By Susan Cooper and Ellen Glazer
Softcover, 400 pages
Choosing Assisted Reproduction: Social, Emotional and Ethical Considerations
A thorough but sensitive guide for infertility patients making complex decisions about whether, where, and how long to pursue treatment with assisted reproductive technology (IVF, GIFT, ICSI, etc) or whether to use the third-party-assisted family building options, including donor insemination, donor ova, donor or created embryos, surrogacy, gestational carrier.
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About the Authors Ellen Sarasohn Glazer and Susan Lewis Cooper
Ellen Sarasohn Glazer, is a clinical social worker with twenty years experience focusing on infertility, pregnancy loss, adoption and related issues. She is also program counselor at the Fertility Center of New England Memorial Hospital in Stoneham.In addition to her PPInc-published book, she is also the author of The Long Awaited Stork :Parenting after Infertility.
Her writing partner was Susan Lewis Cooper, Ph.D, who died in the spring of 2003 of pancreatic cancer. Susan was a psychologist in private practice with over twenty years’ experience specializing in infertility, adoption, and third party reproductive options. In addition she was a psychologist at the Reproductive Science Center-Boston and at Focus Counseling and Consultation, Inc., in Cambridge, where she was co-director.
The two Boston-based women met during years of working with RESOLVE (both served on its national board of directors) and struggling with their own infertility quests. Both women are members of the American Society of Reproductive Medicine’s Mental Health Professional Group. Together they wrote twp previous books (both now out of print) and Ellen wrote the still-in-print The Long Awaited Stork. One of their co-authored books, Beyond Infertility: The New Paths to Parenthood, was revised, rewritten, expanded and updated for a winter, 1998, release through Perspectives Press under the title Choosing Assisted Reproduction: Social, Emotional and Ethical Considerations
Excerpt: Choosing Embryo Adoption
This important and provocative article first appeared in the September, 2001 issue of the newsletter of the American Infertility Association and has been reprinted here with the author’s permission. Ms. Glazer is the co-author of the Perspectives Press, Inc.-published titles Choosing Assisted Reproduction (with Susan Cooper) and Having Your Baby Through Egg Donation (with Evelina Sterling)
For as long as in vitro fertilization has been a way to help make babies, would- be parents have had to face the possibility that their efforts might bear “too much fruit”–namely, that they might end up with more embryos than they were prepared to parent. Until recently, this possibility has been a quiet, private and for the most part, remote concern. Things are changing.
Stem Cell Research. Embryo Adoption. One need look no further than the front page of any newspaper to see alternative destinies for frozen embryos in bold relief. A father holds his twin sons, adopted as embryos, as testimony to the blessings he experiences from embryo adoption. Others, who suffer from illnesses, rare and common, tell of the new hope they see in stem cell research.
Fortunately, few IVF participants find themselves with extra embryos. Most have all their embryos transferred to them, either during their initial IVF attempt, or in a subsequent try, months or years after cryopreservation. It is only a small number of IVF parents who complete their families with embryos remaining and until the recent flurry of news about stem cell research and embryo adoption, most of these couples seemed to deal with the future of their embryos quietly and in private. Because few sought help with this decision, no one can know for sure how much they talked or thought about the “disposition” of their embryos. However, if the number of non-responses to fertility center inquiries are any indication, it surely seems that many couples deal with their decision through avoidance. It is all too common for fertility clinics to be unable to reach IVF parents to determine a plan for the embryos.
Today’s “frozen embryo parents”–couples who have cryopreserved embryos–can no longer approach their dilemma with avoidance or denial. Today’s couples are forced to seriously examine their thoughts and feelings about both stem cell research and embryo adoption. They must do so amid a clammer of opinions. To this cacophony, I add one infertility counselor and adoptive mother’s perspective.
Before I say–as loud and clear as I can–that I see stem cell research as a logical and desirable by-product of infertility treatment and embryo adoption as most likely to be profoundly damaging for the adoptees, their biological parents and siblings, I want to express respect for people’s religious beliefs. This essay is in no way intended as a challenge to religious principles. Rather, it addresses those infertile and formerly infertile families whose decisions about stem cell research and embryo adoption are not shaped by religious doctrine.
Why is stem cell research a “logical and desirable by-product of infertility treatment?” Many infertile couples are deeply troubled by the “high tech” aspects of IVF conception. Although grateful to have this technology available to them, they are troubled to have taken a most private part of their lives out of their bedrooms and into hospital labs. Conception through medical science feels “un-natural,” “like science fiction,” “weird,” “troubling.” As disturbing as IVF can be, the prospect that technology can lead to human wasteage, either through multi-fetal reduction or the discarding of embryos, is distressing. IVF couples sometimes feel that science has gone wild. Now stem cell research offers them an alternative perspective: extra life can be used to help save lives. Wonderously, science comes full circle when the unintentional by-products of technology are enlisted to aid in the treatment and cure of diseases. Infertile parents–the very same people who have struggled with the inability to give life–now have the potential to give life and more life and more life still. Barrenness becomes bounty.
But what of the alternative: embryo adoption? Is this not another way of giving life, of “curing” childlessness, of also transforming barrenness to bounty? Perhaps, but what of the children? How will they feel to know that, unlike other adoptees, they were created by people who desperately wanted to parent them. Unlike any other adoptee in history, their fate was not determined because a pregnancy was unplanned or unwanted or because social or financial circumstances prevented their biological parents from raising them. Rather, this new breed of adoptees will have been placed for adoption because of a simple twist of fate: an embryologist in a lab chose another embryo(s) for transfer. This new breed of adoptees will grow up knowing that the random choice of an embryologist meant that their biological siblings have the privilege of being raised by their intended parents and they do not.
It gets worse. In addition to the profoundly troubling challenges faced by these adoptees, who will live their lives knowing that their identities were shaped by a lab decision, there are the biological parents and biological siblings to consider. Surely the biological siblings will face some of the same questions as their adopted-out embryo sibs. “What if it had been me that landed in deep freeze?” “What if I had lost the opportunity to be raised by my parents?” “What would our family have been like if all of us were together?”
Although parents may feel that they are acting with informed consent, how can people who worked as hard as they did to achieve parenthood, know how they will really feel as they raise children grow knowing that their children¹s biological siblings are in other families. Presumably, these adoptions will be handled with complete openness because people recognize that it would be unconscionable to keep the truth from either the adoptees or their biolgical siblings, So what will it mean to parents when they see their adopted–out offspring struggling? Generations of adoptees have taught us that adoption is difficult, that questions of loss and identity inevitably arise, that those who lose their biological connection often struggle to make sense of their lives. Surely embryo adoptees will have a multitude of questions, challenges, “issues,” as they begin to comprehend their strange pre-birth, pre-gestation journey?
Just as adoptees have taught us about loss and identity, birthparents have poignantly described their own post-placement struggles. Although they may never doubt the “rightness” of their original decision–a decision made because they could not parent the child at that time–many grapple with feelings of regret, guilt, loss and self blame. Multiply this by ten or twenty or fifty fold with our embryo cryo-parents. Surely, they will react when they see their children¹s full biological siblings in another family. No doubt they will react all the more if there are problems within that family. How will they handle their feelings within themselves and as a couple? Will these parents, who have suffered this disenfranchised loss, take it out on each other and what will this mean for their marriages? Questions abound; answers are absent.
Adoption, as we have known it, is a solution to a social problem: a child is in need of parents. Need cries out, adoption answers. In so doing, adoption serves the best interest of children–new lives are entering the world and without adoption, they would have no one to feed them, change them, love them, teach them. It is difficult for me to view a cryopreserved embryo as having the same feelings, needs, destiny as a growing fetus. However, there are those who argue that life begins with fertilization, How then can they act in the best interests of their embryos? It seems to me that they face choices and the challenges of achieving truly informed consent.
In the twenty plus years that I have been meeting with IVF couples, I have known only three who said that they were deeply troubled by the prospect of discarding frozen embryos or donating them “to science” (it is important to acknowledge that stem cell research was not available to them and that had it been, they might have had a different reaction to “experimentation”). Each of their decisions represents a choice that I believe most everyone would regard as ethically and morally sound.
Couple A tried for several years to conceive. When several IVF cycles failed, they left treatment and sought adoption. However, the A’s had one cryopreserved embryo remaining for which they felt responsibility. They chose to have the embryo placed, without concern for timing, in the female partner’s vagina “to allow nature to take it¹s course.” As anticipated, Mrs. A did not conceive and the couple went on to successfully adopt.
Couple B had twins through IVF and when the twins were two years old, the parents decided that their family was complete. However, they, too, felt responsibility for their frozen embryos. Unlike couple A, Couple B felt that they had to do everything in their power to offer the embryos life. In keeping with their beliefs and their faith, they underwent a transfer cycle. Mrs. B did conceive but miscarried early in the pregnancy.
Couple C felt that they could never risk the possibility of having extra embryos to care for. Although Mrs. C produced several eggs each cycle, the C’s chose to have only three inseminated since they were prepared to have no more than three transferred. Because all three rarely fertilized, the C’s went through several cycles of having one or two embryos transferred. After many such unsuccessful cycles the C’s ended treatment and resolved to live without children.
Those of us who want to explore the promise of stem cell research, can feel sad that there are IVF couples who would choose other paths for their extra embryos. We might point out to them that these embryos might help save lives, including their own and those of their children. We could argue that they are choosing to “subject” their embryos to scientific technology in the first place when they choose IVF and that they should therefore make peace with their embryos continued participation in science. However, theirs is too profoundly serious and personal a decision and a choice to be criticized or bullied. Instead, I hope that couples who find themselves in this difficult dilemma will think about Couples A, B, and C. Each grappled with and found a principled alternative to the very troubling new option, “embryo adoption.”
Reviews of Choosing Assisted Reproduction
Library Journal’s April 15, 1998 issue carries the following starred review “In 1997 media attention focused not only on the birth of a child conceived with donor eggs by a 63-year-old mother but also on the birth of septuplets conceived as the result of fertility-enhancing treatments. Here, the authors (Beyond Infertility, LJ 4/1/94), who have been involved in the support and education of infertile couples for many years, explore in compelling detail the medical, legal, ethical and psychological implications of assisted reproductive technology (ART). The first part of the book explains the alphabet of treatments–IVF, GIFT, ZIFT, and ICSI–with a minimum of technical language, also covering pregnancy after ART and pregnancy loss. The second part looks in detail at third-party parenting options–sperm donation, ovum donation, surrogacy, gestational care, and embryo donation. The authors provide guidelines and suggestions for openness with childre born as a result of ART, strongly urging truth concerning genetic origins. A list of resource organizations and references completes this informative and well written book. Essential for anyone considering ART, this is highly recommended for most libraries.”
Choosing Assisted Reproduction goes far beyond other works on this subject. Cooper and Glazer cover an impressively wide range of issues with a thorough, informed and sensitive voice. Addressing each of the available assisted reproductive technologies and all of the potential participants in them, they examine the complex and interrelated medical, psychosocial, and ethical issues involved in family building through the assisted reproductive technologies. A valuable contribution to this growing field, this is a “must read” for anyone—patient, third party contributor, or professionals—seriously considering assisted reproduction.
Susan L. Crockin, Esq. Attorney specializing in reproductive health law.
A bold and much-needed book for patients and professionals alike. Cooper and Glazer integrate complex information and provide insightful guidance for us all. Their years of experience and research are clear to the reader. I appreciate the authors’ willingness to take a stand about the future and attempt to foresee the effects of third-party reproduction on children.
Hilary Hanafin, Ph.D. Clinical Psychologist with the Center for Surrogate Parenting and Egg Donation
Midwest Book Review’s Internet BookWatch for March, 1998 says… Choosing Assisted Reproduction covers all of the new reproductive technologies and reproductive assistances from third parties offering infertile people an area of treatment options and alternative paths to parenthood. Their explanations and recommendations will help these parents make decisions with knowledge and confidence. Drawing upon lessons learned from generations of families expanded by adoption and donor insemination, Cooper and Glazer offer parents and prospective parents guidance about when, how and why to talk with children about their origins. This is must reading for anyone contemplating an assisted reproduction.