Thursday, February 14, 2008

Embryo Adoption

I thought I'd explain Embryo Adoption because we've gotten a lot of "Congratulations! What is it!?" from our non IF friends and family.

In Vitro Fertilization (IVF) is the process of harvesting eggs and sperm from the parents and uniting them in a petri dish. The resulting fertilized embryos (not eggs, which are just gametes and is often mistakenly said) are then transferred to the mother's uterus where the hope is that they will successfully implant and grow to a full term pregnancy and delivery. Because the conditions under which the embryos are created are so much harsher than the natural womb environment, a lot of them do not survive the process. They can die at any number of stages. For this reason fertility clinics and IVF patients often start with numbers of embryos that exceed the number of actual children they can or want to carry. If successful pregnancy is achieved, many patients freeze the remaining embryos for transfer at a later time. Often however, the genetic couple decides to not have or attempt to have any more children and there are still embryos remaining.

Typically there are a few options for what to do with the remaining embryos. Some people donate them to science for research and things such as embryonic stem cell research. Some people choose to leave them frozen indefinitely. Some people ask for them to be intentionally destroyed. Some do what is falsely called a "compassionate transfer" in which they are transferred to the mother's uterus at her non-fertile time in her cycle, giving them very little chance to actually implant, at which time they would be expelled by her body. The remaining option is to donate them to another couple through either Embryo Donation or Embryo Adoption.

In that case, the embryos are transferred to the prospective parents' clinic, where they are transferred to the new mother's uterus, with the hope that they will implant and result in a term pregnancy and live birth.

It's important to note the difference between "transfer" and "implantation." In IVF or Embryo Donation/Adoption, embryos are transferred to the mother, meaning a catheter is inserted in to the uterine cavity through the vaginal and cervical passages, and the embryos are then "injected." Just as in natural conception, when the embryos are released from the fallopian tubes in to the uterine cavity, they must find a place in the uterine wall to burrow and "implant." In an Embryo Transfer, after they're injected, the Embryos must go through the same process of finding a spot in the uterine wall to nest and grow. It is not inserted directly in to the uterine wall. In Embryo Transfer, doctors do their best to "aim" for the most favorable position, but it is still up to God and nature if the embryo is going to successfully implant and grow.


Embryo Donation is similar to a sperm bank. The genetic parents donate their extra embryos to the clinic or bank and the prospective parents go to the bank and select their sample(s). The 4 parents know little (if anything) about each other.

In Embryo Adoption the process is executed largely like a traditional adoption. The Genetic Parents contact the adoption agency with the intent to donate, as well as their criteria for adoptive parents. Criteria can range from age, to race to desired level of openness about the adoption. However, the embryos remain at the Genetic Parents' own clinic and are never transferred to the adoption agency.

The Adoptive Parents (us!) contact the adoption agency, and submit an application and biographies about ourselves. We also undergo the same Adoption Education, Homestudy and Court Certification process that traditional adoption applicants undergo. We also undergo a host of medical tests (some are FDA required) to ensure that we don't have any disease we could pass on, and to make sure I can actually carry a child. (On a side note, the infectious disease requirement of the FDA annoys me because you don't have to undergo those tests for "natural" conception and anyone with any STD can reproduce but the federal government holds "yay" or "nay" power for us. We were chaste until we were married and have been each other's only partner so it seems like a silly waste of money, but the FDA insists anyway. I guess I am grateful that we don't have to wonder whether or not that test will be a barrier for us).

Anyway, once all of that is completed, approved and accepted by the Adoption Agency, we begin the match process. We're put in to their pool of prospective parents and we wait for a genetic family to choose us. Once they do and both they and we agree to the match, they transfer "ownership" of their embryos directly to us, and we undergo a Frozen Embryo Transfer. If successful pregnancy is achieved and there are still remaining embryos, we store those at our own clinic until a future time when we would attempt a second or third pregnancy with the remaining embryos. The neat thing about this is that if multiple successful pregnancies are achieved, our children would have genetic siblings!

Once a successful pregnancy and birth is achieved, we notify the adoption agency and they notify the genetic parents. We also notify the agency periodically and genetic parents can receive those updates if they wish. Whether or not there is contact directly between the genetic parents and us, or between them and the child(ren) is up to all of us and the arrangement we make.

Legally, Embryo Adoption doesn't exist, and none of this extra procedure of homestudy, matching, application, etc, is necessary. Because the law does not grant personhood to pre-born children, they are considered "Property" and any transfer is considered a property transfer. Opponents of the term "embryo adoption" accuse this of being some sneaky way of legitimizing the embryo as a person, and I suppose it may be so, but for us there is comfort in knowing that should we ever need it, we have access to the genetic parents for any medical information, etc. For the genetic parents I think there is comfort in knowing the fate of their embryos, wherein with Embryo Donation, they would not ever know what happened to them. I guess I don't understand people who needlessly politicize it. If it's agreeable for both parties and we all willingly enter a more difficult process, what is it to anyone else?

I know, it's ironic that I'm getting riled up about pro-life politics ;)

Our next steps are to apply to both adoption agencies (because we live out of state from the agency that coordinates the actual embryo adoption, we have to use an Arizona agency in cooperation with them to complete the Homestudy and Court Certification), then begin the homestudy, make some repairs around the house (for example state law (and our own conscience) say we need a pool fence if we're going to have children), and make an appointment with the fertility clinic to undergo the required tests. We hope to be able to begin all of that by the summer time. A homestudy and court certification takes 3-6 months, and then once approved we can enter the pool to be matched. That can take any number of months, depending on how desirable we are. Then from match to transfer can take another couple months to negotiate the logistics between moving the embryos, getting my body on the right cycle at the right time, etc. So assuming we can progress through the financial end of things and get the ball rolling soon, we hope to be completed with the process (including pregnancy) by Christmas 2009 or Spring 2010.

The Placement Agency that we're using, Nightlight Christian Adoption Agency in Fullerton, CA., is the pioneer of the "Embryo Adoption" concept. They have called their program the "Snowflake" adoption program, comparing the uniqueness of each embryo to the uniqueness of every snowflake. So we may use "Snowflake Adoption," "Snowflake Embryos," "Snowflake Babies/Children" and "Snowflake Families" interchageably with "Embryo Adoption [subject]." I think the "Snowflake" concept is really beautiful. Todd got me a beautiful ring bearing snowflakes to commemorate the beginning of our process. Like our own special kind of Mother's Ring! These children, whoever and wherever they are, are already so dear to our hearts!

The whole process is overwhelming. The cost of everything is about $13000-$15000. The details involve an entirely new alphabet soup and list of legal and medical mumbo-jumbo that make my head spin. Things have to be done at the right time, in the correct order. And at the end of it, if none of the embryos successfully implant in me, we still may not have a child at the end of it.

However, though I feel a bit like I'm on mental overload--I'm afraid I'm going to forget or overlook a detail and that the pile of information in my head is going to be so big that things fall out!--I have a remarkable amount of peace about the situation. I'm not at all worried about the homestudy or the matching process and I'm not afraid of embryos not implanting. I'm not really worried about the money either--though I am a bit impatient that something so trivial as money is the only barrier right now, I can also see that it's a very tangible need that God can use to orchestrate His timing of our process so that comforts me too.

We're really excited.

We would ask our friends and family to refrain from referring to this process as "buying" children or embryos and please don't call the resulting children "bought" children. Please don't say it in seriousness or in jest. The doctor's office today used some of that terminology and it made me wince. Though legally these embryos may be regarded as the same as a car or a house, they are children in the sight of God. If we truly believe that life begins at fertilization (we do), then these children need a home as much as the children in foster homes and orphanages do and we are their best chance at survival. We're willingly and wholeheartedly making the decision to enter the more complicated and expensive adoption process rather than the donation process, so that we can be fully equipped with as many resources of knowledge and training as we can before we begin shepherding these precious little ones. In our heart, this is an adoption, whether the law says so or not. Please support and affirm us by considering it the same way.

It's also helpful to note some terminology. The embryo's "original" parents are the Genetic Parents. We are the Adoptive Parents but the child(ren) will be ours. We refrain from using words like "real parents" and "real children" and "children of our own" when distinguishing between the genetic and adopted relationships. The only distinction between any adopted children and any biological children is just that--biology. We will love these children with our whole hearts, as our own.

We chose embryo adoption over traditional adoption for a lot of reasons, but that is also only for a first child. Obviously if we have remaining embryos after the fact we will transfer those too, but traditional adoption is still a very real possibility for us in the future. In our minds, all those children, in "the system" and in test tubes, need homes. That prospect is a little overwhelming but as my sister in law pointed it out, we're each only to do what we're called and equipped to do. Right now we're wholeheartedly convinced that we are called in this season to pursue Embryo Adoption.

Please feel free to ask any questions!