Christine Pagadora

Writer’s comment: Three of my four papers written for English 103 dealt with horrific details of childbirth—details which worsened my fear of bearing children. Other factors have compounded this perpetual fear: one is my concern with infertility. My doctor told me years ago that I may have difficulty bearing children; in addition he told me that I am a victim of what he describes as “lazy” ovaries, after which I was prescribed daily hormone treatment to help “jump-start” my ovaries. Since then, I’ve paid particular attention to infertility issues in my study of both physiological and developmental nutrition as well as in my observations of clinical treatment. I was given the opportunity to research embryonic freezing—cryoembryonics—in a summer program in Seattle. I discovered, as you will in the next few pages, the use of embryos for research poses many ethical problems. What I discovered fascinated me: it more than captured my interest—it stimulated my intellect and drew out my subconscious feelings.
         I was able to write about these personal and scientific issues with the help of two wonderful English teachers, Jared Haynes and Kathleen Dixon (English 102 and 103, respectively), whom I had as my instructors in my last two undergraduate quarters. What a treat it was to have allowed myself two full quarters of advanced, critical writing; to have given myself time to learn good writing skills (102) and then to have saved the time to apply and practice those writing skills in a class that provided great creative freedom (103). Ten weeks of writing can strengthen your writing skills; twenty weeks even more so. Try it yourself—you may love the results.
—Christine Pagadora

Instructor’s comment: Most of my English 103A assignments stipulate that students must write on something that has to do with their major or their anticipated profession. I also advise that students choose a topic that interests them, a topic that can be personally useful for them to know more about. Not until I read Christine’s introduction for Prized Writing did I realize fully how well throughout the quarter Christine had followed the stipulation as well as the advice. Her exploration of the controversies involved with freezing human embryos was written for an assignment that asks students to investigate various points of view concerning an ethical issue or some dilemma or controversy having to do with their field of study or chosen profession. Students are thus able to research and address current hot topics in their fields, as Christine has so ably done by exploring some of the dilemmas that occur when technological advances in the freezing of embryos engender new issues for medical ethics. Christine’s scientific paper and her personal introduction remind us how much individuals may stand to gain or lose when their lives are affected by the objective world of science intersecting with the abstract world of ethics.
—Kathleen Dixon, English Department



Only a decade ago, embryo freezing (cryopreservation) was considered a technique that raised “disturbing,” “extremely difficult,” “incredibly complex,” and even “nightmarish” ethical issues. Currently, however, at least 41 of the 169 infertility clinics in the United States have begun to implement in vitro fertilization protocols (IVF) (Freemann et al., 1986). The number of frozen embryos in this country nearly tripled, from 289 to 824, between 1985 and 1986 (Van Steirteghem and Van Den Abbel, 1988). An estimated ten infants in the U.S. and sixty in the world were born as of 1988 after having been frozen as embryos. The government and professional advisory groups have endorsed embryo cryopreservation in several countries, but despite these developments, human embryo freezing is still not universally accepted. The fact that freezing lengthens, perhaps indefinitely, the period of embryonic existence outside and independent of the human body allows new options for manipulation of the embryo and for its ultimate fate. As a consequence, the emerging technology raises a number of issues that challenge deeply embedded ethical principles.
         Cryopreservation is defined as the scientific technique that utilizes extremely cold temperatures to freeze or suspend an organism for storage and ultimately future use. The ability to freeze human embryos creates several clinical options that might not otherwise be possible or as efficiently achieved. Cryopreservation also opens up new research opportunities such as understanding infertility in men and women. Published studies indicate that cryopreservation increases prospects for pregnancy in infertile couples (Wood, 1988).
         There are at least five reasons why embryo cryopreservation resulting from extracted ovum from the mother herself may be preferred over sperm/ovum donation and any other means of fertilization. First, the number of embryos placed in a woman’s uterus during any one treatment cycle can be limited, with the other embryos preserved for later use, thereby reducing the risk of a multiple pregnancy. Second, embryos preserved from an initial attempt at IVF and replaced later if necessary can help to avoid repeated surgery to secure more eggs. Third, cryopreservation could enhance efforts to detect the presence of infectious diseases and genetic anomalies by providing ample time for proper screening and analysis. This advantage not only has implications for the health of any progeny, but it could also reduce the incidence and associated risks of abortions if abnormalities are discovered at a later point in the pregnancy. Fourth, by preserving embryos that would otherwise be discarded and allowing them to be brought to term at a later date, freezing can lead to offspring who would not otherwise have been born. And fifth, when combined with analysis, freezing will increase the possibility that normal embryos will be frozen for future use in implatation as well as research (Woods, 1988).
         Cryopreservation maximizes possible benefits of IVF in at least three ways. By preserving and storing extra embryos obtained during the course of IVF, it offers opportunities for donating them to other women, who are unable to produce their own eggs or who are carriers of a genetic disease. Also, for persons whose fertility may be adversely affected later in life, cryopreservation provides them with the possibility of storing their embryos for later pregnancies. Finally, cryopreservation creates research opportunities that contribute to human welfare. The healthy birth of future children, whatever the means of conception, may be greatly assisted by knowledge gained only through research on human embryos. Furthermore, research on improving the procedures associated with IVF and cryopreservation can improve treatment of infertility (Freemann et al., 1986).
         In assessing the ethics of cryopreservation, the safety of the procedure is of paramount importance. Concern focuses on the risks of embryo loss and of genetic malformations as a consequence of freezing and thawing. In the case of embryo viability, the specific risk is unknown. Published reports indicate that approximately half the human embryos survive the freezing and thawing process (Van Steirteghem and Van Den Abbel, 1988). The loss may be due less to the quality of the cryopreservation process itself than to the quality of the human embryo before freezing (Freemann et al., 1986). Embryo loss may also occur as a result of mechanical failure of cryopreservation equipment, but proper maintenance of equipment and adequate backup systems ought to reduce this risk.
         Birth defects in offspring resulting from the freezing and thawing of embryos is also a concern. At present, the number of live births following cryopreservation is not sufficient to provide a definitive assessment. However, no increased risk of malformations has been detected simply because if the embryo was strong enough to withstand the insults of freezing and thawing, then chances are the embryo will remain strong throughout its development (Freemann et al., 1986). Moreover, the use of genetic screening of embryos before freezing and thawing could reduce risks of genetic abnormalities in live births.
         Finally, there is the danger that cryopreservation may prolong people’s dependence on infertility treatment in ways that are emotionally unhealthy. Patients may be reluctant to end infertility treatment while they still have embryos in cold storage. The idea that there are potential offspring ready for further growth and development may hinder a couple’s decision to go on with their lives (Bonnicksen, 1988). Counseling of patients and a realistic assessment of their prospects for achieving a pregnancy should reduce this risk. The techniques of artificial reproduction, including cryopreservation, will never be risk free. The moral choice before us is whether to proceed doing everything possible to protect the highly vulnerable embryo or condemn it to nonexistence and have infertile persons remain childless.
         The question is very difficult to answer, but it is so because of the fact that there are varied meanings of “embryo.” Clients use names like “twins” or “preemie” to refer to the embryos, doctors called them “sets of tissues” or “pre-zygotes,” and consent forms refer to them as “property” that have rightful “owners.” The varied meanings that the embryo carries reveal the moral uncertainty still underlying the activities involving the embryos. Scientifically, the embryo is equal to more than the sum of the egg and the sperm that created it. Its disposition has generated considerable public controversy and moral uneasiness. Is it wrong to destroy human embryos? Should we worry at the prospect of embryos frozen for some future specified or unspecified use?
         Answers to such questions will inevitably involve a judgment based on beliefs about the moral status of the embryo, about what it is and what it may become, and about when its life began. Some view the embryo as a full human being with all the claims and rights of people. Therefore, techniques that impose risks to embryos beyond those occurring naturally (and which subordinate the embryo’s welfare to that of others) are morally unacceptable. Consequently, persons responsible for the care of a frozen embryo have an obligation either to maintain its frozen state or place it in an environment (i.e., a woman’s uterus) in which it is likely to survive. Other people view the embryo as disposable tissue, with little or no claim on our protection. As with other extracorporeal human tissue, with the consent of the proper authority any actions using the embryo are permissible.
         Still other people take a middle position, acknowledging the embryo’s unique genotype and its potential, which make it deserving of respect and protection, although not equal to that accorded to live persons. In a report of IVF and embryo transfer, the Department of Health Education and Welfare’s Ethics Advisory Board (1979) concluded that “the human embryo is entitled to profound respect; but this respect does not necessarily encompass the full legal and moral rights attributed to persons.” Such respect may be premised on the embryo’s humanness and/or on its potential to achieve full status as a person. In this view, the good achieved by helping persons overcome their infertility or by performing research intended to reduce existing or future suffering may be sufficient to justify morally the manipulation of embryos, but not in the total absence of safeguards that reflect a proper concern for the welfare and dignity of the embryo.
         Research on embryos is typically justified on the basis of these expected health benefits: (1) that research is intended to assess the safety of procedures related to infertility treatment; (2) that research is aimed at improving the efficacy of procedures for treating infertility; and (3) that research is designed to increase general knowledge about human reproduction, which may or may not lead directly to clinical application. Cryopreservation can facilitate such research by preserving embryos not used for implantation that would otherwise be discarded.
         There are three main positions that have been adopted regarding research on human embryos. One rejects all research that is not therapeutic on the premise that respect for embryos requires that they not be used as a means to serve other ends. A second position approves of research, but only with those embryos that were originally produced during the course of infertility treatment. A third position would permit embryos to be deliberately created for use in research. Among those adopting the latter two positions, there is a consensus that research should not be permitted beyond 14 days of embryonic development, but differences of opinion still remain over what kinds of research should be permitted and whether subsequent transfer to the uterus should be allowed.
         The controversy over embryo research is clearly wrapped up in notions about the moral status of embryos, respect for life, and duties to current or future generations. No embryo research should be undertaken without the consent of the donors. Similarly, no implantation with the intent of creating a live birth should proceed with embryos donated only for research purposes. For those who support research in principle, as I do, there are nevertheless genuine concerns about the permissible limits of experimental investigation. There may be some experimental interventions that should not be condoned, no matter what the promised benefits are. And if there is a shortage of embryos, research might be limited to improving prospects for overcoming infertility.
         There is also controversy about whether embryos used for research should be transferred to a woman’s uterus, especially when nontherapeutic research is involved—research that is exploratory, basic. Research on embryos intended for implantation obligates the researchers to minimize the risks of harm to the evolving embryo. Recognition of this burden has contributed to recommendations by some prominent groups that embryos which are subjected to such experimentation should not be implanted (World Medical Association, 1985).
         Perhaps the most contentious issue is a moral distinction between research on embryos that results from ongoing in vitro efforts and research on those created deliberately for only research purposes. Some advocates consider the creation of embryos only for research morally offensive because of the fact that the research industry views the embryos as an instrumental means to knowledge. One opponent of research-created embryos argues, “It is one thing to take advantage of tragic circumstances (the inablity of a woman to implant her fertilized ovum) in the desire to conduct research. . . . It is quite different to create tragedies in order to learn from them. This a line we ought not cross” (Caplan, 1988). Others argue, however, that to restrict investigation to what are referred to as “spare embryos” will severely curtail research. If embryo research is to proceed, then the following guidelines ought to be given considerable moral weight: (1) The knowledge that is being sought should be important and obtainable in no other way, or at least not without greater risk to others; (2) Informed consent should be obtained from all relevant parties; (3) A research protocol should be approved by an ethics committee at the institution where the research is to be conducted (Bonnicksen, 1988).
         Few areas of human intervention engender as much personal concern and social controversy as those relating to human reproduction. Although some limits are placed on procreative choice in almost all cultures, Western societies such as the United States have traditionally given priority to procreative autonomy and personal choice. But any single right must be considered in a social context relative to other rights. Whether out of concern for the well-being of offspring, the welfare of prospective parents, or the symbolism attached to human life, society may have not only the authority but also the duty to intervene in matters of human reproduction. At present, the initiative has been grasped by the professional communities, with both the American Fertility Society and the American Association of Tissue Banks addressing the ethical issues raised by human cryopreservation and developing professional standards and guidelines. However, these efforts should be accompanied by continuing professional and public debate.
         Research on human tissues, especially tissues with the potential to grow and develop into mature form, is a very complex and difficult issue. There is really no one answer to the questions posed by these ethical issues. However, I believe that research on embryos created especially for research purposes alone is acceptable only if strict guidelines are followed and the research is pertinent and approved by ethical boards. There are only a few things that are important enough to me that I will hold an opinion to: the freedom to have an abortion and the right to embryonic research. As far as I’m concerned, if moderated, this type of research can only be beneficial. Anyone with reproductive problems and the desire to bear children will certainly have an appreciation for embryonic research. Undoubtedly, embryonic research involves a few ethical problems. However, in the long run the window of opportunity for unfortunate infertile couples who cannot conceive will hold tremendous promise.


References

Bonnicksen, A.L. 1988. Embryo freezing: ethical issue in the clinical setting. Hastings Cent. Rep. 18: 26-30.

Caplan, A.L. 1988. Consumer protection issues involving in vitro fertilization clinics. Hearing before the Subcommittee on Regulation and Business Opportunites, House of Representatives, 100th Congress, Second Session, 62-76.

Department of Health, Education and Welfare: Ethics Advisory Board. 1979. Report and conclusions: HEW support of research involving human in vitro fertilization and embryo transfer. Federal Register 44: 35033-35058.

Freemann, L., A. Trounson, and C. Kirby. 1986. Cryopreservation of Human Embryos: Progress on the Clinical use of the Technique in Human in Vitro Fertilization. J. In Vitro Fert. Embryo Transfer 3: 53-61.

Van Steirteghem, A.C., and E. Van Den Abbel. 1988. Survey of cryopreservation. Ann. N.Y Acad. Sci. 541: 571-574.

Woods, E.C. 1988. The future of in vitro fertilization. Ann. N.Y. Acad. Sci. 541: 715-721. World Medical Association. 1985. Interim Statement on Ethical Aspects of in vitro Fertilization. World Medical Association.