Would you adopt an embryo?
Evangelical Christian organisations and pro-life groups in the US match leftover IVF embryos with married couples who are desperate to have children but incapable of doing so, writes Rob Blackhurst
IN A low-rise office block in balmy southern California, the pastel walls are adorned with photographs of babies fresh from the labour ward – still wearing wrist tags and swaddled in hospital blankets – and a montage of elementary-school children with mops of blond hair.
A Post-it note next to the telephone is scrawled with a passage from scripture – if you have faith as small as a mustard seed and say to a mountain, move from there to there, it will move. Nothing will be impossible for you.
These children are the results of telephone calls to Nightlight Christian Adoptions – a non-profit agency at the heart of America's expanding West Coast Bible belt.
But these babies were not adopted at birth; their adoptive parents chose them when they were smaller than the head of a pin.
They were delivered in liquid nitrogen via FedEx. And, unlike many live babies who are adopted, they are the offspring not of 'crisis' pregnancies but of couples who created spare embryos while undergoing IVF and have decided to give them away.
Nightlight Christian Adoptions is one of a handful of organisations around the US that match married couples who want to 'adopt' with those willing to give away embryos.
Since its first embryo adoption, in 1997, its matching has resulted in more than 300 'snowflake' babies, so called by Nightlight because every frozen embryo is unique and precious.
There are an estimated 650,000 leftover embryos stored in US fertility clinics.
For Nightlight – which, as part of the pro-life movement, holds that life begins at conception – the fate of these embryos is a moral emergency.
In America, couples with unused frozen embryos have for years been able to donate them anonymously to infertile couples through IVF clinics. The number of babies born in this way is roughly 4,500.
But those who have gone through a formal adoption process are far fewer.
Embryo adoption, as practised by Nightlight (and so far practised only in the United States), is different in that it treats the adoption of an embryo exactly like the adoption of a baby, and a social worker employed by Nightlight will conduct a 'home study' to ensure that the home is suitable for the unborn adopted child.
Legally speaking, this is not adoption at all since, under US law, embryos are classified as property rather than people, so all that is needed is an agreement between the donor and the recipient couple.
And a woman who gives birth to a baby is the baby's presumed mother, regardless of the origins of the embryo, and the genetic parents relinquish all parental rights. Nightlight, however, encourages an 'open adoption', in which a child grows up knowing its biological parents.
So why, if it is not legally required, should a microscopic embryo less than three days old go through the same adoption process as a baby?
Daniel Nehrbass, the expansive, clean-cut former Baptist pastor in charge of Nightlight, is a torrent of enthusiasm.
"We have learnt over the past 100 years that every child not raised by its biological parents will eventually start looking for them," he said.
"Now we're repeating the mistake with assisted reproduction because we're creating a new set of anonymous parents through sperm and now embryo donation."
Nightlight encourages open adoption also because it is an explicitly pro-life organisation.
For genetic parents, knowing who will raise their biological child encourages them to give away spare embryos rather than to discard them.
The problem of spare embryos arises because IVF doctors cannot predict how many of the embryos they create will grow to be a good enough quality for implantation, and how many will die.
To save time and expense, they create multiple embryos in one procedure, since it often takes several implantations before a woman becomes pregnant.
However, if the first egg implanted results in a pregnancy, and the couple do not want any more children, they will have spare embryos frozen in storage until they decide on their fate.
Their options are to donate them to embryo research; to allow them to thaw and perish; to donate them to a couple who cannot have biological children; or to keep them deep frozen indefinitely for up to $1,200 (€870) a year.
There is no legal limit for how long embryos can be stored in America. (In British law, except in a very few cases of premature infertility, unused embryos must be destroyed within 10 years.)
Fifty miles from Nightlight Christian Adoptions, in Pasadena, a well-heeled suburb of Los Angeles, I meet Dr Jeffrey Nelson, the director of the Huntington Reproductive Centre, one of California's biggest IVF clinics.
"About 25pc of patients want to donate their [spare] embryos – not as many as I'd like," he said.
"People tend to hold on to their embryos because they don't want to make a decision. We started buying more and more cryopreservation tanks, and we finally had to say that there's a fee for a certain number of years' storage, and beyond that the price starts to escalate."
Dr Nelson, with his pro-life instincts, often requests that couples screening embryos for gender (legal under Californian law) allow him to retain embryos they were going to discard.
"I try to talk to my couples who are doing it. Let's say they want little girls – I say, 'Well, I can do that. But can I have the little boys, then?' I put them in frozen storage and use them for couples trying to get pregnant."
But there are, he admits, problems with local clinics, such as his, informally matching donors and adoptive parents, rather than going through a nationwide adoption service such as Nightlight, in that they may come from the same neighbourhood.
"We'd have people say, I'm fine to give up my embryos, but I don't want to walk into the 7/11 and see a baby and think, 'that baby looks an awful lot like me'. The snowflake programme is a great service because they can take these embryos and pool them [with other embryos from around the country].
"People are very comfortable saying, 'You have them, and I don't have to worry about seeing my baby next door'."
I spoke anonymously to a mother on the point of adopting embryos. She has already been through IVF twice, giving birth to two sets of twins.
One of her twins died suddenly when he failed to wake up from a nap one Christmas, and she decided that, aged 43, she wanted to have more children, but she couldn't face going through the gruelling medication required for IVF again.
Like other evangelicals, she had opted not to cryopreserve her own embryos during the previous rounds of IVF.
"I didn't want my people in a freezer," she says.
"The thawing process is just very dangerous – but we loved the idea of these other couples realising that they were children they had frozen, and placing them for adoption."
She feels inspired to rescue embryos: "Some people go to this because they can't conceive but we have heard really great teaching and preaching on rescuing these embryos. God says he can put any baby in your arms and he will make it yours."
Provided that an embryo has no life-threatening disease, she would be happy to adopt a child with health problems.
"No family has the cleanest slate," she says. "The other family that we were considering adopting from, the father had a cleft palate, so we did some research."
Her husband has "done very well for himself financially", she says, so they will be able to absorb any medical bills.
Eventually they decided not to adopt those embryos because the genetic parents wanted to keep in full contact for 18 years.
Instead they have found a couple willing to enter into a "closed' adoption – which Nightlight doesn't advise, but will facilitate if it means saving an embryo.
"As a mum, I could not watch another mum raise my children, so my husband said, 'You know, probably to protect the heart of that mother, we should have a closed adoption'."
Most of the adoptive parents have complex motives for their decision to adopt – a mixture of a desire for children, a concern about going through IVF, and a mission to preserve embryos.
But 36-year-old Tamara already has two biological children aged four and six, and describes herself as a 'rescuer' whose aim is simply to save frozen embryos.
"Having never had fertility issues I was different from almost everyone else that has done embryo adoption,' she says.
"We went to the fertility doctor and he thought I was crazy at first, so he sent me to a psychiatrist.
"I said to my husband, 'If we adopt an embryo, do you see that as taking care of a life in the same way as an orphan?" My husband's comment was, 'I can't think of anything that needs a home more than something that is frozen in liquid nitrogen'. Because of our world view, we believe that life begins at conception, when the sperm and egg get together."
They were matched with a couple in Ohio and received six eggs. A few days before we met, she received some shocking news.
"The lab called me to say that none of the embryos had survived the thaw. One of the six had got liquid nitrogen on it and exploded.
"We never in a million years thought that none of them would survive. Now we're back at the beginning of the process – matching with embryos again."
What motivates those who donate their embryos? Annabel Peterson (40) froze six spare embryos after giving birth through IVF. She had a second child conceived naturally and did not want another child.
"I knew I didn't want to give the embryos to research. I knew I didn't want to destroy them but I had a really tough time parting with them."
Finally she had a moment of revelation while taking a shower. "God spoke to me and said, 'These are not yours.' I said to my husband, 'You are going to do everything. I'll sign it but I don't want to see it.' We did the paperwork real fast."
In December 2011 they were matched with another Christian couple. She said: "I fell in love with this couple. They had the same fertility problem we had struggled with – male infertility. They were artistic, talented people. They wrote beautifully and were both involved in photography, which is one of my passions. I couldn't find anything I didn't like about them."
From the beginning, their relationship was very open.
"They came to our house. They had lunch with the children. That was wonderful."
During the pregnancy, the Petersons were sent the ultrasound pictures via email, which they shared on Facebook.
The birth mother videoed her baby opening gifts the Petersons had sent. Annabel felt a surge of recognition when she set eyes on her biological son.
"He looks like my brother," she said. "I lost him in 1995 in a car accident. He has a lot of his traits – his smile. His feet and his eyelashes are like mine. I see him as a distant cousin with whom I'm going to have a relationship forever – but I don't see him as my child.
"When my husband and I are gone, my kids are going to have an extended family to love them, somewhere to spend Thanksgiving together. How awesome is that? Of course, when he was born I cried – as much for joy as for loss.
"I couldn't give him his opportunity to live. Knowing that he has that opportunity, it's so much greater than my pain."
She has reconciled herself to the fact that it is the adoptive parents, rather than she, who will decide the ground rules.
"It's about their level of comfort and it's about their child.
"I don't know if this child is going to want to have anything to do with me or my kids – and there's a little pain in that."
Fallbrook, California, is a perfect slice of sunlit Americana, with verdant lawns tended by sprinklers, new SUVs in the driveways and pristine flower beds bordering wide suburban roads.
It is the avocado capital of the world, a conservative town with a can-do spirit. I am here to meet Hannah Strege, America's first snowflake baby, and her mother, Marlene.
In 1997 Marlene was diagnosed with premature ovarian failure at the age of 36. Her doctor suggested fertilising a donor egg with her husband's sperm.
"Through my tears – because I had just been hit with the news that we weren't going to have a baby – I said, 'Do you have any embryos we can adopt?'
"And he said, 'I've never been asked that question before but, yeah, we've got lots of embryos'."
This was a better option for the couple as they would not be "inviting a third party into the marriage bond" in the form of another woman's eggs.
They contacted Focus on the Family, an evangelical social policy lobbying group, which at the same time was asked by a Christian couple how they could put their embryos up for adoption.
"They got us connected, and it was a perfect match in terms of faith and ancestry – we're both of German descent."
After an FBI check and a home study, the adoption terms were agreed and the paperwork was signed. A batch of 20 embryos was sent by FedEx to a nearby clinic.
Only three of the 12 they thawed survived, and only one was successfully implanted. Marlene sees all this as part of a divinely ordained plan.
Embryo adoption became a cause celebre for Evangelical Christians when they pressured the Bush administration into withdrawing federal funding for stem-cell research (a move reversed by President Obama).
It offered an alternative solution when scientists argued unwanted embryos should be used for research.
And the existence of children who had started life in test tubes was an emotive campaigning tool for the Christian Right, making flesh their belief that life begins at conception.
Hannah Strege became, quite literally, a poster child for embryo adoption when she was born, in 1998.
Her baby face peered out of the New York Times, and the Republican caucus recruited Marlene to testify at Congressional hearings on stem-cell research.
"I said, 'Really? Talk about a sperm and egg before a Congressman?' I lost 9lb in three weeks preparing my speech.'
I finally meet Hannah. She is now 14, bookish, and ambivalent about media interest in her story.
It can be a lonely position being the oldest snowflake – all the others are several years younger.
When they are old enough, she wants to set up a Yahoo group to communicate with them.
And what advice does she have for snowflake parents?
"We have friends and learnt recently that she hadn't told the kids that they were adopted as children. They need to be open; they need to tell the kid their story. But they are the parent. Their parenting style is up to them."
In the National Embryo Donation Centre in Tennessee, a clinic that performs about 120 donor embryo transfers each year – more than any other clinic in the country – the resident embryologist opens a vessel like a milk churn, in which 5,000 embryos are kept.
Each embryo, invisible to the naked eye, is in a glass straw labelled with the names of its parents. It has been "vitrified" – its fluid removed and dipped in liquid nitrogen – so that it is instantly frozen without damage to the cell membranes.
More than three-quarters of the embryos here survive the thaw, slightly higher than the national average.
Once a month, on the same day, women come to this clinic from around the world (although none so far from Britain) for an embryo transfer.
In July, 22 embryo transfers were made, resulting in nine pregnancies, including four couples who are expecting twins.
Parents wishing to adopt compile a wish list of characteristics they would like, and are presented with the profiles of the biological parents who are the nearest match including such information as, for instance, that the father is Caucasian, 6ft 2in, 250lb and has a degree in chemical engineering.
Once the recipient has chosen the donor they would like, the donor accepts or declines.
"When we get inklings of 'shopping' for embryos we discuss it, and in some cases we have had to tell couples that we don't think their motivations are proper," Dr Jeffrey Keenan, the director of the centre, says.
"Those parents will be disappointed 100pc of the time – there is no such thing as a perfect child."
Dr Keenan is attempting to set up an online pool of embryos across the US to improve the chances of embryos finding someone willing to adopt them. He thinks that today's attitudes towards embryos will be judged harshly.
"It is quite easy to commodify human life and think, 'These are just a couple of cells that I put in liquid nitrogen,' and not have any second thoughts. But you have to think, 'Well, I started that way'.
"Any one of us could have been stored in cryogenic preservation. As people become older, they will look back at this and think, 'Gee, I did not take a good approach to this'."
Improvements in IVF technology now mean that fewer spare embryos are created, but those hundreds of thousands in deep-freeze limbo could last indefinitely.
According to Dr Keenan: "We have had embryos frozen for 14 years that have produced a child.
"It's certainly possible that these embryos could be viable 100 years from now."
But embryo adoption seems as if it will largely remain the choice of the devout minority.
For most people, the discomfort associated with destroying their embryos is outweighed by the more disquieting thought that another couple would raise their genetic children.
A 2008 Duke University Medical Centre survey of fertility patients found that only 16pc would be prepared to donate their embryos to another couple.
In 2009 only 57 embryos in Britain were donated by genetic parents to couples hoping for children.
And whereas once embryo adoption enjoyed strong political support in the United States, it is now facing a funding squeeze, with the Obama administration withdrawing federal funding for the awareness campaign around embryo adoption.
It is difficult to solve the question of what to do with all the IVF embryos entombed in ice.
Even for those who share the belief that such embryos are precious lives, embryo adoption can hardly make a dent in the industrial numbers of embryos being created and frozen in laboratories every day.
But Dr Keenan has done the maths on how many embryos he could give life to if only he could find wombs for them.
He says: "The chance that any one embryo will result in a baby is 11pc. So if you have 600,000 frozen embryos in the US, then if all those were donated then that would be the equivalent of 66,000 children."