The Dilemma of Remaining Frozen Embryos

In-vitro fertilization (IVF) is an expensive process and although success rates are rising, often a woman needs to undergo more than one IVF cycle to achieve a pregnancy. IVF doctors must try to find a balance between retrieving enough eggs to give a couple a reasonable chance of obtaining a pregnancy and running the risk of potentially creating so many embryos that many are destined to remain unused by the couple that created them. In a bid to reduce the rate of multiple pregnancies many IVF doctors are implanting less and less embryos. Multiple pregnancies typically result in premature births, lower birth weights and statistically higher rates of neonatal problems.

Hence, infertile couples are often faced with the dilemma of what to do with their remaining frozen embryos. Unlike England, where a deadline for storage of frozen embryos was implemented, the United States has no criteria for disposal. There are numerous website articles regarding the issue of the ethical issues of frozen embryos and these can easily be found by doing a Google/Yahoo search on such phrases as: embryos disposal or remaining frozen embryos.

However the fact that there is so much information on the Internet regarding the disposition of remaining frozen embryos has prompted our couples to contact us and ask for our input. The ethical question of what to do with remaining frozen embryos once you feel your family is complete, remains unsolved for many couples. Below is a brief overview of our research, (from talking to colleagues in the field to surfing the web to reading books to talking to couples in our program). We hope this is of help to you:

There are 5 options to be considered by couples:
  1. Keep the embryos frozen because you intend to use them in an IVF transfer sometime in the future.

  2. Discard them

  3. Donate them to another recipient

  4. Donate the embryos to research

  5. None of the above

A few thoughts for consideration for each of the above five choices are listed below. Our goal is to give you some information so that you do not feel too overwhelmed by the options. We have tried to identify most of the important issues to give you a place to start your research or to begin a discussion with a basic understanding of this very important topic.
  1. Keep the embryos frozen because you intend to use them in a future IVF transfer.

    • This is a logical option for a couple who area couple that who is undergoing an IVF cycle and are not sure if they will either achieve a pregnancy or they know if they desire to parent more than one child.

    • Because of the success rate of in-vitro fertilization (i.e. multiple pregnancy), many parents may not want to implant the extra embryos.

    • If parents no longer remain married they may be opening themselves to a battle over custody rights of the frozen embryos.

    • A couple should discuss the issue of whether they intend the freezing of their surplus embryos to be a temporary or a long-term situation and state the time periods in writing for each option.

  2. Donate them to another recipient

    • A couple who but for this beautiful donation of your embryos might never have experienced the joy of pregnancy and/or parenting.

    • Should the donation be anonymous or should both sets of parents meet? Is it ethical to consider race, religion, age, financial background and/or whether a couple is childless or not?

    • Should the children – those of the couple donating the embryos and those of the couple receiving the embryos, -- be told that genetic siblings exist? What age should they be told and how should they be told?

    • How to deal with the situation that the children from the donated embryos may want to find their biological parents. Alternatively, the children on either side of the donation may want to find their siblings.

    • What laws apply to this field? Should adoption laws apply (adoption generally involves the placement of a live child in need of a home) or are embryos a personal asset and therefore does contract law apply? Are frozen embryos a little of both, an interim category, which would afford them special treatment because of their potential for human life?

  3. Discard them

    • IVF clinics now offer couples a variety of options in disposing of frozen embryos. Some options include: implanting these embryos into the uterus when the woman is not ovulating and therefore there is no chance of achieving a pregnancy, letting them thaw and disintegrate in a petri dish, performing a religious or ceremonial service prior to disposing of the embryos.

    • Many couples voice concern about the moral status of embryos and consequently suggest that embryos should not be the subject of research.

    • Does life begin at the embryonic stage or only when the embryos are implanted into the womb? Can an embryo ever become a human outside the womb or only if implanted?

  4. Donate the embryos to research

    • An argument can be made that with each donated embryo we contribute to the field of reproductive medicine and thus perhaps help find the cure to some forms of infertility or perhaps contribute new knowledge to how to improve the success rates of thawing embryos.

    • The issues discussed above regarding the moral status of embryos will apply to this option.

    • Stem cell research could offer us a cure to many diseases and ailments.

  5. None of the above.

    • For many couples the journey through infertility is expensive and painful. Once they achieve success, they often want to forget past hardships. Consequently, many couples are simply unable to turn their minds to dealing with their remaining embryos. Unfortunately, many couples go further and simply ignore letters from their doctor’s office and, in effect, abandon their remaining frozen embryos.

    • By not making a decision of what to do with remaining embryos means that the couple is making a decision not to decide. A paradox indeed.

    • Many couples turn away from the responsibility and do not pay their storage fees or answer any correspondence from their fertility doctor’s office. They are putting their burden onto the shoulders of their doctor. Is any thought given to the fact that infertility doctors all face the same ethical and religious questions that we all do?

Before you became a parent, the question of frozen embryos, and when life begins, was all theoretical. Once you become a parent, and especially a parent through IVF, the impact of being a parent is life altering. For the first time you realize it is not just the joy of parenting that is a new feeling to you, but that that you now have another concern: responsibility. This is not just being responsible for your job, your health, extended family, etc. The responsibility of being a parent is so much more complex and is experienced at a much deeper level. Suddenly you are responsible for a life; you need to take care of your child, make sure there are diapers and food in the house, and make sure you wake up when your child cries. It is your responsibility to notice rashes, changes in eating habits or breathing, or sleep patterns, -- is it a small cough or should you see a doctor? Once you experience the feeling of responsibility of parenting, a couple may look at their embryos differently. A parent should do no harm to their children. These feelings are present when deciding what to do with remaining embryos. “Do no harm” does not sit easily with destroying frozen embryos. The detached logic that a frozen embryo is simply a mass of cells can no longer be applied to the potential each embryo has within itself.

We have already stated that are hundreds of articles on the Internet regarding the issue of frozen embryos. A simple Google/Yahoo search will produce a mammoth amount of information. We at CSP feel that there is no information on the consequences of not making a decision of what to do with remaining frozen embryos. In particular, we would like to see a discussion on the legal ramifications of the status of frozen embryos where one or, more importantly, both contributors die.

For example, embryos are assets of the estate. Therefore if you die and do not state what you want done with the embryos, your heirs will inherit the embryos. Typically this will mean that your child/children will inherit their potential siblings in the form of frozen embryos.

If the parents have not stated clearly what they wish to have done with their embryos, there are no directions for the children to follow. Therefore their children have the tremendous burden of making a decision that their parents were unable to make themselves.

Should a child be asked to decide to destroy his/her potential sibling?
Should a child be asked to decide the question of donating his/her sibling to other parents?

If a child who inherits these embryos cannot decide, can he/she afford to pay storage fees for the next 40 years? What if a child cannot afford the $500-$700 per year storage fees?

We humbly submit that there is no Option 5. You simply do not have the option of not making a decision regarding the disposition of remaining frozen embryos. A decision must be made so that your heirs are not burdened with the task of making a decision you refused to make. At the very least add a clause to your will, or write a letter that clearly states what is to be done with these embryos.

Once you agree that there is no Option 5, how do you decide between Options 1-4? The scientific field has provided answers to many questions, but it is doubtful that science can answer the question: when does life become human? Perhaps the answer is that “human-ness” is a religious, or moral, or philosophical question and not a scientific one.

When does life begin?
When does the soul enter an embryo or a fetus?
When does an embryo attain the basic rights of a person?
What does it mean to be alive?
What does it mean to be human?
When is an embryo alive?
Is an embryo a human?

Every person must search within themselves to find the answers to the above questions. Below are a few thoughts and facts that may help you in finding your answers:
  1. Catholic religion declares that life begins when the sperm and egg fertilize. Therefore, an embryos is alive, is a human. Immediately upon fertilization the resulting embryo attains the basic rights of a person.

  2. The religion of Islam espouses the view that strictly forbids abortion after the embryo has acquired a soul, this is said to take place between the 40-120 day after conception.

  3. As stated, the Catholic view is that immediately upon fertilization when the cells begin to duplicate/split, that is the moment life begins and the embryo gains a “soul”. If the embryo splits to form twins, is the soul torn apart? Is that possible? There is an argument that identical twins each have their own soul, not half a soul each. Therefore supporters of this view maintain that a “soul” enters an embryo after the stage that twinning could occur. Separate individuals have unique personalities and their own souls.

  4. The question of when the moment of conception occurs is complicated by the fact that many transferred embryos simply never implant and just disappear. Some embryos will even split into various multiples before they implant. Some or all of the split embryos will implant and some or all will simply never implant into the uterus. Does conception occur only when an embryo implants into the uterus?

  5. There is a universal acceptance that all life is finite. There is a beginning and an ending. The end is generally viewed as some form of death. Perhaps the marker of evidencing death can be used to identify the beginning of life. Some societies define death as the loss of brain activity or cerebral electroencephalogram (EEG). Therefore life could be said to begin when a recognizable EEG pattern is detected. EEG patterns are discernable in uterus at approximately 24-27 weeks after conception. Is this the time period for the beginning of life?

  6. What does “alive” mean? What does it mean to be human? Is an embryo a human being?

  7. Plato contended that the human soul does not enter the body until birth.

  8. There is a view that a fetus is no more than part of a woman’s body. The fetus gains a soul only at birth when the fetus breathes air. At that moment a transformation occurs and a living being comes into existence.

  9. Does life begin upon fertilization, when the fetus gets a soul, when the fetus can live independently outside the mother, or upon delivery?

  10. It is generally agreed that embryos can be frozen for a period of 8-10 years????????

  11. Here is one solution we found on a discussion forum: One couple wrote that after completing their family through IVF they discovered they had strongly different opinions on what to do with their remaining frozen embryos. The wife was Catholic and could simply not destroy or donate her embryos to science. She wanted to donate them to another couple. Her husband did not want another couple to be raising “his” children. Their conclusion was to write into their will that whichever of them was the first to die, their remaining frozen embryos were to be buried with that parent.

  12. Life itself may be easier to define than the issue of what is human.

The circle of life must be completed. You started the process of creating life – the degree towards life or human-ness that the embryos have attained has already been opened for discussion. The reality is that your embryos exist. There is a beginning and there must ultimately be an ending. The circle can only be completed by you.

We hope this article provided you with a starting place to begin a serious discussion. We encourage you to talk to a psychologist or psychotherapist experienced in the field of infertility. They have a huge amount to contribute. They have helped other couples decide these issues and can share their knowledge and the options available with you.

Thank you for giving this matter the attention it so rightly deserves.

Karen Synesiou
CFO & Managing Director
Center for Surrogate Parenting, Inc