Hope for the unchosen

In late November, Emma Wren Gibson was born just in time for the Christmas season—and 25 years after her conception.

A quarter century ago, fertility doctors froze Emma while she was still an embryo created during the process of in vitro fertilization (IVF). Many parents who bear children through IVF choose to freeze indefinitely any remaining embryos after they have the number of children they desire (or if the mother can’t carry more unborn children).

At least 600,000 embryos sit frozen in storage facilities across the United States, according to the Department of Health and Human Services. Some reproductive experts believe the number is closer to 1 million.

Among those frozen long-term, a small fraction of little ones get a chance to live, when couples like Tina and Benjamin Gibson adopt embryos like Emma. Early last year, a physician at the National Embryo Donation Center—a Christian organization based in Knoxville, Tenn.—transferred embryo Emma into Tina’s womb.

On Nov. 25, 2017, baby Emma arrived healthy and whole, weighing 6 pounds, 8 ounces. She likely holds the record for the embryo longest-frozen before birth. Tina, 26, marvels at the process, noting she was a 1-year-old baby when physicians created her daughter in a lab dish.

“People say, ‘Oh, it’s science,’ but … I think it’s a gift from the Lord,” the new mother told a local news station in December. “It’s a gift from the Lord, for sure.”

Not all fertility doctors view it this way. For many physicians, creating embryos and successfully transferring them into their mothers’ wombs—or the womb of an adoptive mother—is a mixture of science and odds. And the so-called “odds” for embryos often aren’t good.

Some embryos don’t successfully implant in the womb. Others don’t survive the thawing process. And many don’t survive the initial screening process to determine whether they should have a chance at life at all. If a pre-implantation test indicates a potential chromosomal abnormality, physicians often discard or freeze the embryo and move on to stronger prospects.

But one problem with the screening process is that it isn’t always accurate.

Over the last few years, a handful of physicians in the United States and Europe have reported that embryos deemed abnormal by early tests could still grow into normal pregnancies—and they have the healthy babies to prove it.

That means physicians have thrown away perhaps tens of thousands of embryos deemed abnormal that could have been healthy. Norbert Gleicher, a New York fertility physician involved in the research, has called it “an unprecedented scandal.”

“We as a profession have been disposing of thousands and thousands of completely normal embryos, with normal potential,” Gleicher told New York magazine last year. “And nobody—nobody—has had the guts to stand up and say we are sorry.”

Gene Rudd, a physician and senior vice president of the Christian Medical & Dental Associations, sees an even bigger scandal: a preoccupation with testing embryos in fertility clinics and babies in wombs to choose those deemed most desirable.

Rudd calls it a “cultural bent on search and destroy. … This notion that life is disposable if we don’t get exactly what we want.”

As physicians debate the accuracy of tests for embryos in test tubes and babies in the womb, others are bent on search and rescue: adopting embryos out of frozen storage and advocating for children and adults who have shown that a life with disabilities is a life worth living too.

MONICA HALEM KNOWS FIRSTHAND the anguish of nearly discarding her child. The New York dermatologist and single mother bore her first daughter in 2013 through IVF. Nearly two years later, at age 44, she began IVF again, but physicians told her that testing showed all her embryos were abnormal.

When pre-implantation genetic screening (PGS) shows a chromosomal abnormality that could make an embryo unlikely to live to birth—or could result in a condition like Down syndrome—physicians often advise discarding those embryos and trying for presumably healthier ones.

But some physicians weren’t convinced the PGS testing always produced accurate results.

Jeffrey Braverman, a New York fertility doctor, had grown suspicious of test results when he saw a handful of younger patients producing abnormal embryos. He joined a program to implant presumably abnormal embryos into older women. Eight women agreed. Five became pregnant. All five women delivered healthy babies.

Braverman encouraged Halem to try a similar approach. In such a scenario, a woman might still abort a baby if later tests showed the unborn child did have abnormalities. This wasn’t a pro-life program, but it yielded live results: In January 2016, Halem delivered another healthy baby girl.

Meanwhile, Norbert Gleicher was alerting his colleagues to the alarming findings. In October 2015, he told the American Society for Reproductive Medicine (ASRM) that in some cases abnormal embryos had been born normal infants.

A month later, a group of doctors in Rome reported similar results: They had implanted presumably abnormal embryos into 18 women struggling to conceive. Six became pregnant. All six bore healthy infants. The consortium now reports 24 normal births. A hospital in Spain has reported 13 healthy infants.

A year later, a study by researchers at the University of Cambridge reported an intriguing possibility: Embryos might be able to “self-correct.”

‘We as a profession have been disposing of thousands and thousands of completely normal embryos, with normal potential.’ – Norbert Gleicher

Professor Magdalena Zernicka-Goetz led the study while waiting on further test results to find out if her 12-week unborn child had abnormalities. (An early genetic test for babies in the womb suggested he did. He was born normal as well.)

The professor decided to learn more about abnormal embryos and created “mosaic” embryos using mice. The term mosaic refers to embryos showing a mixture of abnormal and normal cells. The study suggested these mosaic embryos weeded out abnormal cells during development.

And since PGS testing uses cells from the part of the embryo that forms the placenta, it’s unclear if the results are an accurate picture of the tissue that forms the unborn child.

(It’s also notable that since many IVF embryos haven’t undergone PGS testing, physicians likely have been implanting mosaic embryos for decades without knowing it. It’s impossible to know how many healthy people born through IVF would have been deemed abnormal by PGS tests.)

Gleicher estimates tens of thousands of normal embryos may have been discarded over the last two decades—including embryos belonging to women who gave up on having children because they thought a normal pregnancy was impossible.

In an email interview, Gleicher said he thinks fertility doctors are more open to rethinking the practice of implanting mosaic embryos. Last year, the ASRM released an opinion saying it could be ethically justifiable to implant abnormal embryos, though it still strongly discouraged implanting embryos with “a high likelihood” of abnormality.

Gleicher says the toughest remaining pushback comes from the PGS industry that makes millions of dollars from the tests. Estimates vary widely, but Grand View Research Inc. reported the pre-implantation genetic testing market was valued at $129 million in 2015.

Other companies have even more specific ambitions. An IVF specialist working with the startup Genomic Prediction told MIT Technology Review in November he believes the company will be able to predict which embryos might develop treatable conditions like Type 1 diabetes.

Could that lead to predicting height, weight, IQ, or social skills of embryos—a drop-down menu for choosing or eliminating babies? Physicist Stephen Hsu told Technology Review it’s entirely possible, though he thinks many would deem it unethical.

But if determining some undesirable qualities is already deemed ethical, it’s difficult to predict where the line would stop.

For Halem, who told her story to New York magazine last fall, the statistics and odds seem irrelevant when she looks at a photo of her infant daughter healthy and whole. “Here’s this little abnormal embryo, okay?” she told the reporter. “This is what they would have thrown away.”

FOR EMBRYOS THAT MAKE IT PAST being discarded or donated to science, a formidable obstacle remains: frozen storage. Many parents who don’t want to bear more children after successful IVF pregnancies say they feel conflicted about the embryos they’ve left in storage. It’s one of the most serious ethical problems related to IVF.

Tens of thousands remain in limbo.

Several organizations offer the option of embryo adoption, though the term adoption is controversial to some. The ASRM has released a statement saying embryos deserve “special respect, but they are not afforded the same status as persons.”

Legally, that’s true. Most states consider the donation and reception of an embryo as a property transfer, and contracts typically use such language.

But for Christian organizations finding homes for frozen embryos, adoption is the most fitting term.

Kimberly Tyson facilitates the Snowflakes Embryo Adoption Program for Nightlight Christian Adoptions. The organization matches embryo donors with those seeking to give birth and raise children. The group requires a home study for adopting parents and allows donor families to choose a home for their embryos. A physician at a fertility clinic typically transfers the donated embryo into the hopeful mother.

“I call them babies,” says Tyson. “I call them children. We recognize them as fully human because they have everything it takes to make a human being included at conception.”

One major distinction at Snowflakes: Unlike some fertility clinics that perform embryo transfers, Snowflakes doesn’t conduct PGS testing or allow it after an embryo adoption. If an embryo already has PGS results, Tyson says her organization will still work to find a home for the embryo, even if the results show an abnormality. Some families express a willingness to adopt a special needs embryo.

In some cases, Tyson says, Snowflakes has received embryos with doomed labels: “incompatible with life.” She says one family adopted a set of those embryos, and now has “two perfectly lovely little girls.”

Physicians at the National Embryo Donation Center in Knoxville have a similar policy: They do not perform PGS testing.

Couples travel to NEDC to receive an embryo donation, and the transfer takes place on-site. Like Snowflakes, the center also doesn’t discard embryos. Jeffrey Keenan, the physician who directs the center, says, “As Christians, we’re interested in trying to give every embryo created in God’s image the best chance of coming to birth that it can.”

For some families, the process produces moving results.

Aaron and Rachel Halbert, PCA missionaries in Honduras, adopted two infants after they married, but decided they wanted more. They had hoped to conceive naturally but also grew open to the idea of embryo adoption when Christian friends described it to them.

After going through the application process, the couple traveled from Honduras to NEDC in Tennessee. Since their two adopted children are African-American and biracial, they asked to adopt African-American embryos. The physicians implanted two embryos in September 2015, and the family headed back to Honduras.

Several weeks later, a Honduran doctor performed an ultrasound. Aaron Halbert says he remembers the physician staring at the screen. “You said they implanted two?” he asked the couple. “Are you sure?” The parents said yes, and the doctor replied, “Well, I’m seeing three.”

One of the embryos had divided. The Halberts were expecting triplets.

Several months later, the family traveled back to the United States for Rachel to give birth. Their three African-American daughters were born in April 2016. They were six weeks early, but arrived healthy.

Aaron Halbert says life with five children under age 5 is challenging, but the family is thrilled with God’s providence. When critics suggest families should adopt children already born, Halbert says traditional adoption is a vital option (that his own family has pursued), but Christians should also see embryos as image-bearers who need protection.

“Every one of them is made in the image of their Creator,” he says. “And He has designed each and every one of them, so we ought to have a high view of them.”

He says it’s hard to fathom the reality their daughters sat frozen for 15 years. “When you get to this side of it, you think: ‘You’re telling me that embryo should have been destroyed?’”

The Halberts draw attention in Honduras for their non-traditional makeup, but the father says when people ask if the children “are yours,” he emphatically answers: “Yes, yes, yes. … They bear my name just like I bear Christ’s name, and I am His. These children are ours.”

EMBRYO TESTING isn’t the only screening drawing controversy.

As labs develop earlier tests for conditions like Down syndrome, some physicians and disabilities advocates worry about a booming industry that often leads to abortion of babies deemed undesirable by some.

For example, a fetal DNA blood test on the market since 2011 allows doctors to test a baby for abnormalities earlier in the pregnancy without the invasive and risky techniques involved in procedures like amniocentesis.

If the results come back negative for abnormalities, it’s likely the baby will be healthy, reducing the need for more invasive tests later in the pregnancy.

But if results come back positive for a chromosomal condition, some studies show there’s as much as a 50 percent chance the test isn’t accurate. Expectant mothers would need more invasive testing later in the pregnancy to know for sure. Still, one company marketed the tests with catchphrases like “no room for maybe.”

A 2014 investigation by the New England Center for Investigative Reporting found that likely hundreds of women were aborting babies based on the new tests, instead of getting further tests. The report contended companies were aggressively marketing the tests without fully informing patients about the possibility of errors. The companies denied the accusations.

The study said one market firm estimated the industry would be worth $3.6 billion by 2019.

Meanwhile, adults with Down syndrome—one of the conditions commonly targeted for screening—are living twice as long as they did 35 years ago. Life expectancy rose from about 25 years in the early 1980s to more than 50 years today. Some experts attribute the increase to better quality of life and more opportunities for people with Down syndrome.

Last fall, Frank Stephens, a Special Olympian and disabilities advocate living with Down syndrome, testified before Congress about the importance of protecting people with Down syndrome.

“Some people say prenatal screens will identify Down syndrome in the womb and those pregnancies will just be terminated,” he said. “It’s hard for me to sit here and say those words.”

Stephens—who compared that notion to “a final solution”—noted a Harvard-based study showed people with Down syndrome and their families are happier than society at large. He also noted that because adults with Down syndrome have a high risk of developing early onset Alzheimer’s disease, they could contribute to research in fighting the disease.

“Finally, we are the canary in the eugenics coal mine,” said Stephens. “We are giving the world a chance to think about the ethics of choosing which humans get a chance at life. … Is there really no place for us in the world?”

‘We are giving the world a chance to think about the ethics of choosing which humans get a chance at life. … Is there really no place for us in the world?’ – Frank Stephens

Legislatures in some U.S. states agree with Stephens: Ohio passed a law in December banning abortions of babies diagnosed with Down syndrome. North Dakota passed a similar law in 2013. A federal judge blocked Indiana’s 2016 ban last fall, but the state’s attorney general plans to appeal the injunction. Ohio’s law may also face legal opposition.

Rudd—the physician with the Christian Medical and Dental Associations—notes technology will continue to be used for both good and ill, but when it’s abused, it should concern everyone.

The same arguments about quality of life versus cost to society could be applied to an aging person or a seriously ill person, he says: “Once you cross the lines, it can get really murky. … One day it could be used on you.”