About Those Extra Embryos

Extra embryos are an frequent and generally unavoidable consequence of IVF.   This means that figuring out what to do with those extra embryos is a fairly common dilemma for those engaged in IVF.   This is reflected in a couple of stories I’ve seen on the web recently.   While sometimes the focus is just on the practice of “embryo adoption” I’d like to think more broadly about the topic for a moment.

First off, consider why the extra embryo problem arises and why it will not go away anytime soon.   The best practice now is probably to transfer just a single embryo (or at most two) into the uterus of the woman who will be pregnant.  This vastly reduces the chances of multiple births, which are problematic for a number of reasons.

But even if you know you will only transfer one embryo you very likely begin by creating more than one.  There are at least a couple of reasons for this.   First off, you almost always start with more than one egg.    Given the process used to harvest the eggs, people who are providing them generally use fertility drugs which makes them hyperovulate and that means you start with a batch of eggs.

So you have multiple eggs.   It is possible to freeze and later thaw the eggs, but this is a relatively new deal and probably not common yet.   It’s much easier to freeze embryos.   And you may very well need more than one embryo even if you only transfer one at a time as the first attempt at IVF may not work.

Further, you actually want a few embryos to choose from.  Not all embryos created (by IVF or otherwise) are actually viable–not all have the capacity to develop into a child.   Using PGD it’s possible to eliminate embryos that have no chance of developing properly.   (I realize that the whole PGD process raises tons of questions around eugenics I’ve touched on some of them elsewhere.)

With all this in mind it seems to me highly likely that you will create at least a few embryos with the idea of using one and freezing the rest.   (I have no idea what the average number of embryos created is but it might be interesting to see if it is available somewhere.   Suffice it to say I’m sure it is more than one and would bet a lot it’s closer to six.)

This brings me back to the stories I linked to.   The one from SMH (which I think is the Sydney Morning Herald) notes that it is thought that there are more than 100,000 frozen embryos in Australia.   That’s a very large number if you think about it, and Australia is hardly the most populous nation where IVF is used.   (The population of Australia is a bit less than the population of Texas.)   What is to become of all the frozen embryos?   It sounds like for the moment they are  mostly just sitting in the freezers.

The question of disposition is hard in part because we don’t have a good category for frozen embryos.   They aren’t people (I know some will disagree with that, but I’m starting there.  If you do think they are people this might be easier.)   But many people also feel that they aren’t simple property, like a table or a chair.

It’s pretty clear that the people who have to decide what to do with them are the people for whom they were created–and that’s true whether those are the people whose gametes were used or not.   Presumably these people will already have a child who is a full genetic sibling of any child that might result from use of the frozen embryos.   That makes the proposition rather more complicated, psychologically speaking.  (Legally I think it is fairly clear that you can just give the embryos to whoever you want.  It’s not an adoption question.)

People using IVF are generally overwhelmed by all the unknowns and uncontrollables that are a part of the process.   I wonder if it’s really possible to focus on the question of the potential left-overs in advance.    I wonder too if it’s possible to know what you’ll think at that point.   But clearly this is an issue that will be with us for a while and will only grow larger.   It’s a topic that Naomi Cahn and June Carbone (both insightful academics) are working on, too.  Timely stuff that’s worth reading.

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20 responses to “About Those Extra Embryos

    • I’d love to read these but I cannot get to that page without registration. Is there a more public posting? (I have not checked what the registration process is–maybe I should just do that?)

  1. Sorry, I thought it was public. I’ve pasted it in my post, but there are lots of other posts in the thread:

    This is the sort of thing that keeps bio-ethicists awake at night.

    There are hundreds of thousands, possibly millions of “leftover”
    embryos in clinics around the world. Most of them will never be
    used for anything, but won’t be destroyed either, at least not for
    the time being.

    Some articles:

    http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/12/31/nivf131.xml
    [or http://tinyurl.com/2kdkoc ]

    http://www.motherjones.com/news/feature/2006/07/souls_on_ice.html

    <>

    http://www.usatoday.com/news/nation/2007-01-29-embryo-debate_x.htm

    (“54% of her clinic’s patients who have finished their families ask
    to have their embryos destroyed, 43% donate them to basic science
    unrelated to stem cells, and 3% offer them to other infertile
    couples.” )

    In the UK, unused embryos created for surrogacy must be destroyed
    after five years have elapsed. This caused a problem two years ago
    for a couple who had embryos created after the woman had a
    hysterectomy, and were running out of time to use them:

    http://news.bbc.co.uk/2/hi/health/4753997.stm

    It’s worth remembering that even outside the world of ART (assisted
    reproductive technology), for every three people that are born,
    another seven embryos were created that did not result in live
    births. Five of those would have failed to implant in the womb, and
    another two were miscarried, often too early even to be noticed.
    Those seven embryos also had unique genetic codes, but did not result
    in living babies.

    Anybody who is interested in embryo adoption could contact
    Snowflakes who run an embryo adoption program:
    http://www.snowflakes.org

    They had a good speaker at the 2006 Toronto conference.

    regards, ML

    — original poster wrote:
    >
    > This topic may have already been covered in detail here, but I
    > feel strongly that families with unused fertilized embryos should
    > strongly consider donating them to deserving families.
    > Creating embryos can be a difficult (and even dangerous) process,
    > and if you donate these embryos which you are not planning to use,
    > you may be saving a life, in addition to helping create one!
    > So many families would love to have the joy of having a child (or
    > 2!) and think of the love they could give to your genetic
    > offspring. The families here are so well-screened, I feel they
    > are on average far better than the average family.
    > I was seriously sick a couple years back, and my feelings about
    > the nature of life changed quite a bit during that time, and I now
    > think every life is unique and important. That genetic code will
    > never again be repeated in the entire history of the universe!
    > Think about that!
    > Thanks, David.

    • (The UK couple who were running out of time to use their embryos before legally mandated destruction got an extension, found a surrogate, and had another child btw. Their case led to a change in the law, though sadly the new law didn’t apply to them, and it’s not clear if they were able to export the remaining embryos:
      http://menmedia.co.uk/stockportexpress/news/s/1036292_miracle_baby_boy_is_most_precious_gift_of_all
      http://www.telegraph.co.uk/health/healthnews/5750190/Mother-fights-to-save-frozen-embryos.html
      )

      It looks like WordPress doesn’t like things being in double angle brackets. This is what was missed from my first post:

      “I have tons of embryos, and I can’t track down the owners,” said
      one Los Angeles doctor, Vicken Sahakian of the Pacific Fertility
      Center … . Sahakian practically had his head in his hands,
      thinking about all those embryos. “It’s one of the main problems I
      have. I have thousands of embryos from patients who have been
      through this program for, what, 10-, 12-plus years, changing
      addresses, and never called back, never paid storage fees—you can’t
      track them down.” His “biggest nightmare,” he said, is that he will
      be unable to sell his practice when he is ready to retire, because
      no doctor will want to buy a practice that comes with a closetful of
      unclaimed embryos and the vague, terrible responsibility they
      entail. “The person buying it does not want to buy the embryos.
      That’s the rule,” he said. “People do not want to inherit embryos.
      So what do you do with them? I have embryos that have been here
      since 1992.”

      More than half the couples who had planned to dispose of their
      embryos decided, instead, to use them, or donate them. Conversely,
      seven of the eight couples who had planned to donate them to
      research decided to use them, or dispose of them. Nearly all who had
      planned to donate their embryos to another couple found that, when
      push came to shove, they could not relinquish their potential
      genetic offspring. In short: Almost all reconsidered, not in any way
      that could be neatly summarized. All in all, 71 percent changed
      their minds about what to do. Also striking: Only about half of
      patients with embryos stored for more than three years could be
      located.

      Of the 58 couples … interviewed, the average couple had seven
      frozen embryos in storage. The average embryo had been in storage
      for four years. Even after that much time had elapsed, 72 percent
      had not decided what to do, and a number echoed the words of one
      patient: “We can’t talk about it.”

    • There’s something slightly contradictory in some responses to this issue. In some instances the embryos were created with the genetic material of the people who used them. But sometimes these are embryos that were created using a gamete from those intending to raise the child and a purchased gamete. Now the people who do that are already in this weird position–they value genetic connection enough to be using ART rather than adoption and to use 1/2 of their own gametes, but they are also willing to purchase gametes and (generally speaking) read the gamete provider out of the child’s life.

      Now those same people have extra embryos. Is the genetic relationship between the embryos and their child more important that the relationship was when it was just gametes? I’m just musing here, but there’s something worth thinking about in there somewhere.

      • Julie it’s worth noting a couple of things when you’re thinking and talking about ‘leftover’ embryos in Australia at least. Firstly we don’t purchase gametes as such. That is, we only have altruistic donation for local donors so any gamete purchase costs associated with ART are for legitimate expenses only. I chose a local (i.e. not imported) donor so I didn’t pay for donor sperm when I did ART, although of course I did pay for the treatment, drugs etc. My donor was genuinely altruistic and gave his sperm to ‘help single women and lesbians’ because he’d ‘heard there was a shortage of donor sperm’. He gave freely and without recompense.

        Secondly it’s important to know that domestic adoption is virtually non-existent in Australia and inter-country adoption is extremely difficult, with lengthy (up to ten years) waiting periods, high costs (much higher than ART) and challenging bureaucratic processes. So in many cases it’s not a matter of valuing a genetic connection more when people chose ART over adoption. I know many many solo mums by choice who would have chosen adoption first however it was not available to them.

        I participated in the research discussed in the SMH article. I wrote briefly about it here: http://tortoisetales2.wordpress.com/2011/08/26/all-about-the-embryo/

        • Thanks for providing that info. It’s sometimes hard for me to remember how much I don’t know. For instance, I didn’t realize that adoption was so difficult in Australia. Is there a simple explanation for that? I can sort of see the same rationales running towards restrictions on both ART and adoption.

          PS. I appreciate the link to your blog and have added your blog to my blog role.

          • No problem Julie and thanks for the link.

            Australia has a strong anti-adoption culture which has arisen out of past practices involving child stealing and forced adoption. We have a miserable history of stealing children from “unsuitable” mothers and in the past two decades there have been a number of parliamentary inquiries into this and official apologies. The Stolen Generation of indigenous children continued right up until the seventies, as did forced and coerced adoption from single mothers. We also have a history of accepting children stolen from “unsuitable” mothers in the UK and shipped out here to work as forced labour in religious institutions.

            I’d be happy to write a brief summary of this history and provide some links for people who are interested in further research.

            The upshot of all this is that right around Australia, all jurisdictions have an anti-adoption bias that is quite openly acknowledged. Recent events during our National Adoption Awareness Week highlighted these issues and the impacts they have on intending adoptive parents and children stuck in long term foster care without hope of adoption.

            I wrote a bit about the problems in adoption in Australia here: http://tortoisetales2.wordpress.com/2011/11/12/national-adoption-awareness-week-2011-a-spray/

            I think restrictions around ART come from a totally different place. The cultural acceptance of commercialisation and the aversion to regulation that we see in the US fertility industry is absent here. My experience and observation is that Australians seek more regulation, not less, but want it to be better targetted. Submissions from interest groups including SMC Australia (solo mums by choice) and the DCSG (Donor Conception Support Group) have focussed on how we can tighten regulations to improve donor management; in particular to enforced family limits, ensure that information about donors is current and available to facilitate contact and ensure transparency in donor conception (this last is particularly the focus of SMC Australia). This discussion highlights recent or current government inquiries into donor conception in Australia and the submissions to each highlight the need for more and more appropriate regulation which supports donor conceived families. Regulation is not seen as the bogie man here; in fact it’s largely seen as a force for good.

            Where there are (in some states) restrictions in access to ART itself, for single women and lesbians for example, can be attributed to the inertia of successive progressive and conservative/libertarian governments have allowed this to go unchecked because they have rightly calculated that there aren’t enough votes in it to risk alienating conservative (usually religious) members within their ranks.

  2. I have a hunch that most of the people selling left over embryos or donating them are not genetically related to what would be the resulting child if the embryo were allowed to develop. I cruise the different forums and the people generally purchased the gametes both egg and sperm. That is my unofficial take on the matter. There are some that are concerned about the genetic sibling floating around out there somewhere. But generally they got what they wanted and want someone else to have a chance. They are called house embryos in the Ukrain. Its much cheaper to buy a second rate embryo that was not first choice for implantation than to select a house sperm donor and egg donor and make one custom. Pretty clever in the Eastern block eh?

    I cannot get past what the mind is able to get use to. Its pretty horrific. I’ve said before that there will come a day when I help someone look for his or her parents because they know they were bought as an embryo from some couple and I will sit down and cry like a baby when that day comes. If I find the parents and they tell me that they bought the egg and sperm to make that embro or that they bought the embryo off someone else I’ll just die right there on the spot. I think it must feel so horrible to be abandoned by a parent and then handed around and resold to all these strangers until finally one intends to be your family. If their real family only knew they were out there they could probably just go home.

    That happens all the time by the way Julie, they just go home. Their real families are out there looking for them and they just go home finally. I know you find that offensive but it has happened to hundreds of people that I now count as personal friends. They find their families or their families find them and they go home.

  3. Certain things about the excess embryo problem are clear:
    * More embryos are created than used,
    * There is a high cost to creating those embryos,
    * Intended parents generally avoid discussing disposition,
    * Some jurisdictions/parents/clinics are opposed to donation to science,
    * At least one jurisdiction has banned freezing,
    * A widespread formal mechanism for secondary donation does not exist,
    * Adoption as a mechanism for donation is an artifice,
    * Abandonment as a passive-aggressive decision making paradigm may work for the Intended Parents but merely shifts liability to the Clinics for any ultimate determination it may make (i.e., costs for continued storage vs damages arising from perceived improper disposition).
    There are two reasonable solutions that I can see. First, storage contracts have to be crafted and administered better than in the past. The burden of decision making cannot be shifted to the Clinic unless through clear, unambiguous terms. Second, the professionals themselves or an entrepreneur must establish a formal mechanism for secondary donation that gains traction in the industry, follows legal norms and does not distort bio-ethical standards.

    • I think that’s rather a tidy summary of the situation. As it stands now the decision-makers are the individuals who own the embryos. It’s not hard to see why many find the issues raised very difficult and hence, postpone making any decision–which means more and more embryos in storage. There’s no social consensus on the right answer or even the right way to frame the questions. If there were a consensus–or even a clear dominant view–then you might put that in the standard form contract as sort of the default position. But in the absence of that, it’s hard to know what to do other than to leave it to individuals, which admittedly isn’t working very well.

  4. The government ours or someone elses will commondere them and grow them as an underclass of indentured servants. We owe many countries money. I’m only half kidding. Its the stuff of science fiction movies.

    • How about, the government will commandeer them and set them free, into the grass outside the clinics? That’s my vote. No one has a right to own other people, even when they are embryos. Slaves were bought and owned as soon as they were conceived, too, it didn’t make those slaves OK.

      • john you are projecting your own feelings onto embryos, not based on any sort of reality at all.
        In real life, when dealing with real actual children, you’d never even leave kindergarten child outside some clinic somewhere, in the name of freedom.
        But since deep down we all know embryos are not real people we can project whatever we want onto them.

        • I’m just saying, that’s what I think should happen. I don’t think embryos have feelings or are alive (even if they are naturally fertilized in the womb I don’t think they become alive until they have a beating heart). They aren’t real people either. But rather than say “destroy them” I said “set them free in the grass” to be sensitive to people who think they are living people.

      • I readily agree that people cannot be owned, bought or sold. (They also cannot be given away.) But I don’t think the embryos are people and so don’t reach the conclusion you suggest. That question–whether embryos are essentially people–is a crucial one that will determine the outcome of many of the questions posed by IVF.

  5. the clinics should include a clause placing time limits on embryo storage and any embryos left thereafter, the clinic will have authority to dispose or use for research or stem cells as they see fit.

    • It might seem reasonable for the clinic, which is left holding the items, to take this view. I bet many contracts do have some standard clause about this. And at a minimum, a clinic could certainly bill for annual storage.

      One thing that concerns me, though, is that at the time the contract containing such a clause is signed, the people signing it may have many much more important things on their mind. They may not even consider this clause–it’s all just so much language in pages and pages of text. So I’m not sure the clause reflects any actual choice that the signers are making. Perhaps this is something I shouldn’t worry about–after all, it’s often the case in many contexts. But it seems like people at least ought to think about this aspect of the process at some point and the best moment may not be the very early stages when the desire to get pregnant/have a child must predominate. But then again, maybe I’m being too paternalistic. (Or should I say parentalistic?)

      • It is standard for clinics in Australia to charge for annual storage of gametes and to have a time limit on the storage of gametes. At the end of that time period gametes may be destroyed (in theory). To my knowledge there is no clinic in Australia that could or would appropriate stored gametes that are either unpaid for or run out of time and use them for research or reproduction.

        In my experience and knowledge, no clinic has destroyed embryos without explicit consent. Very few clinics have research facilities to which embryos can be directed. Few clinics (if any?) allow on donation of gametes created using third party gametes.

  6. I have 5 embryos in storage, and we hope to use them for another surrogacy in a few years. It is standard in the United States to be billed an annual storage fee for your embryos. I think ours is about $500. The embryo storage problem is interesting because it suggests that every couple undergoing IVF has embryos leftover to freeze when the reality is that many do not. The couples with frozen embryos are the fortunate ones.

    I don’t know about the generalization that couples making decisions concerning their embryos are doing it at a time in which they are least able emotionally. We have done IVF at two different clinics and we took our decision-making about our embryos very seriously. Plus, each year when we receive our storage bill, we have the opportunity to decide what to do with our embryos.

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