A U.S. senator suggests couples seeking fertility treatment should not be allowed to produce more embryos than they wish to implant simultaneously.
Anti-abortion activists picket a fertility clinic in Virginia, proclaiming, "IVF kills babies."
These and other developments have some reproductive health experts wondering if opposition to embryonic stem cell research may broaden to include in vitro fertilization, a mainstream medical procedure used by millions of people.
Abortion opponents contacted by the Chicago Tribune said they were not aware of any lobbying to ban or restrict IVF - but they'd happily support such legislation.
"IVF requires killing," said Bill Beckman, executive director of the Illinois Right to Life Committee. "They choose which (embryos) to implant, and they create spares that will die."
The cells used in embryonic stem cell research come from IVF embryos, which critics believe deserve the same ethical treatment as living children. The debate has raised awareness that this procedure typically creates more embryos than are used to make babies.
Many experts believe IVF is now far too commonplace to be drastically restricted. The American Society for Reproductive Medicine estimates that one of every 100 children born in the U.S. is conceived this way.
Beckman agreed that trying to limit IVF would be difficult, adding that abortion and euthanasia are higher priorities. "There are too many battles to fight, and IVF is not at the top of the priority list," he said.
"It doesn't have the same priority for us as stem cell research," agreed Carrie Gordon Earll of Focus on the Family. "There are only so many man-hours to go around."
Yet a variety of recent events are provoking anxiety in the field of assisted reproduction.
In Kentucky, draft legislation would force IVF practitioners to fertilize only one egg at a time. The usual practice is to fertilize multiple eggs and preserve some in case the woman doesn't get pregnant on the first try.
If the Kentucky bill passed, it "would dramatically lower pregnancy rates," said Dr. Richard Scott, director of Reproductive Medicine Associates on the East Coast. "Tens of thousands of people a year will go without a family."
President Bush and other politicians, meanwhile, are promoting "embryo adoption" as an alternative to destroying leftover embryos. A spokesman for Americans United for Life said his group is researching model legislation for states that want to regulate reproductive technologies. Already, Louisiana bans the intentional destruction of a viable fertilized egg.
At the individual level, IVF raises complicated moral issues. Many patients who describe themselves as "pro-life" have no compunction about creating new life through the procedure, experts agreed. On the other hand, some "pro-choice" people find they can't destroy or donate their leftover embryos.
In IVF, a woman is given hormones so her ovaries will produce a large number of eggs at once. The eggs are removed and fertilized in a lab. After the fertilized eggs start dividing, one or more embryos are transferred to the woman's uterus in hopes that one will implant and develop into a fetus.
Remaining healthy embryos are usually saved for future pregnancy attempts. Frozen embryos have been accumulating since the late 1970s, creating a stockpile estimated at more than 400,000.
Those embryos are a potential source of stem cells, which researchers believe might be able to generate replacement tissues that could help people with cancer, diabetes and other diseases.
Whether doing that is morally acceptable hinges on the question of when life begins - the same question at the root of the abortion debate.
To those who believe a human life is created the moment egg meets sperm, abortion is murder. So is destroying a frozen embryo.
But Beckman estimates fewer than 10 percent of Americans hold that view. Many who oppose abortion are in favor of IVF and embryonic stem cell research. And some who oppose stem cell research, such as Bush, support IVF.
"Being anti-abortion isn't necessarily going to make you (anti-IVF)," said Eleanor Nicoll of the society for reproductive medicine. "Many people are capable of making distinctions between removal of a fetus from the uterus and an embryo in a dish."
The feelings involved can be complex. Kristin Daus, a church-going Catholic, had two children through assisted reproduction and a third the old-fashioned way.
But once she was done having children, she said, she felt morally obligated to the six frozen embryos she and her husband, Jerry, had left behind.
So, even though she dreaded the thought of having a fourth child, she went through the required hormone treatments to prepare her womb to receive the embryos. As it happened, when the embryos were thawed, none survived.
"I felt, `I created them. It's my responsibility to go ahead and try to give them a chance - like we gave the others,'" said Daus, referring to the embryos that became their daughter Marguerite, now 9, and their son Christopher, 5.
Lynn Boughey, a lawyer from Minot, N.D., and his wife, Lanette, had twins through IVF two years ago. They agreed in principle to let another couple use their excess embryos - the "embryo adoption" option touted by Bush.
But the Bougheys do not oppose stem cell research. If no one wants the embryos, Lynn Boughey said, they would donate them to science.
"I cannot believe that a loving and merciful God would have a problem with us using the science He gave us to provide the joy and love we have in our house right now," said Boughey, who described himself as active in the Presbyterian church.
Dr. Edward Marut, director of the Fertility Centers of Illinois' Highland Park IVF facility, said he sees some patients who are clear from the outset that they don't want to have to dispose of any embryos.
"For those patients, we only try to fertilize a limited number of eggs, usually two or three, and implant whichever do fertilize," he said. "If they're not lucky ... then they have to do it all over again."
That's how IVF is done in Germany and Italy, where the law forbids freezing embryos, says a maximum of three embryos may be created at one time, and requires that every embryo be transferred simultaneously back into the woman who produced the eggs.
Recently, Sen. Sam Brownback (R-Kan.) said those countries might have the right idea. In an interview with ABC's "This Week," he suggested restricting the number of eggs that can be fertilized and requiring doctors to implant all the embryos that result.
Kentucky's bill would allow only one egg to be fertilized at a time. Experts said if that were the standard, many women - especially older ones - would never get pregnant.
For a 35-year-old woman, Scott said, only about 6 percent of inseminated eggs end up becoming babies - and the percentage gets smaller as the woman gets older.
"If you only inseminated one egg," Scott said, "it would take an average of 16 cycles to get a baby."
One IVF cycle involves four to six weeks of hormone injections, ultrasound tests, blood work and a minor surgical procedure to retrieve the eggs; it can cost $10,000 or more.
"If you really believe a (fertilized egg) is a person, it makes things very hard for infertile couples," Scott said.
Medical ethicist Nanette Elster said that although deciding what should be done with unused embryos is a big question, "the bigger question is who is going to decide."
"Do we want government to say you can only make so many embryos (and) you can't destroy any embryos?" she asked.
Pamela Madsen, director of the American Fertility Association, said every couple is entitled to make their own decision. "Many people believe the embryo has a special status," she said. "But how do you interpret that? That it should be handled with care? That it's a child? That it shouldn't be created at all because it's sacrilegious to create life outside a uterus?
"It will be very problematic if the government gets involved and forces us to make certain decisions."
Andrew Koppelman, professor of law and political science at Northwestern University, said regulating IVF would be difficult politically. "Any legislation that does major damage to the interests of large numbers of prosperous white people is going nowhere," he predicted.
But Madsen is not so sure. "Never say never," she said.
