PRESS RELEASE

Toronto East General Hospital

Frozen embryo baby born

“The first baby in Canada resulting from an embryo conceived through in vitro fertilization and then frozen and stored, was born the first week of January 1990, the first such successful case in Canada.

“The healthy 8 ½ lb. baby boy was conceived at Toronto East General Hospital through the pioneering Laboratory Initiated Fetal Emplacement (LIFE) Program.

“The mother first came to the LIFE Program in 1987 after five years of infertility. ‘She began a treatment cycle in 1988 which resulted in nine fertilized eggs. Four of these embryos were transferred back to the woman – resulting in the birth of healthy 8 lb. boy – and five embryos were frozen,’ explained Dr. Peter Leung, the member of the LIFE Program team who performed the procedure.

“‘In April 1989, the frozen embryos were thawed and transferred back into the woman, resulting in the historic birth,’ he said. As a result of this procedure, these fraternal twins were born two years apart.

“‘The reason we use this procedure is to benefit the patient,’ said Dr. Perry Philips, coordinator of the LIFE Program. ‘With embryo freezing, there are no surplus embryos, and the patient doesn’t have to undergo the time-consuming expensive infertility treatment again. Using this procedure, we can also reduce the risk of multiple births.’”

The practical need for freezing embryos arose with in vitro fertilization (IVF). During a woman’s reproductive career, she produces, on average, one fertilizable egg per month. Given the high cost of IVF attempts, financially, physiologically, and psychologically, this slow pace of natural egg production is clearly not in step with the need to develop a baby every time (or at least as often as possible) the IVF technique is employed. Thus it becomes desirable to superovulate the woman with drugs in order to produce as many fertilizable eggs as possible for a given IVF procedure.

In some instances, ovulation-inducing drugs have stimulated the development of as many as 20 eggs in one cycle. This is, of course, unusually high, and fertility specialists look for a less prodigious figure – from four to seven. A superfluity of eggs is considered desirable to start with since failure rates associated with fertilization, implantation, and gestation tend to reduce an initially excessive number of eggs to a more manageable number of eventual births – preferably one.

Multiple births

Once inefficiency is expected, and therefore planned for, efficiency becomes undesirable. For example, doctors at the IVF, Laboratory Initiated Fetal Emplacement (LFE) unit of Toronto East General Hospital were surprised when they discovered that all five fertilized eggs they implanted in one of their patients survived. In this case, Mrs. Collier, of Holland, Ontario, gave birth to quintuplets, whereas she was originally hoping for the birth of a single child. Multiple births have become common place in IVF, thanks to ovulation induction. The Collier babies are the world’s third set of “test-tube” quintuplets. The Toronto East General clinic itself has had 21 sets of twins and 6 sets of triplets among the 120 babies born since the center was established in 1983.

Traumatic

A technology that remedies one problem seems to create another. Ovulation-induction remedies the problem of nature’s low rate of egg production, but creates a high risk of multiple pregnancies. At the same time, the superovulating drugs, together with the administration of anesthesia and the laparoscopy procedure, are traumatic to the woman’s reproductive system and often greatly reduce its capacity to achieve pregnancy. Here, it seems, a mechanism for production within the reproductive system is not in harmony with the operation of the system as a whole. Additional technologies are needed. Thus, in order to offset the problems of multiple pregnancies and trauma to the woman, the technology of embryo freezing has been developed. Embryo freezing provides a temporary storage for the surplus embryos and allows the woman to recover her strength so that in a subsequent cycle successful implantation is a greater likelihood.

Dr. William Karow

The success rate, however, in freezing, thawing, and implanting embryos is quite low, as might be expected with a relatively new technology that involves a highly delicate subject. Dr. William Karow, director of the Southern California Fertility Institute, who routinely freezes embryos in his IVF program, estimates that the chances of producing a “freeze-thaw” baby are only 2 to 3 percent. Nonetheless, the doctor remains optimistic: “My philosophy has always been,” he remarks, “to try everything that’s humanly possible.”

LIFE program

A couple of years ago, Toronto East General Hospital established embryo freezing as an extension of its IVF service, as a regular feature of what it identifies as its LIFE Program.

C.S. Lewis, in That Hideous Strength, created the acronym NICE, representing the National Institute for Coordinated Experimentation, a malefic bureaucracy that possessed the power to destroy society. In this instance, Lewis was using parody to reveal the moral distance that might exist between the acronym and the reality it camouflages – the acronym as inaccuronym.

The LIFE acronym is more a model of ingenuity than accuracy. It stands for Laboratory Initiated Fetal Emplacement. Scrupulous bio-technicians might find LIFE troublesome. Perhaps too much credit is given here to the role of the laboratory in initiating new life. The world “fetal” is not quite accurate since it is the embryo that is transferred to the uterus. “Emplacement” is misleading. The more appropriate word is “implantation.”

The LIFE Program’s Information Booklet Number 11 describes the process of freezing embryos, or “cryopreservation.” It presents the procedure as a “therapy.” Cryopreservation is more likely to kill the embryo than preserve it, but the aim is preservation and the procedure is named in a mood of hope rather than realism.

Chemicals

When an embryo is frozen, the temperature is slowly dropped to below the freezing point. But when the temperature reaches -6C. to -8C., ice crystals begin to form which damage the cellular structure of the embryo. In order to protect the embryo from destruction, chemicals are introduced which are designed to diminish the size of the crystals or dehydrate the embryo to such an extent that the final state prevents ice formation. These chemicals are called cryoprotectants. Their effect on human embryos remains to be established. Approximately 50 per cent of the thawed embryos will not survive in culture. Only 10 per cent of these, or 5 per cent of the original number of frozen embryos, are expected to be born.

Surplus eggs

A couple that has a child through the LIFE Program may not want additional children. Husband and wife may have frozen embryos that they no longer have any use for. In this eventuality, the LIFE Program offers them a variety of options. They may donate these embryos to another patient, donate them for research purposes, or have them disposed of. Moreover, a woman can donate any surplus eggs to the Clinic’s new ovum donation program to help a patient who has inadequate egg production or a genetic condition which makes it undesirable to use her own eggs.

On the other hand, certain factors may arise after freezing that conflict with the original intention of the program to enable a couple to have its own baby. If the couple changes its mind about having a child, if there is disagreement, divorce, or the death of either party, then the LIFE Program exercises its prerogative and disposes of the embryos. The LIFE Program will also dispose of the embryos if the parents have failed to communicate their intentions concerning the disposition of their frozen embryos within six months, or if the couple falls six months behind in its embryo storage payments, if the mother turns 40, or if the Program discontinues its operations and is unable to transfer its frozen embryos to another IVF Centre.

There is an unintended and paradoxical by-product of using a sequence of technologies in order to help a woman have her own child. By trying to give her more control over reproduction, enlarging her reproduction freedom, she ends up with less authority over her progeny. A pregnant woman can abort or carry the child to term without having to obtain the approval of the child’s father. Joint consent is not required in this matter. The woman’s will is sovereign. But if her embryo is frozen in liquid nitrogen, joint consent is required if she hopes to give birth to that child. Here, the father has a veto power which he does not have when the child is in the womb. Furthermore, the clinic’s decision to dispose of the embryo can override the couple’s preference to keep it alive. With embryo freezing, disposal rights shift from the woman to the father and the clinic. The authority she has over her own pregnancy resembles the power a minority stockholder has in determining company policy. The more the woman becomes enmeshed in reproductive technologies, the more she apportions her reproduction rights to sundry external agencies. The myth of progress creates the illusion that technology can gratify our desires without burdening us with unrequested tribulation. Reality, however, remains stubbornly organic; touch a nerve and the whole system trembles. We choose what is convenient and what is inconvenient chooses us. It is the central irony of our modern technocracy.

Donald DeMarco teaches philosophy at St. Jerome’s College, University of Waterloo, Kitchener, Ontario.