Major problems involved in embryo donation

Mark and Luke Borden are four-year-old twins. They have older siblings who are triplets. Before you groan in sympathy for the parents, you should know it is a little more complicated than even the average multiple-birth, five-child family, writes Breda O'Brien.

The twins and the triplets live on opposite coasts of the US. The triplets live with their biological parents, Donna and Tim Zane. The twins, like the triplets, were conceived by in vitro fertilisation (IVF), and the Zanes decided to donate their "surplus" frozen embryos to an infertile couple, Lucinda and John Borden.

Therefore, the siblings have different birth mothers, but the same biological parents. The adoption was mediated by a Christian agency called Snowflakes, which has seen some 30 couples successfully give birth to donated embryos, though, of course, many more attempts have failed.

A classic case of "only in America"?

Well, not since the revision of the Medical Council's Guide to Ethical Conduct and Behaviour, which now states in relation to IVF: "If couples have validly decided they do not wish to make use of their own fertilised ova, the potential for voluntary donation to other recipients may be considered." In theory, the Medical Council has just given the green light to Irish couples to make an arrangement like the Zanes and the Bordens.

In fact, the Medical Council may have sanctioned a great deal more.

Snowflakes is a subsidiary of a traditional adoption agency, set up to deal with embryo adoption when the original agency was approached by an infertile couple who had been investigating embryo donation.

The couple were repelled by the way embryo donation worked. They felt as if their doctor acted as if they were ordering a meal in a restaurant, not an embryo. The embryos would be given by anonymous donors so the children would have no knowledge of their genetic parents.

In contrast, Snowflakes treated them like a traditional adoptive couple, carrying out an exhaustive home study, and screening them very carefully. The children are aware of the circumstances of their birth, and biological parents agree to keep in contact.

The Medical Council has made its decision to declare embryo donation ethical in the complete absence of any rigorous legislative framework that would protect the rights of the child.

In traditional adoption, the rights of the child to a secure and loving home take precedence over any longing of an infertile couple for a child. Adoption is for the sake of the child, not the parents, although it brings great joy to them.

Today, adoptive families are facilitated to keep in touch with birth parents, and birth parents are encouraged to be willing to be contacted after the child turns 18 or before if it is in the interests of the child.

Anonymous embryo donation contradicts this best practice, and could lead to severe problems of identity for a child, not to mention a lack of vital medical history.

For those who believe embryos are human, and therefore entitled to a chance to be born, it makes great sense that embryos should be donated rather than just be thawed out to die. However, there are major ethical and legal questions to be considered.

Who would be the legal parents of the child if the implantation was successful? It is likely to be the birth mother and her husband or partner, but it is far from certain.

What right does a child have to know the identity of his or her biological parents?

What screening of donors and potential parents should be in place to protect the rights of the child?

The Bordens came to public attention when they spoke out against embryonic stem cell research. They wanted to show that Luke and Mark could have been used for stem cell harvesting rather than adoption. They felt their twins, one a solemn little boy, the other mischievous, were human now and human when they were frozen embryos.

In contrast, the Zanes, while they felt incapable of allowing their own embryos to be destroyed, believe that it is ethical to conduct research on embryos.

The Zanes had six "surplus" embryos. Three died while being thawed. Three were implanted, and two survived until birth. The Zanes, not to mention the Bordens, were lucky. Two live, healthy births from six embryos and one implantation would be considered a high success rate in the world of IVF.

The deaths of three of the Zanes' embryos when thawed point to another difficulty with the absence of legislation.

If embryo donation becomes possible, there is less incentive to discontinue the practice of freezing embryos, yet freezing takes place in the full knowledge that many embryos will not survive thawing. The success rate, that is birth rate, is much higher in embryos that are not frozen.

In Italy, carefully crafted legislation has been brought in to protect the rights of embryos. Only three embryos may be created in any one attempt at IVF, and all of them must be implanted in the mother, giving them all a chance of life. The law also prohibits pre-implantation eugenic screening, or experimentation on, or cloning of, embryos.

Within these strict parameters, IVF is legal, and currently frozen embryos may be adopted if their parents do not propose to implant them. Once the embryos frozen before the current legislation are gone, freezing will be illegal.

We have never really had a debate on IVF in this country because people empathise with the pain and longing of infertile couples and are reluctant to appear to stand in judgment on them. However, some people have courageously gone public with the pain of failed attempts, notably writer Martina Devlin, whose marriage crumbled under the strain of three unsuccessful IVF attempts.(See www.martinadevlin.com.)

Her account makes for harrowing reading, and reinforces the fact that people desperate to conceive often do not hear the dry statistics concerning the relatively low chances of a live birth and higher rates of birth defects.

The Medical Council, although it may have been premature in declaring embryo donation ethical, may have done us a favour by promoting discussion on IVF.

The rights of the smallest members of the human race, and the welfare of potential parents, are surely worthy of discussion.