no federal funding for research on embryonic stem cells. So there are those 500,000 frozen embryos, and the political world keeps impinging on that private, family decision. If my husband and I wanted to donate our embryos to another couple or go through an "embryo adoption" situation, it would have been our decision to make. If we had wanted to donate to research, that should have been our decision to make. But in the U.S., lack of federal funding means that the only research being done using embryos is private research...and the private research funds are few and far between. Every couple who has embryos left over from an IVF cycle has to make that decision. It's a highly personal decision. Some people would like to think that their infertility ordeal could add something to the world for other people via embryo donation or adoption. Some would like to add something to the world via research. Some would just like to defer the decision as long as possible. Each of those options should be available. Waving your hands at adult stem cell research as a panacea and saying that embryos shouldn't be destroyed because you're taking a human life...it's not life yet. It's a glorious potential--a potential life, a potential research tool--but frozen on ice, all it is is a bunch of cells.