Most couples, when they are undergoing ART treatment, do not think about making decisions about leftover embryos. Once treatment is complete, the realization that there are frozen embryos excess to their needs often comes as an unwelcome surprise and an unforeseen ethical dilemma. It is the most common problem I find raised in counselling sessions with Christians.

A 2009 study from the University of California in San Francisco found that 72% of couples were undecided about the fate of their stored embryos. In 2008, it was reported to the House of Lords that 1.2 million human embryos had been destroyed in the United Kingdom over the previous 14 years, 82,955 of which were used in destructive research.[1]

Sally, pregnant with twins, said, I never thought there would be leftovers. I was only thinking about having a baby. Jodie said, I think someone may have mentioned it at the beginning, but my thoughts were completely consumed by the children I wanted. There wasn’t room to think of anything else.

Anne Drapkin Lyerly, a professor of obstetrics and gynaecology at Duke University Medical Center, agrees: ‘When you’re pouring your money, your heart, and your soul into creating an embryo and creating a life, the last thing you want to think about is how you’re going to dispose of it”.[2]

A couple may arrive at this point for several reasons. Their treatment may have been successful and they have as many children as they want. They may be finding treatment so stressful that they feel they cannot undergo any more cycles. Don said, We were planning to use all our embryos, but after having a scary emergency delivery and a baby in intensive care, we decided we’d been through enough. Sometimes the couple would like more children but cannot transfer the embryos for medical reasons. Sadly, couples may divorce during treatment. Whatever the reason, the embryos are there in the freezer, and their destiny is in the hands of their parents. Several studies testify to the difficulty of this decision.[3]

Research aimed at understanding how clinic patients manage this situation is in its early stages, and there is still much ambiguity in the results. But by looking at what has been done, we can start to get an idea of the extent of this problem and the challenges it holds for those involved.

One problem identified is that parents often have difficulty talking about their frozen embryos because they have no language to describe them. They have no words available to express their experience of having their potential child outside of the body and in cryostorage (frozen).[4] (I don’t think the parents are the only ones who struggle with this.)

Research suggests that many patients not only know very little about the technical side of freezing embryos but also do not demonstrate a need to know, their confidence in the medical team being enough. However, it has also been noted that patients tended to make comparisons between frozen embryos and food storage, possibly because we use the same words—‘fresh’ and ‘frozen’—for both. The idea that an embryo can reach its expiry date (as can frozen food) may reinforce the idea for some patients that the embryos are just ‘ingredients’ for their fertility treatment. This can be reflected at times in less concern for the embryo’s destiny (see below). Some patients did not realize they had any say in whether embryos would be frozen, but secretly felt that those embryos would be of poorer quality. At times they would create new embryos even though frozen ones remained. This indicates a need for further discussion at the outset of treatment about frozen embryos and their fate.[5] In fact, storage time has no effect on the success of a pregnancy.[6]

Most parents report that something happens to make them begin to start thinking about the leftover embryos—for example, the time limit for storage approaches, or the bill arrives for the clinic storage fees. Anne and David didn’t know what to think, so they paid the bill. The next year when the bill arrived, they paid it again. Adele asked, What do people do? Keep on paying, like me? A 2008 study in the United States of 1000 patients found that 20% of couples who wanted no more children said they planned to keep their embryos frozen indefinitely.[7]

According to a 2010 journal article, while there is no single statistic on the number of ‘surplus’ embryos in storage worldwide, it is estimated that there are roughly 400,000 frozen embryos in the United States, approximately 12% of which will not be used by the couples that are storing them.[8] Australia has up to 120,000 frozen embryos, up from 70,000 a decade ago[9]—although according to the clinics, some of these embryos may still be transferred. The United Kingdom has about 52,000. The number of such embryos is thought to be increasing due to the significant improvement in the technology of cryopreservation (freezing), and the increasing regulation that restricts the number of embryos that may be transferred during a single treatment cycle. At present there is no mechanism in place to minimize the number of embryos made for each couple. In Australia, the ethical guidelines for use in ART recommend that “Clinics must limit the number of embryos created to those that are likely to be needed to achieve a pregnancy”,[10] but as long as there is no correlation between the number of embryos created and the number of live births, it will be impossible to enforce such a recommendation. The maximum number will continue to be encouraged by the clinics (which won’t hurt success statistics, either). One hopes that there is no correlation between the increase in the number of embryos made and the number of embryos used for research.

Some countries, such as Italy and Germany, do not allow cryopreservation of embryos. Others, such as Australia, have statutory limits on the duration of storage; these vary from state to state. The United States also has state-based guidelines, but embryos may be stored indefinitely. In the United Kingdom, embryos may be stored for up to 10 years, with possible extension to 55 years. In Belgium, patients have to decide what they are going to do with possible leftover embryos (embryo disposition decision—EDD) before their first treatment.[11] The cost of storage varies between clinics, averaging between $300-$600 per year.

Professor Jenni Millbank, an Australian health law specialist, is aware of how difficult it is: “It’s a very, very painful decision and it’s one that many couples never consider they’ll have to make when they start down the IVF path”.[12] She notes that at the time of this decision, parents are no longer involved directly with the clinic for support and are not usually offered counselling. She agrees that it might help for clinics to forewarn patients at the outset of treatment about the possibility of surplus embryos. Certainly, I would suggest it is far better to think ahead and try to avoid this situation altogether by limiting the number of embryos created.

Some parents become conscious of the potential problem during their treatment. It can get complicated. Sandy found the prospect of having excess embryos one of the most challenging aspects of ART:

[Becoming concerned about the fate of excess embryos] was difficult, as I became consumed with the ethical dilemma of thinking what to do if something happened to me. What would happen to our children that had been created? And also what if my husband died—would I still have the embryos implanted? We thought through issues like me being pregnant with no husband; or having my sister carrying our children if I were to die; or adopting our embryos to another Christian couple if we both died. These were issues we hadn’t thought through before we began treatment, and if we had, we might not have frozen the embryos. We felt such an urgency to have our other embryos implanted after our first son was born. I remember feeling such relief after our last embryo was implanted that God in his goodness had allowed our embryos to have a chance in the womb.

Basically, there are 6 alternative disposition options for excess frozen embryos following completion of ART treatment:

1. Avoid the decision (thus discarding the embryo by allowing it to ‘expire’)
2. Continue storage
3. Thaw and discard
4. Use the embryos
5. Relinquish the embryos to another couple for reproduction
6. Donate to research

Not all of these options are always available, but we will look at each one in turn.

1. Avoid the decision

A substantial number of parents find it all just too hard, and walk away from their embryos. When the storage term is up for the embryos, if the parents are lost to follow-up and there is no-one to pay the storage costs, the embryos are usually removed from the freezer and allowed to thaw out and perish. Sometimes the parents will pay the storage costs but delay making a decision so that the embryos ‘expire’ legally and can no longer be used for further treatment, research or donation to others. But no decision is itself a decision when such arrangements are in place.

This phenomenon has not been closely studied, but may be associated with the idea some patients have that cryopreserved embryos are a bit like frozen food, which deteriorates over time. It may also be based on the idea of letting “‘nature’ take its course”, and thus seeking to avoid responsibility for the decision.[13] Similarly, a non-decision accompanied by prayer to allow God’s sovereign will to prevail is essentially a decision to abandon the embryo.

Whatever the motivation behind this decision, it is not consistent with the biblical responsibilities parents have for their offspring. The parent’s obligation goes beyond procreation, and continues during the child’s upbringing.[14]

2. Continue storage

This is basically the same decision as (1), except that the storage fees are paid and the decision is put off indefinitely. This is obviously not possible in those jurisdictions where storage time limits are enforced. This is one of the reasons time limits were introduced—because of the number of orphan embryos that were accumulating in clinic freezers.

In 2009, the United Kingdom’s Human Fertilisation and Embryology Authority debated whether frozen embryos could be stored to serve as spare parts; a body repair kit, as it were. The idea was that you would store the embryo(s) until a problem occurred, then thaw it and develop it into stem cells. This was said to be “an attractive commercial possibility”.[15] Pro-life campaigner Josephine Quintavalle commented, “It is sadly almost inevitable that bespoke embryonic stem cells created from frozen surplus will become the latest must-have healthcare accessory”.[16] This would not be an ethical option for Christians.

One problem with postponing the decision is that if you wait too long, you just shift the decision to someone else—whether to a clinic staff member after you have moved without telling them, or to a family member after you die. A famous case in Australia involved the question of whether frozen embryos could inherit from the estate after their wealthy parents were both killed in a plane crash.[17] (Apparently they can’t.) Some decisions are enforced when marriages end. There have been several cases where divorced couples have fought legal battles over the custody of frozen embryos, where one partner wants them transferred and the other doesn’t. It would be wonderful if courts tended to err on the side of life, but more often they seem to be reluctant.

Once again, a non-decision represents an abandonment of the embryo that is not consistent with biblical directives for parents to provide ongoing care for their children (Eph 6:4; 1 Tim 5:8).

3. Thaw and discard

This option involves taking the embryos out of the freezer and leaving them on the laboratory bench. Without a supportive culture medium (nutrient fluid), the embryos expire as they thaw.

It has been reported that “about 90% of IVF couples choose to discard surplus frozen embryos rather than give them to infertile couples, or donate them for scientific research”.[18] IVF Clinic director Gab Kovacs describes this as “a shameful waste”, saying that clinics need to provide patients with better information about their options: “It breaks my heart to discard embryos. They’re such a valuable asset. People go to so much trouble and expense to produce them.”[19]

While some would see this option as an abandoning of the embryo, often it is done as a sign of respect. Some Christians distinguish between ‘letting die’ and ‘killing by destructive research’, and would consider the first option to retain the embryo’s dignity and be morally permissible. I must say that I have struggled with this area. The literature supports my own findings that some parents who think of their embryos as children would rather have these ‘children’ discarded than give them a chance at life (through transfer to a uterus).[20] I find this irrational. But I have never been in this position myself.

My own view is that if these embryos were created with the goal of transferring them to a uterus, they should at least be given that chance at life.

Some religious denominations rule out the option of embryo donation, based on the belief that the generative capacity of a woman belongs to the marital union, and so may not be given outside the marriage. In this argument, embryo donation is seen as equivalent to adultery. Once an embryo is created from the parents’ own gametes, it is argued that it is sinful to place it in the reproductive tract of a third party. Similarly, it would be sinful to receive a donated embryo, as the wife becomes ‘with child’ from outside the marital relationship. On this view, withdrawing the embryo from storage and placing it in a more natural environment to allow it to complete its short life is the most respectful way to treat it.[21] Some parents perform a ceremony to mark the demise of the embryo with reverence.

Some doctors provide the service of ‘compassionate transfer’. This procedure involves transferring the embryo(s) into the woman’s uterus at a time in her cycle when embryo implantation is unlikely/impossible. I have heard people describe this as a way to ease their consciences about letting the embryos die, because they can pretend they tried to give them a chance at life. While the action of uterine transfer is ethical, the intention to do so at a time when pregnancy is nigh impossible is definitely not. (Remember, you need good intentions as well as good actions.) Therefore this would not be a morally acceptable option for Christians.

4. Use the embryos

Some parents find they just can’t make the decision to let their embryos go. I don’t think anybody knows what their opinion is until they’re in this situation, said Betty. She had one embryo left after giving birth to her sons, 8 and 6 years old at the time. After two more years of deliberating about their options, she and her husband finally decided to have a third child. One excess embryo changed my whole life, she says. She is thankful for her daughter, but also thankful that she had only one excess embryo.

Katie and her husband, on the other hand, had 5 embryos plus twins aged 6 years. Every time a bill came in the mail I thought about it, but I couldn’t let them go. Now, at 48 years of age, she has decided to have more children, through a surrogate if necessary, until all the embryos have been transferred. She is very emotional, but also very determined.

Judy and her husband had 6 frozen embryos, plus 3 children, two of whom were born through IVF. I can’t have nine children, Judy said. But neither could she bring herself to consider any other option. Finally she and her husband decided to have one embryo transferred. Now they have 5 frozen embryos, but they only have to decide about one at a time.

The option of using excess embryos yourselves may not be available to all couples, as sometimes a complication of pregnancy or another illness may make a further pregnancy highly dangerous or impossible. This is one of the few cases where I think it would be ethical to consider a surrogate if you wanted more children, or else consider another of the ethical options listed here.[22]

Embryos created by assisted reproductive technology are intended for uterine transfer. Giving them a chance at life in this way is entirely consistent with biblical value for all human life made in the image of God (Gen 1:27, 9:6).

5. Relinquish the embryos to another couple for reproduction

Once they have their own families, it is not uncommon for parents to consider helping other infertile couples. Having known the pain of infertility themselves, they immediately think of others in the same position. A 2009 study examined the way parents make a decision about whether to donate their embryos to another couple. Initially, most would consider donating to another couple, and it was found that the way the parents thought about their embryos was important in whether they decided to go ahead. Parents who thought about their embryos in terms of a “genetic link” or a “symbol of the [marriage] relationship” were less likely to go ahead with relinquishing the embryo to another couple than those who thought of the embryo more as something useful.[23] The “genetic link” and “symbolic meaning” views both involved seeing the embryo as a union of the two parents, the ‘one flesh’ idea, “something of the two of us”.[24] This was associated with positive feelings towards the embryos, but a reluctance to relinquish them to other couples because it would be too difficult to know that their child was ‘out there’ and be unable to protect them. I’d always be thinking whether that child in the street looked like my other children, said Jane. Sandra said: Now suppose that you did that and when that child is 18 years old, in it walks and it has had a very bad childhood. Then that would be painful. This in part helps me understand the conundrum of parents who prefer that their ‘children’ perish rather than be transferred to another family.

By contrast, those who saw the embryos as ‘something that is useful’ saw them more as objects that were valuable because of the effort involved in their creation—and thus their value to the potential beneficiaries of their donation. This was associated with a conscious effort to create emotional distance between themselves and the embryos (to protect themselves), and the parents’ reluctance to destroy the embryos because it would be a waste of their value. However, the main motive in donating to others was to help them.

While interest in relinquishing to another couple has been reported for 5%-39% of participants in research, it appears to be more often contemplated than actually performed.[25] Indeed, the transferring of frozen embryos to another couple raises so many complex psycho-social dilemmas that some countries have prohibited the practice. At the time of writing, relinquishing embryos for transfer by others was not allowed under law in Austria, Denmark, Germany, Israel, Italy, Latvia, Norway, Slovenia, Sweden, Switzerland, Taiwan, Tunisia and Turkey.[26] Check with your clinic—sometimes it is possible in your country but not at your clinic, in which case you may need to have your embryos moved to a clinic that does offer the service. Countries that permit relinquishment of embryos to others for reproduction have procedures in place to regulate the practice. This may include making decisions about who will receive the embryos, intended contact between the genetic parents and the recipients, and arrangements for the child to learn the identity of their genetic parents. Sometimes clinics impose their own rules, such as how many embryos you need to have before they will arrange the relinquishment. This is an area that needs further development. Current legislation is inadequate. Most problematic for legislators is whether you treat the transaction as an adoption (with full screening of the prospective parents) or as a donation (which tends towards anonymity). Lessons have been learnt about the damage done in the past by anonymous adoption of babies, and laws are now in place encouraging contact between birth mothers and children. These issues remain unaddressed with embryos in many jurisdictions.[27]

In 1997, the Nightlight Christian Adoptions organization in the United States began the Snowflakes Frozen Embryo Adoption Program, which helps frozen embryos realize their ultimate purpose—life—while helping infertile couples. They named the program ‘Snowflakes’ because every embryo, like every snowflake, is frozen and unique.[28] The first snowflake baby was born in 1998, and the term ‘Snowflake babies’ has continued to be used to describe babies born in this manner. Last I heard, over 200 babies had been born through this program, which uses the language of adoption even though the actual legal process is different.[29] An Australian study reported many more couples willing to adopt than there were embryos available.[30]

It is interesting to note the response of one United States specialist in reproductive law to the sudden popularity of embryo adoption: “The problem with this label [adoption] is it elevates embryos to the status of a child in many people’s minds, and then you end up on a slippery slope. If you can adopt embryos, how can you do stem-cell research on them or discard them?”[31] How indeed?

One study reported on a small sample of mainly Christian parents who had to make EDDs[32] and who decided to relinquish their surplus embryos to infertile couples (this sample reflecting the population of those most likely to do so). The study found that the reasons for their decision included a sense of responsibility toward their unused embryos, and the thought that it would be wrong not to donate them:

• NOT donating the unused embryos to another couple would have weighed on my conscience…
• …we wanted them to go to something or someone who would do something life sustaining with them…
• …we had created these lives and were responsible for finding them good homes if we could not be that home.[33]

These thoughts were often based on Christian beliefs. All the same, not everyone found it an easy choice:

• …it was the lesser of all evils [compared to destroying the embryos].[34]
• The initial decision was difficult because I felt like I was giving away my children.[35]

In the end, the child’s best interests were what swayed all people in the study.

Once the decision had been made, all participants found the process of relinquishment easier: The biggest feeling was relief. We had given them [the embryos] a shot at life and the rest was in the hands of God.[36] There was a varying amount of contact desired with the adopting families. Some expressed satisfaction in having ongoing contact as ‘aunts’ and ‘uncles’, while others decided to keep their distance. Feelings often changed once a child was born.

The shipment date for the embryos going to another clinic was significant for many, bringing with it a sense of loss:

• There was just a sense of finality about knowing that they were leaving “home” and starting their journey to become someone else’s children.
• I knew one hundred percent that we didn’t want any more children but it was bittersweet.[37]

It can be difficult to know that you no longer have a say in what happens to your embryos. You may feel responsible if the transfer fails, and it could be distressing if there is prenatal screening and the adopting couple decides to abort. You can avoid some problems by careful choice of who will adopt the embryos (e.g. choice of a Christian family), but there are no guarantees. Wes and Gina chose a family they knew and were in regular contact with, but in the end it left them feeling they could have raised the little boy better. I think we now regret our choice. We realize what we missed, said Wes. One mother found it challenging when she heard the adopted baby was a girl, having had only boys herself. Many continued to feel that ‘their’ child was living with another family, but for some this was a positive thing—to know, having been infertile themselves, that they had been able to give the joys (and trials!) of parenting to another couple. Many couples saw relinquishment as a lifelong process. It would be good to see the development of appropriate support services for those involved.

While I am aware there are some Christians who oppose embryo adoption because they believe that procreation should always be the result of normal sexual relations using the gametes of husband and wife, I consider that relinquishment of excess frozen embryos to another couple for the purpose of reproduction is an ethical option for Christians. It rescues embryos that would otherwise be destined for destruction. It gives the embryos a chance at life, which was why they were created. And it is consistent with being as responsible a parent as possible in the situation where one cannot nurture the embryos personally.

‘Snowflake babies’ are the most powerful visual illustration we have of the continuity of life from embryo to live birth.

6. Donate to research

While embryo research has always been associated with the development of IVF, legislation around the world allowing destructive research on human embryos was closely connected to interest in embryonic stem cells (ES cells). This was certainly the case in Australia, where destructive research has been legal since 2002. Soon after taking office in 2008, President Obama lifted a ban on federal funding of ES cell research that had been in place in the United States for 8 years.

I liked the idea of donating to scientific research because without research we would never have been able to have our babies through IVF, said Rhoda. We thought about donating to another couple, said Joe, but I couldn’t live with the idea of my child growing up without me. He and his wife decided to donate to science because without science we wouldn’t be parents. Mary decided to donate to science to give life to other people: I know it’s not life for our embryos, but we’re still giving life.

One study found that the decision of whether or not to donate to science depended more on the parents’ perception of science and scientists, rather than their perception of the embryo.[38] They found that feelings of not having control over what would happen to their embryos, and vivid fears that scientists would allow their embryos to develop into children, were the main arguments against donation to research. One participant thought that “letting an embryo grow” was the only thing you could do with an embryo, obviously ignorant of the destructive nature of most research.[39] This also reflected a poor understanding of the 14-day rule for keeping embryos alive, as well as ignorance of research methods in general and embryonic stem-cell research in particular. A few participants thought research was inappropriate for an embryo: It is really like ‘do some tests on it’ and then into the rubbish bin with it. That’s science all right.[40] But most doubts were directed at the science itself: It may be a strange thought but they might very well transfer it into an animal, you know… Of course, this is a stupid example, but you never know, right?[41]

In terms of medical ethics, there is general consensus that parents must give informed consent before embryos can be donated for destructive research—that is, they must be given adequate information that is comprehended by a mentally competent person in a voluntary manner. However, there is no agreement on what ‘adequate information’ entails. It will vary with the parents concerned.

Donation of excess embryos for use in destructive research will be an unethical choice for Christians. This is because all human beings are made in the image of God and should be treated with respect (Gen 1:27, 9:6). It is wrong to kill innocent people (Exod 20:13). In view of the confusion surrounding stem-cell research, we will look at it more closely in the next chapter to discover the unique ethical challenges it involves.

Conclusion

One thing the research shows is that when there are leftover frozen embryos, parents need to be told about all their options, and these options need to be fully explored before a decision is made. In the end we account for all our own decisions to God and, we need to be at peace with that. This includes taking responsibility for having allowed the embryos to be created in the first place. In some places, the decision as to whether your embryos really are ‘surplus’ to your needs is made separately from the decision regarding what you will do with them. I think this can be a helpful distinction.

Finally, knowing that there may be options for leftover embryos should not make you more cavalier regarding how many embryos you request at the beginning of treatment. It is because of the accumulation of frozen embryos in the first place that these options are necessary. Apart from using all your own embryos, I see even the ‘ethical’ options as a compromise in a fallen world.[42]

Open your mouth for the mute,

for the rights of all who are destitute.

Open your mouth, judge righteously,

defend the rights of the poor and needy. (Prov 31:8-9)