$21 Million from the US Taxpayer to Embryo Adoption Groups

Evangelical organizations received the majority of money, according to Evangelicals seek a future for thousands of frozen embryos [Washington Post 9/10/12 by Krista Kapralos].

“During a decade-long stretch of federal funding to promote embryo adoption, evangelical organizations received most of the $21 million doled out. That funding was cut in July, but leaders at those organizations say the word is spreading about embryo adoption.

“These families are happy, and they tend to write blogs and Facebook,” said Reg Finger, a doctor affiliated with the National Embryo Donation Center, which relied on federal grants.”

The article says “It’s estimated that there are more than 600,000 embryos frozen in storage in the U.S., but it’s not clear how many of those are available for adoption.

Embryo donation and adoption organizations, many of them with evangelical religious affiliations, began forming in the 1990s. The practice gained traction in 2006, when former President George W. Bush invited children who were adopted as embryos, known as “snowflakes,” to join him at the White House.”

Statsitics from Article

“In 2003, about 8,000 fresh and about 3,500 thawed embryos, all donated, were transferred to adoptive women. By 2010, about 9,300 fresh and about 6,100 thawed donated embryos were transferred. More transfers are resulting in live births, too. In 2003, 50 percent of fresh embryo transfers and 30 percent of thawed embryo transfers resulted in live births. By 2010, 55 percent of fresh and 34 percent of thawed embryo transfers resulted in live births.”

Total Statistics About Embryo Adoption

There are a lot of details not mentioned in the article and some that do not appear to be correct, so I will fill in some blanks.

Number of Babies Born via Embryo Adoption and Costs to “adopt” an embryo

Nightlight claims that a only total of 3,500 babies have been born in embryo adoptions from frozen embryos since the 1990s  and that their agency has had 300 total. See their slide presentation here Over half of those have been born since 2008. The article’s statistics appear to come from the CDC ‘s National Summary and those transfers include people who have their own embryos implanted not from embryo adoptions.

If we take Nightlight’s figure of 3,500 as correct, that would mean $6,000 of taxpayer money went to advertise  for each successful birth.

Nightlight and other organizations don’t do this for free. Nightlight gets $8,000 for each client. Their total charges are 

Snowflakes Program fee: $8,000

Home study agency fee: $1,000-3,000

Fertility clinic frozen embryo transfer fees: $3,000-5,000

TOTAL FEES: $12,000-16,000″

There is a $2,000 rematching fee if necessary and there are medical fees for the “adoptive parent” who will be giving birth. Nightlight says “We have heard recent quotes from $2,000-5,000 for a frozen embryo transfer attempt.” Any medications to prepare the”adoptive mother’s” body also may not be included in these prices.So, an estimated $14,000 to $21,000 would be spent.

Number of embryos and whether they actually qualify for adoption

Here is what these generalized articles don’t want you to know:

While embryo adoption agencies, like Nighlight state that there are about 615,000 frozen embryos, they do not all qualify to be adopted. FDA rules must be followed, which include infectious disease testing within 7 days as embryos legally are categorized as “human cell, tissue, and cellular and tissue-based product (HCT/Ps).” The donor eligibility rule became effective on May 25, 2005. You can find a Q and A on it here.

“Donor screening consists of reviewing the donor’s relevant medical records for risk factors for, and clinical evidence of, relevant communicable disease agents and diseases.”

So, the FDA considers the embryo to be tissue that falls under “good tissue practices”. Apparently, one can get an exemption which requires getting a lawyer (or maybe places operate under the radar and get away with it?).What this means in a practical sense is that the new rules mandate that couples who are interested in embryo donation must also have the infectious disease testing 7 days before retrieval. If they do not have this testing, they will not be able to donate embryos now or later. That greatly limits legally the number of those frozen embryos that can be adopted.

Thawing

What the article does not state is how many die in the thaw itself. I have seen statistics of anywhere between 30% to 85% dying. Most like to quote 50%. Yea, that sounds good for marketing. There are various methods and clinics have varying results. Common phrases are “x% of high-quality embryos survive.”

Just like your grocery store labels on chicken eggs, embryos are graded A to D. From Embryo Donation blog, “Day 3 embryos are graded on cell number, the amount of cellular fragmentation and the symmetry of the embryo.

Cell Number

Most Day 3 embryos will be comprised of 6-10 cells called blastomeres. Embryos with too few blastomeres may not be healthy, so we prefer at least 7-8 at this stage. Embryos with fewer cells may not be healthy growing very slowly or may have stopped growing entirely commonly called “cell block”.

Fragmentation

Fragments may be found in many of the embryos, which are “bits” of cells that break off from a blastomere. We prefer as little fragmentation as possible. Fragmentation is estimated as the percentage of fragmentation volume compared to the total embryo volume and is converted to a letter grade in the following way:

• 0 % = A
• 1-10% = B
• 11-25% = C
• >25% = D

A large amount of fragmentation may be caused by death of one or more of the blastomeres. The higher the fragmentation, the lower the quality of the embryo & letter grade and the less likely that the embryos will survive thawing. Embryos with high fragmentation rates implant less frequently when transferred fresh or when thawed.”

The blog link describes the grading of older embryos in great detail.

“Expansion

As the embryo advances in growth, a cavity called the blastocoel fills with fluid. As the cells continue to divide and the fluid collects, the embryo expands and eventually escapes its outer covering called the zona pellucida. The blastomeres continue to group together wherein the individual cell cannot be counted. As the Day 5 embryo expands, differentiates and escapes the outer zona pellucida, the grade increases numerically from 1-5.

Grade	Description	Physiology
1	Early Blastocyst	Starting to form a fluid-filled space in the middle (Blastocoel). Grading the embryo is difficult here.
2	Full Blastocyst	Blastocoel forms and inner cell mass is now distinguishable. Grading can be done from this point forward.
3	Expanded Blastocyst	Blastocyst is starting to expand in size thinning the outer covering, the zona pellucida
4	Hatching Blastocyst	Blastocyst is starting to hatch out of the zona pellucida.
5	Hatched Blastocyst	Blastocyst is fully hatched and now ready for implantation into the uterine wall.

Inner Cell Mass (ICM)

As the blastomeres compact to form the inner cell mass (ICM), this early fetal tissue is graded on a A-D scale:

ICM Grade	Description
A	ICM with total compaction
B	ICM still compacting
C	Reduced ICM
D	Poor with dying cells

Trophectoderm (TE)

The outer cells of the trophectoderm (TE) also reflect the overall health of the embryo and are graded in an A-D scale.

TE Grade	Description
A	Numerous cells forming cohesive layer
B	Few but healthy large cells forming a loose epithelium
C	Few cells present often with asymmetric distribution
D	Poor with degenerating/dying cells

Putting it All Together for Day 5 Embryos

For Day 5 embryos, the order of grading is “expansion,” “inner cell mass” and “trophectoderm.” For example:

• 1 = Early blastocyst is unable to be easily graded with respect to ICM or TE as these haven’t separated well enough yet.
• 2BB = Blastocyst with partial ICM compaction with loose, large trophectoderm cells
• 3AB = Expanding blastocyst with total compaction of ICM and with loose, large trophectoderm cells
• 4AA = Hatching blastocyst with excellent ICM & trophectoderm cell layers
• 5AA = Fully hatched blastocyst with excellent ICM & trophectoderm cell layers

Day 5 embryos that are graded 4AA and 5AA are some of our favorite embryos.”

So, you can see that “success rates” can be manipulated depending on if you include all the grades of embryos or just those high quality Grade A ones.

After 30%-85% die in the thaw,then, another 65.1% die after implantation leaving 34.9% of those surviving previously frozen embryos to successfully implant and be born.

Of course, the industry would prefer the “fresh” embryos as they survive at a higher rate, but they still  use that 600,000 frozen embryo number for their industry marketing because it sounds so “humanitarian”. Pardon me while I swoon…

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