What should be done with excess frozen embryos?

Six years of frustration and heartbreak. That's how Gina Rathan recalls her attempts to become pregnant.

Finally, she and her husband, Cheddi, conceived a daughter, now 3, through in vitro fertilization. About a year later, she became pregnant with a second child, naturally. Their family was complete.

A year ago, the Fountain Valley couple received a bill reminding them that their infertility journey wasn't over. They owed $750 to preserve three frozen embryos they created but hadn't used.

"I don't see them as not being life yet," said Gina Rathan, 42, a pharmaceutical-sales representative. "I thought, 'How can I discard them when I have a beautiful child from that IVF cycle?' "

Many other former infertility patients also appear to be wrestling over the fate of embryos they have no plans to use: About 500,000 embryos are in cryopreservation in the United States.

As with the Rathans, this conundrum often arises well after the infertility crisis has passed, triggering debates about the science and ethics of human life.

The discussion boils down to a fundamental question: What is this icy clump of cells smaller than a grain of sand?

Across the country, people with less personal stakes in the matter are also asking that question.

Colorado voters will decide in November whether to amend the state's Constitution to assert that an embryo is a person. Indiana lawmakers have proposed legislation that would allow abandoned embryos to be adopted for implantation by another couple. New Jersey legislators have moved to allow unused embryos to become wards of the state. And Georgia and West Virginia are considering legislation that would give embryos "personhood" status.

An ideological war

Although these proposals are sponsored in large part by abortion opponents, infertility patients nationwide — whose feelings about abortion run the gamut — are becoming ensnared in a debate about when life begins.

"They are in the middle of this ideological war, although they may not be aware they are in the middle of a war," said Renee Whitley, co-chairwoman of the national advocacy committee for Resolve, an organization supporting people with infertility. "This is the politics of embryos."

Couples with leftover frozen embryos have three choices: discard them, donate to research or donate to another couple for pregnancy. The default option is to leave the embryos in a vat of minus-310-degree liquid nitrogen, paying for the storage and deferring the decision.

Embryo-protection legislation could winnow those options and, said doctors and consumer advocates for the infertile, possibly limit future infertility treatments.

Freezing excess embryos is a common strategy for in vitro fertilization. To make embryos, a doctor injects a woman with potent hormones to produce eggs. These are harvested in a surgical procedure. The eggs are mixed with sperm in the laboratory, and some of the developing embryos are transferred into the uterus. A single cycle with fresh embryos costs more than $15,000, often not covered by insurance.

Subsequent attempts at pregnancy are less costly if frozen embryos are on hand, and the extras spare a woman another round of harsh drugs to produce eggs. About half the people who undergo in vitro fertilization end up with one or more frozen embryos.

Infertility clinics report that they lose contact with 15 percent to 25 percent of families with frozen embryos. According to the American Society for Reproductive Medicine's guidelines, a clinic can consider embryos abandoned and dispose of them if five years have passed without contact with the couple and if significant efforts have been made to reach the couple. But few doctors dispose of the embryos, said Dr. Richard Paulson, chief of reproductive endocrinology and infertility at the University of Southern California Keck School of Medicine.

"To my knowledge, no one in the United States has ever done that," he said. "We're all paranoid that a couple will show up the next day and say they want their embryos."

"Snowflake adoptions"

The federal government supports, via funding, only one option: adoption to another couple for pregnancy.

In a highly publicized event at the White House in May 2005, President Bush posed for pictures with children born from adopted embryos, sometimes called "snowflake adoptions," referring to the fact that the embryos are frozen and unique.

About 1,000 babies have been born in the United States from embryo adoption since it became available 10 years ago, said Ron Stoddart, who founded the Snowflakes Embryo Adoption Program, based in Fullerton, Calif.

However, research by Anne Drapkin Lyerly, an associate professor of obstetrics and gynecology at Duke University, and other surveys have found that most families prefer not to donate embryos for adoption.

Human embryos are the primary source of stem cells, and the uptick in stem-cell research has fostered a growing demand for donated embryos. Although such research destroys the embryos, the broader effort is aimed at curing disease.

Some couples who want to donate to science find that researchers are not nearby, that their infertility clinic isn't associated with a research program and thus can't facilitate donations, or that their state prohibits research on embryos.

"There are tremendous obstacles to being able to donate to research," said Lee Rubin Collins, co-chairwoman of Resolve's national advocacy committee. "The research community hasn't caught up with the desire of many patients to contribute."

Infertility patients may support embryo use in research, but much of the nation appears to be more conflicted.

No federal funding is available for embryonic stem-cell research, and only eight states fund such research within their borders.

Last year, Bush vetoed a bill that would have allowed federal funding for new stem-cell lines derived from fertility-clinic embryos.

Three potential lives

As for the Rathans, they ruled out discarding the embryos. They discussed donating them to research but heard that option was a logistical nightmare. They pondered giving the embryos to another infertile couple.

"Before I became pregnant, I thought the decision would be easier for me," Gina Rathan said. "But when it actually happened, I realized these are three potential lives."

Finally, the couple paid for three more years of cryopreservation.

"I think about the embryos every day," Rathan said. "I am their mother. I see them as my own children."