Dr. Jason Hitkari, co-director at the Genesis Fertility Centre.John Lehmann/The Globe and Mail
Canada's first embryo donation service will offer next week to match tens of thousands of fertilized eggs, abandoned in medical clinics across the country, with would-be parents desperate to start a family.
By doing so, Beginnings Counselling & Adoption Services of Ontario Inc., says it can solve an ethical problem faced by many Canadian couples: After successful in-vitro fertilization treatments, what should be done with leftover embryos that have the potential for life?
"There are probably a lot of people out there with embryos that are frozen that would give this consideration," said Kerry Vandergrift, executive director of Beginnings Counselling & Adoption Services of Ontario Inc., a non-profit agency based in Hamilton. "It's filling a real need out there for other ways to create families; I think it solves a dilemma for a lot of couples out there."
Advances in reproductive technology mean couples who would have never had children are now faced with the potential for too many. Frozen embryos sit in costly holding tanks in fertility centres across Canada, the remnants of an unnatural process of selection: They were not picked for placement by a doctor simply because other embryos looked more promising.
The new service, which costs $13,500 not including medical and legal bills, aims to match these embryos - clumps of cells often only visible under a microscope - to would-be mothers and fathers, with the understanding that an open relationship with the biological parents is crucial as children must know their genetic origins.
The dilemma of surplus embryos is morally wrenching for couples and an ethical minefield for fertility specialists, and it comes at a time when the very constitutionality of Canada's reproductive laws is in question.
The Supreme Court of Canada has yet to rule on certain provisions of the Assisted Human Reproduction Act, challenged in 2008 by Quebec. That province contested several provisions of the act, saying that since they are not matters of criminal justice and do not put the public's health at risk, they should be governed by provincial legislation.
Consequently, Health Canada has put a moratorium on all new regulations. Against this policy vacuum, many fertility centres do not destroy embryos - abandoned as long as 15 years ago - even though clients have signed waivers allowing the clinics to do so if they have faltered on their annual storage fees, which cost $200 to $300.
"Every clinic that has been around for as long as we have has thousands of embryos sitting in the freezer, where people have essentially abandoned them," said Jason Hitkari, fertility specialist and co-director at Genesis Fertility Centre in Vancouver, where 400 patients have deserted thousands of embryos. "We're looking for some guidance … to know what type of hoops we have to go through to discard these abandoned embryos. Are two registered letters enough for notification? We're always worried somebody will come back."
Health lawyer Kathryn Frelick said the one set of consent regulations, which took effect on Dec. 1, 2007, is enough for couples to proceed with Beginnings' new embryo donation program, for which she provided legal advice.
"In Canada, there hasn't really been the option in a way that protects the individuals involved and ensures that they're aware of the process," said Ms. Frelick of Toronto.
She, like Ms. Vandergrift, stressed it is not an adoption but an embryo donation - a legal transfer of tissue - and will be listed as such under an agreement between both parties. While women may get several embryos, leading to multiple children, there are no guarantees of a baby.
Under the program, those who have surplus embryos would donate all of them for free to prospective parents whom they would select from a pool that has been screened by Beginnings. Among other things, that includes a Criminal Record check and a home visit of would-be parents.
Recipients pay education and profile posting services [$1,500] donor and recipient assessment and counselling services [$3,500]and a retainer fee [$8,500]at the time they are matched to cover all services from then on.
Other costs, such as paying the fertility centres for oral drug therapy of estrogen and progesterone, plus the embryo transfer, are not included. Legal agreements would add another cost.
Beginnings, which has been an adoption agency for a quarter century, sees this as an extension of its services. As such, it has formed an Embryo Assistance Reserve Fund to help subsidize eligible potential parents; it would offset some but not all of the costs.
"We are not there to make a whack of money off this," Ms. Vandergrift said. "It's not about making money; it's about providing an enriched service to what they get now."
The Regional Fertility Program in Calgary offers embryo donation for its patients, where there is a 2 1/2-year waiting list. "We get far more requests and need for embryos than we have embryos," said Cal Greene, its medical director.
Unlike Beginnings, which is open to all Canadians, the Calgary program is limited to the clinic's patients.
Since the program began, 65 babies have been born, with the oldest child being age 14. Although some who donate embryos say they would be open to meeting the children, so far no child has sought out their biological parents, he said.
Others with surplus embryos choose to donate them to science or to destroy them.
Those women who find neither option appealing can have their thawed embryos placed in their reproductive tracts, where there is no chance of pregnancy, said Ken Cadesky, medical director of LifeQuest Centre for Reproductive Medicine in Toronto. "Some have a sense of security, knowing fate will deal with it," he said.
Typically, patients are asked to renew consent forms - spelling out their wishes - when paying their annual storage fees, according to fertility specialist Arthur Leader, professor of obstetrics and gynecology at the University of Ottawa. That includes a form that says if the embryos are abandoned, they can be destroyed.
In one case, a couple who had a child with embryos in 1997 had abandoned the remaining ones at an Ottawa clinic. Office staff scrambled to find the pair, sending registered letters, contacting their family doctors and telephoning their home. Recently, the couple returned to Dr. Leader's Ottawa office, wanting to know the status of the embryos.
"After 10 years, we figured they were truly abandoned and so we followed their wishes, which was to dispose of them," Dr. Leader said. The couple, he said, are still young enough to start a fresh cycle of IVF, which they plan to do.
Arthur Schafer, director of the University of Manitoba's Centre for Professional and Applied Ethics, said so long as the embryos are not being sold directly or indirectly, and it's not a discriminatory service, there is nothing ethically wrong with donating them.
"If we're commercializing the selling of human body parts or gametes, that's ethically problematic as Canadian law prohibits it," Mr. Schafer said. "I'd want to be sure we didn't have either directly or indirectly the buying or selling of human gametes or embryos."
Some Canadians have done a cross-border embryo donation through a California-based agency called Snowflakes, an offshoot of Nightlight Christian Adoptions.
A 41-year-old Vancouverite obtained 10 embryos from the agency after a traditional adoption failed - the biological mother changed her mind - and efforts to produce her own child faltered.
Two embryos were implanted, resulting in a baby born in December. That child has two other siblings in the United States, but even the recipient does not know their address or last name as all contact is through the agency.
"If we decide to have another child," said the woman, who spoke on the condition of anonymity, "I would certainly use more of the embryos so that our child would have another full sibling."
With eight more embryos in storage and the possibility of not using them all, she says she may give them back to Snowflakes, where they will likely return to the original genetic family, who could authorize them to be adopted again.
Of its benefits, she said: "It was great to actually be the 'birth mother' and not have to worry about anyone changing their minds."