I spoke with Bonnie Bernard M.Ed., Cincinnati-based founder of Embryos Alive, who works with women around the country who are in search of frozen embryos with which to start their families.

She's been involved in the field for seven years, and sees the provision of frozen embryos from IVF procedures to waiting wombs (my term) as one of "God's blessings." Sometimes high-quality embryos don't implant successfully. Sometimes lower grade ones do, she reports. She works with single women, even those living overseas, to find a match with a clinic that has embryos in storage that have been made available for adoption, but considers it God's work how it unfolds.

In 2005, the FDA -- the only regulatory body overseeing the industry -- changed its requirements. Now gametes from the successful IVFs of infertile couples are being implanted in women. Many of those biological parents never thought at the time about donating their remaining embryos; their clinics did not require these patients to repeat STD and infectious disease blood work. The 2005 guidelines suggest screening three months after retrieval, which is routinely done for paid egg and sperm donors.

Bonnie says the hundreds of clinics she works with often interpret the guidelines differently. One clinic might require biological parents to repeat blood work. Another might suggest that -- with an informed discussion and consult with their patients, documentation and a waiver of additional physicals, blood work or other guidelines -- the embryos can be placed for donation if the paperwork is placed in the adopter's file. Bonnie's belief is that it is best for clinics to decide on the protocol they want to use. She also suspects that an embryo's status is not likely to change after the original bloodwork was done.

Another complication: Bonnie matches embryos with recipients. But since the recipient should be entitled to go to her own clinic for transfer, and there are more than 1,000 qualified clinics in the U.S., many of those clinics have never done a frozen embryo transfer (FET) with donor embryos, or worked with Embryos Alive. Bonnie finds about one clinic every few months that does not have an in-house protocol in place to receive donated embryos.

Embryos Alive requests the embryology report, blood tests and results, physicals, determination of eligibility, along with the embryo grading system and thaw protocols. But obtaining the donor records is time consuming, especially when handwritten records arrive and are illegible. Bonnie would much prefer a standardized format for documenting embryology reports. Even the grading systems for embryo quality differ -- "1" might mean excellent quality at one clinic, while at another the same meaning is graded "4." Others grade the embryos from A to F. So, the paperwork takes time to get clarified and complete.

Unlike traditional adoption, there is no home study requirement for the recipient of embryo donation. Many donors and recipients might not receive counseling about how they or the children might feel about this unique adoption process years down the road. Embryos Alive offers a list of fertility and adoption counselors on her website and in her informational packets. She also offers a closed support group option for donors whose embryos have resulted in a baby (embiedonorsupport@yahoogroups.com), but few have joined yet. Bonnie's website provides other resources.

The oldest child conceived through Embryos Alive is now six years old, so it's a new enough field that we can't see what the parallels might be to those families who have made open adoption and open-identity donation more popular options. Will offspring eventually want to ask questions of the biological donors? Will the donors eventually, as their own children of embryo transfer grow into adulthood, wish they could have connection with the full "siblings" essentially placed for adoption with another family?

With these questions in mind, Embryos Alive advocates honesty and openness, and encourages the use of the Donor Sibling Registry. Stay tuned to the "embryo" keyword on ChoiceMoms.org for more on this topic.

This is uncharted territory, much as sperm donation was 30 years ago. For now, Bonnie is amiably rolling with all of it.

-- Mikki

What questions do you have about embryo donation that we can discuss on ChoiceMoms.org?