The Embryo Disposition Dilemma: Helping Patients Making Final Decisions for their Remaining Embryos
The challenge surrounding what to do with remaining embryos is real for former IVF patients. What can feel like a huge win on the front end of an IVF cycle (many quality embryos to choose from!) can become decision paralysis on the back-end, after their family building is complete. Add in the information PGT-A provides, including the sex of an embryo and the estimated chance of success, and you get a perfect storm of confusion for many patients around how to conceptualize their remaining embryos, and what to do with them. Patients often turn to their fertility clinic for support on next steps.
In a 2020 article in Fertility and Sterility, Embryo cryopreservation and utilization in the United States from 2004-2013, Christianson et al. concluded that "Embryo cryopreservation has increased sharply in the United States in a 10-year period from 2003-2013. . . resulting in more embryos in storage and a subsequent increase in disposition decisions required by patients and clinics. In our 10-year analysis of linked fresh and frozen ART cycles, more than half of cryopreserved embryos were not subsequently transferred, further demonstrating the importance of counseling patients regarding accumulation of excess embryos after family-building goals are made. A taskforce is needed to address the issue of excess embryo accumulation."
While there is no taskforce for embryo disposition counseling and education, there is a way clinics can support patients with remaining embryos.
Meet EM•POWER with Moxi, an organization dedicated to education and support for embryo donation. The team at EM•POWER has created an education platform to help patients navigate the disposition decision and gather information at their own pace in a non-directive and unbiased way. The process of making an embryo disposition decision is deeply personal and complex. Individuals conceptualize embryos in varying ways. For some, embryos may be seen as a bundle of cells, while for others, they represent potential lives or carry deeper meaning. Factors such as family dynamics, cultural and religious beliefs, and the connection to the embryos also play a pivotal role in shaping the disposition decision. And having remaining embryos can evoke strong emotional attachments and a feeling of responsibility to make "the right" choice, often when none of the options may seem appealing.
We know the disposition options for remaining embryos:
Store embryos indefinitely
Keep transferring embryos and potentially expand beyond initial family size desires
Discard the embryos, opting for a more finite solution
Donate the embryos to scientific research or lab training
A symbolic closure: include compassionate transfer or a memorial option
Embryo donation to another for family building
Donating embryos to someone else for family building is an option that appeals to some patients, who might find new meaning in helping another family to grow. This choice can feel more complex than other options, and for that reason, it is what we spend the most time unpacking in our educational modules for patients considering their options. Understanding the emotional and logistical implications of embryo donation for family building is vital, because it opens a new chapter for embryo donors and for the recipients of their donation. Families connected through embryo donation often desire some contact down the line, even when they initially desire more distance. And with the advent of at-home DNA testing kits and social media, these facts are becoming more widely known, and families are finding out first-hand that anonymity in embryo donation does not exist. At EM•POWER with Moxi, our education modules and support options can help those looking for more insight into the world of embryo donation. And if it feels like the right decision, our Moxi Matching platform can help with the process of matching, managing the embryo donation journey, and fostering healthy relationships between donors and recipients.
Ultimately, there is no "one-size-fits-all" option for embryo disposition decisions. Making an embryo disposition decision is deeply personal. We believe that education and support are essential in empowering individuals to make well-informed choices aligned with their unique circumstances. Ultimately, with careful reflection and access to valuable resources, individuals can navigate this complex decision and find a path that resonates with them, providing a sense of peace and closure on their fertility journey.
Empower choice. Let’s connect and learn more about Moxi Matching.