An embryo from a donor woman was transferred to the uterus of an infertile woman, enabling her to give birth to a genetically unrelated infant.
The 1978 announcement that a “test-tube baby” had been born caused many to wonder whether a new era in reproductive biology had begun. After all, if a woman could have her eggs fertilized in a dish and then transferred to her uterus, then maybe it would be possible to transfer her fertilized eggs to another woman. The notion that some women would become breeders for others was reminiscent of scenarios from dystopian futuristic novels.
Although the public was not aware of it, these possibilities were not so remote. The necessary technology had been developing in the laboratory for almost a century. In 1890, a Cambridge physiologist, Walter Heape, first produced the birth of young from an unrelated mother. He surgically removed two embryos from a pregnant Angora rabbit and placed them into the reproductive tract of a Belgian hare. The hare gave birth to six young four hares and two rabbits. Over the years, embryo transfer had been tried successfully by scientists in several laboratories and had been successful in fourteen different species.
Farmers, particularly, were quick to recognize the potential of this technology. By the early 1980’s, embryo transfer was widely used in the cattle industry, with more than ten thousand calves a year produced in this way. A prize cow would be artificially inseminated with sperm from a superior bull and, after a few days, the embryo would be flushed out and inserted into the uterus of a genetically less valuable cow. Whereas a top milk-producing cow could naturally give birth to about ten calves in her lifetime, with embryo transfer, some cows have produced as many as fifty offspring a year. Conservation biologists also exploited this technique. To increase the reproductive rate of an endangered species, they transferred embryos to a more common species for gestation. In 1982, an ordinary cow gave birth to a rare, wild Asian ox at the Bronx Zoo in New York City.
There was little question that the procedure of embryo transfer could be performed eventually on humans as well. In 1972, Horacio B. Croxatto and his team in Chile reported that a human egg could be safely flushed out of the uterus. They suggested that “egg transfer may have a place in the future as an alternative for the infertile couple.” Concerns about the ethical implications of embryo transfer hindered research on humans. Even after the success of in vitro fertilization in England, the National Institutes of Health refused to fund research dealing with human embryos.
A solution was suggested by two brothers, Richard Seed,
To assemble a group of egg donors, they placed an advertisement in the local newspapers: “Help an infertile woman have a baby. Fertile women ages 20-35 willing to donate an egg. Similar to artificial insemination. No surgery required. Reasonable compensation.” Of four hundred respondents, forty-six women were selected after medical and psychological screening.
The doctors were treating fourteen women who were unable to conceive because of blockage of the oviduct, the tube where an egg and sperm usually meet. Conventional surgical therapy had not helped them. As each donor woman reached the fertile point of her menstrual cycle, the physicians called in one of the infertile women who was similar in general appearance and stage of her menstrual cycle. The infertile woman’s husband provided sperm, which was injected into the uterus of the donor. Under natural conditions, a fertilized egg enters the uterus but does not attach to the wall of the uterus until five days after fertilization takes place. The donor women were recalled to the hospital five days after they had been inseminated. A small amount of fluid was injected into the uterus and then sucked out, bringing the embryo with it. The embryo was then placed through the narrow cervical opening into the uterus of the infertile woman. From January through October of 1983, twenty-nine inseminations were performed, from which twelve embryos were transferred. Two of these developed into normal pregnancies.
Early in 1984, the first embryo-transferred baby was born. In a year that was filled with comparisons to Orwell’s classic novel, the press was quick to cover the story of a woman giving birth to a baby conceived in another woman’s womb. Another baby born the same year caused a similar stir. An Australian woman was twenty-five years old when doctors diagnosed her infertility as resulting from premature menopause. Although her ovaries were not functioning, her uterus seemed normal. A second woman, undergoing surgery for in vitro fertilization, agreed to donate one of her eggs to the first woman. After the egg was fertilized in vitro with sperm from the recipient’s husband, it was transferred to the woman’s uterus. She was treated with hormones usually produced by the normal ovary, and eventually gave birth to a baby that was not genetically related to her. The physicians who performed the procedure, Peter Lutjen,
Physicians were generally pleased with the success of these new methods of treating infertility. In the work of Buster and Bustillo, however, a second problem was raised, that of financial profit. The members of Fertility and Genetics Research sought to recoup their investment by obtaining a patent on an instrument that had been developed in the research, a catheter used to retrieve and transfer the embryo. To the consternation of most medical practitioners, they also sought a patent on the technique used in the transfer. Patenting a medical technique means that users would be required to pay a fee to the company, raising concern that privacy would be compromised. The vision of medicine as a profit-making venture was abhorrent to many.
Buster went on to study the possibility that embryo transfer might be used for prenatal diagnosis of genetic disease. The other investigators continued their work as medical practitioners, researching and treating infertility in women.
Like other advances in reproductive technology, embryo transfer was hailed by infertile couples who might benefit from the technology. Its potential use includes treatment of women with scarred oviducts, premature menopause, or congenital malfunctioning of the ovaries, as well as women who risk passing on a serious genetic disease if their own eggs are used. Despite these potential benefits, the technique is not without risk. For the donor woman, there is the chance that the embryo will implant in the uterus before it can be washed out, leading to an unwanted pregnancy. There is also the risk of infection for both the donor and the recipient. These risks can be minimized by using an egg fertilized in vitro, rather than in a donor woman.
The technique of embryo transfer brought into focus some ethical and legal questions. For the first time, the genetic mother and the gestational mother were not the same person. That raised the question of who should be considered the legal mother. Also, a genetic mother might decide to keep the baby herself. In general, the woman who carries the baby throughout pregnancy is considered the legal mother.
Perhaps the most significant impact of embryo transfer was in the discussion it generated regarding the commercialization of medical technology. Although a small number of patents had been granted in the past for certain medical techniques, these were related generally to some specific surgical advances. The general consensus in the medical community was that this situation did not qualify for a patent. Although the catheter used by the California team was patented, other workers were able to develop similar catheters that were equally as effective. In 1986, Leonardo Fonmigli reported a third embryo-transfer baby born in a clinic in Italy.
It is too early to tell how extensively embryo transfer will be used to treat infertility. Possibly, ovum transfer, with its lesser risk for both women, will be more appealing than other methods in most cases. Nevertheless, the 1984 birth of a genetically unrelated infant sparked the imagination of the world with its potential for a new reproductive technology.
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Alpern, Kenneth D., ed. The Ethics of Reproductive Technology. New York: Oxford University Press, 1992. An array of essays discuss ethical issues surrounding innovations in human reproduction, including embryo transfer, in vitro fertilization, and surrogate motherhood. -
Andrews, Lori B. “Legal Aspects of Assisted Reproduction.” In In Vitro Fertilization and Other Assisted Reproduction, edited by Howard J. Jones and Charlotte Schrader. New York: New York Academy of Sciences, 1988. Written by a research fellow of the American Bar Foundation who describes the legal permissibility of embryo research in the United States, permissibility of paying an egg donor, laws regarding the screening of donors, assigning legal parenthood, and payment for the service. Well written, with a bibliography. -
Austin, C. R. The Mammalian Egg. Springfield, Illinois: Charles C Thomas, 1961. A detailed account of information available at the time on mammalian eggs. The final chapter on the manipulation of the egg includes discussion of studies on in vitro fertilization and embryo transfer. The first appendix summarizes ninety-eight reports published since 1890 in which eggs were transferred between individuals, including pigs, cows, sheep, rats, mice, and rabbits. -
Becker, Gay. The Elusive Embryo: How Men and Women Approach New Reproductive Technologies. Berkeley: University of California Press, 2000. A sociological study based on hundreds of interviews, this work examines reproductive technology from the perspective of the consumer. -
Glover, Jonathan, et al. Ethics of New Reproductive Technologies. De Kalb: Northern Illinois University Press, 1989. A report to the European Commission on some of the ethical issues raised by embryo transfer and other reproductive technologies. A thoughtful book on the possible social, ethical, and political ramifications of the different ways humans may have children. -
Hull, Richard T., ed. Ethical Issues in the New Reproductive Technologies. 2d ed. Amherst, N.Y.: Prometheus Books, 2005. Offers a variety of perspectives on ethical issues surrounding reproductive technology. -
Robertson, John A. “Ethical and Legal Issues in Human Egg Donation.” Fertility and Sterility 52 (1989): 353-363. Written by a professor of law; discusses questions raised by embryo transfer. Topics include welfare of offspring, donor anonymity, rights of donor and recipient to rear an infant, donation of eggs by relatives, paying egg donors, ownership of human eggs, research on donor eggs, and freezing eggs. References. -
Walters, Leroy. “Ethical Aspects of the New Reproductive Technologies.” In In Vitro Fertilization and Other Assisted Reproduction, edited by Howard J. Jones and Charlotte Schrader. New York: New York Academy of Sciences, 1988. Summarizes the statements produced by ethical committees from six countries on issues such as embryo freezing and egg donation. Provides a source of information on the use of ovum transfer to treat infertility. Includes references.
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