A Pro-Life Catch-22

This article first appeared in the July/August 2006 issue of BreakPoint WorldView magazine. Subscribe today—or get a friend or family member a gift subscription. Call 1-877-322-5527.

Infertile couples desperate to conceive children are turning increasingly to fertility specialists for help. Yet, widespread use of assisted reproductive technology (ART) has led to a completely unforeseen consequence: the creation of the world’s largest population of frozen human embryos. That reality has ignited a vigorous moral debate among scientists, politicians, theologians, and parents about what should be done with the surplus store of nascent human life.

LIFE ON ICE
Currently, in the United States alone, nearly 500,000 human embryos are being cryopreserved (frozen in tanks of liquid nitrogen at minus 321 degrees Fahrenheit) at some 430 fertility clinics. A staggering 88 percent of these embryos, which are only a few days old and much smaller than the dot on this i, were created by doctors for use in some form of assisted reproduction.

Since the birth of Louise Brown, the world’s first test-tube baby, nearly twenty-eight years ago, the field of ART has grown substantially. With about 2.1 million North American couples struggling to conceive, infertility has become an estimated $2 billion a year industry in the United States alone. In 2003, the most current reporting year, the Centers for Disease Control and Prevention (CDC) registered more than 48,000 births as a result of various ART techniques, a number that has been on the rise in each reporting cycle since 2000.

The most common ART technique is in vitro fertilization with embryo transfer (IVF-ET), in which a woman is induced to produce multiple eggs in which four to six of the most viable are retrieved and then fertilized in the laboratory, with the resulting embryos transferred to the woman’s uterus. At the best clinics, the success rate for each in vitro attempt is between 25 and 50 percent. This means that many patients make two, three, or more attempts before achieving a successful pregnancy, but some never do.

THE EMBRYO ASSEMBLY LINE
To stimulate the overproduction of eggs, in vitro patients receive deep muscle injections (usually self-administered) of follicle stimulating hormone (FSH) starting on cycle day three and continuing daily for approximately two weeks. During this phase, ultrasound measurements are also taken regularly to assess egg development. When the eggs are mature, the patient is injected with human chorionic gonadotropin (hCG) to stimulate ovulation. During ovulation the patient is medicated for pain, and a needle aligned with a vaginal ultrasound is guided through the top of the vagina to the ovary, where eggs are aspirated into a test tube and fertilized in the laboratory. Two to five days later, a set number of embryos are transferred to the uterus by means of a catheter inserted through the cervix.

Each in vitro attempt can cost anywhere from $4,000 to $18,000 for doctor’s fees, plus thousands more for drugs to stimulate ovulation. Unfortunately, the procedure also significantly increases the likelihood of higher order multiple pregnancies, and such pregnancies increase risks of preterm labor, premature births, and the possible physician-recommended “selective reduction” (abortion) of the weakest fetus(es) to ensure that the others will be brought safely to term. To decrease the probability of these complications only two to three embryos are usually transferred to the uterus in each in vitro attempt.

With the high demand for repeat attempts and the need to minimize the pain, costs, and risks involved, ART doctors typically respond by producing more embryos than are feasible to implant in utero at a single time. This overproduction of embryos requires the surplus to be stored for later possible use. Yet cryopreservation is itself expensive with fees averaging around $2,000 or more per year.

There are also questions concerning mortality rates and how long frozen embryos will remain viable. The most recent report by the Society for Reproductive Medicine and the CDC on frozen embryo transfer indicates a 16.6 percent live birth rate per transfer (this statistic excludes embryos that did not survive freezing and thawing) compared to a rate of 27.9 percent per transfer for fresh embryos used in conventional in vitro procedures. In both cases, these numbers point to a high, built-in mortality rate for embryos in IVF-ET. Some even estimate a one-in-ten chance for an embryo frozen less than five years to grow to full term, and less for those that have been frozen longer. No one really knows how long frozen embryos will remain viable, but healthy children have been born from embryos stored for up to ten years.

CONSCIENCE OUTPACED BY SCIENCE
With the routine overproduction of embryos in IVF-ET—the issues surrounding maintenance of these embryos in a frozen state, and the ultimate need to determine whether they are used, destroyed, or donated—questions arise that science alone cannot answer. Technology, it seems, has outpaced our understanding of the fundamental legal, political, theological, and moral issues in the creation and management of human embryos. “By necessity, rather than choice,” writes healthcare ethicist Michael R. Panicola in the National Catholic Bioethics Quarterly, “we have been charged with the responsibility of deciding whether the preimplantation embryo is a full member of the moral community. How we answer the question of the moral status of the preimplantation embryo will have serious practical implications.”

Some of these moral implications will no doubt include deciding whether embryos are: (1) personal beings with dignity that deserve respect and legal protection; (2) mere property of the parties who contributed the sperm and the egg and thus may be disposed of according to their owners’ wishes; or (3) simply cells, which are more than property but less than personal human life, deserving “special respect.”

But there are no easy solutions to the embryo surplus. While those favoring options two and three, above, face no significant moral burden, Christians who acknowledge embryos to be preborn persons have a dual responsibility to protect the innocent and also to do no harm (Exodus 23:7). The stakes are high because, as Ron Stoddart, founder of Nightlight Christian Adoptions, stresses, “An embryo is not a potential human life—it is human life with potential.”

PRE-ORPHANS
Frozen embryo technology has made it possible to create a time lapse between fertilization of the eggs and transfer into the womb. “This time lapse is critical,” points out complex family law attorney John C. Mayoue in The Morality of Adoption, “because it allows contingencies to intervene, such as divorce, a decision not to procreate, or an election to pursue traditional adoption.” It is understandable how life changes could suddenly render frozen embryos unwanted by their genetic parentage and lead to an attitude of indifference or even resentment toward potential offspring.

People who find themselves in this situation can choose among five possible courses of action: (1) use the embryo to fulfill their reproductive goals; (2) donate the embryo to research; (3) destroy the embryo by allowing it to thaw and disintegrate; (4) maintain the embryo in a frozen state (which may result in abandonment); or (5) donate the embryo to an infertile individual or couple who cannot otherwise conceive. It is the fifth option—donation to infertile couples who want to conceive a child—that has led to the practice of embryo adoption.

EMBRYO ADOPTION—A MORAL CATCH-22
Four U.S. agencies currently facilitate embryo adoption: Nightlight Christian Adoptions, Center for Human Reproduction, Bethany Christian Services, and the National Embryo Donation Center. The goal of each program is to transfer frozen donor embryos to infertile recipients who intend to use them to procreate.

But embryo adoption is much more than merely receiving and implanting donated embryos. In embryo donation, neither the mother nor the father of the embryo is genetically related to the couples who have the child, and donor recipients may be barred from accessing genetic profiles of the persons who created the embryos. Whereas in embryo adoption, an adoption agency matches the genetic parents of the embryos with the adopting couple into whom the embryos will be transferred, making open adoption a real possibility. Unlike embryo donations, embryo adoptions provide some of the same safeguards that the traditional adoption process offers. Specifically, the genetic family will know that the family they have chosen to parent their offspring has been screened for a criminal history and child abuse record, passed a home study, and received instruction about how to parent an adoptee.

At first glance, embryo adoption appears to be a life-affirming response to the vast number of frozen embryos being stored at fertility clinics. And it certainly is, compared to the 100-percent mortality rate for human embryos used in stem-cell research. Yet it is not without problems, two of which are that a donor’s frozen embryos are handed over to recipients en masse, regardless of how many may be needed or wanted, and that frozen embryos face significantly higher mortality rates than fresh embryos. In embryo adoption, as in IVF-ET, it often takes repeated attempts before a successful pregnancy is achieved with frozen donor embryos.

At this point, what is the relevant moral difference between IVF-ET and embryo adoption? Have the embryos lost in unsuccessful thawing and transfer attempts been treated properly as individually unique and personal beings created in God’s image? Can any form of technology that instrumentalizes life, regardless of the ultimate use to which it is put, be morally satisfying? Will embryo adoption decrease the number of embryos being produced and stored? These questions point to a moral catch-22 for Christians who support IVF-ET and embryo adoption. Embryo adoption is, at best, a response to the embryo surplus created by IVF-ET, which itself raises fundamental moral questions that Protestant ethicists have not yet probed in sufficient depth.

NATURAL LAW—A FORGOTTEN PROTESTANT TRADITION
The challenge for pro-life evangelicals is to develop systematic moral reasoning that can be applied to a range of issues, including embryo adoption, human embryonic stem-cell research, ART, and birth control. Evangelicals tend to be pragmatic, wedding political activism with biblical appeals, but this has resulted in moral reflection operating on a mostly private and intuitive plane. The tragic pitfall with this style of ethical decision-making is that adverse spiritual and moral consequences often go undetected.

Among Protestants in general, there is an absence of critical moral discernment on such bioethical issues as birth control, ART, and the treatment of embryos. This stems, in part, from Protestant skepticism toward natural law (God’s will as expressed in creation, imprinted on the conscience, and known through reason) and from an underdeveloped role for the legal, as opposed to the teaching, aspect of ethics. Informing people what principles ought to guide their conduct and what actions are morally illicit is the teaching aspect of ethics, whereas developing theological and philosophical criteria to adjudicate the morality and severity of illicit human acts is the legal aspect.

The now-neglected legal aspect of Protestant ethics was once a vital part of Anglican and Puritan moral theology, as theological ethicist James M. Gustafson shows in Protestant and Roman Catholic Ethics. Older Protestant luminaries such as Richard Hooker, William Ames, William Perkins, and Increase Mather, to mention only a few, developed texts on “cases of conscience,” which attempted to discern whether a specific behavior was right or wrong and to evaluate the moral gravity of wrong behavior. They were assisted in this project by their appropriation of Christian Aristotelian philosophy and the natural-law tradition.

To adequately address the moral issues involved in IVF-ET, embryo adoption, and birth control, Protestants today need to rediscover natural law and to revive the practice of closely evaluating the morality and gravity of human acts.

THINK OF THE CONSEQUENCES
Routine overproduction of embryos and high mortality rates suggest that IVF-ET degrades and instrumentalizes the very life it seeks to create. The fundamental purpose of every embryo is to realize its own life: to fulfill its divine purpose of achieving life as a rational, social, creative, spiritual, and morally free and responsible person. In assisted reproduction and cryopreservation—unlike in normal conception and gestation—the natural progression of an embryo’s life from potential to actual can be temporarily interrupted, stalled for a time, or worse, permanently thwarted from achieving its purpose.

So aside from the issue of what to do with surplus embryos, the more fundamental question remains: How will pro-life Christian supporters of IVF-ET and embryo adoption resolve the moral catch-22 brought to light by the vast stores of nascent human life? Protestants need to think seriously about this moral paradox and to retrieve older, more sophisticated traditions in ethics—such as natural law—to provide assistance. In the meantime, however, every couple considering ART should ponder the words of Alexander Pope, who said, “Whatever you do, do wisely, and think of the consequences.”

Stephen J. Grabill, Ph.D., is research scholar in theology and editor of the Journal of Markets & Morality at the Acton Institute for the Study of Religion and Liberty. His most recent book, Rediscovering the Natural Law in Reformed Theological Ethics, has just been released by Eerdmans. Visit his blog Common Notions.