In fertility treatment, everything that happens before the embryo transfer is to get as many eggs retrieved and embryos created in order to have options when it comes to transfer time. While we hope a first transfer is successful, for many it can take multiple transfers to achieve a viable pregnancy, so it doesn’t hurt to have additional embryos ready should a second (or third or fourth) transfer be needed. Many IVF patients will end up with remaining embryos after their family is complete, or if they decide to stop trying. So, now what? What do you do with embryos that were created (and are technically viable, with reproductive potential, and available for transfer) but you’ve decided not to use them? Alease Daniel, an embryologist based in North Carolina, shares the options for embryo disposition.
What is embryo disposition?
Embryo disposition refers to the decision about what to do with embryos that you have chosen not to transfer. There are different options available, and many of these depend on your particular clinic and your geographical location. (For example, when Roe v. Wade was overturned, there was some question about access to embryo disposition—among other IVF-related concerns—in states that are restricting healthcare access, including abortion.) It’s important to be in touch with your clinic and physician about your options. It’s also possible that certain laws may have evolved since your embryos have been frozen which can impact your options. Clinics want to respect the wishes of their patients and are often open to more unconventional requests.
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What are your options when disposing of embryos?
It’s important to remember that clinics need your permission and consent (and potentially your partner’s as well) to do anything with your embryos. They will remain safe and sound until the proper paperwork is in place. There are also reproductive counselors that are available to help support you during the decision-making process, as it’s not always an easy decision to make.
Storing
The first and most common option is to continue storage, indefinitely. This option allows patients to keep their embryos safe in cryogenic tanks and allows them time to decide on an embryo disposition method. Embryos can essentially be stored forever, barring any unforeseen circumstances. Patients do however need to consider what they want to do with these embryos upon their death and the death of their spouse.
Discarding
The next most common option is discarding the embryos. This process involves verifying all patient information including consents and records and placing the straws in biohazard containers for disposal under the witness of another embryologist.
Donating
One of the options that is the least understood is donating to research, science or quality control (QC). This option varies widely by clinic —in some there will be active research projects and the clinic will outline the project and give specifics on how exactly the embryos will be used. If there are no active research projects, embryos donated to QC are often used to train embryologists or try new techniques and equipment. Ultimately, these embryos are discarded and will not be used to create a viable pregnancy.
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The only option that will result in a viable pregnancy is donating the embryos to an agency or donor embryo program. These programs can be either anonymous, open or even be donated to a known recipient. This option does require legal paperwork and often additional FDA testing. Keep in mind it could be a longer process than some of the other options due to the matching process.
Keeping
If these options aren’t for you, there are some more creative disposition options that may be a better fit. Over the years, more and more patients have asked to take their embryos home. This allows them to honor and celebrate their embryos in the way they see fit.
Transferring
Another option that is becoming more popular is doing a compassionate transfer. This is when the embryo is transferred into the vagina or at a time in the cycle where the chance of pregnancy is essentially zero. This is a great option for those in stricter states that may have limitations on embryo disposition options. The only drawback to this option is that there is a cost involved, which limits accessibility for some patients.
