There’s a game Alisa Roost plays with her son when he’s just out of the bath.
“We have a fleece blanket I call ‘the snuggle blanket,’” Roost, 50, says. “It’s a nice blanket to get warm in after you’ve been in the tub and are cold.”
Her son is 5 and after the bath, he likes to hide under the blanket.
“And I say, ‘Doctor, I want to be a mommy, can I get a frozen embryo?!’” says Roost, “and then, then he’ll eventually go, ‘Can you tell the doctor I’m ready to come out?’”
“He loves to pretend to be a frozen embryo,” she says, laughing.
Roost’s son started out as a frozen embryo. But his embryo wasn’t created using his mother’s egg. His embryo was donated to Roost by a couple in Oregon who had done IVF and were finished having children of their own.
Increasingly, “embryo donation” or, in some spaces, “embryo adoption,” is becoming a path to parenthood for people who have exhausted other options or don’t have the financial means to go through IVF.
Though embryo donation is relatively new, a small but growing number of Oregonians are becoming parents this way. But the process these new parents must navigate is only lightly regulated and comes with its own set of difficult questions. What does it mean to choose to donate an embryo or become a parent to an embryo donor-conceived child? And what are the implications for children born from embryo donation?
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Many people struggle to get pregnant. And every year, after exhausting other options, thousands of those people turn to in-vitro fertilization, or IVF.
IVF is the process of fertilizing an egg with sperm outside of the body (”In vitro” is Latin for “in glass”). The resulting embryo is grown in a lab for about five or six days and then implanted in a uterus or frozen.
Since the first baby was born using IVF in 1978, use of the process has grown exponentially. Preliminary data from the Centers for Disease Control and Prevention show that in 2020, 79,942 U.S. infants were born alive using fertility treatments that involved handling eggs or embryos, or about 2.2% of all children born in the United States. According to the CDC, use of those treatments “has more than doubled over the past decade.”
“Typically, in one round of IVF, several embryos are created,” says Dr. Diana Wu, a reproductive endocrinologist and infertility specialist and the medical director at Oregon Health & Science University’s fertility consultants practice, which is one of a handful of clinics in Oregon that do this work.
“The cryopreserved embryos allow the couple chances for siblings in the years to come, without having to repeat the ovarian stimulation and egg retrievals again,” Wu says.
Sometimes, there are more embryos than a person uses. The financial impact of storing embryos doesn’t come close to the cost of creating them – a few hundred dollars a year versus tens of thousands of dollars per IVF cycle. But deciding what to do with stored embryos ends up being a difficult challenge for many people, one they are reminded of every year when they get a bill for storage.
According to experts, there are more than a million embryos on ice in the United States. And at some point, parents usually make a choice: destroy the embryos, donate them to science or donate them to someone who wants to have children.
Increasingly, people are choosing embryo donation. According to the CDC, national numbers for these kinds of transfers are growing. Data collected by the agency shows 2,089 donated embryo transfers in 2017, about 2,500 each in 2018 and 2019 and, preliminarily, 2,705 in 2020.
OHSU’s fertility clinic on Portland’s South Waterfront did 11 embryo transfers in 2018, and 19 in 2019. After a pandemic-related down year of 10 in 2020, the clinic did 21 in 2021. At Oregon Reproductive Medicine, near Providence Park in Portland, the numbers are even bigger. Doctors there did 60 embryo transfers in 2018, 69 in 2019, 61 in 2020 and 93 in 2021.
IVF can cost between $14,000 and $34,000 per cycle, according to a spokesperson for Oregon Reproductive Medicine. Additional genetic testing can range from $5,000 to $8,000. Embryo donation with medications costs about $12,000 to $14,000 for each attempt.
Regulations that govern the practice are scarce. The FDA requires screening for infectious diseases, or notification to recipients if no screening happened. The American Society for Reproductive Medicine and Society for Assisted Reproductive Technology has further recommendations, which include counseling for donors and recipients, legal consultation and shared medical and genetic histories. But enforceable laws about the process are nearly nonexistent.
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When Jennifer Vesbit got married in 2005, she wasn’t yet 30 and didn’t plan on getting pregnant right away. But when she and her husband did start to try, a year or so later, it wasn’t as easy as she assumed it would be.
After trying other options, a fertility doctor told them to go straight to IVF.
Vesbit underwent her first round of IVF in 2010 at age 33. That round ended in two viable embryos, one of which implanted. But eight weeks in, that pregnancy ended in a miscarriage.
“I probably still consider that the worst day of my life,” she says.
She and her husband decided to give it one more try and after moving from Michigan to Oregon, they began to work with Oregon Reproductive Medicine. They ended up with three viable embryos and in 2011, transferred two.
Vesbit gave birth to twins when she was 35 in 2012 and froze her remaining embryo.
“At first I was just too overwhelmed to even think about it,” says Vesbit, “and it’s like, of course, we’re going to keep paying for storage.”
They were dealing with the intensity of new parenthood and there was the question of whether they would try for a third child.
When her twins were 4, Vesbit and her husband started talking seriously about what to do with the final embryo.
“I was pretty adamant,” she says, “either we’re gonna try for this baby … or I want to donate it.”
Because the embryo contains the genes of both the person who donated the egg and the person who contributed the sperm, both donors must agree. They decided to donate the final embryo.
At the time, Vesbit’s options were somewhat limited. Oregon Reproductive Medicine offered only anonymous donations, as most clinics still do, and she was committed to knowing the person she donated to.
Vesbit turned to Miracles Waiting, a website where embryo donors and recipients can post profiles and match with each other.
Almost immediately, Vesbit found Roost, who was also committed to being honest with her child about their origins and having a relationship between the families involved in the donation.
Roost, who grew up in Eugene but now lives in New York City where she is a community college professor, had frozen her eggs when she was 38, planning on becoming a single mother by choice, and waited until she had tenure several years later to use them. Of her 22 eggs, 15 survived the thaw, five made it to 5-day-old embryos using donor sperm and one of those was genetically normal. Doctors transferred that embryo into her uterus when she was 42. Then, when she was 11 weeks pregnant, she had a miscarriage.
She decided to turn to embryo donation. Roost calls the meeting with Vesbit “kismet.” She did the embryo transfer in Oregon when she was 44. When it took, both families hoped for a lifelong relationship.
For Vesbit and her husband, the process of donating an embryo was intense.
“I was feeling tons of emotions,” Vesbit says. When she found out Roost was pregnant, when she found out Roost was having a boy, when he was born. Each moment was a discovery of a new type of feeling – good, bad, happy, sad, complicated, uncomfortable and joyful. The child is genetically related to Vesbit and her husband, but he is Roost’s son.
Vesbit and her husband met Roost’s son for the first time when he was 6 months old. At the time, she said, they were in counseling, both processing their feelings in different ways.
“We showed up at a park and there they were, sitting on a blanket, and it was this really surreal and beautiful experience,” she said.
They took turns holding the baby in Portland’s Laurelhurst Park on that summer day.
“There were people sitting around us,” Vesbit says, “and I was just thinking, ‘What if that person on the blanket over there knew what was going on here?’ ”
“It’s the most crazy roller coaster of emotions you can ever imagine, going to meet your genetic child that somebody else is raising,” Vesbit says. “Who’s he gonna look like? Is he going to feel like, you know, ours?”
“Luckily,” she says, “I felt like I was holding another woman’s baby.”
Vesbit has taken this experience and turned it into her full-time job. She now runs Embryo Donation Support, a community for embryo donors. And she is part of the team at Empower with Moxi, a company that educates people about embryo donation.
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Miracles Waiting, the website that Roost and Vesbit used, is almost akin to a classified page. People place ads and match themselves. It doesn’t offer structure or support for people going through the process and it doesn’t vet donors or potential parents.
Structured experiences that more closely mirror adoption are also available, and up until recently, most of the organizations that offer that option have been Christian.
In 2002, the U.S. government started the Embryo Adoption Awareness and Services program, with the stated goal of bringing awareness to the fact that so many frozen embryos existed and some were available for donation.
According to a New York Times report, up until 2019, the year the story was written, only two grants funded through that program, which most years funds several grants, had ever gone to groups that weren’t affiliated with organizations that were Christian or anti-abortion.
For some people who believe life starts at conception, frozen embryos are already humans, which could be the reason anti-abortion and Christian groups were some of the first to facilitate more adoption-like embryo donations.
Critics say many of these programs only allow embryo adoption to straight married couples, and have age and other restrictions on potential parents. But for Christians hoping to donate embryos, they can be a way to pass values along to future biological children they cannot parent.
Snowflake Embryo Adoptions, a division of Nightlight Christian Adoptions, is one of the Christian groups that received federal dollars in the past. The group, based in Colorado, is not a grant recipient for 2022 but was a recipient for all except two years between 2007 and 2021.
Kimberly Tyson, the vice president of Snowflake, said the agency had been doing embryo adoption since 1997.
“We’ve had over 900 babies born through our program and we use the best practices of adoption,” Tyson says.
That means the agency does background checks and home visits with prospective families.
Snowflake allows anyone to apply to become a donor parent, including people who aren’t straight and who are single, Tyson says. They also require a letter from a doctor saying the person who will carry the pregnancy can carry to term and the application must be received before that person is 45 years old.
“What we are going to be is very transparent with them about how the program works, how long it might take us to match them,” Tyson says. “Of course, because we are a Christian organization, we are attracting people who have the same faith that we have.”
Also, she adds, “The types of families who are placing into our program are generally looking for heterosexual couples that have been married for a certain period of time.”
There is also the question of when life begins.
These embryos, Tyson says, “were created to become a life and now they’re frozen. And unless there is somebody who’s willing to give them a friendly womb, they will never be born.”
While Christian groups and anonymous donations once dominated the embryo donation space, secular groups with an interest in inclusive, open donations are beginning to take hold.
Vesbit’s organization, Empower, is currently a recipient of one of the federal grants to support embryo donation. They offer matching services through Moxi Matching. And OHSU’s fertility consultants practice is working with Embryo Connections, another federal grant recipient, that is inclusive and pairs donors with recipients, allowing for many types of donations.
• • •
Sarah Spalding, 39, and Jen Dugger-Spalding, 40, knew they wanted to have children.
The women sit next to each other on a couch over Zoom, taking turns holding a gurgling 5-week-old baby. Occasionally, a dog barks in the background.
Dugger-Spalding is the director of the disability resource center at Portland State University and Spalding is a medical assistant at OHSU’s fertility clinic.
“Being a queer couple, a lesbian couple, we had to go with scientific methods,” Dugger-Spalding says.
First, Dugger-Spalding tried intrauterine insemination, or IUI. After three unsuccessful attempts, they had to make a decision.
“We were using donor sperm, so there was a cost to that. And of course, there’s a cost every time you go into the clinic to try to get pregnant,” Dugger-Spalding says.
“The thing that most people do after that is go with IVF, which can cost like $20,000,” she continues. “We also knew that there was a risk with that, that we wouldn’t get pregnant.”
So, she says, they spoke with their fertility doctor at OHSU. The doctor mentioned Embryo Connections and the possibility of using a donated embryo to have a child.
Spalding and Dugger-Spalding decided to work with that group, hoping to find another family interested in an open relationship.
“My mom is adopted,” Dugger-Spalding says, “and she’s spent her entire life wondering who her family is. I was not about to do that to our child.”
“We had always wanted to have a big, queer family,” adds Spalding, “and so this gave us a good opportunity.”
It only took three weeks for the couple to get profiles of two donor families. Ultimately they chose to go with a gay couple in California who had 14 embryos available.
Spalding and Dugger-Spalding received three of those embryos and others have been given to several other families.
When more babies are born, the plan is to make introductions throughout the whole group.
“Eventually we’ll all be connected,” Dugger-Spalding says.
Already they know that one other baby, a full genetic sibling to their daughter, was born four days before her.
The process of getting pregnant for Dugger-Spalding started with taking birth control to regulate her cycle. Then she took oral estrogen for a couple of weeks.
A week before the transfer, Spalding started giving her progesterone injections. She needed those injections until the 12th week of pregnancy.
After that, her body took over completely. Like many pregnant people, Dugger-Spalding was happy being pregnant, until she wasn’t.
“I actually enjoyed it until about 34 weeks,” she says. “And then I was like out, out, out.”
Their baby was born in February.
• • •
According to Wu, psychological counseling is required for all potential donors and recipients at OHSU’s clinic. The FDA also requires infectious disease screening, Wu says, before the tissue can be transferred.
“The legal contracting of the donating of the tissue as well as relinquishing rights to the future offspring is all completed upstream,” Wu says.
“The beauty of embryo donation is that an individual is able to carry the pregnancy and deliver the newborn and possibly breastfeed the newborn and have control over the prenatal care,” she said. “When they deliver the baby, both the intended parents are on the birth certificate.”
Embryo donation, unlike traditional adoption, is a process that involves the transfer of biological material, not a transfer of guardianship of a person.
Denise Seidelman is a lawyer who works in New York and New Jersey helping people draw up agreements between donors and prospective parents.
The agreements she creates deal with the kind of background and medical information that donors will share, as well as what restrictions they might have if the donor couple decides to pass their unused genetic material to someone else.
She says they all have provisions for some exchange of contact information, and they could include expectations on communications. Seidelman says it remains to be seen what would happen if someone breached one of those agreements.
Seidelman says she had seen an uptick in these kinds of legal documents for embryo donations in recent years, and an evolution of the understanding of how being donor-conceived affects children and adults.
“I think children all have a right to know,” she says, echoing a sentiment shared by the majority of the professional adoption and donor-conceived community.
She has been working in third-party reproduction for about 15 years, after working in the traditional adoption world. She says embryo donation is growing as IVF remains very expensive and traditional adoption becomes even more difficult – the number of infants available for adoption in the U.S. has dropped, due to changes in international adoption and an emphasis on helping families stay together if they want to.
Embryo donation on a wider scale is relatively new, so it’s hard to say how embryo donor-conceived children will view themselves as adults. But there is a large number of adults today who were conceived using donor sperm and eggs and there is a vocal community of those people pushing for more transparency and laws to protect their rights.
Kara Rubinstein Deyerin is the CEO of Right to Know, a group that advocates for genetic identity rights. Right to Know was founded in response to DNA test surprises – the phenomenon of people taking over-the-counter DNA tests and finding out their parents aren’t who they thought they were.
Deyerin, who lives in Seattle, has her own experience with this. When she was 44, she found out that she was not half-Black as she had grown up believing but, in fact, half-Jewish.
Right to Know works with people who are products of “non-paternal events” – a secret affair, for example – adoptees and people born from assisted conception.
“We like to say like a Venn diagram, you have your NPE community, your adoption community and your assisted conception community,” Deyerin says. “And when you do that, there’s that spot in the middle for all of the traumas.”
Those traumas, Deyerin said, frequently come from not knowing who you are.
“You have genetic bewilderment if you grow up without knowing why you don’t look like or act like the people in your family,” she says. “You think something’s wrong with you, from a child therapy perspective.”
Deyerin advocates for telling children before they can even speak or form thoughts about the truth of their genetic parentage. That honesty can lead to a stronger and more stable sense of self, she says.
She points to the evolution of traditional adoption, which used to be mostly closed and secretive. Now, Deyerin said, the vast majority of adoptions are open to some degree.
“People didn’t take that leap that it’s going to be the same for assisted conception,” she said, of the system that remains frequently anonymous. “And they are now, because you have donor-conceived people who are now older.”
What do many of those adults say they want? To know where they came from.
• • •
Vesbit, her husband and Roost have stuck with their intention of staying in contact. And it continues to be an emotional and evolving process.
“She’s such a different person and parent than me,” Vesbit says of Roost. “And so I would talk to my therapist about it and my therapist brought up so many good points, like, ‘Well, maybe that’s actually really good because, in terms of jealousies and things, if you saw somebody raising him in the exact same way, that might be more difficult for you.’”
Vesbit will sometimes babysit while Roost and her son are in town.
“The most difficult part is seeing my daughter with him,” she says, choking up a little bit, “because she would’ve made such a good big sister.”
But Vesbit is also ready to let the boy go back to Roost when she comes to pick him up.
Roost is also always working on her relationship with her son. She follows donor-conceived forums and incorporates what she learns. She initially told her son he came from “a magic seed,” but as he got older, explained that scientists call that “magic seed” an embryo.
Originally, she says, she planned to refer to Vesbit and her husband as “aunt and uncle.”
“But I spent some time on donor-conceived pages, and they hated that really,” Roost says. “So we just go by names.”
Roost’s son is 5 now. It’s been some time since the families have been in the same place, due to the COVID pandemic, but Roost sends monthly updates. She’s working on getting her son into kindergarten and making plans for what their future will look like.
When the families meet up again this summer, pandemic-willing, all the kids will be older. Someday, they will guide the relationship, because it will be theirs, between genetic siblings.
Dugger-Spalding and Spalding are much earlier in the process. They may have more children from their two remaining embryos and they are currently just working through the early days of new parenthood – feeding, changing and staring in awe at their brand-new child.
Spalding is excited to create the big queer family she imagined, and for her daughter to someday get to meet her genetic siblings around the country.
Dugger-Spalding is also excited: the baby they wanted is now in her arms.
“I had some hesitations at the beginning,” says Dugger-Spalding, “because I wanted my baby to be genetically connected to me, and I feel like a lot of people probably feel that same way and that’s why IVF is so popular.”
But, she says, IVF is also not financially available to everyone. For Dugger-Spalding and Spalding, the cost of becoming pregnant via embryo donation, including legal costs, was about $10,000, or half of one round of IVF.
“But,” Dugger-Spalding continues, “ultimately, she’s here and it doesn’t matter that she’s not genetically, biologically connected. She’s healthy, she’s happy, she’s thriving. It’s incredible.”
And, in the most scientific sense, the baby is biologically connected to Dugger-Spalding. The embryo that turned into that baby was transferred into Dugger-Spalding’s uterus when she was only a tiny dot under a microscope. Everything else, beyond those first 100 or so cells, was created with nutrients from Dugger-Spalding’s body, fed via a placenta she grew, nurtured over nine months inside her uterus.
“You can still say,” Dugger-Spalding says, as she gently rocks her baby at her shoulder, “‘I made this.’”