What to do with embryos you aren’t transferring?
In the world of In Vitro Fertilization (IVF), the main goal is to obtain embryos that are eligible for transfer. Everyone hopes to achieve at least one, if not more, embryos that don't carry the genetic variants they’re testing for with PGT-M or any chromosomal conditions being examined through PGT-A.
But, while there is a lot of emphasis on getting those eligible embryos, there is not a lot of talk about what happens to those embryos not eligible for transfer. These are the embryos that might have the genetic variants being tested for or chromosomal conditions. Figuring out what to do with these embryos often comes up before someone even knows if they’ve got any embryos at all. There is also the discussion of what to do with embryos that may be eligible for transfer but the individuals have completed their family.
Let's dive into these important questions —something that is often called "embryo disposition" on consent forms. We'll explore the choices available and try to make sense of this complex decision-making process.
Thaw and Memorialize:
Description: Individuals may choose to thaw their embryos and bury them or other acts of memorialization
Considerations: May be a way to acknowledge the work to create the embryos and their meaning but also avoid some of the emotional challenges that arise with other options
Pros: Provides closure, eliminates ongoing storage fees.
Cons: Emotional distress, ethical considerations.
Transfer the Embryos - AKA Compassionate Transfer:
Description: This option involves intentionally transferring embryos with identified chromosomal abnormalities, with the expectation that the outcome will either be a miscarriage or implantation failure. Individuals may choose to transfer embryos that have the genetic variant, if they feel that the resulting symptoms from the genetic variant are manageable to care for a child with the condition.
Considerations: While the intended outcome may be a miscarriage or implantation failure, it's crucial to acknowledge the unpredictability of the process. An ongoing pregnancy could occur despite expectations, and the accuracy of Preimplantation Genetic Testing for Aneuploidy (PGT-A) is not foolproof, allowing for the possibility of an ongoing pregnancy without the anticipated chromosomal condition. If the embryo tests positive for a genetic variant, the resulting baby may face health concerns.
Pros: Reduces the number of embryos in storage
Cons: An ongoing pregnancy with a chromosomal abnormality may defy the initially expected outcome. If the embryo carries a genetic variant, the resulting baby could exhibit symptoms related to the condition. Ethical considerations also come into play such as the knowledge of the baby’s genetic status before they have a chance to decide to know this information. Additionally, there is a potential risk of associated miscarriage, especially if that was the anticipated outcome for transferring aneuploid embryos.
Embryo Donation:
Description: Individuals can choose to donate their embryos to another couple/individual - this can be a family member or unrelated individuals.
Considerations: Involves legal agreements and open communication between the donating and receiving families. Will there be the option to meet the children born from the donated embryos? If anonymity is desired, it may not be possible with the current direct to consumer genetic testing revealing biological relationships.
Pros: Offers a chance for the embryos to develop into a family, reduces the number of embryos in storage.
Cons: Emotional challenges, potential legal complexities.
Thaw and Dispose:
Description: Individuals may choose to thaw their embryos and allow them to expire.
Considerations: Often chosen when other options are emotionally or ethically challenging.
Pros: Provides closure, eliminates ongoing storage fees.
Cons: Emotional distress, ethical considerations.
Donation for Research:
Description: Some individuals opt to donate their embryos for scientific research, contributing to advancements in fertility treatments.
Considerations: Strict ethical guidelines and institutional review board (IRB) approval are usually required.
Pros: Advances medical knowledge, may help others facing infertility.
Cons: Ethical concerns, potential emotional impact.
Cryopreservation and Future Use:
Description: Some individuals choose to keep their embryos frozen for potential future use. For embryos that are not eligible for transfer, some people may wait hold onto their embryos to see if there are recommendations and new scientific discoveries later.
Considerations: This option provides the chance for additional attempts at pregnancy without going through the entire IVF process again.
Pros: Cost-effective, less invasive than repeated IVF cycles.
Cons: Uncertain success rates, ongoing storage fees.
The decision regarding embryo disposition is deeply personal and influenced by a multitude of factors, including emotional attachment, ethical beliefs, and practical considerations. As technology continues to evolve, new options may emerge, providing individuals with even more choices. It's crucial for individuals to thoroughly explore each option, seek guidance from medical professionals, and engage in open and honest communication with their partners to make a decision that aligns with their values and brings them a sense of peace on their path to parenthood.
Often the decision is made at a time where things are still hypothetical, so once someone is faced with the reality, they may choose another option. It is okay to change your mind at a later date, as it is not uncommon to do so. This article discusses what people have done with frozen egg cells, and highlights the changing opinions and various perspectives on the options available. Ultimately, navigating the complex terrain of embryo disposition requires careful consideration, compassion, and a deep understanding of the unique journey each person undertakes.
