Correspondence
The Disposition of Unused Frozen Embryos
N Engl J Med 2001; 345:69-70July 5, 2001
- Article
To the Editor:
The disposition of unused embryos is a pressing problem for in vitro fertilization programs.1,2 Although cryopreservation of embryos gives couples the chance to make additional attempts at pregnancy, unused frozen embryos create a storage problem and require couples to make difficult decisions regarding their disposition. Divorcing couples have had contentious disputes over embryos.3 In addition, interest in the use of these omnipotent cells for genetic research raises concern about unauthorized or inappropriate use.
In vitro fertilization clinics offer these disposition options: continued cryopreservation, uterine transfer, donation to an infertile couple, donation to research, and disposal. In a study of the experience at our in vitro fertilization program, 107 of 404 couples (26 percent) had embryos remaining in the freezer after the three-year storage deadline. Sixteen of these 107 couples were still in treatment. Attempts were made to contact the other 91 couples with the use of information from charts, directory assistance, and birth announcements and with the use of forwarding addresses. Over a three-month period, only 52 of the 91 couples (57 percent) could be located. At the time of contact, 17 of the 52 couples (33 percent) chose to dispose of the embryos, 7 (13 percent) chose to donate them to an infertile couple, 5 (10 percent) wanted to donate them to research, 15 (29 percent) chose to continue storage, 6 (12 percent) decided to undergo another transfer cycle, and 2 (4 percent) were undecided.
A comparison of the initial and current disposition choices of 41 couples for whom both initial and current information was available indicated that only 12 of these couples (29 percent) kept their initial disposition choice; 29 couples (71 percent) changed their preferences. Thirteen of 22 couples who had initially opted for disposal now wanted either to use or to donate the embryos. Nine of 11 couples who had initially opted for donation to an infertile couple no longer chose that option: 2 couples now decided to use the embryos, 2 chose to thaw them, 3 continued storage, and 2 donated the embryos to research. Seven of eight couples who had initially planned to donate the embryos to research now chose either to use the embryos or to dispose of them. Having a child was not significantly associated with the final choice regarding disposition.
The American Society for Reproductive Medicine recommends that couples indicate their preferences for embryo disposition in many potential scenarios, including abandonment, so that programs are not required to cryopreserve embryos indefinitely.4 Improved systems for embryo disposition require appropriate counseling of couples, documentation of disposition choices, and clear definition of time limits for storage. The current findings highlight the need for ongoing contact between programs and couples to facilitate reassessment and confirmation of decisions regarding embryo disposition.
4 ReferencesSusan C. Klock, Ph.D.
Sandra Sheinin, M.D.
Ralph R. Kazer, M.D.
Northwestern University School of Medicine, Chicago, IL 60611
sck318@northwestern.edu 1
Annas GJ . Ulysses and the fate of frozen embryos -- reproduction, research, or destruction? N Engl J Med 2000;343:373-376
Full Text | Web of Science | Medline2
Oghoetuoma JO ,McKeating C ,Horne G ,Brison DR ,Lieberman BA . Use of in-vitro fertilisation embryos cryopreserved for 5 years or more. Lancet 2000;355:1336-1336
CrossRef | Web of Science | Medline3
Robertson JA . Disposition of frozen embryos by divorcing couples without prior agreement. Fertil Steril 1999;71:996-997
CrossRef | Web of Science | Medline4
American Society for Reproductive Medicine
CrossRef | Web of Science
- Citing Articles (14)
Citing Articles
1
V. Provoost, G. Pennings, P. De Sutter, A. Van de Velde, M. Dhont. (2011) Trends in embryo disposition decisions: patients' responses to a 15-year mailing program. Human Reproduction
CrossRef2
L. Frith, E. Blyth, M. S. Paul, R. Berger. (2011) Conditional embryo relinquishment: choosing to relinquish embryos for family-building through a Christian embryo 'adoption' programme. Human Reproduction 26:12, 3327-3338
CrossRef3
Nabeel Manzar, Bushra Manzar, Nuzhat Hussain, M. Fawwad Ahmed Hussain, Sajjad Raza. (2011) The Ethical Dilemma of Embryonic Stem Cell Research. Science and Engineering Ethics
CrossRef4
E. Blyth, L. Frith, M. S. Paul, R. Berger. (2011) Embryo Relinquishment for Family Building: How Should it be Conceptualised?. International Journal of Law, Policy and the Family 25:2, 260-285
CrossRef5
Veerle Provoost, Guido Pennings, Petra De Sutter, Marc Dhont. (2011) The frozen embryo and its nonresponding parents. Fertility and Sterility 95:6, 1980-1984.e1
CrossRef6
Harsha Sharma, Erica B. Johnstone, Elena Gates, Sae H. Sohn, Heather G. Huddleston, Victor Y. Fujimoto. (2011) Asian immigrants to the United States are less likely to donate cryopreserved embryos for research use. Fertility and Sterility 95:5, 1672-1676
CrossRef7
K Kufner, M Tonne, J Barth. (2009) What is to be done with surplus embryos? Attitude formation with ambivalence in German fertility patients. Reproductive BioMedicine Online 18, 68-77
CrossRef8
M Luna, M Boada, B Aran, B Coroleu, PN Barri, A Veiga. (2009) Couples' opinions regarding the fate of surplus frozen embryos. Reproductive BioMedicine Online 19, 11-15
CrossRef9
V. Provoost, G. Pennings, P. De Sutter, J. Gerris, A. Van de Velde, E. De Lissnyder, M. Dhont. (2008) Infertility patients' beliefs about their embryos and their disposition preferences. Human Reproduction 24:4, 896-905
CrossRef10
Kristina Hug. (2008) Motivation to donate or not donate surplus embryos for stem-cell research: literature review. Fertility and Sterility 89:2, 263-277
CrossRef11
CAROLYN MCLEOD, FRANÇOISE BAYLIS. (2007) DONATING FRESH VERSUS FROZEN EMBRYOS TO STEM CELL RESEARCH: IN WHOSE INTERESTS?. Bioethics 21:9, 465-477
CrossRef12
Julianne Zweifel, Mindy Christianson, Ami S. Jaeger, David Olive, Steven R. Lindheim. (2007) Needs assessment for those donating to stem cell research. Fertility and Sterility 88:3, 560-564
CrossRef13
Sheryl de Lacey. (2007) Patients' attitudes to their embryos and their destiny: social conditioning?. Best Practice & Research Clinical Obstetrics & Gynaecology 21:1, 101-112
CrossRef14
Robert D. Nachtigall, Gay Becker, Carrie Friese, Anneliese Butler, Kirstin MacDougall. (2005) Parents’ conceptualization of their frozen embryos complicates the disposition decision. Fertility and Sterility 84:2, 431-434
CrossRef
