Penn bioethicists have long examined the ethical issues surrounding fertility treatments, considering questions that arise about the use of frozen eggs, embryos, and other aspects of the procedures, as well as the appropriate level of regulation over access to treatments, such as age limits or other restrictions.
In 2004, a paper coauthored by Art Caplan, then head of Penn’s Center for Bioethics, along with Dominic Sisti GGS’00 and Andrea Gurmankin G’00 Gr’03, reported the results of a questionnaire mailed to 341 American IVF clinics to find out what they did with their extra frozen embryos. The answers varied among discarding, donating, and keeping them indefinitely. Caplan, now affiliated with New York University, says that egg freezing leads to similar types of questions: “Can a frozen egg be used three generations from now? Can you sell the eggs if you choose not to use them?”
Interestingly, newer egg-freezing techniques have been promoted in European countries as an ethical alternative to the practice of single women fertilizing their eggs with donor sperm and freezing the embryos, which yielded better results than the old slow-freezing method for eggs. Europeans generally find it more morally acceptable to deal with excess eggs than excess embryos.
Despite any ethical questions, many women, and couples, are grateful for the assistance provided by infertility treatments.
After Meesh Joslyn Pierce W’93 WG’98 got married at 36, she and her husband suffered from unexplained infertility. She underwent IVF and intrauterine insemination to conceive her two boys. She has five friends who have frozen their eggs, she says, and knows “three or four” single women who decided to have children on their own. One of the single moms made the choice after battling breast cancer at 39.
“She didn’t want to wait any longer,” Pierce says.
Michael Friedman C’94 and his wife Deena, who live in Massachusetts, struggled with reproductive issues in their early thirties, endured unsuccessful infertility treatments, and spent two and a half years trying to navigate the red tape of foreign adoption. In 2009, the couple brought home twins—a boy and a girl—conceived using a surrogate in India.
And certainly, for many infertility is a major life trauma. In “Recovery from Traumatic Loss,” her doctoral dissertation in the School of Social Policy and Practice, Marni Rosner GrS’12 examined the psychological effects on women who ended up childless after fertility treatments. Besides the potential heartbreak of not having their own children to love and receive love from, they face a lifetime of being left out of motherly rites of passage (like seeing their children get married), of exclusion from their peer group who are raising children, and the “‘death’ of their desired future”—a severe loss not validated or acknowledged by others. For the 12 women Rosner studied, it took an average of 3-4 years “to fully emerge from feeling like being infertile was their primary identity,” she writes.
Rosner and her husband began trying for kids when she was 39, and she was surprised to find herself “devastated” when doctors told her that her hormone levels indicated a low chance of success with IVF. At her therapy practice in New York, she has talked to patients considering egg freezing, which she thinks is “fantastic.” She doesn’t want a host of new regulations for fertility procedures, but believes that counseling should be required for those undergoing treatment, considering the emotional impact.
“It does take the pressure off of women to find someone right away,” she says of egg freezing. “It’s not a guarantee. There needs to be a lot of education around it. I have younger women who are talking about this. They haven’t met partners yet. One met a partner but was at that age where, do you want to put pressure on the relationship to have a baby soon if you’re not ready?”
Right now, doctors at Penn Fertility Care are looking at ways to improve the success rates of all reproductive treatments, studying the effects of fertility medications, and looking at how egg and egg-tissue cryopreservation can preserve the fertility of young cancer patients. While reproductive medicine can be controversial, and society may not be used to the idea of women having more choices about when to have children, Pfeifer believes it’s “a gift” to be able to give couples and single people options through modern techniques.
“I think it’s a very exciting field of medicine,” she says. “It’s important to be cautious and look at the data and [make sure] that we’re doing things that are safe and benefiting patients, but it does offer great hope to people, and it’s great technology.”
Caren Lissner C’93 is working on the Someday Mom Book for busy women who want to know their options for the future. Her website is carenlissner.com.