Fertility medicine brings babies — and tough decisions

Brenda Loblein never wanted to be in this position. She didn't want to be faced with a decision about what to do with an extra embryo — a potential child — sitting on ice in a sterilized storage facility.

Loblein was 35 when she walked down the aisle for the second time, and she was already a mother to three children from her first marriage. But the meteorological satellite operator knew that she wanted a child with her new husband, and in vitro fertilization was necessary.

Today they have a little boy and a little girl — and, despite Loblein's best efforts not to create more than they needed, that extra embryo she'd wanted to avoid. Waiting in limbo for her to decide its fate.

The Lobleins are among thousands of couples and individuals grappling with difficult choices regarding their stored genetic material. The Department of Health and Human Services estimates that more than 600,000 frozen embryos are stored in the United States, in addition to countless more cryopreserved eggs and sperm.

The issue made for dramatic headlines recently as “Modern Family” star Sofia Vergara was hit with a lawsuit by her ex-fiance, who wants custody of their two fertilized embryos to use for a potential pregnancy.

But for most people who have used assisted reproductive technologies, the question of what to do with frozen eggs, sperm and embryos plays out in a much more private, if no less wrenching, manner.

“Having embryos in limbo is a huge problem for our field,” says Eric Widra, medical director at Shady Grove Fertility Center. “Parents are apprehensive or conflicted and don't know what to do.”

Most couples never consider the fate of excess embryos when they start down the path of fertility medicine. Especially for childless pairs, longing to conceive, “addressing that is not on the list of priorities,” Widra says. “Many of them take a ‘We'll cross that bridge when we come to it' approach.”

A 2005 study funded by the National Institutes of Health found that of 58 couples with leftover embryos, 72 percent hadn't decided what to do with them.

Unexpected choices

The possibility of extra embryos never occurred to Elizabeth, a 42-year-old lawyer in Virginia who asked that only her middle name be used because not all of her family members and colleagues are aware of her decisions.

She married at 36 and soon became pregnant. But she always thought that if she had one child, she'd want to have another and was surprised when she had trouble conceiving a second time.

After nearly a year of trying, she and her husband consulted a fertility specialist, who first attempted the less invasive and less costly process of intrauterine insemination. When that didn't work, they moved on to a round of in vitro fertilization that resulted in nine fertilized embryos.

The first two implanted didn't take. The doctors then implanted three, one of which resulted in a viable pregnancy. Forty weeks later, Elizabeth's second son was born.

Family life felt full and busy, she says, “but then it started weighing on me that we have four frozen embryos that potentially could be another sibling for the two that we have.”

It's not that Elizabeth or her husband are desperate for a third child — it would stretch them financially and add to their already hectic schedules — but Elizabeth was raised a Catholic, and it gnawed at her that a potential new life sat frozen in a storage facility.

“I did not think we'd be in a position where we had to think about, ‘Oh, now we have leftover, what do we do?'” she says. “I was more concerned with, ‘We only have three attempts covered by insurance — are we going to spend money after that if we don't have a kid?' “

If it were solely up to her husband, they might try to donate the remaining embryos to scientific research, but that option doesn't sit well with Elizabeth.

“I felt this need to know whether there was potentially another viable life among the embryos,” she says. The couple decided to have the four embryos thawed and tested to see whether any were chromosomally normal and would thus have a significantly higher likelihood of surviving. One of the four was.

So last week, Elizabeth had one healthy embryo implanted. The couple will find out at the end of the month whether she is pregnant.

“I don't want to say that I felt like I had no option,” she says. “But it felt like the best option for me, personally.”

Considering options

After becoming pregnant with twins, Teresa Crawford and her husband, Michael Hess, didn't want more children.

Hess already had two from a previous marriage, and the twins were born 10 weeks early. “We felt very lucky to have two healthy kids, especially because they were born premature,” says Crawford, who works in international development.

In 2006, a year after their IVF cycle, the Washington couple received a bill in the mail for nearly $1,000, with a letter asking what they wanted the clinic to do with their six remaining embryos.

The options, they were informed, were to implant them, offer them for donation to another couple, pay the hefty annual storage fee or have them destroyed.

“And we did not like those options at all,” Crawford says.

They would have preferred to donate the embryos to science, but at the time, embryonic stem cell research was banned, so that choice was off the table.

Ultimately, the couple decided to have the embryos destroyed, as neither felt a strong emotional attachment to them.

But for some people, the decision to destroy is much more fraught.

On DC Urban Moms and Dads, an online parenting message board, one woman posted that after debating the options for her leftover embryos, she brought the vials home, “burned some incense, held them and cried. I could've had the lab dispose of them, but this felt better to me, for whatever it's worth.”

Legal issues

Meryl Rosenberg, a Maryland lawyer who specializes in assisted reproductive technology law, says that as the use of fertility medicine becomes more common, these issues are increasingly making their way through the judicial system. They become particularly complicated when a couple divorces or someone dies, and the interested parties are at odds over the fate of the stored material.

“The relationship sours,” she says, “and one person wants to use the embryos and the other partner does not want to use them.”

“Generally,” she says, “courts have found that the right not to procreate outweighs the right to procreate. But there have been exceptions to that.”

Widra, of Shady Grove, says that his clinic tries to get patients to address the topic proactively, “without drama and with good legal advice.” They sign consent forms acknowledging that embryos are jointly held property, and that “once you make these they are made forever. They are yours and it's your problem to solve should it come to separation or death.”

Widra says the clinic is trying to offer clients more options.

Since President Barack Obama repealed the ban on stem cell research in 2009, there has been some resurgence of interest in donated embryos from the scientific community, he says. And although donating embryos to other people has for many years been arduous and time-consuming, leaders in the field are trying to streamline the process to make it easier “to offer more embryos for adoption and for (adoptive parents) to find them.”

But even that option comes with its own calculations.

Emotional decisions

Loblein was so conscious of the possibility of having extra embryos that when she and her husband had trouble conceiving, they first attempted natural-cycle IVF, fertilizing only one egg at a time. But after two attempts, each costing $5,000, they moved on to traditional IVF.

The couple wound up with three embryos, implanted two and had a boy. A little more than a year later, Loblein became pregnant naturally, this time with a girl. That left her and her husband with one frozen embryo. They talked about donating it, but Loblein fears that she would always wonder whether a child was born and how he or she was being cared for.

Now, with two kids younger than 4, the thought of adding a third sometimes seems overwhelming, especially to Loblein's husband.

“It's the stressed-out times when both the kids are screaming and he's like, ‘I don't know if I can handle another,'” she says.

“But at the end of the day I always come back to, ‘Well we just need to try it because I don't know if I can live with all the other decisions and options.' “

So sometime early next year, they've agreed, the final embryo will be implanted. And then, regardless of the outcome, their family will be complete.