Friday, September 17, 2004

Fertility Clinics Vary in Embryo-Disposal Methods

Fertility Clinics Vary on Embryo Disposal
Fri Sep 17, 7:50 AM ET
By DAVID B. CARUSO, Associated Press Writer

PHILADELPHIA - The nation's fertility clinics vary widely when it comes to how they perform one of the most delicate aspects of their jobs: disposing of unused frozen human embryos that were created to help infertile women become pregnant.
In a survey believed to be the first of its kind, 217 in vitro fertilization clinics across the country described the variety of methods they use to dispose of the frozen clusters of cells, which are the size of a dot and incapable of living outside a womb.
The reverence that some clinics gave to the task surprised researchers at the University of Pennsylvania and Rutgers University.
Seven clinics said they performed a quasi-religious ceremony, including a prayer, for each embryo they destroyed.
Seven others took the technically unnecessary step of culturing the cells in a lab dish, then allowing them to multiply on their own, briefly, before they perish.
Four insisted that, whatever method was chosen for disposal, the patient be present when it happens. Others barred them from being in the room, or recommended that they be uninvolved.
University of Pennsylvania bioethicist Arthur Caplan said the survey results, published last month in the journal Politics and the Life Sciences, show that the clinics have a level of moral sensitivity unrealized by the public.
"I don't think anyone who deals with these frozen embryos considers them to be persons," Caplan said. "But I think that they feel they are deserving of respect ... They see the potential for life in this material."
Other studies have estimated that there are about 400,000 frozen embryos in storage in the United States. Each has fewer than 100 cells.
Some religious groups, including the Roman Catholic church, have condemned both the creation of embryos in a laboratory and their destruction if they go unused, saying children should only be created by sex between a married man and woman.
In 2001, President Bush said he would no longer allow federal tax dollars to be used to make discarded embryos available for stem cell research.
Of the 217 clinics that responded to the survey, 33 said they were willing to create extra embryos as part of the in vitro fertilization process, but were not willing to dispose of them.
Almost all were willing to permanently preserve the frozen embryos in cold storage. About three in four clinics allowed patients to donate them to be used by other couples. Sixty percent allowed them to be donated for research.
Four clinics said they gave the thawed embryos back to their clients.
Dr. Stephen Somkuti, medical director of the IVF program at Abington Reproductive Medicine, said ethics policies at the Abington hospital, where his clinic is based, bar it from destroying any embryos itself.
Some patients simply toss the embryos out themselves, Somkuti said. Others take the small straws containing the cells home with them.
"Some people just decide to have us keep them in the freezer ad infinitum because they can't come to terms with what to do with them," Somkuti said.
Seven clinics, or about three percent of all that participated in the study, said that because of religious or ethical concerns, they would not create more embryos than they intended to implant, and thus had no cells to freeze or destroy.
Dr. Vincent A. Pellegrini, a fertility doctor in West Reading, Pa., said he wrestled with the issue for two years before deciding that destroying surplus embryos would be akin to "throwing away human life."
"It just wasn't an option," Pellegrini said. "Once we have a dividing embryo, it is human material I can't discard."
The policy poses an additional burden for patients. It requires that the clinic sometimes implant more developing embryos in a woman's body than they generally need to ensure a successful pregnancy, meaning that the women carry an increased risk of having twins, triplets or quadruplets.
Pellegrini said some patients decide to go elsewhere because of his policies. But he also attracts some patients who share his views.
"One couple came from the middle of New Jersey because morally, they had problems with it, and they couldn't find a clinic closer to them that could satisfy their concerns."