Last year -- for the second time -- the U.S. Department of Health and Human Services gave away nearly $1 million in grants to promote awareness of embryo donation, a fertility procedure wherein a couple's embryo is implanted in a woman's womb and, assuming the pregnancy takes, raised as her child. Such embryos are normally donated by couples whose in vitro fertilization (IVF) procedure (in which the egg and the sperm are combined outside the body and then implanted) has yielded more embryos than they intend to make use of. Rather than keeping the embryos frozen indefinitely, offering them to fertility researchers or disposing of them, the donor couple -- either anonymously or in an "open" process -- makes them available to a woman who can, in many senses, give them a good home. The appeal of impregnation with a donor embryo includes the relatively low cost -- thousands of dollars as opposed to tens of thousands of dollars with a donor egg -- along with the experience of pregnancy. "I can't afford to use eggs," says Kim Bell, 40, of Howard Beach, N.Y., who is currently searching online message boards for an embryo donor. Embryo donation, she says, "would give me a chance to nurture the baby from the very start."
Embryo donation has been medically available, though not widely used, since the 1980s. A 2003 Harris poll commissioned by RESOLVE: The National Infertility Association, and funded in part by a 2002 HHS grant, found that 75 percent of people diagnosed with infertility who had considered treatment believed that they did not have enough information about embryo donation to make an informed decision about whether to try it. IVF clinics currently offer a patchwork of embryo-donation information and services, and the number of wait-listed would-be recipients far exceeds donor-embryo supply. Hence the effort to "promote awareness."
Now, however, this personal reproductive decision is also becoming -- with the switch of just one word -- political. HHS, along with some of the organizations it supports with funding, explicitly calls the process embryo "adoption."
"There's no such thing as embryo 'adoption,'" says Sean Tipton, spokesperson for the American Society for Reproductive Medicine. "You adopt a child. Embryo donation is a donation of medical tissue, like sperm or an egg. The groups that advocate 'adoption' have a vastly different and rather transparent political agenda. [They] have a very high political stake in establishing that a fertilized egg is a human being with legal rights and moral standing."
Most people who believe that embryos can be adopted, even symbolically, believe that embryos are children, or even, in the words of one conservative columnist writing in favor of embryo adoption, "microscopic Americans." And, the logic follows, if embryos are mini-children, they shouldn't be mined for stem cells -- which they can't be anyway, given the limits President Bush imposed in 2001-- or lost to abortion.
"The attempt to change the vocabulary around embryos is part of a larger strategy to elevate the fetus to 'personhood' under the 14th Amendment -- and an effort to overturn Roe," says Suzanne Martinez, vice president for public policy at the Planned Parenthood Federation of America. The imposition of the term "embryo adoption," she says, goes hand in hand with other ongoing efforts to confer personhood on embryos and fetuses: laws that make it a separate criminal offense to harm a fetus, for example, or government insurance plans that cover "an individual in the period between conception and birth up to age 19." What do those have to do specifically with Roe vs. Wade? Though the 1973 Supreme Court decision legalizing abortion turns largely on the right to privacy, it also notes -- in an aside that has become anything but -- if fetuses were "people," they would be entitled to protection under the 14th Amendment, and abortion would still be illegal. The Center for Women Policy Studies has stated that "legislative efforts to establish fetal patienthood, victimhood and, therefore, personhood represent the primary threat to Roe v. Wade."
As far as current law is concerned, the word "adoption" in the context of embryos is purely symbolic. "Embryo 'adoption' is a misnomer from a legal perspective," says Susan Crockin, a Boston-area attorney who frequently writes about reproductive technology law. "In every state, adoption is a very specific, statutorily mandated set of procedures applicable to born children, birth parents and adoptive parents, and that model does not fit embryo donation." Currently, only eight states have enacted statutes that govern parental rights in embryo-donation arrangements: All but one use the term "donation" and state that an embryo donor is not a parent. Only Louisiana identifies embryos as "juridical persons" that are subject to "adoption." (Specifically, if fertility patients in that state terminate their rights to an embryo, the embryo cannot be destroyed or otherwise donated; it must be made available for "adoptive implantation" -- but only to married couples.)
Still, while Martinez and other abortion rights activists don't think the word "adoption" is going to sink Roe, they point out that the increasingly widespread use of the word -- as well as the implicit recognition of it by the federal government -- is a poisonous rhetorical arrow in the quiver of the anti-abortion (and anti-stem cell research) forces.
"The more people talk about it as 'adoption' rather than 'donation,' the more we as a culture start changing," says Martinez. "This is part of a concerted strategy. One day we're going to wake up and they're going to ask the court to say that society has recognized that a fetus is a person."
Recipients of HHS public-awareness grants do include RESOLVE, which uses the term "donation" and supports embryonic stem cell research (it received $236,000 in 2002 and $120,000 in 2004), along with the American Fertility Association, whose president, Pamela Madsen, opposes both the term "adoption" and the conflation of infertility treatment and abortion politics. (The AFA received $197,000 in 2003.) Another 2002 recipient (of $223,000) was the Women and Infants Hospital in Providence, R.I., the primary teaching affiliate for Brown University Medical School in obstetrics, gynecology and newborn pediatrics.
But at least five other organizations the HHS grants support are doing their part to contribute to what President Bush calls a "culture of life."
The Christian Medical and Dental Associations, the nation's largest faith-based organization for doctors -- which opposes abortion and stem cell research and supports the Unborn Child Pain Awareness Act -- is sharing $304,000 with the Baptist Health System Foundation, Bethany Christian Services and the National Embryo Donation Center (NEDC), which is housed at Knoxville, Tenn.'s Baptist Hospital for Women and which offers medical, legal and psychological services for embryo donors and recipients. (The salary of the NEDC's spokesperson, who travels around educating infertility clinics about the center's services, is paid by HHS.) In that regard, they're doing much the same work as RESOLVE -- and they share the goal of tapping into the estimated 400,000 frozen embryos currently stored in the U.S. -- but they're coming from a different place.
"If you believe that an embryo is human life, you think there ought to be something better to do with that human life than to discard it," says Dr. Jeffrey Keenan, director of the NEDC. After about a year in operation, the center has approximately 200 couples wait-listed for embryos and about 80 sets of embryos available; they've performed eight embryo transfers, resulting in two pregnancies, and have just completed seven or eight additional transfers. Keenan acknowledges that his views, and the Christian overtones of many embryo "adoption" endeavors, are "part of the pro-life spectrum."
Nightlight Christian Adoptions, home of the eight-year-old Snowflakes embryo adoption program, received $506,000 in 2002 (roughly half that year's grant) and $329,000 in 2004. Snowflakes functions not merely as a donor-recipient matching service but also, in many ways, as a traditional adoption agency, requiring prospective adopting families -- who are selected by the genetic parents -- to undergo screenings and complete classes on the raising of adopted children. Since 1997, they have matched 207 genetic families with 136 adopting families, with a live-birth success rate of 35 percent.
"Nightlight Christian Adoptions does take the position that the embryo is an unborn child, and we have 85-plus children here and on the way that unequivocally prove that," says Lori Maze, director of the Snowflakes program. "We also believe that children are adopted and not donated, but we don't use the term 'adoption' to further any political or legal agenda. When we use the term 'adoption,' as opposed to 'donation,' we are using it from a social service perspective, focusing on the child who results from the adoption of those embryos. Any resistance to embryos being adopted is simply a matter of some portions of society being overly sensitive to anything that they perceive might give greater value or importance to the human embryo."
Likewise, Nightlight's executive director, Ron Stoddart, said in a 2004 press conference that the use of the word "adoption" is a means of recognizing the emotional effect of the arrangement on the child. "We don't talk about children being born from an embryo transfer as being 'donated,' we talk about them being 'adopted.' By creating a positive emotional framework for embryo transfers from one family to another, we respect the contribution of the genetic family and, most importantly, reinforce the identity of the adopted child."
Snowflakes, however, has not sat on the political sidelines. That press conference -- held in the Capitol last September with seven Republican senators present including Rick Santorum, R-Pa. -- was sponsored by Snowflakes to voice its opposition to H.R. 4682, the Stem Cell Research Enhancement Act of 2004, which would revoke the Bush policy limiting federal funding to embryonic stem cell lines created prior to August 2001.
Critics of embryo adoption claim that proponents of the term tend to exaggerate the number of actual available, viable embryos -- along with the notion that they're trapped somewhere in a "frozen orphanage" waiting to be rescued. According to a May 2003 study conducted by the Society for Assisted Reproductive Technology with the Rand Corp. and published in the journal Fertility and Sterility, of the estimated 400,000 embryos cryogenically preserved in the U.S., about 88 percent still belong to the families who created them; only 2 percent were earmarked for donation to others. What's more, their quality deteriorates over time, and many do not survive the thawing process.
Might some of those who own the 88 percent be persuaded to offer them for donation when they feel their families are complete? Maybe, but it's a hard sell. In other words, organizations promoting embryo donation -- no matter what they call it -- have their work cut out for them. Far removed from the rhetorical skirmishes and political banner waving, actual couples face the nuances and complexities of infertility, agonizing over their decisions.
A study by Dr. Susan Klock, of Northwestern University's Feinberg Medical School, found that 20 to 30 percent of couples who freeze embryos after IVF say that when the time comes to decide what to do with them, they'll donate -- but three years later, two-thirds of them change their minds. Attorney Crockin says that of the dozens of people who come to her every year for legal help with donating their embryos to another couple, one-half to three-quarters wind up backing out after they receive counseling. And she hears similar numbers from her colleagues nationwide. "We can't get 5 percent of our patients to even think about it," says registered nurse Mary Fusillo, the third-party coordinator at Houston's Center for Reproductive Medicine, a member of RESOLVE's board of directors, and herself an initially reluctant embryo donor.
Fusillo also says that among her peers with frozen embryos in storage -- which can cost several hundred dollars a year in storage fees -- offering them up for stem cell research would be Plan A. Not comfortable with either donation or destruction, they see no other Plan B but to keep them around. "I'm not doing anything with them until I'm 50," she once heard a woman say. "I can't bear the thought of giving them to someone else, or destroying them, so I'm going to leave them in the freezer."
What makes donation so challenging? For many people, it's just difficult to think about somebody else's body -- or home -- housing your baby. Those who work with families considering embryo donation say that at first -- especially when they identify with another couple's infertility struggles -- it sounds like an amazing, generous, satisfying thing to do. But once they have children -- or when they don't -- it becomes hard to stomach the notion of someone else having a child who's a genetic sibling to theirs, or someone else having the child they couldn't.
Efforts at raising embryo donation "awareness" may be increasing, and some may be effective -- alarmingly so -- in shifting public consciousness, even subliminally, toward a view of the embryo as an adoptable human. But persuading women to donate their embryos is another story. Politics and religion aside, many women already do view an embryo as potential life -- life that they gave. Which is precisely why they won't give it away.