Created on Purpose

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(A reflection on my work as an embryologist, from 2006.)

Your eyes saw my substance, being yet unformed
And in Your book they all were written
The days fashioned for me, when as yet there were none of them.
Psalm 139:16 NKJ

     There is a purpose instilled in each of us at the beginning. Actually before our beginning, known by God alone, until our physical lives are set in motion and our purpose begins to be manifested. But when I refer to the beginning, it is the beginning of our physical being; when egg meets sperm in a narrow fallopian tube. Some beginnings don't start there though; they start in a petri dish, where life is aided by a medical team. Couples hoping to be parents, but unable to have children on their own, turn to a fertility clinic to deliver them from childlessness. Among a team of many, I am an embryologist; a lab technician trained in the nurture of early human life.
     In the lab where I work, eggs and sperm are combined to produce embryos for infertile couples. By the time patients get to that stage in their medical odyssey, they have endured months, if not years, of invasive, embarrassing, expensive treatments. Each month is valuable; one less month until the wife’s menopause, one more month of empty arms among her circle of friends with babies who are growing so fast. Each month is another chance at pregnancy. The menstrual cycle is meant to launch a new life; the new life of the baby, the new life as parents, the newness of all the family relationships viewed through the lens of the child. If only this month it would work, then they could finally put this nightmare behind them and move on into the future, never looking back. The whole clinic, from the medical director on down to the clerical staff, knows the desperation and the hope. It permeates the air. Although the whole medical team participates during treatment, creation of life is not achieved by us. It is a divine yet natural process that we can only aid, not force.
      During the course of the medical treatment, the fertilized eggs become embryos. The fertility drugs given have enhanced the woman’s egg production, so a single month’s cycle could yield between 6 to 24 embryos. All embryos are infinitely precious to the couple. Each fertilized egg is a real baby to them; they imagine a personality, a soul, a sun-browned laughing child in their back yard. They each have that potential, but they can't all be transferred back safely to the woman’s body at one time. So the lab technician looks the embryos over carefully, grades them, and unsentimentally selects the best. Two days after the egg retrieval, two to four embryos are loaded into a thin catheter to be returned to the patient’s uterus.
     At this point, the extra embryos have now become a by-product of a medical treatment. Because of their much debated human status, they must be dealt with in an ethical manner. To our clinic means that any embryo of average quality or better gets cryopreserved, or frozen. The freezing process involves chemical dehydration to prevent the cells from bursting (as the water in them expands), loading them into small plastic containers and very slowly cooling them. Lastly, they are kept frozen in a storage tank of liquid nitrogen at the clinic until the couple comes back for them.
     Should the excess have been produced in the first place? The medical team has limited control over the number of embryos produced without sacrificing successful pregnancy outcome. For example, if three eggs were used for fertilization, some may not have fertilized at all or been of good quality, leaving little or nothing to put back in the uterus. Complete fertilization failure, probably the worst disappointment, results in no embryo transfer and a cancelled cycle. Fertilizing more eggs than are needed directly improves the likelihood of pregnancy by increasing the pool of embryos to choose from. Reducing the need for repeat treatment cycles is better for the patients financially and emotionally. Many patients are unable to withstand repeat failures, and seek aggressive treatment plans which maximize the number of embryos produced in each cycle. 
     At our clinic, around fifty five percent of the women get pregnant on their first try with this therapy. For those with frozen embryos, it means a long wait to be reunited with their mother, if ever. If she is pregnant, especially if there are multiple babies expected, she won't come back for her embryos for at least two years. That is, if she even wants more children. Now the couple must consider their choices as to what to do with the excess embryos.
     The patients are offered four choices. Embryos can be stored indefinitely, donated to another infertile couple, donated to a research lab, or destroyed. Not only is their fate decided, but also the reality of what they are. If storage is continued, they are still the promise of future children. If they are donated to another couple, they are the promise of future children plus a beautiful and unselfish gift. The option of donation to a research lab makes the embryos an unselfish gift also, but they lose their humanity, becoming a biological specimen of curiosity. To choose to destroy them can also deny their humanity; or be viewed as an act of respect; letting them go instead of holding them in frozen storage.
     Many embryos have waited frozen more than a decade with couples unable to return for them. Some couples have finished their families now, with enough children to fill their lives. Others have divorced, exhausted their ability to pay for the expensive treatments, or are emotionally unable to face the strain of continued therapy.
     The embryos wait. The lab begins billing a hefty quarterly storage fee. The tanks are full; more tanks are purchased, taking up considerable space in the clinic. The abundant blessing the lab has helped produce now becomes a curse. Many patients continue to pay the storage fee out of obligation, but are unsure of what to do with their embryos. Some just don’t pay and their accounts go to a collections agency. Although these embryos are abandoned, the lab has no other option than continue storage. All these lives are still left waiting. In a decade or two, the patients will be physically too old to attempt a pregnancy. The billing defrays the storage cost for the lab, but more importantly also puts pressure on the couple to make a decision. “Don’t leave these here forever,” is the unwritten message.
     Now the embryos are a burden, once they were precious. Have the embryos themselves changed? No. They contain exactly the same physical and spiritual components as the day they were frozen. They remain unchanged; only our perception of them is different. Does our perception of life dictate truth? What happens next is the result of hard, tearful, sleepless choices made by people desperate to have children. Who defines what the embryos are? Is it the opinion of the parents, the medical staff, or society? Is it the courts of law, varying from state to state?
     There is a truth to each embryo that transcends all of these factors. How can it be a child one day, but garbage the next? It has no less human potential based on our thoughts toward it. All that is lacking is the willing womb. The biological purpose of embryos is to grow, divide and expand, eventually connecting to the uterus wall. Their God-created purpose is to become fully human, to be those smiling children in the yard. Making these hard choices about embryonic life has left us all weaker for it. The joy of a new baby is incomparable; it is the hope that drives us on. There are countless families that would not exist without medical assistance. So many lives have been positively impacted by the sheer miracle of life where there once was none.
     Do we go too far? Are we trying to act as God? Are we causing more harm than good? These are my own hard, tearful, sleepless questions. The benefit of working in the lab is being shielded from the most painful parts of the patients’ experience. Often it is easy to manage; retreating to the lab during the worst times, but gladly coming out when the families visit later to show off the babies.
     Recently though, a female patient of our office came in to claim and destroy her last frozen embryo. It had been more than ten years since the day that I had cryopreserved the small life, along with several other embryos of hers. This one embryo had been accidentally misplaced, floating in the liquid nitrogen tank in a sealed straw, separated from the rest. This one had been left behind when the others were thawed and transferred back to her uterus. When I finally located the errant straw and recaptured it, too much time had passed. The patient was no longer seeking treatment; actually she was unaware that we still had it, at first. Although she hadn't become pregnant, she stopped treatment; likely financially, physically or emotionally exhausted. Probably it was all three.
     She and her husband kept in contact with us. The storage fee had been waved due to their circumstance, since they had intended to thaw them all at the same time. For years they didn't come back; although checking in several times to review their options. One day not long ago, they did return, but only the woman came to the office. I had always refused to participate in the destruction of embryos; I had been promised by the doctor many years ago that our practice would never do it.
     The embryos don't belong to us though, and that promise didn't anticipate the overriding rights of the patients to direct an embryo’s fate at will. Instead we pass them over to the patients, still frozen - though quickly thawing, inside their tiny plastic container tucked in a brown paper lunch sack. "What should I do with this?" is often the question. I answer, "Some people bury them, some people throw them away, it's really up to you. You just can't dispose of it on the hospital's property." That is our standard answer, although it is somehow lacking. So as they turn to leave, it is the patients who ultimately are responsible for the act. Obviously the staff is an accessory to this, and I could never bring myself to pull them out of the deep freeze with the intent of destruction. Except this one time.
     This embryo felt like mine, I remembered the patients, their case, everything so vividly etched in my mind. Back then, we didn't see the volume of people we do today. Back then, I could hope and pray desperately for each of them, the embryos. I saw much more of the embryos than I ever did the patients. I knew them before they were; as eggs and sperm. Through the microscope I saw them first as fertilized eggs, then dividing into multicelled embryos. I'd be the last one to see them before they were transferred to the patient, or before they slipped into the treacherous slumber of cryopreservation. Not knowing if they'd survive the thaw, or the wishes of their parents.
     "It's been a long time" was all I could think to say, as we stood face to face. She agreed slowly, this exchange containing more than the words spoken. She explained to me, as though I needed to know (which I did) that she was ok. She had just completed the adoption of two beautiful children, it had been more than a two year process while they foster-parented them. The other embryologist brought out the tank, and her brown bag was prepared. With small smiles and tears in our eyes, we parted she and I. This embryo, this last left behind, but not forgotten human mass of cells, had fulfilled its purpose that day. It had been her vessel of hope; which on that day, seemed like quite enough.