Friday, December 6, 2024

What Is an Embryo in a Post-Roe World?

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For Becky Alprin, embryos are like acorns. While they could become children one day, it’s obvious they aren’t yet. For MD Sitzes, they’re a spark—igniting the beginning of pregnancy, birth, and parenthood. For Megan Castro, embryos are packets of genetic information, opportunities to help others suffering through the infertility she once faced. For Erica Freeman, it doesn’t matter that an embryo is hardly more than a clump of cells. To her, it’s still a child.

These earliest beginnings of life hold a multitude of possibilities and no guarantees. They can be created through sex or in a lab and later transferred into the womb. They can be frozen for years and later thawed. However they came to be, once the embryos are in the uterus—and if they implant successfully —they can then grow and divide, eventually becoming fetuses, and one day, emerging into the world as newborn children. Or they might not. They might fail to thaw properly or fail to implant, or there might be abnormalities in their chromosomes that hamper development and cause a miscarriage.

In the United States, embryos exist in a strange moral, emotional, and legal gray area. Legally, these cells can be considered property, though traditionally, it’s been illegal to buy and sell them—a legal precedent that has been up for debate in recent years. When embryos are donated, the Food and Drug Administration regulates these exchanges just like other kinds of human tissue. But, as the American Society of Reproductive Medicine’s ethics committee notes, these entities hold “special significance,” because unlike other pieces of our bodies—like blood, skin, or bone marrow—these donations have the potential to become a person.

In the wake of the Supreme Court’s 2022 decision to strike down Roe v. Wade, this ambivalence has taken on new, heightened importance. Without federal protections for abortion rights, states are enacting increasingly restrictive abortion bans, the most severe of which include ideas about embryonic and fetal “personhood.” Georgia’s current six-week abortion ban “declares a fetus a person as soon as embryonic cardiac activity can be detected,” typically around six weeks, per The New York Times; in the state, a fetus even qualifies for tax credits and child support. Describing these groups of cells as humans—and giving them the same legal rights—could ultimately lead to laws that criminalize basic health care, like contraception and miscarriage management. Earlier this year a U.S. district judge suspended the FDA’s approval of the abortion pill mifepristone and referenced “unborn children” in his ruling. (As of now, the pill remains available.)

But for the people who create and house those embryos, “personhood” often isn’t so straightforward. “An embryo is not any one thing,” says Katie Watson, a bioethics professor at Northwestern University. “It’s the ultimate Rorschach blot upon which we project our deepest personal fears and hopes, as well as cultural ideas and ideals.”

Below, four people who support reproductive freedom share their experiences living with the ambiguity of embryos—how they celebrated the possibilities embryos hold, how they cherished them, and sometimes, how they learned to let them go.


Becky

45 years old | Washington D.C.

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Every time Becky Alprin had an embryo—a cluster of cells that are the very beginning of a pregnancy—transferred to her uterus, she would whisper to it. “You’re home,” she’d say. “Now you can have your destiny.” Alprin and her husband, Russel Flench, spent years struggling to conceive, eventually deciding to use in vitro fertilization. Doctors harvested Alprin’s eggs and collected Flench’s sperm, combining them in the lab to create embryos and freezing those embryos until the time was right to transfer them into Alprin’s womb. There was always a significant possibility that the egg wouldn’t take. Alprin hoped for the best, but after years of disappointment, she’d reached a kind of acceptance: If she miscarried, then that embryo wasn’t meant to develop into a child.

Alprin describes IVF like being trapped in a cave deep underground. The only way to get out was to stay laser focused on her goal and keep blasting her way through. In hindsight, she says, it seems obvious that she and Flench should have thought about what to do if they ended up with extra embryos. But it was a numbers game, and the odds were generally stacked against them. “Our hearts and minds were devoted to thinking about how to have enough embryos,” Alprin says.

The couple started out with 10 embryos. After a failed transfer, they discovered that only four of the remaining embryos were viable. In 2017, Alprin finally gave birth to a healthy baby girl. A few years later, she tried again. Again, she had one failed transfer and one successful pregnancy. She had her second daughter in 2019. The girls grew into giggly kids crowned with masses of blond curls. Alprin and Flench had the family they wanted. But they also had one embryo left.

After so many miscarriages, she understands viscerally that having an embryo doesn’t equate to having a living, breathing baby.”

There are four options for handling extra or “surplus” embryos. Parents can dispose of them. They can donate to other families or to research. Or parents can ask for a “compassionate transfer,” in which the embryo is transferred at a time in the menstrual cycle when it’s highly unlikely to result in a pregnancy. Alprin and Flench debated what to do, but like an estimated 63 percent of parents with frozen embryos, they couldn’t decide. Instead, they continued paying to keep the embryo frozen—prolonging the decision year after year. Alprin had no illusions that this was a child. After so many miscarriages, she understands viscerally that having an embryo doesn’t equate to having a living, breathing baby. And yet, when she looked at her younger daughter, Gilda, Alprin wondered about that single embryo. “What if we had chosen a different embryo?” she says. “Sometimes I have twinges. What if there’s a potential Gilda? Another creature that I cannot live without?”

When the Supreme Court overturned Roe v. Wade, Alprin started to worry. While the ruling didn’t immediately affect IVF, she didn’t want to risk losing control of that last embryo. She and Flench made arrangements to donate it to a cancer research lab. “It’s a weird feeling. BUT WHY?” she texts after signing the paperwork.

She still chafes against any rhetoric that describes embryos as children. “Calling an embryo a baby is like calling an acorn an oak tree,” she says. “It’s silly. It’s not the same thing.” That rhetoric is just too binary to encapsulate what she’s experienced as a continuum. Eventually, an embryo might become a child, and Alprin lives with two perfect, beautiful examples of that. But an embryo may just as well never become a child, and Alprin lives with that reality too.


Erica

38 years old | Washington D.C.

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Sven Hagolani//Getty Images

The first time Erica Freeman got pregnant, she was 19 years old and a sophomore at Virginia Commonwealth University. Freeman didn’t think about the cells in her uterus as embryos or blastocysts or possibilities. “I definitely thought about it as a child that I was carrying and bringing into the world,” she says. She wanted a baby, but it wasn’t the right time. Her mother drove her to an abortion clinic where they walked past protesters yelling that this decision would doom them to hell. Freeman had a vaginal ultrasound to confirm the pregnancy and a dilation and curettage abortion. An hour later, she left the clinic. Walking past the protesters, she burst into tears. She didn’t doubt her decision, but it was still scary to think God might judge her. She decided the abortion was just one part of her journey to motherhood.

Eight years later, Freeman and her then-fiancé conceived a child, and she felt ready—excited—to be a parent. She bonded with her baby, played him music and felt him move inside her. She named him Brandon Jr., after his father, her now husband. At 39 weeks, she was induced and labored for 16 hours before doctors decided she needed a C-section. From behind the surgical curtain, Freeman felt them tugging and pulling at her. She strained to hear her baby’s first cries, but there was silence. Brandon Jr. was stillborn.

She’s come to understand conception, birth, and parenthood as a much more diverse set of realities than most people realize. Some women who want babies have abortions. Some mothers don’t have children on this Earth.”

For the first time, Freeman started to wonder if God was punishing her for her abortion. She went to therapy, prayed. She decided that a God who loved her unconditionally could not also be a God who punished her this way. She and her husband conceived another baby, Brielle. Freeman miscarried at 18 weeks. After each loss, she grieved for her children—whether she had known them for eight weeks or more than eight months. She defined herself as a mother with children in heaven. She got pregnant again. Ten years to the day after her abortion, Freeman gave birth to her son Maxwell.

Freeman is now a pregnancy, birth, postpartum, and bereavement doula. She facilitates group therapy for women who have lost a pregnancy, and she hosts a podcast called Sisters in Loss, where she’s interviewed more than 400 Black women about their experiences with infertility, miscarriage, and abortion. She sees all pregnancy losses—no matter the cause—as traumatic experiences that deserve healing. Unlike Alprin, she sees every embryo as a child and every pregnancy experience as a birth. “Every loss is a birth,” she says. Whether a child is stillborn, miscarried, or aborted, women often endure the same procedures and then face similar recoveries, navigating postpartum bodies while finding their way back to themselves and to a new future that no longer includes a child. “No matter the decision, it’s gone,” she says. “And then you have to heal with the fact that you don’t have this [child] physically with you anymore.”

Freeman also doesn’t think that calling embryos children or babies conflicts with the right to have an abortion. “I’m pro choosing your body first, for any birthing person,” she says. She’s come to understand conception, birth, and parenthood as a much more diverse set of realities than most people realize. Some women who want babies have abortions. Some mothers don’t have children on this Earth. “We don’t always talk about our reproductive health experiences in totality,” she says, but we need to. It can help everyone heal.


Megan

38 years old | Salem, Oregon

flower bud and lady bug

Krzysztof Winnik//Getty Images

Seven of Megan Castro’s embryos have developed into people, but she only calls two of them her children. She describes the others as “genetic dibblings”: kids made from the same ingredients as her six-year-old twins but who have different parents.

Castro and her husband went through IVF convinced it wouldn’t work. Instead, they ended up with twins on their first try. They didn’t want a bigger family, and it didn’t seem like researchers were clammering for embryos. They didn’t feel like these were souls that needed saving, but they wanted to help other families who were struggling to become parents. Castro found an LGBTQ+-inclusive embryo donation group on Facebook and started scrolling through profiles. She and her husband bonded with one family over Star Wars and Marvel comics. With a second family, they connected over a shared love of gardening and canning. So far, their embryos have been used by three different families. “It feels so joyful to watch other people who truly, deeply want to be parents, get to be parents,” she says.

…but she doesn’t feel any maternal tug, no heartache, no sense of loss.”

Castro and her husband arranged all of their donations to be open, meaning that the families and kids could contact them. They wanted all the kids to know they have genetic siblings and to give them ways to communicate. They’re young now, and it’s hard to know if those relationships will be meaningful in the future, but it felt important to give them that option to connect and navigate those choices for themselves as they grow up. Castro had no expectation that the families would be close, but as it turns out, they all get along. They’re spread across three states, but they regularly send pictures and stories and sometimes all get on a big Zoom. Castro loves watching the babies grow from afar and especially loves that she doesn’t have to get up in the middle of the night or change diapers anymore. “It’s a good solution to baby fever,” she says.

She watches the miracle of genetics play out across the different kids—seeing all the different ways her genes and her husband’s have combined. One girl resembles Castro more than her own two kids do, but she doesn’t feel any maternal tug, no heartache, no sense of loss. She doesn’t feel any lingering ownership over the children she isn’t raising, and she feels more bonded to the other parents through their shared experiences of infertility than through the genetic links she has to their kids. “I know their children are genetically mine,” she says. “But they’re not.”


MD

44 years old | North Bay, California

flower bud

Roc Canals//Getty Images

When MD Sitzes talks about their kids, they like to say that they weren’t the musician, but they were the DJ. Sitzes, who uses both they/them and she/her pronouns, didn’t make their kids’ genetics—those original notes—but they housed them and birthed them, and their parenting shapes the people those kids are growing up to be.

Sitzes and their wife, Cathy, went through six rounds of intrauterine insemination, a procedure that places sperm directly into the uterus, increasing its chances of reaching an egg. They got pregnant with twins, but there were complications. Sitzes miscarried. The couple was desperate and depressed. They had spent tens of thousands of dollars. They were fully committed to having kids. But they didn’t know how many more times they could endure losing a child. They looked into fostering or adopting children. Through a doctor, they heard about embryo donation. They lurked around an LGBTQ+ Facebook group for a week before making their profile. Fifteen minutes after posting, they got a message from Megan Castro.

Connecting with Castro and her husband felt like dating. “I remember feeling really vulnerable and scared,” Sitzes says. They felt so aware that they might one day carry these sacred, precious things that Castro and her husband had made. The couples started by DMing on Facebook Messenger and eventually moved to email. Sitzes and Cathy agonized over every communication. “We would work for hours making sure all the grammar was correct,” Sitzes says. They fine-tuned every transition and final sentence. “We weren’t trying to achieve perfection, but we wanted to show that we really cared,” they say. “And if we cared about our words to them, then we would care for these embryos, and we would care for these future children.” Finally, Sitzes and their wife traveled to meet Castro and her family in person. Three months after their first DM, Castro offered them five of her embryos.

As soon as those embryos were implanted in my body, they were mine.”

Doctors told them they had a 20 percent chance of success, but the first two transfers stuck. On New Year’s Eve 2019, Sitzes gave birth to twins. Part of their contract with Castro stipulated that Sitzes had to carry the donation forward: any embryos they didn’t use had to go to another family. Suddenly, they were on the other side of the experience, interviewing families and hearing their vulnerable stories. “To be on both sides of the coin was very, very special for us, because we know how it is from all sides,” Sitzes says. They donated to a family that gave birth to a little boy.

Sitzes feels deeply connected to the community built through these open donations. In Castro’s childhood pictures, Sitzes recognizes their daughter’s smile, their son’s curly hair. They recognize the faces that they kiss every night, the children they get to hold and love and raise. It’s a special and deeply personal bond. While they’re grateful for the gift of those embryos, Sitzes is also clear that they are fully and completely their children’s parent. They housed those embryos; their wife cut the cord. They feel ownership over them and not just because they signed a legal contract. “As soon as those embryos were implanted in my body, they were mine,” they say. “I have never— not once—felt that they weren’t part of me.”

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Sara Harrison

Sara Harrison is a freelance journalist who writes about science, health, and technology. Her work has appeared in outlets including The New York Times Magazine, WIRED, Scientific American and The Best American Science and Nature Writing 2020. 

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