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Embryo Disposition Decisions

Lesson 4 of 4

Regional, Legal, & Other Considerations

Video Lesson

Written Lesson

Options in Various Countries

Your options for embryo disposition may vary depending on the country where you live and the country where your embryos are stored. Furthermore, laws and regulations are in flux and may affect the options available to you at any given time.

For example, until recently, embryos stored in the UK were only allowed to remain in storage for 10 years before being disposed of according to the patient’s original disposition decision. Now, embryos are allowed to be stored for up to 55 years, with a requirement to update consent forms every 10 years. This change in law is a prime example of the ways in which a country’s laws or a change in the country’s laws may affect the options available to you.

Whether you are undergoing fertility treatment in your own country or traveling abroad, it’s important to understand your long-term options for embryo storage and ultimately for ending storage.

As earlier mentioned, the Dobbs v Jackson court case opened the doors for individual states to pass laws which could potentially affect the legality of some of the disposition options we outlined here.

Although we’ve mainly focused on embryo disposition decisions in the case of patients who have completed their family building attempts, there are other situations in which these decisions may need to be made.

As always, it’s important to consult a qualified attorney experienced in local reproductive law when considering such cases.

For example, embryos are often a point of dispute in divorces, particularly in a case where one party intends to use the embryo for reproductive purposes and the other party no longer wishes to become a parent.

In most cases, the right to not reproduce wins out and the court rules in favor of the person who wishes to not have the embryos used for reproductive purposes.

Some disputes may be avoided by indicating on your initial IVF consent forms who is to receive ownership of the embryos in the case of divorce. However, doing so is not a sure fire way to avoid conflict in the future.

Another case in which embryo disposition decisions can be complicated is in the case of an untimely death of one of the partners. In this case, having addressed the partner’s wishes for the embryos in a will or advanced directive can be helpful.

Finally, if a donor egg or sperm were used in the creation of your embryo, it may add a layer of complexity. It will be important to look at the original contract, as some options may be limited.

Avoiding “Supernumerary” Embryos

For many patients having more embryos feels reassuring. Not every embryo leads to a live birth, and having more embryos available gives you a better chance of obtaining your ideal family size.

However, for other patients, the idea of having too many embryos, or supernumerary embryos, and needing to make a decision can be cause for concern.

There may be steps that can be taken during IVF to possibly mitigate (but by no means eliminate) the odds patients will create more embryos than they want.

Some of these steps may also serve to mitigate the odds of conceiving, and so it’s critical you consult closely with your doctor about your priorities to understand the implications of any treatment-related decision.

Adjust Medication Protocol to Lower Number of Eggs Retrieved

For many IVF patients, increased drug doses increase the number of eggs retrieved and embryos created. For some patients, attenuating the doses, or substituting out certain medications, may mitigate the number of embryos available.

In some cases, this could have dramatic effects on the odds-of-success, and so such considerations must be made carefully. For more on drugs and protocols, see our dedicated lesson here.

Selective Fertilization

If a large number of eggs are retrieved, one may consider fertilizing a portion and freezing the rest. While this will limit the number of embryos created, it will subject inherently-delicate eggs to the freeze/thaw process.

The egg freezing and thawing process can be precarious as you can see in our dedicated lesson here. As a result, this approach likely introduces some measure of risk and needs to be discussed at length.

Grow Embryos to Blastocyst

As seen below, having your embryos grown to the “blastocyst” stage of development will mean fewer embryos will need to be frozen, and those blastocysts that are frozen are more likely to eventually lead to a live birth.

Sample Funnel from Fertilized Eggs to Blastocysts

There are many advantages to growing embryos to this stage but also plausible reasons not to. For instance, some clinics have difficulty culturing embryos to this stage and asking them to do so may have a negative impact on your odds of success.

Screen Embryos Using Preimplantation Genetic Testing for Aneuploidy (PGT-A)

Depending upon the parent’s age, a large percentage of embryos created will not have the correct number of chromosomes (known as euploid), and in such cases, are unlikely to lead to a live birth.

Submitting embryos to PGT-A will help “rule out” many of the embryos that were highly unlikely to lead to a live birth.

However, credible experts disagree on the value and accuracy of PGT-A and so rigorous discussion with your doctor is needed.

Procure Donated Eggs from a Donor Egg Bank

For patients who will try to conceive with donated eggs, selecting eggs from a donor egg bank may reduce the number of embryos created.

Donor egg banks typically provide eggs in batches of 6–8, and from these eggs, it's uncommon to have additional embryos left over after a successful birth.

Working with a donor egg bank is not always possible and has trade-offs (e.g.a high cost per embryo—which we characterize below), and so a close consultation with your doctor is necessary. In addition, we have a dedicated course on the subject here.