Life on Ice
In 1995, a California doctor took responsibility for thousands of unwanted embryos. He's still figuring out what to do with them.
By Tali Woodward
June 19, 2009 / Newsweek.com
Police cruisers typically escort heads of state, but on a November morning in 1995, the VIP heading down California's Highway 405 was an ordinary-looking moving truck. It was, however, carrying some particularly fragile cargo: several metal tanks, each just larger than a beer keg, containing a total of roughly 2,000 frozen human embryos. They were being transported from a scandal-plagued IVF clinic in Laguna Hills, Calif., to their new adoptive home in Newport Beach. Today, many still remain there, unclaimed. The embryos' unusual journey illustrates just how complicated the business of assisted reproduction can get.
The story starts at Saddleback Memorial Hospital in Laguna Hills. The fertility clinic there had been shuttered earlier in 1995, when an investigation found that its doctors had mixed up embryos and impregnated women with eggs that weren't theirs. As many as 300 patients were thought to have been involved, and at least three cases had surfaced in which women had unwittingly given birth to children not theirs. The clinic's top doctors, Ricardo Asch and Jose Balmaceda, had fled the county. Thousands of unused or extra embryos were left behind, and because the clinic was run by the University of California, Irvine, they were in the custody of the state.
Officials asked several nearby fertility clinics to take the orphan embryos, but initially no one was willing; most clinic doctors preferred to stay clear of the scandal's taint. Dr. Robert Anderson felt differently. "To me, it seemed unfair to the couples," he says. Anderson agreed to house the frozen embryos at the clinic he'd opened three years earlier in Newport Beach, the Southern California Center for Reproductive Medicine. "I thought it was the right thing to do," he says with more than a hint of resignation. "I actually thought I was doing a good thing."
Anderson signed a contract laying out how he would take care of the embryos and releasing him from any liability related to their origins. He didn't ask for payment, and he never suspected he'd be taking care of some of the embryos nearly 15 years later.
His staff began the process of tracking down the patients connected to each set of embryos using records from the Saddleback clinic. When the patients could be found, they were asked to make a decision about what to do with their embryos, and until they decided, they were billed for storage, just as Anderson's own clients are. But because the University of California clinic was one of the first fertility centers in the world, many of its patients lived abroad, and tracking them down proved to be difficult. "We did what we could do," Anderson says. Today, about a thousand of the Saddleback embryos remain.
Even if the patients are available to make a choice about the embryos, the decision often isn't an easy one. Many couples opt to freeze extra embryos created for in vitro fertilization treatments; when they're finished with IVF, they must decide what to do with these little clusters of cells, which were a challenge to produce and expensive. There are an estimated half million unused embryos, some decades old, being stored around the nation in fertility centers like Anderson's. "There are huge differences in the thinking about what these embryos represent," Anderson says. "From 'they're leftover biological material' to 'they're little people'."
Between the remaining Saddleback embryos and the ones from his own patients, Anderson estimates that he is responsible for about 6,700 embryos. These tiny bits of humanity are housed in 19 Thermos-like tanks lining the walls and peeking out from under counters at his lab. Each one is full of liquid nitrogen, which keeps its temperature under 300 degrees below zero, and is equipped with an alarm that's set to go off if the nitrogen evaporates more quickly than it should. An embryologist checks on the tanks each week and tops them off.
Every year, Anderson's team bills the couples whom the embryos belong to—in most cases, the genetic parents; in others, the men and women who acquired the sperm or eggs to make them. Along with a notice requesting $300 for annual storage costs, the "owners" receive a reminder that there are options for embryos like theirs. They can be donated to research or given to another couple that's trying to conceive. Or they can be discarded as medical waste.
Anderson has tried to make each option hassle-free. He has developed relationships with scientists who use surplus embryos in their research. About a decade ago, he partnered with a San Diego firm that became one of the first institutions to derive stem cells from human embryos. (At least one of those cell lines was among the 21 eligible for federally funded research under President George W. Bush.)
The renewed attention given to stem-cell research may make this kind of donation more appealing to Anderson's patients, he says: "It used to be that we would ask, 'Are you interested in donation to research?' and many [people] didn't really know what that meant." And now that President Barack Obama has decided that federal funding should be available for work on stem cells derived from leftover embryos, research demand is likely to intensify. Today Anderson is collaborating with a new stem-cell company, and about 50 of his current patients have signed up to have their embryos sent there.
He has also developed a donor-embryo program for patients who'd prefer to give their excess embryos to other people who are struggling to conceive. But knowing that your genetic child will be raised by another family isn't easy for many people. "That's the smallest group, and for obvious reasons," Anderson says.
Despite Anderson's efforts, most of the unneeded or abandoned embryos continue to sit in their tanks. Anderson says he feels burdened by them, but not because of the maintenance or associated costs. "It's all these unresolved issues. At some point, it just gets ridiculous. In a perfect world," he says, "when a couple is done with having all their children, they would make a decision. The farther and farther we get from that, the less likely they are to make a decision." And sometimes patients simply disappear. "I wish there was a way of making a disposition on a lot of these embryos that have been abandoned," Anderson says.
The American Society for Reproductive Medicine, which represents fertility doctors, says it is acceptable to destroy embryos if the patients they belong to have been out of touch for five years. Few clinics in the U.S. follow the guideline, however. "If nothing else, it would be a public-relations nightmare if anyone who has custody of embryos decided to terminate them," says bioethicist Lori Andrews, who teaches at the Chicago-Kent College of Law. But keeping embryos on ice indefinitely is not much of a solution. "There's really no forever," Andrews says, pointing out that some IVF clinics have been forced out of business by the recession. The bottom line, she says, is that "we have no agreement over the social or moral status of the embryo. We need to be more forward-looking in terms of the policies and regulation."
The lack of clear regulations also leaves clinics open to the ever-present threat of a lawsuit. Numerous cases dealing with embryo custody have wended their way through the judicial system in recent decades. The parents of a woman who died in 1996 sued for control of the embryos she'd frozen before she underwent treatment for leukemia. Later that decade, two couples sued Women and Infants Hospital in Providence, R.I., after it lost track of several of their embryos. Many other cases have involved disputes between divorced couples.
Anderson says he may ask UC-Irvine to cover storage costs for the unclaimed Saddleback embryos housed in his lab, although he'd prefer a more definitive decision from the parents about what to do with them. He believes that at least a few of them date from the 1980s, suggesting that their clinical value is limited. But as Anderson notes, any of them could still be viable. "Twice I've used embryos that were frozen for 10 years, and both times it resulted in twins," he says. When the potential of human life is involved, it seems there are no simple answers.