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Freezing Embryos—A Woman's Best Option, But Is It Legal?
An Italian woman wanted to freeze embryos before her cancer treatment so that she could have children in the future. She spoke to her partner and informed her doctor, Antonella Surbone, M.D., Ph.D., at the European School of Oncology in Milan, Italy. But Italy's laws don't permit a single woman to preserve her embryos, and Surbone had to tell her no.
"This patient had major problems doing this because of the laws of the country. This is because of ethical and religious issues. Embryo cryopreservation is only possible for married couples. In Italy there is presently a very heated debate on this," Surbone said.
The laws governing fertility preservation measures for women are under debate in many parts of Europe and North America. Compared with the options in Italy and other parts of Europe, regulations in the United States are not restrictive—they allow all women to cryopreserve embryos. But freedoms for single women may be challenged in the future; proposed bills in Virginia and Indiana would allow only married couples to cryopreserve embryos, and a bill in Arizona would have made reimbursement for egg donation illegal. All were quickly defeated, but the propositions got the attention of lawmakers and researchers around the country.
"I think researchers and professionals working in the field were pretty shocked when the bills in Virginia and Indiana were proposed. We forget that people aren't always supportive of the reproductive work that's being done," said Ami Jaeger, J.D., of the BioLaw Group in Santa Fe, N.M. "This is a wake-up call that we need to be more involved in explaining what we do and working with legislators involved to help get them information about how these practices support people."
Restrictions both in the United States and abroad can be based on religious beliefs, legal systems, or opinions on what is moral. Some fertility treatments, such as embryo cryopreservation, face more restrictions than others because they touch on the belief that an embryo should not be frozen or destroyed because it contains a potential human life.
U.S. federal regulations currently protect sperm, egg, and embryo cryopreservation for both single and married women and permit people to hire surrogate parents. Any other regulations, including those on embryo disposal, are set by courts in individual states.
The U.S. public doesn't seem interested in laws that restrict access to fertility options, said Judith Daar, J.D., of Loyola University Law School in Los Angeles. "The approach to these technologies in the United States is laissez-faire. Perhaps it's that approach that has helped squelch the desire to legislate."
Canada's laws also permit cryopreservation, but surrogate mothers are not allowed to be reimbursed, which makes surrogacy a less common practice. In Europe, many legal restrictions exist, but these vary from country to country. For example, egg, sperm, and embryo preservation in Norway are allowed only if the patient has a genetic disease or if a man is sterile. In Germany and Sweden, cryopreservation is allowed only for married females, and Sweden's laws add that a woman must be younger than 40 years when she undergoes the preservation procedure. Other countries are not as strict. Spain, Switzerland, England, and Belgium allow single men and women to preserve their eggs, sperm, or embryos, and England and Belgium also allow surrogacy.
Surbone says she knows several Italian women who have gone to Spain for embryo cryopreservation and IVF because they'd have a better chance of a future pregnancy. Italian laws ban freezing and destroying embryos, in part because of the country's strong ties to the Catholic Church, she said.
Although American women don't find themselves tied by such legal restrictions, they have to weigh the high price of fertility treatment with the possibility that cancer treatment will leave them unable to carry a baby. And with bills coming up for debate like the ones in Virginia, Indiana, and Arizona, researchers say they have to work on educating the general public and state legislators so that researchers don't face future restrictions.
"We have to have a much more honest and open dialogue about what happens in infertility clinics and what doesn't," Jaeger said. "When heart transplants were introduced, some of the general population thought a new heart would change their personality and beliefs. Now we don't think twice about it. We're not going to create a Frankenstein by changing someone's heart. And it's important to think about fertility treatment in the same way."
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