We have a basket in our kitchen. It's a pretty big basket. And it's usually overflowing, because it's where we throw unopened mail, receipts, magazines, preschool artwork, papers that come home from school in the kids' backpacks, even the odd library book (found it!).
We pay almost all our bills online, but there are a few that end up in the basket. So unless I've got time to empty the whole thing -- and believe me, blue moons come around more often than that -- I have to root through the pile a once a month looking for accounts that need to be paid the prehistoric way (with a check and a stamp).
One of those comes quarterly, from our infertility clinic. A fee for storage of our frozen embryos.
Before Lilly was born, I paid the fee four times a year without a thought. We were worried about trying again after Madelyn's spina bifida, but somewhere inside me, I knew I'd be doing a frozen embryo transfer cycle. At that time we had eight embryos remaining. Before the cycle that gave us Lilly, I remember considering, briefly, the idea of thawing all of them and transferring the two or three that looked best.
Why would I do that? Embryos are precious, requiring many thousands of dollars to create, and freighted with all our hopes and dreams of parenthood. The more logical course -- and the one we ended up following -- was to thaw four, transfer two or three, and leave four in reserve in case I did not become pregnant. But I did, and now we have our precious Lilly.
And we still have four embryos.
Lilly is a thriving one-year-old, and the embryo storage bill has appeared in the basket once again. It's time to make the decision I wanted to weasel out of by thawing all eight and letting the embryologist choose. Rather coldly, doctors call this "embryo disposition."
In a perfect world -- in which I win the lottery, quit my job, mother my girls full-time, and travel the globe in search of money-is-no-object treatments for Madelyn -- I would not have to face this choice. Or rather, its terms would be different. The decision would become the same as before Lilly: The recurrence risk for neural tube defect is 1-2 in 100 births, versus 1 in 2,000 for the general population. If we chose to roll the dice again, I could take enough folic acid to choke a cow, do another frozen cycle, and let the pee sticks fall where they may.
But in the world I have to live in, we cannot afford another child, especially if that child might have spina bifida. We are still in debt for our donor cycle, and our family's medical expenses are steep. I have no option but to work, yet if I had a third baby we couldn't afford the daycare that allows my income. And even if we could somehow solve that problem, if we had another spina bifida baby, the financial consequences would be crippling.
Some women who don't want to discard embryos would just take the chance of cycling, assuming it's unlikely they'd get pregnant anyway. After all, the success rate for frozen cycles is less than 50 percent. But if there's one thing I'm good at, in my whole sorry reproductive history, it's implanting embryos. (I have done five cycles and became pregnant four times.)
So for all these reasons, I cannot risk another cycle. Even though a deep and irrational part of me desperately wants to. And in complete honesty, I do not know where that urge comes from. It is just a mother's normal sadness when she realizes that she'll never have another baby? Or is it the embryos themselves that trouble me?
I'm not the only one facing this problem, according to a Mother Jones article titled Souls on Ice: America's Embryo Glut and the Wasted Promise of Stem Cell Research. As the article describes, people like me just keep writing the check, year after year, because we cannot decide what to do with embryos we have chosen not to transfer.
I know what you're thinking. You're wondering why I didn't consider the moral and emotional dilemma of excess embryos before I did the cycle that created them. And possibly you're wondering whether I did think about it, and just brushed it aside amid my overwhelming desire for a child.
What I can share is this: It's different now that I have Madelyn and Lilly, born of the embryos we made. Back when we were cycling, embryos were science--and the more we could make, the better our chances of becoming parents together. Now, my embryos are potential siblings to my daughters. No matter a woman's opinions on abortion, reproductive rights, and all the rest, she will think differently about embryos after she becomes a mother through IVF.
Incredibly, as reported at Science Daily and confirmed in a Los Angeles Times article on embryo legislation, some states are considering the idea of making abandoned embryos "wards of the state." Many people, it seems, consider embryos to be unborn children.
It follows that to those who hold that belief, discarding embryos is equivalent to abortion. This idea horrifies me. I have always opposed abortion, the more so since doctors offered me the chance to terminate Madelyn at 19 weeks (after seeing eyelashes on the ultrasound!).
People can and will argue "when does life begin?" until the fabled cows come home, and I won't bite on that one. But I do not believe that allowing a few-celled embryo to stop dividing is the same as detaching a growing fetus from a womb, given the fact that the fetus from very early days has a nervous system to feel the experience.
Is that just an easy answer for my situation, something they call "moral relativism?" Is it ethically indefensible? Maybe. But it's what I've arrived at after more than one sleepless night. I still wish things were different, and we could give those four embryos the chance I gave to Madelyn's and Lilly's embryos. But we can't.
So what are the options for couples with left over embryos? Miracles Waiting has a nice summary:
1. Leave frozen indefinitely
2. Thaw and discard
3. Transfer in a way that cannot produce pregnancy
4. Donate for scientific research
5. Seek embryo adoption
My husband is not comfortable with embryo adoption. And I feel it is disrespectful to thaw and discard our embryos, or donate them for research.
So we have chosen the third option, commonly called "compassionate transfer," in which the embryos are thawed and placed in my body at a time and using a method that cannot produce pregnancy.
It's a strange choice when you think about it. What does it matter whether the embryos stop growing in a dish in the laboratory, or inside my body?
My obstetrician, who is also a friend, put this in context for me: "More often than women will ever know, fertilized eggs 'roll on through' and do not implant. It's the way nature works." In fact, that's exactly what happened to the embryos that we transferred with Madelyn's and Lilly's embryos, that did not grow into children. By choosing compassionate transfer, I'll be putting our remaining embryos back where they would have been if naturally conceived, but not implanted.
And the mother in me, as I think about the children who are not but might have been, simply wants to hold them for that brief time. And say goodbye.