The issue of frozen embryos

Publié le 31 Mar, 2009

In its 2007 Statement, the French Biomedicine Agency estimates at 176,523 the number of frozen embryos in France for 49,618 couples (at 31st December 2006)1. At this date, only 52.8% of these embryos were subject to “parental project”, or in other words had already a chance to be reimplanted. 26% of the parents did not reply to the annual mail asking them what they wanted to do with their embryos or disagreed with their lot and 21.2% abandoned their “parental project”. At the end of 2005, 141,460 frozen embryos were counted, what means that the stock of embryos increased by 25% within one year.


The origin of frozen embryos


These embryos, called “supernumerary”, come from the medical assistance to procreation (MAP). Indeed, in order not to repeat the oocyte sampling in women which resort to MAP, we sample, at once, several oocytes which are fertilized in vitro (FIV). Among the embryos thus obtained, ten in average, only one or two are, in almost 70% of the cases, reimplanted in the mother uterus; the others are frozen in prevision of a second cycle of implantation, in the event the first attempts fails or in the event the parents would like to have another child. We state that the reimplantation of several embryos generates a high number of multiple pregnancies (twin, triplets, quadruplets…) and, as these are considered “at risk”, the women are proposed an “embryonic reduction”, in other words the abortion of one or several embryos. 


Each year, the parents are contacted, in writing, to know what they want to do with their stored embryos. If they want to preserve their embryos beyond the term of five years foreseen by the law, then they have to pay for the storage fees (estimated around €40 per year) without being reimbursed by the social security. Moreover, in the event of absence of “parental project”, the embryos are, with the consent of the parents, either destroyed, or given to adoption, or given to the research (and thus destroyed). In theory, their destruction is automatic if the parents fail to reply or if they disagree, after the five years of preservation.


Over the 119,000 attempts of MAP performed in 2006, 14,300 were frozen embryo transfers (FET). 13,802 FET were intra-marital and gave birth to 1,988 children; 262 came from spermatozoid donation and led to the birth of 40 children; 189 resulted from oocyte donation and 27 children were born alive from it. Finally, 57 FET were performed in the framework of an embryo donation, giving birth to 10 children.


The suffering of the parents


Widely common today, the practice which consists in conceiving more embryos than the number that will be reimplanted, is not without problems. 


In June 2006, Le Nouvel Observateur dedicated an article to these “ufos born from the success of the science“, “objects unpublished in the history of humanity” and real “legal, ethical and philosophical headache for physicians, and above all for the parents who, one day, must decide about their lot“. Parents of twins, Thibault and Aude told they tried to limit the number of frozen embryos but the reaction of their physician – “you should know what you want” – persuaded them to have, “like everybody“, “reserves“. And then, how to decide to destroy these embryos so desired and obtained after what looks like an obstacle course? “It is like if I sign the death sentence of my children“, stated a father; “I would have the feeling of a big mess“, said another. Head of the Centres for the Study and Preservation of Human Eggs and Sperm (Cecos) in Cochin, Jean-Marie Kunstmann declared: “we can manage it starting from a chid project, the embryo is something from the moment it has a future for the parents. Otherwise we get mad“. 


On 8th December 2006, Le Figaro, at its turn, published an article revealing the suffering of the parents faced with these embryos preserved at -196°. Parents of twins born from an IVF, Eric and Nathalie, who do not want another child, attest the absurd dilemma in which they are trapped: “even if I examine the question in all its aspects, I do not know what decision to make. (…) they are our genetic heritage and our history. We like them, they are the outcome of our struggle to found a family“, Nathalie said. “After having wanted more than everything children, gift offered by the science, we should make an omelette with the remaining eggs?”, wonders Éric. Same questions for Laurence who has four embryos in the freezer: “how to decide to destroy or to give what it turns out to be my future children, the potential brothers or sisters of my twins?“. President of the association Maia which supports the people faced with infertility, Laure Camborieux denounced the lack of information of French system on the problematic of these embryos: “each parent should be informed before his first IVF on the freezing and the long-term consequences“. 
More recently, a study of the INED dedicated to the medicalisation of the reproduction2 mentioned the “culpability badly assumed” caused by the fact to renounce to non transferred or non frozen embryos (in 2002, 46% of embryos obtained by IVF and 36% of those obtained by intracytoplasmic injection (ICSI) could not be transferred nor frozen). For Christine, jurist, “we do not realize the maternal instinct women can have on the embryos they leave, and it is true that I had the feeling to have them abandoned“.
Irreparable injustice


Because there is not remedy to this injustice, the Church, in its last Instruction Dignitas Personae on certain questions of bioethics, wants this production of human embryos to be stopped which exposes those “to serious death hazards or to alterations of their physical integrity, like shows the high percentage which does not survive to the technique of freezing and unfreezing“.


There is no moral solution to an immoral situation“, sums up Mgr Jacques Suaudeau, head of the scientific section of the Pontifical Academy for Life. Thus, the “solution” of embryo adoption proposed by some people is not a solution to the extent that it “takes place materially in the framework specific to the extracorporeal artificial fertilizations with embryo transfer and treats automatically the illicit aspect of these techniques“. Apparently generous, the embryo adoption raises the question of the respect due to any human being, including that due to the women, because of the fact it denies the indivisible unity of procreation and pregnancy.
Moreover the Church considered as “disproportioned” the massive transfer of all the embryos stored in the uterus of their biological mother without procreative purpose. “The physicians who [this practice, editor’s note] perform it estimate only that it deals with a more ethical and cheaper mode of destroying these embryos than the simple unfreezing.


Regarding the “solution” which would consist in using these human embryos for research, it is against their dignity: still alive, they must be respected in their integrity until the death is observed and non instrumentalised. 


It is only by negative deduction that we manage to say that the destruction of frozen embryos is a “lesser evil“. In order to avoid they are instrumentalised and delivered to the researchers, the Church proposes to unfreeze these embryos to put them back in normal conditions of survival, in culture medium, at 37°. The embryos which survived to the unfreezing thus will finish their existence by natural degeneration.


Embryonic raw material 


By creating embryos in number, the MAP is become the 1st supplier of embryonic raw material for researchers. By principle prohibited in France, the research on human embryos is authorised, since 2004, by derogation, on these embryos called “supernumerary”. “We have the unpleasant feeling that the conception not at all necessary of supernumerary embryos in the French MAP is the affective blackmail the politic and scientific authorities exerts on the parents to benefit from the continuous flows of “fresh” embryos”, denounces Pierre-Olivier Arduin, head of the bioethical commission of the diocese of Fréjus-Toulon.


What is the future in case of separation?


Several times, the justice had to pronounce on the delicate question of the future of embryos in case of separation of their parents. 


Thus, on 7th March 2006, the European Court of Human Right (ECHR) has, in last instance, repudiated the motion of a young British woman, Natallie Evans, who asked the restitution of her frozen embryos to which her ex-boyfriend opposed.


The first proceeding of this kind was held in Maryville (Tennessee, USA) in 1989: a woman, Mary, asked she was given the frozen embryos she had with her husband, who opposed to this process. The geneticist Jérôme Lejeune was called to the witness box and testified to the humanity of the seven frozen embryos. On 2nd September 1989, the judge Dale Young recognised that an embryo was not a personal property which can be destroyed and its mother was given custody of these embryos so that they can be reimplanted3.


Post-mortem embryo transfer


Moreover, the embryo freezing opens the way for post-mortem embryo transfer. If this practice is today prohibited in France – the MAP being reserved to couples formed of two living members – the next revision of the law of bioethics could authorises it, according to, in particular, the recommendations of the Parliamentary office for scientific and technological assessment (OPECST). Such requests raise the question to know if the society can deliberately make born orphans of father and, more widely, wonder about the legitimacy of the power of the society on these embryos and their family.


To break the deadlock


According to two recent studies, one from Finland, the other from Netherlands, published in the journalHuman Reproduction, the single embryo transfer (SET) would be cheaper and more efficient. The first study established that one birth coming from SET cost €20,000 less than a birth coming from double embryo transfer (DET). The second study, by comparing the period 1995 – 1999 when the SET was under-used to that of 2000 – 2004 when its practice was widely developed, showed better results of efficiency during the last period. Should not these results encourage the legislator to take measures inciting MAP centres to advocate the single embryo transfer? 


Finally, regarding the multiple problems caused by the frozen embryos, should not France, like Germany which learnt the lessons from the past, prohibit the cryopreservation of embryos to limit the creation of embryos up to the number which will be immediately reimplanted?


1- Au Royaume-Uni, entre 1991 et 2005, ce sont 1,2 million d’embryons qui n’ont pas été utilisés sur les 2 137 924 créés dans le cadre d’une AMP. 
2- De la pilule au bébé-éprouvette, sous la direction d’E. de La Rochebrochard, Les cahiers de l’Ined N°161, 2008, 264 p., 25 €
3- Embryon, mon amour, Céline SIORAC, coll. e/dite, février 2004.

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