Before starting IVF, having numerous embryos ‘left over’ was my biggest fear. I mean obviously I was going to do one cycle, have my 1.8 children (1.8 being the average fertility rate in Australia) and then have all these embryos left over that I had created and didn’t need anymore.
It was why I wasted over a year doing several IUI’s despite being told I was not really the best candidate for it and also why I asked the laboratory to limit the amount of eggs they tried to fertilise on my first IVF cycle.
But to be fair, it also had a ‘protective factor’ in that it was also why I was never disappointed when I didn’t get the massive numbers of eggs retrieved and fertilised that women often hope for. It came as a relief in a way to get those small numbers because I wouldn’t have to make that decision.
For those who have read Eat Think Grow and know my story you would know that dozen’s of left over embryo’s wasn’t something that I needed to worry about, but none the less for a growing number of women it is.
As IVF increases in ‘popularity’ and accessibility, the industry matures and success rates increase, the issue of what to do with left over embryo’s is also going to increase. It also seems like a growing practice to do full cycles and ‘bank’ embryos while you are younger before doing transfers.
What to do with left over embryos is also an issue that is being discussed more frequently in mainstream podcasts (ie not just those for subfertiles), and in the numerous blog and news articles already written on the topic.
There are all sorts of reasons why women have embryos they won’t use. Relationships end, illness happens and now with PGS testing more embryos are likely to be found as mosaic or ‘abnormal’ meaning that, understandably, these embryos too will not be used (though if you read my article on PGS I think there is still reason to have some caution).
Generally, families have five main choices to choose from when they have completed their families (or can no longer use their embryos) and need to think about what to do with excess embryos.
The problem with this is that, not only can it be expensive, but it is time limited to around 5 – 10 years depending on where you live. Again, depending on your location and surrounding circumstances, you can sometimes apply to have it extended for another 5 years, but that is generally only if you are still receiving IVF treatment, still want to extend your family or some other medical condition has temporarily stopped you from using them before now.
It isn’t an indefinite option, but it does buy you some time to make a decision that you can find peace with or at least access some counseling so that you can make a decision that you can live with.
Thaw and Dispose
This is also referred to as letting the embryos succumb, disposing of them or stopping cryopreservation. In this process they are taken out of the freezer and left at room temperature for a period of 24 hours, a process which destroys the cells and therefore the embryo.
In one piece of research done in Australia in 2006 (1; so it is over 13 years now and attitudes to IVF have changed a lot in that time) 30% of persons chose to dispose of their embryos when they had completed their family. Other studies have had this number as being higher.
There are many factors that influence what decision a couple (or person) makes for their embryos. Religion, psychosocial factors, values and beliefs and how they regard or think of the embryos all plays a role. Interestingly, in a recent study (2) it was found that couples who chose to ‘stop cryopreserving’, seemed to have had the most attachment to the embryos and thought of them as their ‘children-embryos’. The authors report that it could be that people who choose this option have invested a lot in the potential of their embryos and are too emotionally attached to them to donate them and know that they will have a future that they will never witness (2). They also report the most distress in needing to make the decision with 46% of respondents in a survey of 243 people reporting that it was a difficulty decision to make.
After the thaw
After the embryos have been thawed and destroyed there are several options. The laboratory can dispose of them for you, some people take them home for a ceremony to plant them under a tree for example and there is even the option of turning them into jewellery. In this process the embryo’s are cremated and then mixed with other substances so that they can be made into a ring, for example. Some women find comfort in knowing where their embryos are and having them close to their heart. Making the jewellery can also a symbol of not only what they have been through but also that the door has now closed. It probably wouldn’t be my first option, but I get it.
Donate to another person or couple
I think this decision in itself takes a huge amount of bravery, strength and is perhaps the most altruistic thing a person could ever do. There are so many factors into what influence this decision but it does appear that those who have received donor sperm or eggs to make their embryos are more likely to donate them to a couple in need. As one articles puts its like they are continuing a Chain of Hope (2). I like it.
Approximately 16% of couples with excess embryos after completing their family choose to donate them to them to another person or couple (1).
But even if a couple does make the decision to donate their embryos, depending where you are in the world, there may be other reasons why your embryos wouldn’t be eligible to be donated (2). These can include the embryo coming from a couple where the man or woman is known to have a genetic anomaly, where a woman is over the age of 40, the quality of the embryo (for example if there is only one embryo of poor quality) and the parental status of the couple wanting to donate (it is sometimes a stipulation that the biological ‘parents’ of the embryo needs to have a child between them).
Once you decide to donate to another couple there is also the decision of whether to have an ‘open adoption’ or an anonymous donation. Although again, this is a decision that is going to have things to consider I’ve been listening to a great podcast recently called Half of Me. It is by a sperm donor conceived adult and covers issues around donor conception from all angles. Although there isn’t necessarily a one size fits all approach, there does seem to be reoccurring themes about how donor conceived adults found out about their genetics and generally speaking it seems that the earlier and more open you can be about your son or daughters genetic history the better.
The good news is, that for those who chose to donate to another couple, 85% of people say that it was an easy decision to make and didn’t involve all the torment of some of the other decisions. When you know, you know I guess.
Donate to Research
This is traditionally where you would donate your embryos to science. One article has said that people that choose to donate to research tend to focus on the embryos being a bunch of cells and the biologic aspect of this as opposed to those couples that choose to donate and generally speaking tend to mentally represent embryos as being a potential child (2). Around 42% of couples who have left over embryo’s after completing their families choose to donate it to science (1).
I’ve read a few comments where people have been told that their laboratory couldn’t accept the embryos for research (and hence they needed to be thawed and disposed of instead) as there can be strict rules around needing to have proper research projects and ethics approvals and others being told they embryos will be used by lab staff to practice their techniques.
Couples who choose this option have reported that they also feel like they are contributing to the future happiness of fellow subfertiles by helping to contribute to the science and improve success rates, but couldn’t live knowing that a genetic sibling to their children or a genetic child is out there walking around.
This option doesn’t really get mentioned that much…but I do remember it being suggested to me by my Fertility Specialist when I couldn’t quite get my head into needing to do IVF for the reason of having loads of left over embryos. During a compassionate transfer, embryos are transferred into you, much like a normal fresh or frozen embryo transfer but at a time or location when pregnancy is going to be highly unlikely, for example transferring in the first week of your cycle or transferring into the vagina (over 26% of Reproductive Endocrinolgoists responding to a survey stated that they transfer embryo’s into the vagina when doing compassionate transfers; 3) . It is believed that you are still giving your embryos ‘a chance’ and their fate is a little less predetermined than if you, for example, donate to research.
It appears that not all doctors are willing to do a compassionate transfer though. Criticisms of it state that it is huge waste of resources and doctors time could be much better spent doing activities that was at least aiming to result in a positive outcome. They have a point. But in an industry that thrives on privatization surely if women are going to pay for it, as well as help support their long term mental health, than surely that is ok? According to the same survey costs for compassionate transfers range from $0 to the full $4500 frozen embryo transfer fee (3).
But is a compassionate transfer just trying to fool yourself? And I ask this from the perspective of someone who genuinely would have considered it as an option and thought about it with respect to my own circumstances. I say this because for all we know about reproductive cycles and anatomy we kind of know that transferring an embryo during week one of your cycle into the vagina (as opposed to where it should go in the endometrium a few days after ovulation) is kind of going to guarantee that the embryo is not going to implant. But then again there is such a wide variety in the reported timings and locations for transfers and after all three doctors in the above survey did report pregnancies after doing compassionate transfers. So in that respect, if you are doing a compassionate transfer to feel as if you are giving your embryo a chance than it might be an option for you.
To sum it up
What to do with your surplus of embryos can be a massive and anguished decision. Other times the path of what to do with your left over embryos can either be that not big of a deal or it is obvious what path you are going to take. And often you can swing between the two as your thoughts and feelings change.
Typically, the longer you have experienced infertility the more troubling of a decision it may be. One study even point a time on it suggesting that those who have experienced infertility for three or more years have more trouble than those that have experienced less than three years. I guess experiencing infertility over that time allows a lot of time, money and emotion to go into creating those embryos. Also layered into that is that the thoughts you have on it now might also change by the time you have a child.
Nothing about infertility is easy. Above are the general options that you have to choose from, but remember you don’t necessarily need to make the perfect decision – because sometimes it doesn’t exist. But taking the time to know the details of what your options are and find the one that you can rest with is what is important.
- Hammarberg, K. & Tinney, L. (2006) Deciding the fate of supernumerary frozen embryos: a survey of couples’ decisions and the factors influencing their choice. Fertility and Sterility 86 (1) 86 – 91.
- Bruno, C., Dudkiewicz-Sibony, Co., Berthaut, I., Weil, E. Brunet, L., Fortier, C., Pfeffer, J., Ravel, C., Fauque, P, Mathieu, E., Antoine, J.M., Kotti, S. & Mandelbaum, J. (2016) Survey of 243 ART patients having made a final disposition decision about their surplus cryopreserved embryos: the crucial role of symbolic embryo representation. Human Reproduction 31 (7) 1508-14
- Hairston, J. & Feinberg, E (2018). Compassionate Transfer: Provider Practices and Perspectives. Fertility and Sterility 110 (4) Supplement, Page e374