Leftover embryos pose dilemma

Providence Journal-Bulletin
August 3, 2003

By: Jenny Holland

* “I understand people who feel very strongly that these embryos deserve a chance at life.”

* * *

Greg and Barbara Cantara separated after only 15 months of marriage. So there were few leftovers to pick at in divorce court.

She owned the condo before the marriage, so she kept it. And she agreed to let him have the frozen embryo.

Six months after the divorce became final, Greg Cantara is on a quest to find a surrogate mother willing to carry the embryo he and Barbara made in happier times.

Cantara’s story is part of a nationwide debate over what to do with embryos created by in vitro fertilization and then left behind when couples break up, move away, or simply change their minds.

For now, the Cantara embryo is frozen in liquid nitrogen in a glass tube about the size of a fine straw, one of an estimated 400,000 frozen embryos stored across the country, according to a recent report by The Society for Assisted Reproductive Technology. It is also one of almost 10,000 frozen embryos at Women & Infants Hospital.

Cantara started his search for a woman to carry his embryo at two surrogate agencies in the Northeast. Both told him that as a single father of four he didn’t qualify.

He has talked with friends about the possibility of serving as a surrogate for him, and he sought out The Journal in hopes that a story might help him find a surrogate mother.

“Something’s got to be done,” he said of the embryo, which has been at Women & Infants Hospital for three years. “It can’t just sit there. I don’t feel right about it.”

He’s not alone.

“I understand people who feel very strongly that these embryos deserve a chance at life,” said Pamela Madsen, executive director of the American Infertility Association, and the mother of two children born through in vitro fertilization.

She said she has spoken to “hundreds and hundreds” of couples facing wrenching decisions.

Should they give the embryo to another couple? Should they let it be destroyed? Should they allow it to be used for research?

“There is no way to slice and dice this so that it’s neat,” Madsen said.

CANTARA, who has four sons from two previous relationships, cannot be neatly categorized either. A conversation about his interests and beliefs veers from Native American spiritual rituals to rock music to Alcoholics Anonymous.

He believes life begins at conception, although on the issue of abortion, he describes himself as pro-choice.

“I don’t want to put my convictions on someone else,” he explained.

He believes in following through on decisions he has made, and wants to set an example for his sons, three of whom live with him in Bristol. His quest to find a surrogate mother is driven in part by that belief, he says.

“I never wanted to leave it lying in limbo,” the construction designer said of the embryo.

“I raised my boys to stand by their convictions and to do the things they set out to do,” Cantara said. “How can you teach your children one thing and not act on it?”

The three sons who live with him, ages 10 to 16, are supportive.

“Half [of the embryo] is him, and half is her,” Aaron, 16, said, and if he wanted to go through with it he should be allowed to.

“I wouldn’t mind a sister,” he said. But pointing to the two younger boys, he added, “I’m expecting a brother, odds are….”

IN RECENT years, new options have opened up to those dealing with infertility, including adopting an embryo.

A Christian adoption agency in Fullerton, Calif., has run an embryo-adoption program called Snowflakes since 1997. JoAnn Eiman, the spokeswoman for Snowflakes, also testified to the roiling, varied emotions people going through infertility experience.

Eiman recounted the story of one woman who had undergone in vitro fertilization and had given birth to twins. She had two remaining frozen embryos, Eiman said, and felt conflicted about their potential for life. Her twins were the result of an arbitrary decision made by a doctor who chose which embryos to implant.

“What if they were the ones in the freezer?” Eiman said, voicing the concerns the mother had expressed. “Wouldn’t I want them to have a chance to be born?”

Since 1997, Eiman said, 30 babies have been born to families through the embryo-adoption program, which uses the same standards as a traditional adoption agency. People wanting to receive an embryo must participate in a home study. The donors – whom Snowflakes refers to as the “genetic family” – can keep contact with the children, or not. They can also help decide who gets their embryo.

Last year, the federal government embraced the idea of embryo adoption and handed out $1 million in grants to promote it. Women & Infants Hospital received $240,000, and will use it to study what factors influence people when deciding to donate their embryos.

Cantara is not interested in donation.

If a child results from the embryo, he said, he wants to raise it himself. His first son, Greg, was born when he was 16. The boy grew up with his mother. “I don’t want to donate the embryo and have that baby happen and have all these things in the back of my head again,” Cantara said. “All these questions. Then how do you explain to the other children what you did? You have a brother or sister out there. Where? When? Who? Don’t know?”

FROM A LEGAL standpoint, the Cantara case is unusual. While other couples have engaged in protracted court fights, the Cantaras made their own agreement in Massachusetts Family Court.

Barbara Cantara told the judge last November that she was willing to let Greg have the embryo. She just wanted to get divorced, she said, adding that she did not believe Greg would be successful in his attempts to implant it in another woman. Earlier attempts to implant their embryos had failed.

“Your Honor, can’t I just take my chances?” she asked Judge Armand Fernandes Jr. “I just want the divorce. I honestly don’t think that he’s going to be able to do it.”

The divorce contract presented to the judge included a clause in which Barbara Cantara agreed to let Greg Cantara attempt to transfer the embryo to another woman, with the understanding that he would pay all costs for the endeavor.

After considering the legal and moral ramifications of allowing Barbara Cantara to give up her potential rights and obligations as a parent, the judge granted the divorce without deciding whether either party could be relieved of their responsibilities under their contract with the hospital.

” [The] parties understand this court makes no finding as to the responsibilities, validity of the agreement, or any conditions or responsibilities that flow from it,” Judge Fernandes told them.

The Woman & Infants contract states that regardless of matrimonial status, both parties will bear the responsibility, “financial and otherwise” of any child resulting from the treatment.

John Mayoue, an Atlanta-based family lawyer who has handled several cases involving disputed frozen embryos, praised Fernandes.

“First and foremost, is the embryo property?” he asked. “Is there a human right here, if the embryo is not property?”

The judge, Mayoue said, gave “weight to the private rights of the individual. I applaud this judge for his restraint.”

THE CONSENT form that the Cantaras signed with Women & Infants allows for either the disposal of the embryo or anonymous donation to another party.

Dr. Carol Wheeler, a reproductive endocrinologist who used to work at Women & Infants, and who now runs the Providence branch of the Waltham, Mass.-based Reproductive Science Center, said it is important for both the patients and the doctors to think ahead of other options that would be acceptable, should their circumstances change.

“It’s a really good idea to have that all up front,” before starting IVF treatment, Wheeler said.

“There are so many permutations,” Wheeler said, among heterosexual and same-sex couples, “you are not going to be able to address them all… It does get very complex.”

Citing federal privacy laws, Women & Infants declined to discuss the Cantara case.

But one Newton lawyer, who specializes in reproductive law, said she doubts the hospital would refuse to implant the Cantara embryo.

“There is no way a hospital is going to hold on to or donate an embryo over the objections of the people who created it,” said Susan Crockin, who advises IVF clinics across the country on their consent forms and who specializes in reproductive-technology law.

Women & Infants said it will not thaw an embryo without explicit permission.

“The vast majority of people are just holding on to them,” said Dr. David L. Keefe, director of reproductive medicine and infertility. “They are really precious.”

In Rhode Island, insurance companies must cover 80 percent of the cost of treatment (in Massachussetts, it is 100 percent). One treatment – including fertility drugs, harvesting eggs and implantation – costs about $7,500. After three years, Women & Infants charges $500 a year for storage.

Trying to estimate a percentage of embryos in limbo at the hospital is “a moving target” said IVF laboratory director James R. Trimarchi, somewhere between 10 percent and 25 percent.

A SINGLE embryo only has about a 2-percent chance of becoming a successful pregnancy, Keefe said. The process of preserving the tiny organism – which involves removing the water and replacing it with a chemical cryopreservant – weakens it, according to Dr. Sandra Carson, president of the American Society of Reproductive Medicine and professor of obstetrics and gynecology at Baylor College of Medicine in Houston.

When a patient wants to attempt to implant the embryo, the reverse happens: the cryopreservant is removed and the water put back in. All of this is done to an organism of up to 200 cells, smaller than the eye can see.

“It’s a big stress on the embryo,” Carson said.

CANTARA SAYS he is leaving it up to God, but acknowledges that it is an emotionally difficult process.

“The couple of times me and Barbara went through it and it didn’t take, yeah, it was a difficult situation,” he said.

“You get your hopes up, you have your desires, you have your wants. If it doesn’t happen, it doesn’t happen. That’s the will of the creator. You know, God.”

Despite the odds, Cantara says he is fully committed to the embryo, which he has even given a nickname.

“I made an agreement between my God, Barbara and myself,” Cantara, 43, said.

“Just because she backed out of the deal doesn’t mean I have to. I think Little Frosty deserves a shot.”

BY ERIN EMLOCK

Journal Staff Writer

From as early as he can remember, Kevin Robillard always dreamed of having a family.

But for most of his childhood, it seemed as if it wasn’t going to happen.

Kevin was in state care starting at the age of 3, when his birth mother, who had problems with drugs, left him at a shelter. For the next couple of years, he was at a number of foster homes, as the state tried to get him adopted. None of the families worked out.

When he was 5, Kevin went to live at a group home in Burrillville. Two years later, another family sought to adopt him – but once again, it wasn’t to be. He went back to the group home, and when he was 8, he was moved to a group home in Johnston.

“I just kept praying and hoping I’d get a family,” says Kevin, now 19.

At 13, Kevin was featured in The Journal as “March’s Child,” one of a series of profiles meant to introduce people to children in state care eligible for adoption.

It was a long shot.

Not only was he already a teenager in a world where most people looking to adopt ——-want younger children, but he also faced challenges resulting from his unstable childhood. In the write-up, Kevin was described as having emotional needs, learning disabilities and trouble with coordination due to prenatal drug exposure.

But the essay also highlighted Kevin’s sense of humor, tendency to keep his room neat and his determination to succeed. And it featured a photo that showcased Kevin’s enthusiastic smile.

In March 1997, Ernie and Karen Robillard, of North Kingstown, were already caring for two children: their daughter Hannah, born just the previous summer, and Mary Jane, Ernie’s 13-year-old daughter from a previous marriage. Karen was soon to become pregnant with their son Samuel.

The couple had never thought about adopting – until Ernie picked up the paper that March day and read about Kevin.

Ernie was struck by Kevin’s story, and by the fact that Kevin even resembled him.

“It just kind of clicked,” Ernie says.

Without a word, he left the paper on his wife’s desk. It sat there for several days, until Karen finally asked him what he was suggesting she read.

She read Kevin’s profile – and the two agreed that they had to have him.

Karen and Ernie, who is the pastor at First Baptist Church in East Providence, say they are convinced that God meant for them to have Kevin.

“It was the Lord that spoke to our hearts,” Karen says.

The Robillards began what would turn out to be an almost two-year process to bring Kevin into their home.

MEANWHILE, Kevin was at the group home, still wishing for a family. He knew about the newspaper profile but didn’t know if anything had come of it. The staff at his home couldn’t tell him that a family was interested.

“But I remember someone saying, ‘There’s something good coming up, I can’t tell you what it is, but just hang in there,’” Kevin says.

That’s exactly what he did.

Despite his turbulent childhood, Kevin always managed to focus on the future. He set goals: first and foremost, he wanted a family. He also wanted to join the Army, a dream he’d had since the age of 6.

“In the past, things haven’t always gone smoothly,” Kevin says. “I have always tried to have a positive attitude, saying, ‘This is how things are now but they will get better.’ It’s all about attitude.”

Surrounded by other young people facing similar challenges, it wasn’t always easy for Kevin to maintain his upbeat outlook.

“I know many kids who just stay – they stay in their traumatic past,” Kevin says. “I vowed I would not do that.”

Once they decided to pursue adopting Kevin, the Robillards began an extensive application process that included taking classes with the state to prepare them for adoption.

Karen and Ernie met Kevin informally at an “adoption party” in August 1997 – but they couldn’t tell him that they wanted to adopt him, and there was another family interested in him as well.

“I just had this mother instinct,” Karen says. “We had such tender feelings toward him, we wanted to take him home that day. We were heartbroken when we left.”

They were approved by the Department of Children, Youth and Families that December, and in March – a year after they first saw his picture in the paper – Karen and Ernie finally met Kevin as his potential parents.

It was clear that they wanted him, but the DCYF wanted to be sure that Kevin liked the Robillards. Kevin started with day visits at their home, and then progressed to overnight stays.

By August, Kevin had told the state that he wanted to be adopted by the Robillards. On Christmas Eve 1998, Kevin moved in with Ernie, Karen, Mary Jane, Hannah and little Samuel.

Kevin says moving in gave him a “great sense of freedom,” but also made him feel bad for the four kids he was leaving behind at the group home.

“I had been with them for five years,” he says. “I felt sad leaving them, knowing that they are stuck there and don’t have the opportunity that I had.”

Well aware of his luck in finding such loving parents, Kevin has taken full advantage of the avenues that opened to him when he joined his new family.

He finished eighth grade at the Spurwink School II in Lincoln, where he was enrolled while living in the Johnston group home, and started at North Kingstown High School in September 1999. He was a little behind his peers, and was initially placed in a special class to help with the transition into high school. By the second semester of his freshman year, Kevin was taking all regular courses.

The young man who had been described as having learning disabilities and coordination problems became a regular on the high school’s honor roll and a member of both its track and cross-country teams.

The coordination problems resolved on their own and Kevin contends that he never really had learning disabilities – he just needed to find the right learning environment. He still stutters occasionally, when he has trouble finding the word he is looking for, but overcomes it quickly.

Kevin says he believes that his progress is due in large part to the stability of having a family.

He graduated from North Kingstown High School last month not only as an honor roll student, but also having earned the distinction of getting perfect attendance for all four years at the school. He was recently honored at the State House for that accomplishment, and received a citation from the state House of Representatives.

Kevin decided to pursue his childhood dream of joining the Army and left this month for Fort Benning, Ga., to begin basic training. He plans to take college classes during his six-year term of service, and work toward his bachelor’s degree. His ultimate goal is to find a career that combines his interest in government and the medical field.

“There are a lot of kids in state care who don’t have the help that I’ve had,” he said. “I want a career that will help people. I feel that I was helped and I want to give a portion of that back.”

Kevin also says he plans to adopt a child someday – and there will be plenty of potential adoptees out there waiting for him.

ACCORDING TO Adoption Rhode Island, there are generally between 100 and 140 children in the state who are eligible for adoption and are awaiting families at any given time. The organization, which was involved in Kevin’s case, is a private nonprofit that assists in finding adoptive families for children in state care.

There are many families registered with Adoption Rhode Island who are on a waiting list to adopt. But they are waiting for babies and very young children, according to Executive Director Darlene Allen. Most of the children waiting to be adopted are between the ages of 6 and 16, she said.

In the fiscal year that ended June 30, only 14 percent were 5 or younger. Nearly three-quarters were 6 to 16, and 14 percent were 16 or older.

Allen said it is more challenging to place older children, children with disabilities, children of color and large sibling groups, since an effort is always made to keep siblings together. Many families are interested in adopting kids similar to their race and culture, young children, and those who have fewer emotional or physical issues, she said.

Adoption Rhode Island does more specialized recruitment for children who have been waiting a long time to be adopted. It has also launched programs, such as bringing in inspirational speakers, to help the children keep the faith that a family is out there for them, Allen said.

Individuals who want to help the children but who cannot commit to adoption can develop relationships with the kids through a visitation program, Allen said. This program allows children who have not yet been adopted to have some sort of connection to people outside of their group home.

Allen says that while adoption is worthwhile, prospective parents should remember that it can be a challenge.

“It’s not necessarily going to be an easy path, but it’s probably one of the most meaningful and potentially wonderful paths a family can embark on,” she said.

KAREN AND ERNIE Robillard readily acknowledge that incorporating Kevin into their family wasn’t always easy. Ernie says that there were some, including members of his extended family, who initially questioned their choice to adopt Kevin.

“Everybody only ever hears the horror stories” about adoption, Ernie says.

Ernie, in addition to his church duties, works as the patient safety officer at the Veterans Administration Medical Center in Providence. This enables Karen to stay home with the children – but with four, it did sometimes get overwhelming, she says.

Karen, Ernie and Kevin agree that they did have their challenges. But no matter what happened, one thing never changed.

“Each trial reaffirmed that we love him, we are committed to him, and we aren’t going to leave him ever,” Karen says.

Adoption Rhode Island’s Allen said that this kind of unconditional love is what allows adopted children to flourish. She said her organization recently placed a 17-year-old with new parents, and he told her that this past fall he experienced his first family Thanksgiving in 11 years.

“It’s never too late,” she says.

Karen and Ernie – who say they would consider adopting again – hope more families will think about adopting older children. And so does Kevin.

“What people need to do is give kids a shot,” Kevin says. “Look at where I came from and look at where I am now.”

For more information about adopting an older child, call Adoption Rhode Island at (401) 724-1910 or visit its Web site, www.adoptionri.com.

Copyright 2003 Providence Publications, LLC