As technology moves forward, frozen embryos get left behind presenting a huge ethical dilemma
Advances in our techniques and technology for creating embryos in the lab have gotten us to the point where we often have more embryos than a couple or individual would use during in vitro fertilization (IVF). This is also the case for fertility clinics across the country.
This becomes more complicated as fertility specialists are moving to elective single embryo transfer (eSET) for the safety and health of the mother and baby. It used to be common practice to transfer more than one embryo to increase the chances for success. Now eSET results in even more embryos remaining in cryopreservation.
Fertility specialists have been using embryo cryopreservation in assisted reproductive technology since the 1980s and during that time have not used every frozen embryo. There are a number of reasons an individual or couple may choose to not use these frozen embryos.
The options for what to do with them are fairly limited: use them for other children, donate them to a needy couple or for medical research, discard them, or leave them in cryostorage. While this decision on how to use or not use these frozen embryos should not be taken lightly, those that go unused raise ethical and financial concerns.
After a 10-year analysis, CU Advanced Reproductive Medicine researchers found that over half of all cryopreserved embryos were not transferred for possible pregnancy. This means more than 400,000 frozen embryos created for IVF remain in cryostorage, possibly indefinitely.
At what emotional and financial cost?
Cryopreservation cost can range from a few hundred to thousands of dollars per year, and without explicit consent from the patient, the embryos must be preserved forever. The burden and cost of preserving these embryos falls to the patient or the practice.
However, the cost isn’t the only burden associated with unused embryos. There is an emotional aspect that many individuals don’t realize is something to consider, often only facing the consequences after the fact.
A study published by the American Society for Reproductive Medicine’s Fertility and Sterility journal found that most couples were unprepared when it came time to make decisions regarding their unused embryos. The majority of those surveyed felt their healthcare provider did not adequately inform them of their options for the frozen embryos.
Another study from the National Institutes of Health interviewed couples with an average of seven embryos in storage for a little more than four years. Most of those interviewed had not anticipated, or fully understood, the consequences of having surplus embryos. Many individuals see these embryos as potential children, and after struggling with infertility have emotional reservations about what to do with them.
Discover, donate or discard unused embryos
While our enhanced ability to create more embryos easier is valuable during the IVF process, it comes with complications. For starters, that 400,000 number is growing exponentially.
The excess embryos retain their value in that they can still potentially become children. But that’s not what the parents want to do in many cases.
So, what are the options for unused embryos?
- Research: A couple can donate unused embryos to science, which could help us learn more about how to treat infertility.
- Donation to others: Whether through anonymous or directed donation, embryos can be given to another couple or individual struggling with infertility. This option often requires more testing on the donors as the embryos have to meet a higher quality standard.
- Discard: Individuals or couples can decide to thaw and destroy these unused embryos.
- Storage: Leave them preserved in the cryopreservation tanks.
Understandably this is a complex, emotional and financial decision for those who have worked so hard to overcome infertility. Of these four options, we have found most people with extra embryos simply continue to store them.
Time for action and embryo cryopreservation regulation
Despite the regularity of embryo cryopreservation – and a heightened awareness of it with the news on the failure at two such storage facilities in recent years – there is no governing body to oversee these embryos. With almost half a million unused embryos in storage currently, this problem will only compound over time.
With an organization or group empowered to make decisions and define the options for patients, much of the confusion and concern could be addressed early and clearly.
What can fertility specialists do to address this problem?
- Encourage more preimplantation genetic testing (PGT) when a large number of embryos are produced. Because genetically defective embryos are discarded so they don’t result in implantation failure, miscarriage or birth defects, this could decrease chances of having a huge surplus of embryos for the couples.
- Provide adequate counseling for patients and address what to do with unused embryos.
- Identify opportunities to screen couples as potential tissue donors before the IVF cycle to make it easier for unused embryos to become available for embryo donation.