Surplus Embryos: A Tough Decision

Once a couple has completed fertility treatment, it can be difficult to now make the decision of what to do with the remaining embryos that have taken so much time and effort to produce. This is often one aspect of IVF treatment that is not initially considered.

Couples often enter into IVF without fully comprehending that there may be unused embryos in frozen storage, and do not realise the magnitude of this decision until after the process. The ethical, moral and philosophical issues around what to do with any remaining embryos may never have surfaced prior to that time.

Options For Couples With Surplus Embryos

Couples usually have two choices regarding their unused embryos; they can either discard them or donate them to another couple.

Existing guidelines prevent clinics from storing these embryos indefinitely. This choice is not as straight forward as it sounds, and for most couples it is a very emotionally challenging, and deeply personal decision. Unfortunately, at the present time the option for donating embryos for research purposes is limited in Australia, as there is currently few clinics conduction research.

It is also important to be aware of Fertility Solutions policy on remaining embryo use. It is Fertility Solution’s advice to keep embryos stored until the youngest offspring is 12 months old. Before this time, life can be very hectic with emotions running high and therefore not a good time to be making important decisions that may well be regretted later down the track.

Embryo Donation

Although emotionally challenging and a difficult decision, embryo donation can be a lifelong gift. It can provide an embryo with the opportunity to be born and live in a loving family, and can provide the chance for a couple to have a much wanted child. The donor couple can experience the satisfaction of helping another couple fulfil their dream for a family, and can resolve the dilemma of what to do with their unused embryos.

Who uses donated embryos? Couples who use donated embryos have usually exhausted all other options in their desire to conceive their own genetic children, and have chosen donated embryos over adoption (or perhaps adoption is not available to them). It is not uncommon for couples to experience a compromise in the quality of eggs, sperm, or embryo’s and a donated embryo can be the only option for them. Embryo donation may also be used by couples who carry genetic defects, have undergone chemotherapy or radiation, or have had multiple unsuccessful IVF cycles without explanation. In some cases, single women or women in same sex relationships may also elect to use donor embryos.

Unknown vs. Known Embryo Donation

Currently, there is the option for donors to elect to be unknown to the recipients until such time as the child turns 18 years of age. Alternatively, donors may choose to meet the potential recipients. Further information about the donation process can be obtained from the clinic upon request and staff would be more than happy to assist you with any queries you may have.

Discarding Embryos

Discarding embryos is conducted respectfully within the clinic laboratory. Once a couple chooses this option, they will need to sign the necessary paperwork, and the clinic will provide a 30 day cooling off period, in case a couple changes their minds. You will also be encouraged to talk with a Fertility Solutions counsellor to assist you with this decision. Before the embryos are discarded both parties will need to provide the clinic with verbal confirmation that this is their desire.

Research into Making the Decision to Donate or Discard

Research has concluded that the decision to donate or discard embryos is extremely difficult for some people and that these complex and personal choices can be susceptible to change over time, and should not be taken lightly. Therefore, counselling is encourage by the clinic to help you with your decision making.

A South Australian study in 2007 (de Lacey) found that most couples have a strong opinion about what they do NOT want to do with their embryos and, given the limited options, this guides their decision. For example, donating embryos to another couple was chosen because the relinquishing couple could not to contemplate discarding them. On the other hand, those who chose to discard the embryos did so because they were uncomfortable with the idea of donation. In other words, both couples chose an outcome according to their morals and beliefs. In addition, the decision was based on their perception of what an embryo was for example, they either considered an embryo as a potential child or as cells and tissue. Consequently, the decision for you may focus on what you do not want as much as what you do want.

A large Australian study was conducted at Monash IVF in 2002, and of 1246 couples, nearly 90% opted to discard their embryos rather than donate them. Of the embryos donated, 50 women (or 92 cycles) received donor embryos, and 11 babies were born as a result. Despite this success, most clinics still have a long waiting list of couples wanting donor embryo’s (Kovacs et al, 2002).

Having a Private Ceremony

Some couples consider the best option for them is to request that the embryo(s) be thawed and placed in a test tube that they take home and conduct their own private ceremony.  The ceremony may be where the couple bury the embryo and then plant a special plant in memory or other couples may wish to have a ceremony where they engage a celebrant to conduct a service for them.  If this is something you would like to have further discussions on please let us know.

A Non Viable Transfer

For some couples, disposing or donating of their embryos is not an option and they decide to request the clinic to perform a transfer that is not going to result in a pregnancy.  The way in which this is conducted is that the embryo(s) are thawed and at a later date they are transferred into the vagina rather than the uterus.  Within the vagina the embryos naturally succumb and no pregnancy will result.

Counseling

If you are experiencing extended difficulty in making your decision or if you are finding this a very emotional time, we encourage you to access professional counseling from one of the Fertility Solutions qualified and experienced counselors.

Counseling is also a requirement for couples who are considering donating unused embryos or those considering using donor embryos to make sure that all participants are fully aware of the immediate and long term implications of the donation, and are comfortable to proceed.

The donating and receiving parties need to be prepared for the emotions involved in such a decision, and the consequence not only for themselves, but also for the possible child and extended family members. One way to ensure that everyone is prepared for the process is through the provision of counseling by a qualified Fertility Counselor. Most people find the donor counseling process very informative and not the daunting process they initially thought.

References

Sheryl de Lacey( 2007). Decisions for the fate of frozen embryos: Fresh insights into patients’ thinking and their rationales for donating or discarding embryos. Human Reproduction Journal, vol 22, No 6, pgs 1751-1758.

Kovacs GT, Breheny SA, Dear MJ. ( 2003 ) Embryo donation at an Australian university in-vitro fertilisation clinic: issues and outcomes. The Medicine Journal of Australia. 178 (3)pages 127-129.

If you would like to talk more with our psychologists about this decision, please contact us.