The Fate of Frozen Embryos

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An estimated 600,000 to two million frozen embryos are stored at fertility clinics and cryopreservation facilities in the United States. Some are destined for implantation but many will remain frozen in perpetuity because no one is willing to decide their fate. Intense disagreement over when life begins entangles these embryos in a complex web of legal, ethical, moral and religious debate and results in decisional paralysis. In contrast to Australia and the United Kingdom, the U.S. has no state or federal policies to regulate management of unneeded frozen embryos and the pendulum of support swings from one extreme to the other. Fertility clinics have inconsistent practices and professional societies such as American Society of Reproductive Medicine (ASRM) and American College of Obstetricians and Gynecologists (ACOG) have produced only position statements. With approximately 60,000 babies born via IVF each year and 4-6 frozen embryos for each live birth, the quantity of frozen embryos in storage will grow exponentially if we continue to allow indecision to be the de facto policy.

Federal or state regulations to manage the large population of unneeded frozen embryos is unlikely because religious and right to life groups wield strong political and financial power in this contentious debate.  The onus is on ASRM and ACOG to develop and enforce a comprehensive policy requiring an advance directive prior to creation of any embryos.  The directive, completed by the couple, will determine the fate of the embryos – disposal, donation for stem cell research, or donation to another couple –  if they are not used within a 5 year period.  In addition, the directive must address contingencies such as divorce or death.  Accreditation of fertility clinics predicated on policy compliance will be the mechanism for enforcement.  Only a clear, firm stance will turn the tide from benign neglect to thoughtful action.

 

 

 

 

 

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2 Responses to “The Fate of Frozen Embryos”

  1. tehseenladha Says:

    Thanks for your interesting and informative post regarding the state of frozen embryos! although aware of the significant increase in couples seeking and pursuing fertility treatment, I did not think about all the frozen embryos that would be in storage for indefinite periods of time due to the lack of regulations.
    One question I have is what would be the harm in having frozen embryos stored for long periods of time. I know there are costs and resources associated, but my impression was that most fertility clinics are private and patients are paying for the storage of their frozen embryos so it shouldn’t adversely affect health systems or cause issues with resources allocation. Furthermore, 5 years may be an arbitrarily short time for many couples to keep their embryos prior to having to donate or discard them. The fertility journey can be one that not uncommonly spans several years as couples go through IVF cycles (that are often unsuccessful) and slowly build their families. Perhaps 10 years would be a more appropriate time period, with the option for having and extension on a case by case basis if the couple was still interested in continuing to build their family.

  2. atfoxblog Says:

    Thank you for responding. I appreciate your insightful comments. This is a very complex topic with no easy answers. The main issues with keeping embryos stored for extended periods of time are:
    1) A significant number of couples, once their family is complete, do not want to make the tough decision about the fate of remaining embryos. As an act of benign neglect, they stop paying the storage fees, abandon the embryos, and assume that the clinic or storage facility will dispose of or donate the embryos. However, in the US, facilities do not have the authority to independently donate or dispose of the embryos. The facility or clinic then assumes the cost of storage and invests resources (staff, time) in attempting to contact the couple to obtain a decision from them.
    2) There is some concern that longer storage times decreases the rate of successful implantation and viability of frozen embryos. There is limited data available that up to 3 years of freezing does not impact embryo viability but there is no data regarding viability of embryos frozen for 5 years, 10 years, or longer.
    3) Is permanent freezing more humane, more ethical, and more moral? Does indefinite storage of the embryos serve some purpose? I would say no to both these questions but obviously others would disagree. This is the crux of this issue and the reason we have up to 2 million embryos in storage in the US alone. This number will continue to exponentially increase if we take the path of indecision and allow the embryos to remain frozen indefinitely.

    I appreciate your comment about 5 years potentially being too short of a time period for some families. You are absolutely right that those struggling with infertility often try numerous cycles of IVF over many years. Your thought about giving families the option to extend the time period is well taken and should be part of any policy created. Thank you.

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