As I’ve said before, there is very little black and white about the emotionally and financially draining quest for parenthood. Here’s a case in point. Is it ethical to create embryos from donor eggs and sperm with the specific intent to “donate” (sell?) to a group of people who are struggling to conceive?
While in the media room at the American Society of Reproductive Medicine conference last month, I ran into the reporter from the LA Times who was researching this story. This practice by a clinic in Davis California, California Conceptions, has been whispered about at infertility gatherings for a couple of years, but as far as I know, this is the first time it has gone public. The journalist promised to tell me when it was published, and I’ve been waiting to discuss this controversy here until the story came out.
In a nutshell, this is what happens. California Conceptions takes sperm and egg from donors. Since both the donors are young, healthy, and fertile, the in vitro process usually results in multiple viable embryos. The clinic offers the resulting embryos one or two at a time to different people looking to conceive. They freeze any unused embryos to offer to future infertility patients. Since the cost of the donor egg, donor sperm, and in vitro process is divided among all the people using the embryos, the clinic is able to offer this process for $9,800 with a guarantee of your money back if you do not get pregnant. The cost has recently increased to $12,500, but it is still considerably less than the typical in vitro fertilization process using donor eggs, which can easily cost $25,000.
California Conceptions has had almost 200 patients so far, and they say that they have a 95% success rate, with half of their patients having twins. With traditional embryo donation, infertility patients with unused frozen embryos can decide to donate these embryos to another couple to use in an attempt to get pregnant. Most clinics and agencies tell me that they have far more people wanting embryos than they have couples willing to donate. The cost of typical embryo donation can range from $5,000 to 18,000, but there is no money back guarantee, and since many of the embryos were created from older couples with fertility problems, most clinics do not have a 95% success rate.
Before the clinic makes a batch of embryos, it sends an extensive profile of a sperm donor and an egg donor to prospective parents. Once the clinic gets buy-in from a few patients, it purchases the sperm from a sperm bank, harvests eggs from the egg donor and combines them in the laboratory. A single pairing can result in a dozen embryos, and the clinic keeps the extras frozen while it looks for patients who want them.
“We want to keep the embryos moving,” Zeringue said. “The goal is not to create a bank.”
The clinic usually has a supply of about 10 unclaimed embryos available, he said.
The clinic says that all donors and intended parents are fully informed of what is being done. It is important to note, that typically any embryos from IVF, even with donor egg and sperm, are being created for a specific intended parent and belong to those parents, not the clinic. In this case, the embryos “belong” to the clinic not the intended parents.
Do you see a problem with this? Are we on the slippery slope of selling humans? Does this differ in any significant way from other forms of infertility treatment?
Image credit: Katy Batchelor
Looking in the wrong place, not wetting place. Oops.
Let’s go down the slippery slope. What would make a clinic want to create an embryo bank? Aside from the clinic having control, how does it benefit them to have control and what would be the result? Please understand that I am in no way advocating it, I am just trying to take it to the worst conclusion to understand the fear of what could happen. One we understand the concern, then we figure out how to solve it.
If the concern is unused embryos, we are looking in the wetting place imho. Btw, I do not advocate that people shouldn’t be able to freeze and store embryos which is the case in some other countries.
As to costs, we dont seem to be concerned about how much clinics are making on services in fresh donor cycles, why is it different here? Because it is a flat fee?
my thinking is along the lines of Sue Taylor
Oh, I do understand the differences, just not practically how that equates to legal and ethical issues necessarily.
Also, in my research the typical current US donor egg IVF cycle costs at clinics with high success rates was more like $30K – $45K (with donor fees, donor meds, screening, etc.) but with no guarantees of embryos. I can see why patients would find it appealing to have the chance at up to 3 frozen cycles (6 embryos) for $12K and if it didn’t work to get their money back. If they need all 3 cycles, the amortized cost is $4K per cycle. With that money back guarantee, in some cases the clinic will pay donors, donor meds, etc. and not get paid anything (if the recipient is not successful). BUT the pressure is off of the recipient patients with the money back guarantee if they qualify for it – I have heard about people who went that route because they wanted to try to get pregnant but still have money left to try other family building options if it didn’t work.
FYI, I have never had any clients use the CC program, so I have not fully investigated personally, I only know what I have read on their website and from people who did have treatment there – so it may not be accurate.
There are a couple just off the top differences I see Sue. 1st in current donor/adoption programs the original (or biological parents) have access to all of the embryos if they wish, not just 1-2 (potentially ALL the embryos could end up in the same family). In this case, both are donors and have no access…………and those that purchase the “rights” still only have access to 1-2.
In ALL adoption, there is the potential for multiple siblings to be out there, even among different families. And that IS a potential issue when it comes to dating, etc.
With CC’s type of donation, the fees are ridiculous, imo. If IVF costs 20,000 and each of the donors pays 12000, then CC is raking in the money. For just 2 recipients the pay is over what the original costs were to the CC clinic……….UNLESS, there is also a significant fee being paid — beyond “normal” to the donors.
With our “donation”/adoption, we paid about 6,000. We were not guaranteed a child……….but honestly, we got to choose pretty much everything possible about our donors from what they had available and could choose the absolute best quality embryos as well if we waited long enough — which we didn’t need to wait long either for the 2nd best quality. Is there really a need to charge more than that? I mean in my cycle, the clinic didn’t have to pay the IVF fees at all and got the embryos for “free”, so that is probably the difference in costs, but still why make that much money off of people in need — and usually almost desperate?
This is an interesting debate – in thinking it through, I’m playing devil’s advocate a bit trying to explore the real practical concerns or slippery slopes here. I apologize in advance for the length of my reply.
As I understand it the stated legal and ethical issues are primarily twofold – ownership, and paying for embryos.
First, in the CC scenario, the clinic owns the embryos rather than an individual patient or patients. However, if the report is accurate, at CC the donor cycle only happens after they have at least two intended recipient parents for the specific embryos from that donor cycle – which sounds a lot more like a frozen version of a shared double donor cycle to me – so it this just a nuance as to when the patient becomes financially and legally responsible for them (before or after fertilization)? If the scenario was instead that the donor’s eggs were fertilized but each of the two intended recipients that committed to this donor in advance legally “owned” half of the embryos, and then they kept 2 of the frozen embryos for themselves and donated the remaining embryos for the clinic to use in an anonymous donation program for other recipients – would that somehow solve the “ownership” concern? If so, how is that truly practically different from what is happening? I’m not sure that in practice it is so dramatically different than what happens when embryos from any IVF cycle are being donated and are relinquished to a clinic to distribute in an anonymous donation program – the clinic is also in control of those embryos (although legally perhaps the paperwork transfers ownership of a limited number of embryos prior to the transfer) – practically speaking once the patient has relinquished them to the program for donation they are no longer making decisions on behalf of those embryos, the clinic is, right? So what exactly is the fear about the clinic having control of them in this scenario that is different from other anonymous donation programs where the program controls distribution of the embryos?
Is the concern that multiple different families are having children from the exact same genetics/IVF batch? That is not unique to this scenario – the same thing happens when patients donate their embryos when they are done family building. Many existing embryo donation programs accept donated embryos then divide them between multiple recipient families. In a smaller way, shared genetic links can also happen when doing an IVF cycle with a donor (egg or sperm) that has or may donate again. If the issue is about the anonymous nature of the donation – well, again, that is not unique to this type of program it factors into any anonymous donor gamete treatment scenario.
The second main ethics question as I understand it is about the fees being charged for the embryos – does that equate to buying embryos or are they paying the clinic for the donor’s time, meds, treatment, etc.? Well, if we looked at this as a traditional fresh egg donor/sperm donor cycle where recipients are paying for all of those things, we wouldn’t say the recipients were buying embryos – so how is this different? From my research, I find that many well respected donor embryo or embryo adoption programs have donor embryo cycle fees equal to or in excess of the fees being charged by CC. However, those organizations just account for the fees differently – calling them legal and administrative fees. But practically speaking – in all cases (fresh double donor, frozen double donor embryos or donated embryos), the recipient pays fees and typically receives embryos – the variation is in how much they pay and how we label the fees.
One other ethics concern I’ve read is a fear that a clinic will create a bank of embryos that is unused. Again, if reports are correct, this does not seem to be the case. But, what would prompt them to create stores of unused embryos? If the clinic is bearing the entire cost of the donor, donor meds and cycle fees prior to relinquishing the embryos to an intended patient – what reason would they have to create excess of embryos that would be unused? If creating excess embryos that might not be used is a big concern, I think we’re looking in the wrong place. It is not rare for a fresh IVF cycle or especially a donor egg IVF cycle to result in 10 – 20 frozen embryos after the fresh transfer. And according to recent reports, only a very small percentage of these remaining frozen embryos are used or donated.
Perhaps I am just overlooking some bigger picture issues on this. I know that there are well respected professionals in the industry on both sides of the fence on this issue. I really would like to better understand what the practical fears are about this type of a program if anyone cares to share – and perhaps in what ways the program could be modified to alleviate those concerns?
From a patient perspective, there are many families who simply are unable to continue fertility treatments due to the high cost of using donor eggs here in the US – so options such as this, or frozen eggs, or split cycles/price per donor egg programs with high success rates that can make the dreams of parenthood more accessible would certainly be welcomed by many.
I welcome your insight (legal and ethical) about the practical potential issues you see Dawn.
Just a note……..when you do embryo “donation” or adoption, the couple (or donors) age is also listed. So there is a good chance, when they are both younger, that this too could be a good match. Just because many are older with infertility does not mean that most or all are………..don’t give up on the idea of embryo adoption just because it doesn’t have as high a chance as this does consistently………..and cost effective, it’s about 1/2 the price of this guy creating them just for his profit.
This is no different than using double donors anywhere at any clinic. It’s been done for years. They have streamlined the process to make it more affordable. That is all. This is about making infertility treatments for those in need of double donors more attainable. All I see is a clinic that has found a way to do that and be cost effective.
I honestly don’t like how you’ve described an embryo as a tradeable good using words like “owning” and “selling” and not think it is legally or factually accurate. There is nothing wrong with a donor being compensated for their time, including going through surgery, and the fact that they are being compensated does not make the embryo a trade-able good or object that is “owned”. I am also sure there are releases in place, like WE ALL SIGNED when doing IVF using our own eggs, that dictate what may be done with unused embryos, in this case donation. That does not make the embryo take the on the properties of a trade-able good. It just means the clinic has custody of the embryo until it can be used as directed by the donor in a legal document.
I say good for CC for making parenthood attainable for people that don’t have $35k to drop on adoption or donor egg cycles that may or may not work.
They didn’t create the technology, They didn’t pioneer double donor IVF, they just found a way to make it affordable. If people don’t agree with CC but think double donor IVF is okay else where, I think that’s a little inconsistent. You either think IVF is okay or you don’t, but don’t judge people who want to do it more cost effectively.
There is a very fine line here. Scared to cross it, but we chose emrbyo’s, believing they’re already children………..basically abandoned (in the best sense of that word here) by their biological parents……………..what CC is doing is not creating an abandonment so to speak, but they are creating more children that are basically orphans……..which is sad when there are already plenty of them out there as it is (both in embryonic form and post-birth form).
Dawn, I see your point. I think possibly it isn’t quite the same economically as donor sperm or donor egg banks though – because that is just 1/2 of the equation, whereas with embryos they would have to get the exact right combination of gametes together – I think the shared cycle approach might actually be financially better for the clinic because paying for donors, meds and embryo storage isn’t cheap. Doing a cycle when you already have committed recipients seems like a better financial option from a clinic perspective.
I do find it interesting that the worst case being discussed is the possibility of embryo banks – but there doesn’t seem to be much industry concern about creating a large number of embryos in a single cycle (thus likely resulting in large stores of frozen embryos from the cycle) or the huge numbers of cryopreserved embryos that are already stored (and not intended for donation) – don’t all of those scenarios result in the same issue of unused frozen embryos?
I read Dr. Sweet’s blog post – it’s an interesting perspective and good food for thought. I agree that calling these double donor embryos “donated embryos” is a bit misleading, and perhaps the industry should have different language for them as we do for other types of fertility treatments so that the origin is clear to everyone.
However, I just don’t think patients are terribly concerned about most of the logistical and ethical issues he outlined– mostly because many of the issues raised could just as easily be raised about other types of IVF (like fresh donor egg/donor sperm cycles). It’s just that no one is being vocal about these same issues when it applies to those very expensive treatment options. As a result, patients sometimes feel like it is only the affordable programs that are being scrutinized, and the same questions are overlooked if they are willing to spend upwards of $30k – $50K for fresh IVF treatment.
Let’s look at the issues raised….
The “McEmbryos” as he defined them (patients choosing based on egg donor and sperm donor characteristics they find desirable), is happening in fresh double donor IVF cycles at reputable IVF clinics across the world. The same “designer baby” claim has been made for years about using donor eggs or donor sperm. This isn’t a new issue or unique to this new scenario.
The questions of sperm and egg donors being aware of what is being done with their embryos – which parts do we think would be concerning to them? The fact that embryos might be frozen and not used? How is that different from a fresh donor cycle where the family might not use all of their embryos? Or the fact that embryos might be shared between families? Occasionally I have heard of donors specifying that remaining frozen embryos cannot be donated, but it is not commonplace – surely any donor donating at CC recognizes the programs that they offer may result in their eggs going to multiple families.
About tracking donor-donor conceived offspring – well, that certainly also applies to fresh cycles with either donor eggs or donor sperm (or both)….and probably even to most sets of donated embryos, since last reports showed the majority of donated embryos are anonymous donations and they may end up going to multiple families too. This is an issue that applies to almost any type of anonymous donation fresh or cryopreserved.
I also don’t think typical patients are terribly concerned about whether the clinic owns the cryopreserved embryos, because they don’t see how it impacts them. In fact, they might prefer that the clinic owned them if it mitigates the possibility of the donating family changing their mind at the last minute before they are legally transferred. I think recipients are mostly concerned that the embryos are legally able to be transferred and that they own them once they are transferred.
He also raises good questions about what happens to embryos that are never chosen, or if a clinic closes. But I’m not sure it is so different than what happens to cryopreserved embryos stored at a clinic that closes – or what happens to embryos that are abandoned (when patients stop paying the storage fees), or just cryopreserved in perpetuity.
As an industry, I think it makes sense to set standards that are balanced and ethical –and I respect Dr. Sweet for taking an active approach in addressing something that he feels is at issue. I think it should be noted that countries around the world have various legal and ethical standards that are often in conflict with each other – but the US tends to be the most liberal in many aspects of fertility treatment options.
I think one of my biggest concerns with stories like this is similar to Dr. Sweets in that any fertility industry scandal (whether real or perceived) can create a backlash of bad legislation. It will also deter the significant progress that has been made over the past years in bringing donor conception options to light and helping them become more accepted in our society. It will be an absolute tragedy if this results in donor conceived children being shamed or further stigmatized in our society, at a time when donor conception is becoming more and more mainstream.
What a thought-provoking post. Thank you for sharing it.
Visiting from ICLW.
Very interesting indeed. I haven’t studied or considered this in depth (as it would not apply to our situation), but there interesting ideas here.
There needs to be something to help bring costs down for infertility treatment. /.If doctors are unable to do it themselves (and I understand that in some or many cases they can not) then people will always look for alternative solutions, and someone will be there to provide them.
Dawn:
While I have absolute respect for my peers, people who have dedicated their professional lives, such as yourself, to building families that would otherwise not exist, there comes a time when one has to openly comment on what is perceived as questionable ethical practices.
As you may be aware, I have been working with our main regulatory organizations (ASRM & SART) at some level regarding the creation of embryos without a certain destination, as is apparently being practices at California Conceptions, for over one year. I wrote a blog on the topic at http://bit.ly/XDTJvt. If I had distill my remarks (minus the lengthy discussion that should accompany each statement, as in the blog), they would be as follows:
* Combining egg donors with sperm donors and creating embryos for transfer is commonly called a donor/donor split cycle but should never be called “donor embryos” from the get go. This demeans the amazing gift that true embryo donors give in donating their embryos to patients in need.
* Embryos deserve an intermediate level of respect somewhere between simple cells and the ultimate legal and moral respect we give to our patients.
* Business, corporations or sole practitioners should never own life. They can help to maintain and foster the embryos but should not be responsible for disposition decisions. The only entity that is donating the embryos here is the practice itself.
* While I suspect the physicians of California Conceptions have truly tried to not create a bank of embryos, it is inevitable that some of their recipients will, at least temporarily or perhaps for longer, be unable to receive created embryos (i.e., illness, transportation issues, financial constraints and so on) and that they will remain cryopreserved at California Conceptions, owned by the practice and waiting to find a home. In the L.A. Times story, they make it clear that they actually do have a bank of embryos that they own consisting of at least 10 sets of embryos. An embryo bank may have ten sets of embryos in it or thousands. Certainly, it would might all agree that it would be egregious to have thousands of embryos languishing in cryopreservation. The inevitable issue is that a bank of ten sets of embryos is still concerning making this topic worthy of continued discourse.
* Even though this process touted by California Conceptions potentially saves some patients money and builds families, the ends do not always justify the means.
* You can be certain that forces that want to control IVF and/or give personhood to embryos will jump on any situation where a business can own the embryos for even a short period of time. The law of unintended consequences marches forward.
* Our guiding societies need to take a very careful look at this practice and render a decision that will be fair and best to the greatest number of individuals.
* While I am a potential competitor to California Conceptions, this issue is far bigger than either of our practices. I did not come to my decision to write the blog, publish the position statement and bring these issues up on websites such as this lightly. It took me over a year and the L.A. Times article to come to the conclusion that I needed to take a stand.
We also developed a position statement stressing how a true embryo donation program differs from California Conceptions (http://bit.ly/UfPIJY). This might be worth a review by your readers.
Thank you for allowing me to chime in on this very important topic.
Craig R. Sweet, M.D.
Medical & Practice Director
Embryo Donation International
Thank you Dr. Sweet for your concise summary of a great blog. Now, for those of you who haven’t read it, I recommend going to his blog to read the long version where he develops his points in greater depth.
Why Creating “McEmbryos” is Just Plain Wrong http://www.embryodonationblog.com/769/why-creating-mcembryos-is-just-plain-wrong/
I’m trying to put myself in the shoes of the child conceived out of this practice. Something just does not feel right about being created solely for the purpose of being sold (or given) to another couple in support of the fertility industry. It is a different thing to be created via donor gametes for a specific couple. To some extent, it reminds me of the surrogate scandal that broke earlier this year (minus the surrogacy part). And it may “pencil out” cost-wise, but doing that cost analysis feels pretty icky. So yeah, for me, it does walk a dangerous line towards cheapening human life and i don’t like how it reflects on the infertility community.
Here is another blog by Dr. Craig Sweet of Embryo Donation Int’l on this topic that is worth reading: Why Creating “McEmbryos” is Just Plain Wrong http://www.embryodonationblog.com/769/why-creating-mcembryos-is-just-plain-wrong/
Sue, good idea to go ahead and imagine sliding down the slope. I assume that the reason they would want to bank embryos is the same reason they bank sperm and now eggs. It makes economic sense. If they had a bank of embryos, wouldn’t they be able to meet more peoples request for the type of child–even the gender–that they wanted? I realize that is not what CC is doing right now, but you asked us to go down the slope and isn’t this a possibility of where we’d end up? I understand, however, the point you are trying to make.
Hi from ICLW. I think that it is a good idea. At one time they thought IVF was unethical.
Michelle, oh OK, I understand what you are saying. I’m calling it a donor egg/donor sperm cycle, but it sounds like we are talking about the same thing. The distinction I’ve heard people make is that with a traditional donor egg/donor sperm cycle from the get-go, any embryos being created “belong” to a specific person or couple. They are legally, financially (and morally) responsible for them rather than the business/clinic where they were created.
We create embryos for intended parents. ( a genetic adoption.) When a couple or a single hire an egg donor and a sperm donor and put it together in a petri dish and they are not in anyway related, as far as I am concerned ( and probably the person to be ) is a genetic adoption. The mom may be legally an intended parent as opposed to adoptive parent but realistically it is the same as an adoption except she gets to be pregnant with the child she is not genetically related too. The child may at some point have the same questions some adult adoptees have- where did I come from etc…
Michelle, I’m not trying to be thick, but what do you mean by genetic adoption? We don’t create babies specifically for adoption.
genetic adoption- no connection to intended parents. It really is an adoption just pre pregnancy.
Michelle, how are we currently creating embryos for adoption?
Sue, Michelle, Terri, and others: As to the buying an embryo concern–in a typical double donor cycle (donor egg & donor sperm) the intended parents pay for the actual costs incurred–donor egg, donor sperm, medications, etc. and although it may cost a lot, they are paying for actual services. In the CC program, CC is not taking the incurred cost and dividing it evenly between the # of embryos created and then passing this cost on to the people receiving the embryos. If they did, then there could not be a set cost b/c each cycle would be different.
Let’s say that a donor egg/sperm cycle costs $30,000. If they ended up with 16 fertilized embryos, the cost/embryo would be $1875. (The clinic would have other costs associated with the transfer.) If however, the only had 10 embryos created from a cycle, then the cost per embryo would be $3,000. I would assume that CC has pooled all their costs and averaged how many embryos they usually get and charge a set fee accordingly. I see how it actually differs, but can’t decide if this difference changes the ethics of the situation.
But even as I type, I have a queasy feeling–are we setting a price to create a human. But don’t we on some level do that already?
Dawn, I agree with you we are already doing it in shared programs. This article raised the question should we be creating embryos for adoption? And my point is we already do. The ship has sailed. This may be a new shared cost way but we ( our society) already does it.
Sue, thank you so much for your thoughtful and lengthy reply. It really helped me start to sort through this issue. One of my concerns is the fear that we are on the slippery slope of creating embryo banks. CC claims that they first get “buy-in” from a number of recipients and don’t try to hold onto embryos, but what about the next clinic? On the other hand, how does this differ from a shared donor egg/donor sperm cycle, where the unused embryos are donated? Plus, wouldn’t it be better to use all the embryos from a donor egg/donor sperm cycle, which in theory happens with the CC program, rather than use a few and thaw/discard the rest, which is what currently happens with most donor egg/donor sperm cycles. But I am still left with the feeling that this has the potential to cheapen human life.
Michelle, how has that shipped sail? I’m trying to work through in my head how this practice differs from what we are currently doing–especially in shared donor egg/donor sperm cycles.
Just have to love the answer to incest and they can’t even call it what it is – instead they call it mixing genes? Seriously?
“As for concerns that biological siblings could unwittingly meet someday and mix their genes, Zeringue said the chances are remote because patients are scattered geographically.”
Really? People today don’t ever move from where they grow up? They don’t go to colleges across the country? They don’t move to take jobs in their desired fields?
You know what was missing in that conversation? What about the human being created? Are there needs and desires of no concern in this?
This is wrong. I agree with what Dr. Robert Klitzman, a bioethicist at Columbia University, says.
The only thing I see here as really new is the legal implications of a clinic “owning” embryos rather than a couple (or individual). I don’t know what specific legal implications that might have but for me, it doesn’t make much difference morally who makes or owns them.
Is it really any different for clinic staff to pick out egg and sperm donors than for the intended parents to pick them?
Using donor gametes is already well-accepted. Yes, there are the same issues here about number of siblings that there are with any donor situation but that’s not new.
So I also see this as quite similar to the way we currently do IVF, especially donor egg IVF. The biggest difference is probably that CA Conceptions intends to use all the high-quality embryos they create, while it seems like many couples do not. And the benefit to the recipients of lower cost and amazingly high success rate are wonderful.
This is a lot to think about, but honestly my largest concern is the volume per donor. How many biological siblings will my child/children have?
As far as I know, they do not have specific policies in place to limit the number of times a donor can donate, although I believe the ASRM has guidelines limiting the number of time an egg donor should donate–6 I think. Many embryos donated the traditional way come from donor egg and sometimes donor egg and sperm.
Y response on same article on my page:
Creating embryos for people to become parents – that shipped has sailed. I see this article about a cost analysis for potential parents -not about the debate should embryos be created. Whether one family pays for the sperm and eggs or the clinic pays- it effects overall cost more than addressing is it ethical or not. Basically this is Costco v. Jewel grocery store.
Michelle, in what way has the shipped sail. Do you see this as analogous to how we are currently doing embryo donation or IVF?