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In the mid-1980s, successful cryopreservation techniques were developed that allowed couples undergoing IVF-ET the option of freezing extra embryos for use at a later date, an option that most couples welcome. Approximately 400,000 embryos are cryopreserved in the United States, according to a report by the Society for Assisted Reproduction (SART) and the nonprofit research institution RAND. In the US, there are no legal limits on the length of time embryos can be stored and decisions on the continued storage are left up to the individual clinics.
Couples who elect to cryopreserve extra embryos may decide not to use them for a variety of reasons. They may have been successful on their initial try and have completed their families. Extraordinary circumstances, such as death, divorce or health problems, may arise that force them to change their plans. Finally, they may have depleted their financial resources.

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Before embryos are cryopreserved the couple is required to sign an informed consent that outlines their choices for the disposition of the embryos in the event they are not used. A typical consent would include the following options:

• Thaw the embryos without intent to transfer
• Donate the embryos to research
• Donate the embryos to another couple (laws vary from state to state)
• Continue to store the embryos for a fee, until they can decide what to do with them

It is not uncommon for a couple to change their mind once their family is complete. Donating to another couple may seem like a great idea when signing a consent form yet, of the aforementioned choices, the one chosen by the fewest number of patients is to donate to another couple. The number declines further, when the donating couples realize how much time and effort is required for psycho-educational counseling and screening.

Indications for the use of donated embryos are similar to those for the use of donor eggs and sperm. They include severe/ irreversible male or female factor infertility; to avoid the transmission of genetic disease; or a history of recurrent pregnancy loss not associated with uterine or implantation problems. Some couples are uncomfortable with the inequitable genetic contribution that is set up by egg or sperm donation, while other couples are uncomfortable with adoption. Finally, practical considerations, such as finances, may determine the use of donated embryos, since the cost compares favorably to a single IVF cycle and is generally less than adopting a child.

For some couples, deciding what to do with spare embryos is exceedingly difficult. If any doubt exists the couple should seek the counsel of their physician and/or mental health professional before any decision is made regarding the disposition of unwanted embryos.

References:
The frozen embryo dilemma. A matter of privacy, responsibility and choice. The American Fertility Association. Available from: http://theafa.org/faqs/afa_frozenembryodilemna.html.

Bangsboll S, Pinborg A, Yding Andersen C, Nyboe Anderson A. Patients’ attitudes towards donation of surplus embryos for treatment or research. Hum Reprod 2004; 19: 2415-19.

Beyler S, Meyer W, Fritz M. Disposition of extra embryos. Fertil Steril 2000; 74: 213-15.

Elford K, Lawrence C, Leader A. Research implications of embryo cryopreservation choices made by patients undergoing in vitro fertilization.
Fertil Steril 2004; 81: 1154-55.

Fasouliotis S, Schenker J. Cryopreservation of embryos: medical, ethical, and legal issues. J Assist Reprod Genet 1996; 13: 756-61.

Hoffman D, Zellman G, Fair C, Mayer J, Zeitz J, Gibbons W, Turner Jr T. Cryopreserved embryos in the United States and their availability for research. Fertil Steril 2003; 79: 1063-69.

Hounshell C, Chetcowski R. Donation of frozen embryos after in vitro fertilization is uncommon. Fertil Steril. 1996; 66: 837-838.