Couples Face Tough Choices on Unused Embryos

Hundreds of thousands of human embryos are currently sitting in tiny cylinders and suspended in minus-340-degree Fahrenheit liquid-nitrogen tanks. What should happen to them? In the new issue of the journal Fertility and Sterility, researchers who surveyed 1,020 patients at nine American fertility clinics reported that 54 percent of respondents with cryopreserved embryos said they were "very likely" to use them for reproduction and 21 percent were "very likely" to donate them for research.

Only 7 percent of the respondents said they were "very likely" to donate the embryos to another couple trying to conceive and just 6 percent said they were "very likely" to thaw and dispose of the embryos. "They felt like thawing and discarding embryos was wasteful. There was also some sense that that was not respectful," says lead author Dr. Anne Drapkin Lyerly, associate professor of obstetrics and gynecology at the Duke University Medical Center's Trent Center for Bioethics, Humanities and History of Medicine. Unfortunately, thawing and discarding is often the only choice for many couples. Only four of nine of the reproduction clinics surveyed offered donation for research.

To find out more about the complex emotional dilemmas that couples face when making choices about stored embryos, NEWSWEEK's Karen Springen spoke with psychologist Sandra Leiblum, director of psychological services at the New Jersey Center for Sexual Wellness and editor of "Infertility: Psychological Issues and Counseling Strategies" (Wiley). Excerpts:

NEWSWEEK: Do these results surprise you—the lack of enthusiasm for thawing and discarding the embryos or for giving them to other couples?
Sandra Leiblum: It makes sense. To store and dispose of embryos, which are living genetic material, feels like a wanton disregard for the potential for life. To treat it like some cellular remains that have no genetic significance feels too cavalier and too disrespectful. To donate them [to another couple] is kind of like prenatal adoption. You don't have any choice as to who the embryo would go to. People really feel a huge level of uncertainty about what to do with frozen embryos.

Does donating the embryos for research make sense from a psychological standpoint?
Using [them] for research means you do want something useful to happen as a result of your commitment to going through the misery of infertility treatment. The embryos are precious in a sense in terms of what they represent, materially and financially and psychologically. You want to feel as though something important and significant is happening with them.

Do some people want to keep storing embryos because they're worried that they'll lose a child someday?
If a catastrophe occurs, you always want the possibility of having recourse. People who go through infertility have gone through years of trying to conceive. Years of the woman being on fertility drugs or having sex based on when ovulation occurs, having these huge disappointments of either miscarriage or inability to conceive. The amount of psychological devotion, angst, money, stress, trying to conceive is not trivial. So if you finally succeed in getting embryos, it's too precious to just destroy. There's a sense of you don't want to just let go of them. It's partly insurance against future catastrophe. Or if you have a divorce and remarry and you have a new partner, you may want to have options. Women these days are conceiving in their 40s.

Or even into their 60s?
Theoretically. Or you could get a surrogate. It's your egg, it's your material, and that of someone you love. You hear these stories where the male partner goes to Iraq. And then if you have his embryo, you can still kind of manage to recreate.

What's the problem with storing the embryos indefinitely?
It's a huge burden for these cryopreservation banks. It's expensive. It's a huge bioethical dilemma. Sometimes you lose touch with the women or couples who have preserved their embryos. What does the bank do? They can't discard the embryos themselves. What if the power is lost and they die. There are all kinds of issues. We have a situation where we have thousands of these embryos that are not doing anything.

What about an alternative like putting the embryos back in the woman's body at a time she's not likely to conceive or holding a ceremony at the time of disposal? (Seven percent of the respondents in the "fertility and sterility" survey said they were "very likely" to choose each of those options.)
That shows, I think, respect for the possibility of life. That this material is not like ordinary material.

In other words, it's not like thawing out and discarding an old pot roast?
Exactly. It's special. It's endowed. It has life potential. It's meaningful … It's important in some way. It's kind of like even when you have a stillbirth or you have a miscarriage, sometimes people want to name it and do a ceremony around that.

Is a ceremony a healthy thing to do?
Yes. Ceremonies and rituals help people kind of cope with meaningful events in their life. The ceremony makes sense to me. It's a commemoration.

Why don't centers offer more of these options?
I wonder if it's because they don't have personnel. You need someone who's trained in terms of the importance of this. Maybe having kind of a divinity person would make it more sensible than expecting a physician to do it. Have someone who knows about rituals.