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Frozen generation

"Frozen generation" Continued...

Issue: "Malaria: Kill or be killed," Oct. 29, 2005

Some countries give couples, clinics, and scientists license to do almost anything they want with embryos. Great Britain's Human Fertilisation and Embryology Authority hands out licenses for human cloning and arranges egg swaps between infertile couples and young, fertile women. Italy, in contrast, passed a law in 2003 banning embryo freezing and limiting the number of embryos that can be fertilized during IVF. Earlier this year, that law withstood a public referendum to repeal portions of it.

The United States has no law governing IVF other than general medical licensure and health requirements. The government keeps statistics on IVF success rates, but clinic participation is voluntary. Only one state, Louisiana, has a statute that regulates the storage of IVF embryos and defines their legal status.

The United States' refusal to regulate IVF has close ties to the importance Americans place on privacy. In his book Brave New Families: Biblical Ethics and Reproductive Technologies, Biola University professor Scott Rae traces how the Supreme Court secured "procreative liberty" in the United States with cases like Eisenstadt v. Baird, a case over an unmarried couple's right to use contraceptives.

In the majority opinion of that case, Justice William Brennan wrote: "If the right of privacy means anything, it is the right of the individual, married or single, to be free from unwarranted government intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child." In other words, reproduction is none of the government's business. It is, however, the business of the doctors who perform IVF-big business.

According to the American Society of Reproductive Medicine, the average cost of one round of IVF in the United States is $12,400, which health insurance may or may not cover. Retrieving eggs from a woman's ovaries can account for as much as half of the cost-and most of the inconvenience-of IVF. Before egg retrieval, a woman has to take expensive medicine to make her ovaries produce more mature eggs than normal. The drugs can cause side effects like bloating, nausea, diarrhea, and sometimes severe enlargement of the ovaries. Then a doctor retrieves the eggs from the woman's ovary with a small needle, usually while the woman is sedated.

The U.S. success rates for IVF hover around 30 percent, so clinics counsel their patients to prepare for multiple rounds of treatment before conceiving. Almost half of the women who underwent IVF in 2002 had had the treatment before, according to the Centers for Disease Control.

Given those facts, it's easy to see why embryo freezing became so widespread. By retrieving enough eggs for three or four cycles at once, couples could greatly reduce the cost and discomfort of future cycles. Doctors had to fertilize the eggs first because the freezing process typically destroyed unfertilized eggs. Only embryos could survive freezing and thawing.

By the late 1980s, embryo freezing had become an integral part of all assisted reproductive technology, not just IVF. Doctors took for granted that couples like Greg and Kathy May of Irvine, Calif., wanted to freeze their eggs.

After failing to conceive a second child following the birth of their son Bryan in 1987, the Mays chose to undergo gamete intrafallopian transfer (GIFT). GIFT is similar to IVF, but instead of fertilizing the eggs in a dish, the doctors implanted the egg and sperm separately into the fallopian tube. As in IVF, Mrs. May underwent ovarian stimulation and egg retrieval. She and Greg even drove an hour and a half to Mexico to buy the necessary drugs at a lower price.

Doctors harvested nine eggs and implanted four. The other five they fertilized in vitro and froze. Mr. May said he looked at the frozen embryos as a kind of "insurance policy," in case Mrs. May did not get pregnant on the first try.

"That was a lot less expensive than having to go to Mexico," he said. The first attempt succeeded. On Dec. 30, 1992, Mrs. May gave birth to triplets: Melissa, Stephanie, and Doug.

The years following the triplets' births are a blur of excitement in Mrs. May's memory. Keeping up with a grade-schooler and three babies left little time to think about the five leftover embryos frozen at the clinic at Saddleback Memorial Hospital. Once a year, the Mays paid the clinic's storage fee, not yet ready to decide what to do with the embryos. A few years after the triplets' birth, they decided to give them up for adoption.

What the Mays lacked, at least early on, was spiritual guidance. When the Mays first discussed their infertility with their friends from church and Bible study, they received encouragement. "They all said, 'God has given the doctors this wisdom. You should try it . . . God's in total control,'" Mrs. May said. The topic of embryo freezing never came up. The only literature the Mays read before the procedure was provided by the clinic.

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