For more than 20 years, infertile couples have been storing embryos for future children. Now there's an oversupply, and parents and doctors are struggling with the ethics of disposal, says LIZA MUNDY.

Aanis Elspas is a mother of four. Unlike most parents, she had three of her children simultaneously. The 9-year-old triplets were born in 1997 after Ms. Elspas underwent a series of in vitro fertilization treatments for infertility. Her oldest child, 10, is the happy result of a prior IVF treatment round. Ms. Elspas worked hard to get her children and is grateful to have them. But four, thanks very much, are plenty.

The problem is that Ms. Elspas also has 14 embryos left over from the treatment that produced her 10-year-old. The embryos are stored in liquid nitrogen at a California frozen storage facility - she is not entirely sure where - while Ms. Elspas and her husband ponder what to do with them.Give them away to another couple, to gestate and bear? Her own children's full biological siblings - raised in a different family? Donate them to scientific research? Let them ... finally ... lapse? It is, she and her husband find, an intractable problem, one for which there is no satisfactory answer. So what they have done - thus far - is nothing. Nothing, that is, but agonize.

"I don't have the heart to thaw them," says Ms. Elspas, who works as media-relations director for a multibirth networking group called the Triplet Connection. "But then again, I don't have the will to do something with them."

Ms. Elspas is by no means alone, either in having frozen human embryos she and her husband must eventually figure out what to do with, or in the moral paralysis she feels, surveying the landscape of available choices. In fact, she is part of an explosively growing group. In 2002, the Society for Assisted Reproductive Technology - the research arm for U.S. fertility doctors - decided to find out how many unused embryos had accumulated in the nation's 430 fertility clinics. The RAND consulting group, hired to do a head count, concluded that 400,000 frozen embryos existed - a staggering number, twice as large as previous estimates. Given that hundreds of thousands of IVF treatment rounds have since been performed, it seems fair to estimate that by now the number of embryos in limbo in the United States alone is closer to half a million.

This embryo glut is forcing many people to reconsider whatever they thought they thought about issues such as life and death and choice and reproductive freedom.

It's a dilemma that has been quietly building: The first American IVF baby was born in 1981, less than a decade after Roe vs. Wade was decided. Thanks in part to Roe, fertility medicine in this country developed in an atmosphere of considerable reproductive freedom (read: very little government oversight), meaning, among other things, that responsibility for embryo disposition rests squarely with patients. The number of IVF rounds, or "cycles," has grown to the point that in 2003, about 123,000 cycles were performed to help some of the estimated one in seven American couples who have difficulty conceiving naturally.

Early on, it proved relatively easy to freeze a lab-created human embryo. (To be precise, the technical term is "pre-embryo," or "conceptus"; a fertilized egg is not considered an embryo until about two weeks of development, and IVF embryos are frozen well before this point.) Over time - as fertility drugs have gotten more powerful and lab procedures more efficient - it has become possible to coax more and more embryos into being during the average cycle. Moreover, as doctors transfer fewer embryos back into patients in an effort to reduce multiple births, more of the embryos made are subsequently frozen.

And so, far from going away, the accumulation of human embryos is likely to grow, and grow, and grow. And in growing, the embryo overstock is likely to change - or at least complicate - the way we collectively think about human life at its earliest stages, and morally what is the right thing to do with it. At some point, embryos may alter or even explode the reproductive landscape: It is IVF embryos, after all, that are at the center of the nation's stem cell debate, which itself has prompted a new national conversation about life and reproductive liberty, creating new alliances as well as schisms.

In the course of the stem-cell research debate, embryos have emerged as another tool for truly hard-line conservatives looking for new ways to beat back abortion rights. But the impact of the embryo is also taking place on a more subtle and personal level. The glut's very existence illuminates how the newest reproductive technologies are complicating questions about life; issues that many people thought they had resolved are being revived and reconsidered in a different emotional context.

As with ultrasound technology - which permits parents to visualize a fetus in utero - IVF allows many patients to form an emotional attachment to a form of human life that is very early, it's true, but still life, and still human. People bond with photos of three-day-old, eight-cell embryos. They ardently wish for them to grow into children. The experience can be transforming.

"I was like, 'I created these things, I feel a sense of responsibility for them,' " is how one IVF patient put it. Describing herself as staunchly pro-choice, this patient found that she could not rest until she located a person - actually, two people - willing to bring her excess embryos to term. The presence of embryos for whom (for which?) they feel a certain undefined moral responsibility presents tens of thousands of Americans with a dilemma for which nothing - nothing - has prepared them.

A new demographic is wrestling with questions initially posed by contraception and abortion. A world away from the exigencies, mitigating circumstances and carefully honed ideologies that have grown up in and around U.S. abortion clinics, it is people like Janis Elspas who are being called upon to think, hard, about when life begins and when it is - or is not - right to terminate it. Among the nation's growing ranks of IVF patients, deciding the fate of frozen embryos is known as the "disposition decision," and it is one of the hardest decisions patients face, so unexpectedly problematic that many decide, in the end, to punt - a choice that is only going to make the glut bigger, the moral problem more looming and unresolved.

To show just how difficult embryo disposition can be: Dr. Robert Nachtigall, a veteran San Francisco reproductive endocrinologist, directed a study of patients who had conceived using IVF together with egg donation, another rapidly growing niche of fertility medicine. As Dr. Nachtigall and his colleagues at the University of California-San Francisco were interviewing these parents, they were struck by comments made, separately, by several couples. Hard as it was deciding whether to go ahead with egg donation, these parents said, it was harder still deciding the fate of their leftover embryos.

"Until recently, I don't know if any of us were aware of the scope of the embryo dilemma," Dr. Nachtigall told colleagues at the 2005 annual meeting held by the American Society for Reproductive Medicine (ASRM), the trade group for fertility doctors. Struck by these unprompted revelations, he and fellow researchers decided to do a new study, this one looking explicitly at the way patients think about their unused, iced-down embryos.

Dr. Nachtigall found that even in one of the most liberal regions of the country, few were able to view a 3-day-old laboratory embryo with anything like detachment. "Parents variously conceptualized frozen embryos as biological tissue, living entities, 'virtual' children having interests that must be considered and protected, siblings of their living children, genetic or psychological 'insurance policies,' and symbolic reminders of their past infertility," his report noted. Many seemed to think of them simultaneously as both children and tissue. For virtually all patients, Dr. Nachtigall found, the disposition decision was torturous, the end result unpredictable. "Nothing feels right," he reported patients telling him. "They literally don't know what the right, the good, the moral thing is." "You weigh what's best," Dr. Nachtigall quoted one parent as saying, but what's best is not often clear. This parent continued: "Are they people? Aren't they people? In part of my mind, they're potential people, but the point is, it seems odd to me to keep them frozen forever. It seems like not facing the issue."

It should be noted that the confusion felt by parents is shared by the minds who guide American jurisprudence. As University of Wisconsin law professor and bioethicist Alta Charo pointed out at the 2005 ASRM meeting, the embryo issue tends to emerge as a point of dispute in divorce cases.

For the most part, courts often do regard embryos as property, but property with an elevated moral status, "like pets, or natural resources, or pieces of art," as Ms. Charo put it.

The federal government, in its role as regulator, has found the embryo a slippery creature to define. Despite President Bush's advocacy of "embryo adoption," which could imply a belief in the moral personhood of the embryo, "tissue" remains the designation conferred on embryos by the U.S. Food and Drug Administration. Like abortion rights groups, the infertility field likes this designation, which helps preserve for it total reproductive freedom by encouraging the notion of the embryo as a multicelled clump of tissue.

But the idea of potential personhood has clearly been implanted, so to speak; human embryos are going to continue to be a political battleground as anti-abortion advocates include them in the umbrella concept of "pre-born life."

Unnerved, advocacy groups for the infertile and those who serve them called a press conference in 2005, where Sean Tipton, spokesman for ASRM, said that "patients control and make the decision about what happens with those embryos, and that's the way it is now, and it's important that that's the way it stays." The problem is that many patients do view embryos as nascent human life and, paralyzed by this thought, cannot decide how to decide.

It's an issue that affects anybody with an interest in reproductive issues - which is to say, pretty much every American. Some think that the embryo glut may offer the next serious challenge to Roe.

California Rep. Dana Rohrabacher, a reliably anti-abortion Republican member of the House, was one of some 50 Republicans who defied the president by voting in favor of federal funding for stem cell research using surplus IVF embryos.

For Mr. Rohrabacher, it was not abstract: He and his wife, Rhonda, went through IVF treatment and have triplets as a result. Going through that process, Mr. Rohrabacher told me, fundamentally changed his thinking about life and its origins. That conception can take place outside the human body is, for him, a meaningful difference.

"I don't think that the potential for human life exists in a human embryo until it's implanted in a human body," says Mr. Rohrabacher. "So you are not destroying a human life by basically not using a fertilized egg."

The embryo glut presents an immediate and pressing problem for the very people who helped create it: fertility doctors. In clinics around the country, doctors are at their wits' end trying to figure out what to do with abandoned embryos that have fallen, willy-nilly, under their moral, medical and, possibly, legal purview.

"Nobody does it [destroys abandoned embryos]," says Alan DeCherney, the editor of Fertility and Sterility and a reproductive endocrinologist who is now at the National Institutes of Health. "It's a hot topic. People think the risk of holding them is less than the risk of destroying them."

So what are we going to do with our embryo glut? Robert Nachtigall believes that with better patient counseling and logistical coordination between fertility clinics and research labs, many more unused embryos could be directed toward stem cell research.

The problem is, few fertility clinics counsel patients about disposition, at least not at any length; and because of the ban on federal funding, few labs can receive human embryos for research. Nor has the fertility profession served itself or its patients entirely well, encouraging the idea that embryos are multicelled clumps of tissue. They are multicelled clumps of tissue, it's true, but they are also more complicated and more emotionally fraught.

One of the powerful findings of Dr. Nachtigall's study was how isolated patients felt in making the disposition decision; how they longed for counseling, advice, an out-loud, moral conversation between people who had been through, and thought through, the same issues. Whether the reproductive rights community might ever hold such a grand, collective conversation seems unlikely in this charged political atmosphere. But it would be useful, to put it mildly.

Meanwhile, after weighing all the options and rejecting them, one patient says wryly, but a little wearily: "Maybe when I die, they'll just bury my embryos with me."

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