Human Reproduction, Vol.26, No.12 pp.

3327–3338, 2011
Advanced Access publication on September 21, 2011 doi:10.1093/humrep/der313

ORIGINAL ARTICLE Psychology and counselling

Conditional embryo relinquishment:

choosing to relinquish embryos for
family-building through a Christian
embryo ‘adoption’ programme
Lucy Frith 1,*, Eric Blyth 2, Marilyn S. Paul 3, and Roni Berger 3
1
Department of Health Services Research, University of Liverpool, Block B, Waterhouse Building, Brownlow Street, Liverpool L69 3GL, UK
2
University of Huddersfield, Queensgate, Huddersfield HD1 3DH, UK 3Adelphi University School of Social Work Hudson Valley Program,
457 Maple St., Poughkeepsie, NY 12601, USA

*Correspondence address. Tel: +44-0151-795-5333; Fax: +44-0151-794-5604; E-mail: [email protected]

Submitted on February 7, 2011; resubmitted on August 14, 2011; accepted on August 18, 2011

background: Currently, there is little evidence about conditional relinquishment of frozen embryos to others for family-building. This
paper begins to address this gap by reporting findings from a study that investigated the experiences of couples who chose to relinquish their
embryos conditionally through an embryo ‘adoption’ programme.
methods: An exploratory qualitative study was conducted between September 2008 and December 2009. Participants were recruited
from a Christian embryo ‘adoption’ programme in the USA. Forty-three people (18 couples and 7 wives) participated in in-depth email
interviews.
results: The data show that the following factors contributed to the participants choosing an embryo ‘adoption’ programme: how they
conceptualized their embryos; dislike of alternative disposition options available; conceptions of their parental responsibility towards their
embryo and a desire to have an ‘open’ relinquishment with (varying) degrees of information-sharing and contact arrangements between
themselves and recipient couples.
conclusions: This study identifies a diversity of views on embryo relinquishment and some couples’ wishes for elements of conditional
relinquishment that are offered by embryo ‘adoption’ programmes. A range of disposition options should be available to enhance choice for
those with unused embryos so that they can relinquish in ways that are both morally and practically acceptable to them. The current polar-
ized debate concerning the language of embryo ‘adoption’ detracts attention from the practical considerations of formulating ‘best practice’ in
this area. These considerations are better addressed by the use of less politically charged terminology such as ‘conditional relinquishment’.
Key words: cryopreserved embryos / embryo disposition / embryo relinquishment / decision-making / patient attitudes

Introduction Background
As a result of recent developments in reproductive technology,
This paper aims to contribute to the understanding of the complex
women undergoing IVF are likely to produce more oocytes than
decision-making process regarding the disposition of unused cryopre-
can be used in a single treatment cycle. Frequently, efforts will
served embryos, by drawing on findings from an exploratory study that
be made to fertilize the oocytes not used and cryopreserve the
investigated the perspectives of couples who relinquished their
resulting embryos. Subject to legal and regulatory provisions in
embryos conditionally using a Christian embryo ‘adoption’ programme
different jurisdictions, four disposition options may be available
in the USA. The paper concentrates on why these couples chose to
regarding any unused cryopreserved embryos at the end of a
relinquish their embryos in this way. Other findings from the study
couple’s treatment: leaving them in storage; permitting their
have been reported elsewhere (Paul et al., 2010). Previously, there
destruction; allowing them to be used for research; or—the focus
has been little investigation into the experiences of those who have
of this paper—transferring them to one or more couples or individ-
relinquished their embryos ‘conditionally’ to guide policy and practice
uals for family-building.
in this area.

& The Author 2011. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.
For Permissions, please email: [email protected]
3328 Frith et al.

Options that are actually available vary between jurisdictions, as relinquishing their embryos to vet and choose the recipient(s) of
indicated by the global survey of assisted reproduction technology their embryos—if they wish—based on recipients having undertaken
regulation undertaken by Jones et al. (2010). This survey provided a home study evaluation; and the possibility of negotiating with
data on time limits placed on the storage of cryopreserved them possible future information exchange, contact and involvement
embryos. Thirty-one jurisdictions were identified that had relevant in the life of the resulting child. Even if the relinquishing couple
regulation or legislation on storage limits, ranging from 3 years in chooses not to know the identity of recipients and plans no contact
Brazil and Montenegro to unlimited in Canada and unspecified in with them, conditional relinquishment programmes generally operate
the Czech Republic. In 14 of these jurisdictions, the maximum as an ‘open’ non-anonymous system and stipulate that any child
storage period is 5 years, although some allow for further extension born should be able to learn the identity of his/her genetic parents.
in some circumstances, and the limit is 10 years in eight jurisdictions. Therefore, records are kept and the possibility of the child having
In the USA, where there is neither legislation nor regulations regarding access to the identifying information about their genetic parents is
the time limits for storage of cryopreserved embryos, such embryos ensured. A key difference between infant adoption and embryo
can be stored indefinitely—and even where storage fees have not relinquishment under an embryo ‘adoption’ programme is that no
been paid, storage facilities are reluctant to destroy embryos court proceedings have, to date, taken place regarding the transfer
without explicit consent from the individuals who deposited them of parental responsibility for an embryo. However, the State of
(Gurmankinn et al., 2004). Storage fees for cryopreserved embryos Georgia recently passed a law to facilitate such transfer—the
vary from facility to facility, but range from approximately $700 to Option of Adoption Act (Georgia State Senate, 2009).
$1150 per annum (MHPG, 2011). The first embryo ‘adoption’ programme, Snowflakesw Embryo
Embryo donation for family-building was first reported in 1983 Adoption, was launched in 1997 by Nightlight Christian Adoptions,
(Trounson et al., 1983). However, such practices are expressly forbid- a California-based adoption agency [Nightlight (personal communi-
den in many jurisdictions (Jones et al., 2010), and where they are per- cation), 2006]. In 2002, the US government launched a programme
mitted, the prevalence is not easy to ascertain. In the USA, according of significant federal funding for ‘public awareness campaigns on
to the Centers for Disease Control and Prevention (CDC, 2009), in embryo adoption’ (Federal Register, 2002) and provided money to
2007, 67% of the 430 fertility clinics reporting treatment outcomes embryo ‘adoption’ programmes that met certain criteria. This raised
offered donor embryo services. However, the CDC data offer no considerable controversy and public debate due to the ‘pro-life’
further information about the services actually provided. In 2004, agenda that was seen to underpin the campaign. By 2010, the federal
Gurmankin et al. reported that 76% of the clinics responding to administration had disbursed a total of $17 489 000 to several pro-
their survey offered donor embryo services but, as with the CDC grammes under this funding stream (Office of Population Affairs,
data, provide no information regarding the prevelance of the services 2010). Currently, seven organizations in the USA are reported as offer-
actually provided. Two studies indicated varying differences between ing an embryo ‘adoption’ service (EmbryoAdoption.com, 2009).
the number of clinics offering embryo relinquishment services and In New Zealand, guidelines on relinquishment of embryos for
those actually providing them. Kingsberg et al. (2000) reported that family-building incorporate conditional relinquishment procedures
only 37% of clinics had provided embryo relinquishment, while that have similarities to those applied by USA embryo ‘adoption’ pro-
Hurwitz et al. (2005) reported that 60% had done so. A study by grammes. These provide both for those relinquishing embryos to be
Hammond et al. (2009) reported on an opportunistic poll of fertility involved in choosing recipients and for future offspring to find out
clinics’ representatives attending a symposium on third party repro- information about their genetic origins (including their donors’ identi-
duction, of whom 41% claimed to currently offer a programme and ties) (ACART, 2008). The guidelines require relinquishing couples to
another 20% were considering doing so. be provided with a recipient profile that includes any police vetting
information and both relinquishing and recipient couples to have inde-
pendent legal advice and counselling. Counselling is expected to
Embryo relinquishment for family-building include discussion of the impact of the relinquishment on both the
Embryo relinquishment for family-building can operate on a continuum child born as a result of the relinquishment and any children of the
from anonymous relinquishment to procedures that have parallels with donors and to have considered the participation in the decision
the adoption of an existing child—conditional relinquishment. Anon- making of any existing children of either party or of extended family
ymous embryo relinquishment operates in a way similar to anonymous members (Goedeke and Payne, 2009).
gamete donation, in which the donors of the embryos would generally
play no part in any decision regarding the selection of recipients of
their embryos (ASRM, 2009a,b). The recipients of the embryo(s) Studies on embryo disposition
could receive some information about the donors, but this (as is the A number of studies have examined the views of couples and individ-
case for gamete donation) is generally limited to physical character- uals with unused cryopreserved embryos regarding their use for
istics and health status of the donor (ASRM, 2006). The ASRM guide- family-building by others (see Blyth et al., 2011 for a detailed review
lines on this initially promoted anonymous donation, ‘but by 2002 of this literature), with four main themes emerging that are relevant
indicated an acceptance of directed, known donation if all parties to our study. First, several studies have reported that disposition
agree . . . and also regard known oocyte donation as acceptable.’ decisions are very difficult emotionally (Oke et al., 1998; McMahon
(ASRM, 2004, p. 530). et al., 2000, 2003; Newton et al., 2003; de Lacey, 2005; Nachtigall
Conditional relinquishment services offered by embryo ‘adoption’ et al., 2005; Hammarberg and Tinney, 2006; Fuscaldo et al., 2007;
programmes have the following features: the ability of those McMahon and Saunders, 2009; Provoost et al., 2009, 2010).
Conditional embryo relinquishment 3329

Second, studies have consistently reported that, where comparison Against the trend, Elford et al. (2004) reported on the decision of
with other disposition options is made, relinquishment of embryos 11 couples to anonymously relinquish their embryos because of
is frequently the least-favoured alternative (Klipstein et al., 2001; their unwillingness to destroy what they considered to be their
Klock et al., 2001; Kovacs et al., 2003; Newton et al., 2003; Elford ‘unborn children’.
et al., 2004; Nachtigall et al., 2005; Hammarberg and Tinney, 2006; Despite this wealth of literature, except for one previous study in
Lyerly et al., 2006, 2010; Lanzendorf et al., 2010; McMahon and Spanish (Collard and Kashmeri, 2009), the experiences of people
Saunders, 2009). who have actually relinquished embryos conditionally through an
Two studies have solicited views of those with stored embryos embryo ‘adoption’ programme has been under-researched—and
about their attitudes to the amount of information and the type of this study seeks to address this gap in our knowledge.
contact they would like to have with the potential recipients of their
embryos that are particularly relevant for our study. Newton et al.
(2003) undertook a postal survey of IVF patients at a Canadian infer-
Methods
tility clinic to ascertain their reasons for continuing to store their This exploratory qualitative study sought to examine the attitudes and
embryos and their attitudes towards relinquishment to others. views of couples about their decision to relinquish their frozen embryos
Almost three quarters (73%) ‘moderately or completely agreed’ for family-building through a Christian embryo ‘adoption’ programme in
with relinquishment, although only 12% claimed that they would ‘defi- the USA. Embryo relinquishment is a two-stage process. In the first
nitely consider’ relinquishment if a programme was available (at the phase, a relinquishing couple registers with the programme and the
embryos are made available to potential recipients. In the second phase,
time of the survey, the clinic did not offer such a programme), while
potential recipients are matched with relinquishing couples, who then
18% stated that they might consider ‘conditional’ relinquishment, i.e.
choose the recipient couple (unless they have delegated this decision to
an arrangement giving them some choice in respect of potential reci- the programme), and the embryos transferred to the recipients’ medical
pients. McMahon and Saunders (2009) also conducted a postal survey facility, completing the relinquishment process. Couples for the current
of 283 couples from an Australian clinic with embryos in store for at study were recruited at both stages of this process and whether it had
least 3 years to ascertain their willingness to relinquish their embryos led to the birth of a child or not.
for family-building to others, their attitudes towards conditional relin- Despite its own religious orientation, the programme did not require
quishment and the extent to which its availability would influence their either relinquishing or recipient couples to be Christian and those of
decision-making. Ninety-nine women (35%) and 66 male partners other faiths, or none, were eligible. Those planning to relinquish
(23%) responded. Of these respondents, 4% claimed that they were embryos could take an active part in choosing the recipients of their
likely to relinquish their embryos, 48% endorsed the ability of relin- embryos, by specifying criteria and evaluating information on potential
recipients by means of a family profile completed by all potential recipi-
quishing couples to specify desired characteristics of recipients and
ents. Relinquishing couples could also arrange meetings prior to relinquish-
41% indicated that they were more likely to relinquish their
ment with prospective recipients if they wished. Alternatively, relinquishing
embryos if a conditional relinquishment arrangement was available. couples could adopt a more passive approach and leave the programme to
However, these studies did not investigate the views of couples choose recipients for their embryo. Thus, exactly how the relinquishment
who had actually relinquished their embryos in this way. was organized could be determined by the couples involved. Potential
Third, relinquishing embryos to another couple has been found to be recipients completed a Home Study that included counselling by a social
more often contemplated than actually performed. While some studies worker, a medical evaluation and education/preparation (through the
(Laruelle and Englert, 1995; Bangsbøll et al., 2004; Lyerly et al., 2006; social worker and/or books and short courses) and a family profile. Irre-
Mohler-Kuo et al., 2009) indicate moderately high levels of support in spective of the chosen approach, the programme required that channels of
principle for relinquishment among patients with unused embryos communication remain open, to allow resulting children to have the possi-
(52, 39, 29 and 28% respectively), studies of actual relinquishment bility of finding identifying information about their genetic parents.
All participants were recruited through the programme by sending an
typically report rates lower than 10% (Kovacs et al., 2003; Elford et al.,
email to all their eligible clients, approximately 300 couples, outlining the
2004; Lanzendorf et al., 2010; Nachtigall et al., 2010).
study and inviting them to participate. Over the course of the study, 36
Fourth, couples’ disposition decisions appear not to be influenced consent forms were mailed to couples, of which 30 were returned.
by abstract religious or philosophical beliefs regarding the inherent Interviewing continued until theoretical saturation was reached (Bryman,
value of embryonic life per se . Rather, they are grounded more in 2001), resulting in 25 couples taking part in the study. See Table I for
their conceptualization of their embryo(s) as their ‘future’ or ‘virtual’ demographic information and the details of numbers of existing children
child(ren) and—where they have conceived children themselves—as and brief fertility history, time of embryo storage, numbers of embryos
their children’s full sibling(s). Most studies reporting this phenomenon relinquished and outcomes of these relinquishments. There was a lower
noted that conceptualization of embryos as ‘virtual’ children contra- completion rate from the husbands (despite their initial agreement to
indicates relinquishment to facilitate the building of someone else’s take part) who were less likely to either reply or continue with the
family (Laruelle and Englert, 1995; Oke et al., 1998; Van Voorhis interview—a phenomenon previously reported in this area (Provoost
et al., 2009). Seven husbands did not participate and interviews with
et al., 1999; McMahon et al., 2000, 2003; Klipstein et al., 2001;
their wives were included in the data set so as not to lose valuable
Söderström-Anttila et al., 2001; Svanberg et al., 2001; Tinney et al.,
data. Due to the low number of husbands responding and the method
2002; Newton et al., 2003; Bangsbøll et al., 2004; Burton and of email interviewing, it was not possible to analyse the data by gender
Sanders, 2004; Lyerly et al., 2004, 2006, 2010; de Lacey, 2005, or couple dynamic.
2007; Nachtigall et al., 2005; Hammarberg and Tinney, 2006; Couples were allocated randomly to one of the four researchers and
Roberts, 2007; Zweifel et al., 2007; McMahon and Saunders, 2009; the researcher began emailing, in most cases, individually with each
Melamed et al., 2009; Nachtigall et al., 2010; Provoost et al., 2009). member of the couple. Completion of the interviews took a varying
 3330
Table I Demographic information.

Participant Religious Education Number of children (from ART, Number of Number of Number of Resulting pregnancies, and if relevant
affiliation, level adopted etc.) embryos in embryos given embryos used age of child
practising storage (time up for
yes or no if known) relinquishment
..........................................................................................................................................................................................................................................................
Couple 1
Woman Catholic—yes Diploma level Three from previous relationship 3 3 3 Twin pregnancy
Two with husband conceived naturally 3 years 5 years (approximately)
Two adopted
Two from IVF (egg donor)
Man Catholic—yes Degree
Couple 2
Woman Jewish Degree One from IUI 3 3 Waiting to be matched to a suitable couple
One from IVF PGD (couples own gametes) 9 months
Man Catholic—no Masters
Couple 3
Woman Protestant—yes Masters Twins by IVF (donor egg) 15 15 15 One pregnancy ectopic
1 year Only one transferred
(rest perished)
Man Protestant—yes Degree
Couple 4
Woman None Degree Twins by IVF (own gametes) 9 9 9 One girl
3 years 2 years old
Man Christian—yes Degree
Couple 5
Woman Christian—yes Diploma Twins by IVF (own gametes) 3 3 3 One girl, died at 6 months gestation
1 year
Man None Diploma
Couple 6
Woman Christian—yes Degree Twin by IVF (own gametes) 4 4 4 One boy 8 years old
2 years
Man Christian—yes Degree
Couple 7
Woman Christian—yes Not stated Four naturally conceived 4 4 4 One boy 1 year old
Two by IVF (own gametes) 2 years
Man Christian—yes ‘‘
Couple 8

Frith et al.
Woman Christian—yes Degree Triplets by IVF (own gametes) 2 2 Waiting to be matched to a suitable couple
One child conceived naturally 12 years
Man Christian—yes Masters
 Conditional embryo relinquishment
Couple 9
Woman Christians—yes Degree One by IVF (own gametes) 4 4 4 Twins 2 years old
One conceived naturally 4 12 years
Man Christians—yes Degree One from previous relationship
Couple 10
Woman Christian—yes Degree One girl and then twins by IVF (own gametes) 3 3 3 One child 4 years old
6 months
Man Did not respond Masters
Couple 11
Woman Christian—yes Degree Twins by IVF (own gametes) 10 10 10 One boy 3 12 years old
One conceived naturally 6 months
Man Christian—yes Degree
Couple 12
Woman Christian—yes High school One child naturally 2 2 2 One girl 8 months old
Twins by IVF (own gametes 2 years
Man Christian—yes Diploma
Couple 13
Woman None Master One child with donor sperm insemination 4 4 4 Two boys from two pregnancies
Twins IVF (with donor sperm) 3 years 6 and 4
Man Catholic—no Degree
Couple 14
Woman None Degree One child by IVF (donor egg) 5 5 5 No pregnancy resulted
1 year
Man None Degree
Couple 15
Woman None Masters Twin by IVF (own gametes) 9 9 9 Pregnancy that did not go to term
4 years
Man None Degree
Couple 16
Woman Catholic—yes Degree Adopted child 10 10 10 Two transferred to one couple who had a
miscarriage
Twins by IVF (own gametes) 4 years Others relinquished to another couple who
have had a baby boy, 4 years old
Man Did not respond
Couple 17
Woman Christian—yes Degree One by IVF (own gametes) 5 5 5 Implanted but pregnancy not achieved
One by IVF (with egg donor) 2 years
Man Christian—yes Degree

Continued

3331
 3332
Table I Continued

Participant Religious Education Number of children (from ART, Number of Number of Number of Resulting pregnancies, and if relevant
affiliation, level adopted etc.) embryos in embryos given embryos used age of child
practising storage (time up for
yes or no if known) relinquishment
..........................................................................................................................................................................................................................................................
Couple 18
Woman Christian—yes Not stated Twins by IVF (own gametes) 2 2 2 Found a couple, but embryos did not survive
the thawing process (2 years ago)
Man Christian—yes Not stated
Couple 19
Woman None Degree Two by IVF (own gametes) 3 3 3 Relinquished to a couple (no pregnancy so far)
1 year
Man None Masters
Couple 20
Woman None Degree Twins by IVF (own gametes) 4 4 4 No pregnancy achieved
2 years
Man None Degree
Couple 21
Woman Christian—yes Masters One by IVF (own gametes) 4 4 4 No pregnancy achieved
2 years
Man Christian—yes Degree Two by previous relationship
Couple 22
Woman None Diploma Twins by IVF (own gametes) 2 2 2 Waiting to be matched to a suitable couple
Man Did not respond
Couple 23
Woman Christian—yes Degree One by IVF (own gametes) 3 3 3 No pregnancy achieved
Twins by IVF (own gametes)
Man Did not respond
Couple 24
Woman Degree Twins, by surrogacy had embryos left over 16 16 16 Twins
4 10 years old
Man Did not respond
Couple 25
Woman Christian—yes Degree Twins by IVF (donor eggs) 1 1 1 Did not survive thawing process
Man Did not respond

Frith et al.
Conditional embryo relinquishment 3333

amount of time, with an average of one month. The email interviews were I do believe life begins at conception and those eggs on ice are children.
semi-structured, guided by a topic guide that was based on a theoretical Husband 2
approach that seeks participants’ own categories and frames of reference
(McCracken, 1988). Questions were open and broad, such as ‘What was Because they are my ‘babies’ and I do believe life begins at conception, I
couldn’t destroy them or have them used for research. Wife 8
the post-relinquishment experience like?’ (see attached topic guide for
details of the questions asked) and researchers followed up participants’
We believe, strongly, that life begins at conception, so there was never any
answers by specific, probing questions. doubt that we would not have the embryos destroyed or donated to
The choice of asynchronous email interviewing as the data collection scientific research—they were children. Wife 9
method was informed by practical considerations because the participants
were spread over a large geographic area in the USA and the research I believe that life begins at conception. I did not mean to make those
team comprised both UK-based and US-based researchers. This made 10 extra embryos, but once I did I became responsible for them. If I
synchronous email, telephone or face-to-face interviewing logistically chal- could not use them I would find someone who could. I am also pro-life
lenging, whereas conducting asynchronous email interviews allowed for and anti-abortion. Wife 16
interviewing a greater number of couples than would have been possible
otherwise. Although there are negative aspects of email interviewing,
Many participants thought that the embryo deserved ‘special’ and
such as lack of visual cues, possible distractions and lack of concentration careful consideration—but not a status akin to an existing child:
during the interview (McCoyd, 2003), it can offer advantages of practical
Those embryos are very important to many different things. Whether or
efficacy and a richness of communication and opportunities for reflection.
not you donate them to science, or donate them to an organization, those
Further, this can all be achieved at a relatively low cost (McCoyd and embryos can mean a lot to someone and I don’t think a lot of people
Kerson, 2006). Ethical issues raised by email interviewing were addressed know about that. Wife 5
through adherence to the ethical guidelines of the Association of Internet
Researchers (2002) and ethics approval was given by IRBs at each of the Discarding seemed wasteful and sad (even though at least I have no moral
researchers’ universities. or religious objection to that). Husband 14
Transcripts from the email interviews were content analysed, using a
modified grounded theory approach (Strauss and Corbin, 1998), by all A common view expressed was that embryos deserved some chance
members of the research team. Open and axial codings were used to of life:
identify emerging categories. A constant comparison method was used
both for the comparison of data between interviews of each participant The thought that they might have a chance at becoming a living person was
very important to me. Wife 3
(and for differences between couples) and also for comparison of
themes and categories within interviews. The research team reviewed
I, personally, could not bear to think of ‘flushing’ them. We had to go
the transcripts for quality assurance to ensure a consistent approach to through a great deal more to accomplish this, but I felt that it was
data analysis. Inter-coder triangulation was achieved by securing worth anything to make sure that they had a viable chance at finding a
consensus among the members of the research team relative to coding place in the world. Husband 4
(Krefting, 1999).
Some participants did think of embryos as potential people:

Results I would have to say that I believe the embryos to be potential children not
merely reproductive cells. Wife 3
This paper focuses on participants’ reasons for relinquishing their
embryos via an embryo ‘adoption’ programme. Illustrative quotations Although our recruitment site might have indicated that all participants
are taken from the email transcripts and are reproduced verbatim. In would share views such as those cited earlier, this was not the case as
keeping with conventions for reporting results from qualitative studies some were unsure of how they saw the status of the embryo:
using a relatively small number of participants, the terms ‘many’ or
I guess a small part of me believes that life begins at conception. Wife 17
‘most’ are used to refer to commonly reported responses and
‘several’, ‘some’ and ‘a number’ to refer to responses by more than Several participants thought that the embryo had no moral
two participants. The data analysis identified four inter-related significance:
factors that contributed to participants’ decisions to relinquish their
embryos using an embryo ‘adoption’ programme: (i) how they I guess I didn’t really care what happened to them. Husband 16
conceptualized the ‘status’ of their embryo(s); (ii) dislike of the
other disposition options available; (iii) conceptions of their parental Thus, our participants held a wide range of views on the moral status
responsibility towards their embryo(s) and (iv) a desire to have an of the embryo.
‘open’ relinquishment where (varying) degrees of information giving
and contact were arranged. Dislike of other disposition options
Views on other disposition options were often related to participants’
Conceptualizations of the embryo perceptions of the embryo.
It is not surprising, given the source of our recruitment, that the domi- Discard the embryos. I didn’t feel we could do this based on our Christian
nant conception of the embryo was one that accorded it (some) moral beliefs. I don’t know if life begins at conception, but it might, and this felt
importance. Several participants believed that life began at conception: morally wrong, so I could not make this choice. Wife 18

Disposal or using them for research wasn’t an option as we see embryos I don’t think I would ever be comfortable destroying the frozen embryos
as potential people (from the moment of conception). Wife 1 or using them for a purpose that would have destroyed them. Husband 1
3334 Frith et al.

Not all participants were opposed to embryo experimentation. For terms of adoption. We wanted to make sure that the couple that received
instance, one couple did consider donating their embryos to research the embryos had the same beliefs and ideas that we hold. Husband 8
as a first option:
This meant that we could review potential parents and they could view
our profile. We felt that this gave us some control over where the
At that point we did speak with our fertility specialist about embryo
embryos ended up. Wife 19
studies and asked if there were projects being done on certain diseases
etc that we could donate the embryos for. At that time we were told
This element of embryo relinquishment, the ability to have input into
no. Wife 19
who received their embryos, was very important to the participants
Using an embryo ‘adoption’ programme was frequently seen as the and an aspect of the relinquishment process that an anonymous
least ‘bad’ option out of a range of unattractive ones. For example, embryo donation programme is unlikely to provide.
one wife wrote:

Embryo adoption. In truth, this was the lesser of all evils, not something Desire for an ‘open’ relinquishment
we were ever 100% comfortable with. Wife 18 Participants were asked a broad question on their views on how open
they would like the relinquishment to be and their thoughts on the
We were very much done having children and keeping them frozen wasn’t
an option, neither was research. Wife 7 issue of openness versus secrecy. For many participants, the possibility
of negotiating an open arrangement for the relinquishment of their
We were still reluctant to destroy the last two embryos. Although selfishly embryos was what had attracted them to the embryo ‘adoption’
it would have been much easier on my wife and myself, we could not bring programme:
ourselves to destroying the two remaining embryo’s. Husband 12
I wanted as much openness as possible. Husband 4
Well, we could have implanted them, destroyed them or donated and the
last was the only option that worked. Husband 17 But, we knew we could do our best to select a good home for them
through the program, and it would be an ‘open’ adoption where we
Therefore, embryo relinquishment to others for family-building was would keep in touch. Wife 18
not always perceived as an ideal disposition for unused embryos.
Rather, some participants thought it was the ‘least bad’ among a This ability to have information as the child was growing up was impor-
range of unattractive alternatives. Destroying them, donating them tant to some of the participants, as Husband 6 said:
for research or leaving them in storage were all, for different
The most rewarding part has definitely been the updates. We have
reasons, seen as undesirable—and less acceptable—options, and received some photos and I think we both find joy in seeing bits of this
most participants wanted to give their embryos a chance of becoming life we were able to share.
a child.
My wife and I think of them [recipient couple] as friends. I am not sure
what their position is, perhaps they send us emails in friendship,
perhaps it is out of some feeling of obligation or as a way to keep the
Conceptions of parental responsibility door open for [child] when she comes of age and wants to explore her
A predominant theme emerging from the data that influenced couples’ biological roots. Husband 4
disposition decisions was their feelings of responsibility for the future
welfare of their embryos. This was reflected in their concern to find a Others had requested information following the birth of a child:
‘good’ home for their embryos—a view held by most participants, At my request, she sends a descriptive letter telling us about him and his
irrespective of their views of the embryos’ status: sisters along with photos. Wife 6

We felt responsible that we had created these lives and were responsible Different levels of contact and involvement were negotiated between
for finding them good homes if we could not be that home. Wife 18
couples and embryo recipients following relinquishment. However, it
My hope is that we can place our three frozen embryos with great families
was recognized that it was an evolving process and that the exact levels
who will appreciate and love them as much as I am sure we would if we of future contact and involvement could not be determined in advance.
chose to have more children. Wife 2 One wife shared a letter she had written to the recipients of her embryo:

Since I would not obviously be there in person to protect the child I do I would never ask to meet or intrude on your lives. If you choose to
feel that it is my obligation to do so as much as I can. Husband 8 include us further we can explore this. It is important for a child to
have a stable and secure home life, thus my request is to watch my
My only feelings were that I wanted them to be in a good place and today I biological child grow from a silent distance. Wife 2
have never looked back at the decision we made. Husband 13
Several reported having developed a close relationship with the
Further, most wanted to be involved in the process of selecting the recipient family:
families that would receive their embryos:
We are very good friends with the adoptive couple now, in fact. We travel
I really liked the idea that we were able to be involved in the process and to see each other at least twice a year, but communicate on a regular basis
pick the couple that we donated to. Husband 5 with them. We are very blessed to have them in our lives. Our children
call them Aunt, Uncle, and (the children born from the embryos)
The reason we chose the agency was because we could be more selective cousins. Their children call us Aunt, Uncle, and our children, cousins.
on who received the embryos. In my opinion it is the same as a child in Wife 11
Conditional embryo relinquishment 3335

We have formed a fantastic friendship and even travelled to their home to desire to give the embryo a chance of life; not wanting to destroy
meet the baby and his mom and dad. Wife 7 them or donate them to research; and helping others build a family.
For example, Husband 21 articulates these types of reasons:
As her husband said:
When my wife first told me about the agency, I was thrilled. It seemed like
It’s a friendship that crosses all boundaries. We share a wonderful love in a
the perfect way to handle our frozen embryos given my discomfort with
little boy named baby R. Husband 7
destroying them or donating them to research. At least this way, the
embryos had a chance to survive and possibly provide a couple with a
The desire for contact with the recipients was often related to the
child they would otherwise not be able to have on their own. Husband 18
anticipated future relationships between the participants’ children
and the child(ren) born from the relinquished embryo(s): Many couples began investigating how they might relinquish their
embryos for others’ family-building without having firm ideas of
So, I would say the whole thing about helping other people was less
what they wanted and not having previously heard of embryo ‘adop-
important (at least to me) than our own interest of giving our own
embryos a chance at life, and for our son to have ‘brothers or sisters’, tion’ programmes (Paul et al, 2010). When they learned of the Pro-
with whom I hoped he could possibly have a special relationship later in gramme they were attracted by what was offered and chose it in
life. I always felt our decision had more to do with our hopes than to preference to anonymous relinquishment. When considering relin-
do with the hopes of the adopting couple. Husband 14 quishing her embryos to another couple, Wife 5 said:
We were also excited about the possibility of our daughter having a So I mentioned it one night in the chat room and someone said why don’t
natural sibling. Wife 21 you donate them? Good idea . . . Someone else said they knew of an
organization that let you pick who you donated them to and was really
Others were keen to keep the channels of communication open for good. Even cooler idea. They told me about [The Programme] and I
future contact with the child produced from their embryo. looked it up that night.

We don’t want to insert ourselves in their lives but after 18 years old, we In sum, our participants’ motivations for opting for relinquishing their
want them to have our information so they can get answers to questions. embryos through an embryo ‘adoption’ programme were varied and
It will also let [our twins] have their questions answered. Wife 15
not all of them would have been unwilling to relinquish their
Despite choosing to relinquish their embryos through an embryo embryos for family-building anonymously or unconditionally.
‘adoption’ programme, participants held different views about the However, most wanted the elements that only a conditional model
level of contact they wanted with the recipient family: of embryo relinquishment, in which they could choose the recipients
of their embryos and negotiate contact, could provide. The following
I was most concerned that these babies—if they were born successfully— quote encapsulates many of the reasons couples pursued this particu-
would not be linked back to me and my family. Husband 1 lar option:
I preferred the adopting couple to be a healthy distance away. Husband 14 It has been a relief. I rest assured that we have done the right thing for our
embryos. My husband and I are satisfied that [child] will be taken care of
Thus, our participants had diverse opinions on the amount of contact to the standards that we had hoped for her. I feel confident that one day
and the kind of relationship they wanted with recipient families, there will be a meeting for the children. I have no worries or concerns.
ranging from: those who had formed close relationships with the reci- Wife 4
pient family and had face-to-face contact; others who wanted regular
photos and news; some who wanted periodic updates only; to those
who did not want any contact with the family while the child was Discussion
growing up, but wanted to keep open the possibility of future
In interpreting the results of this study, a number of limitations should
contact; and some who wanted no contact. Others felt it was impor-
be borne in mind. First, the participants were drawn from a self-
tant that the child could have a relationship with his or her siblings (the
selected group who had chosen an embryo ‘adoption’ programme
children of the relinquishing couple) in the future.
through which to relinquish their embryos to others for family-
building, and the participants were predominantly Christians (although
Types of relinquishment not all were practicing). This could result in a selection bias; their per-
Although all couples taking part in this study had relinquished their spectives are unlikely to be representative of all those relinquishing
embryos through an ‘adoption’ programme, not all were opposed unused embryos. Further, the number interviewed cannot allow us
to donating their embryos anonymously for family-building. to make generalizations from our participants to the subpopulation
of those relinquishing through the embryo ‘adoption’ programme.
I would have been comfortable donating them anonymously through Second, the data were gathered by conducting email interviews, and
another reproductive facility but my husband wanted input. Wife 20 there are drawbacks to this form of data gathering. Compared with
face-to-face engagement between researcher and participants, visual
We were initially going to donate them to the storage facility’s anonymous
donation program. Wife 4
and aural clues are absent in email interviewing and it can be harder
to probe extensively.
For many couples, the reasons for choosing to relinquish their Despite these limitations, the results of this exploratory study
embryos through an embryo ‘adoption’ programme could also be provide insight into what aspects specifically attracted couples to an
given for other forms of embryo relinquishment for family-building: a embryo ‘adoption’ programme for relinquishing their embryos. This
3336 Frith et al.

study focused on those who had actually gone through or were going (MacCallum et al., 2007). Given the anonymous nature of the place-
through this process rather than surveying possible intentions of ments featured in these studies, neither makes any reference to the
couples—that may or may not be realized in practice. The study pro- information and contact arrangements that are a key element of the
duced a number of important findings that contribute to our under- conditional relinquishment arrangements entered into by participants
standing of embryo relinquishment to others for family-building. in our study.
First, this group of participants, despite relinquishing their embryos Previous studies have commented on the wishes of individuals and
through a Christian embryo ‘adoption’ programme, held a wide couples for greater input into the selection of potential recipients of
range of views on a number of issues—they were not a homogenous their unused embryos than is afforded by many donation programmes
group either in their conceptualization of the embryo or in how they offered by medical facilities, and for information and exchange arrange-
perceived the best way to organize relinquishment of their embryos. ments with recipients of their embryos that are similar to certain prac-
Second, the study explored the type of open arrangements that tices in infant adoption, where some level of contact is maintained
couples were developing and negotiating with recipients of their between the child’s birth and recipient family (Newton et al., 2003,
embryos. Third, it gave an insight into the process of relinquishment McMahon and Saunders, 2009). As we have previously noted, existing
using this model and what attracted couples to use such programmes. studies have consistently reported significant disparities between
Our study shows that not all those who wanted to relinquish in this reported ‘willingness’ to relinquish and ‘actual’ relinquishment; so
way believed that the embryo has a moral status akin to an existing the hypothetical levels of interest in conditional relinquishment
child (personhood). Many saw the embryo as a future child whose expressed by respondents in these two studies should be treated
importance derived more from future kin relationships with them- with circumspection. Nevertheless, findings such as these and ours
selves and their existing children and the difficulty, stress and have encouraged proposals for the availability of conditional embryo
expense that they had undergone to create it, than abstract concepts relinquishment programmes (Kovacs et al., 2003; de Lacey, 2005;
of its moral status. Hence, the embryo’s importance rested in its Fuscaldo and Savulescu, 2005; Fuscaldo et al., 2007; MacCallum,
place in a couple’s life narratives and kinship ties (de Lacey, 2005; 2009; McMahon and Saunders, 2009; Nachtigall et al., 2010). The
Paul et al., 2010). recent guidelines in New Zealand on embryo relinquishment
Two specific features of conditional relinquishment offered by the provide an example of such a conditional relinquishment programme.
embryo ‘adoption’ programme were very attractive to many of our While our own study cannot ascertain the levels of interest in such
participants. First, the opportunity to play an active role in choosing programmes, it does highlight the existence of a demand on the
the recipients of their embryos. Most of our participants thought part of couples with unused embryos and a potential loss of
that making sure their embryos went to a ‘good home’ enabled embryos for family-building where such programmes are not readily
them to act as ‘responsible parents’ to their embryos. Second, in accessible.
some cases, there was the opportunity to receive information and Our exploratory study has highlighted the need for future research
updates as the child was growing up and/or to have contact with to examine the longer-term implications of embryo relinquishment.
the child. Further, an open relinquishment allowed the child, at For example, areas such as: how much contact is maintained or
some future point, to be able to learn the identity of his/her initiated when the child is older; how this is experienced by the
genetic parents and any siblings. This model has certain advantages respective parties and the perspectives of the siblings of the child
as non-anonymity has been argued to be the most ethical way of born following embryo relinquishment need further exploration.
approaching gamete donation (Frith, 2001) and embryo relinquish- With fuller information about the longer-term consequences of
ment, with a number of jurisdictions having moved towards this embryo relinquishment for family-building, those considering relin-
model (Blyth and Frith, 2009). Other reasons for using an embryo quishing unused embryos will be able to ensure that their decisions
‘adoption’ programme, which reflect findings from previous studies are based on the best available evidence.
regarding embryo relinquishment, were participants’ view of the
status of their embryos and their dislike of alternative disposition
options available.
At the time of the study, given the stage that most participants had
Conclusions
reached, they were only able to reflect on the early implications of Our study has shown that those who choose to relinquish their
their arrangements for themselves and to refer to their perceptions embryos using an embryo ‘adoption’ programme have diverse prefer-
of the children’s experiences. What was apparent was that they had ences over how they would like to relinquish their embryos. Further,
become engaged in an evolving process, the precise nature of which there are elements of the services offered by embryo ‘adoption’
was still to be determined. None of the participants reported difficul- agencies (relinquishing couples’ ability to choose recipients of
ties following the relinquishment of their embryos or that their expec- embryos and negotiation of contact and/or information-sharing
tations of the arrangement had not been realized. However, any while the child is growing up) that were important to most of our par-
conclusions are by necessity preliminary, since this study focused on ticipants. Conditional embryo relinquishment could be organized to
a very early stage of not only a lifetime’s, but an inter-generational, reflect the diversity of views that our study has found on the
project. That this remains a relatively under-investigated field as amount, nature and organization of contact between relinquishing
regards social science research is indicated by the fact that, to and recipient families. The assessment procedures for potential recipi-
date, only two empirical studies investigating the development of ents could also be negotiated by the different parties in order to
families built using relinquished embryos have been reported, reflect the needs of both the recipients and those relinquishing the
undertaken in Finland (Söderström-Anttila et al., 2001) and the UK embryos.
Conditional embryo relinquishment 3337

The political sensitivity of the language of ‘embryo adoption’, the Association of Internet Researchers. Ethical decision-making and Internet
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ductive goals and values.’ (Lyerly et al., 2010, p. 508) As long as those programa SnowflakesTM (From frozen embryos to forever families:
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