Something for everyone-Health blog

Today, couples that have chosen the path of in vitro fertilization face a tough choice at the end of the process that they never expected when they started: disposition of their remaining embryos. Once they have completed the in vitro process and no longer have need for their surplus harvested embryos, they have three basic options: donate to research, allow another couple to implant, or dispose of the remaining embryos. This can be a tough choice when it comes time.

Approximately 400,000 embryos are currently frozen in clinics around the country, with more being added daily. Many clients, finished having children, are finding it harder than they originally thought to decide the fate of the embryos when they no longer need them.

A new survey conducted of 1,020 fertility patients at nine different clinics reveals more than a little discontent with the most common options that are offered. (This survey was published in the December 5, 2008 issue of the journal Fertility and Sterility.) Among the patients that did not want any more children, approximately 53 percent did not want to donate their embryos to another couple, primarily because they did not want someone else raising their children, or they did not want their own children to worry about encountering a sibling that is unknown to them at some point in the future.

Approximately 43 percent did not want their embryos to be discarded, and about 66 percent said that they would be likely to donate their embryos for research, but that option was only available in four of the nine clinics that participated in the survey. Approximately 20 percent said that they were likely to keep their embryos frozen forever. Embryos can remain viable for a decade or possible more if they are properly frozen, but not all of the embryos survive when they are thawed.

A smaller number of the patients wished for solutions that are typically not offered. Among those possible solutions, they would have a small ceremony during the thawing and disposal of their embryos, or have them placed back in the woman’s body during her cycle when she would most likely not become pregnant, so that the embryos would die naturally.

Couples contemplating in vitro fertilization need more information earlier in the process so that they understand that they will have to make a decision about donation or disposal of unused embryos, and that this decision could be more difficult in ways that they don’t anticipate, according to Dr. Anne Drapkin Lyerly, who is the first author of the study and a bioethicist and associate professor of gynecology and obstetrics at Duke University. Dr. Lyler also stated that discussions about the embryos should be “revisited, and not happen just at the time of embryo freezing, because people’s goals and their way of thinking about embryos change as time passes and they go through infertility treatment.”

Some couples, due to desperation or health issues, want to create as many embryos as possible so that they can maximize their future chances of having children. At that point in time, the notion that there could be too many embryos being frozen may seem unimaginable. In a study previously conducted by Dr. Lyerly, women expressed a wide range of views about embryos: one called them “just another laboratory specimen,” but another said it is just a freezer full of embryos was similar to an orphanage.

Dr. Mark V. Sauer, who is the director of the Center for Women’s Reproductive Care at the Columbia University Medical Center in Manhattan, stated that this is a huge issue and the husband and wife may not be on the same page. Some couples pay storage fees for many years, however, others just stop paying and then disappear leaving the clinic to decide whether to maintain their embryos free of charge or discard them.

State and federal regulations have made it increasingly difficult for those couples who want to donate their embryos to other couples, requiring that the donors come back to the clinic to be screened for any infectious diseases, sometimes at their own expense.