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Unused Frozen Embryos End Up In Limbo

Fertility clinics must do better job staying in touch with past clients, study says

THURSDAY, July 5, 2001 (HealthDayNews) -- Fertility clinics need to do a better job of keeping in touch with past clients, so the clinics will know what to do with stored frozen embryos, new research suggests.

A study of couples who went through in-vitro fertilization at one clinic in Chicago and had unused embryos stored in the clinic's freezer found that more than 40 percent of the couples could not be contacted after three years. And of those couples who could be reached, less than 30 percent wanted to stick with their initial choice of what to do with the unused embryos, the researchers found.

"As part of the in-vitro fertilization process, we wanted to know the answer to a simple question: How many couples left unused frozen embryos in the freezer?" says lead author Susan Klock, associate professor of obstetrics, gynecology and psychiatry at the Northwestern University School of Medicine in Chicago.

"The question is important because in the U.S., we do not have the same rules they have in the United Kingdom where every five years everything gets thawed and destroyed."

During in-vitro fertilization, sperm and eggs are joined outside a woman's body. Some of the resulting embryos are placed in the uterus, and some are frozen, in case the woman fails to become pregnant, Klock says.

"It's a difficult process and the results vary," she says. "Only half the couples even have anything frozen. Some women can only have a few eggs harvested, while others get an excess."

Klock says most U.S. clinics use guidelines established by the American Society of Reproductive Medicine (ASRM) to decide what to do with frozen embryos.

"When you create the embryos and put them in the freezer, you get both partners' permission as to what they want to do with the frozen embryos if they're not claimed later," she explains. "And the [ASRM] guidelines suggest that you contact the couples after a certain period of time, which varies from clinic to clinic."

Couples are generally given three choices during the "informed consent" process, Klock adds. "The couple can agree to use the embryos again to try and get pregnant; they can agree to have the embryos thawed and disposed of; or they can donate them to either research or another couple."

Klock and her colleagues searched the clinic's records on the 404 couples who had embryos stored between 1991 and 1997.

"By February of 2000, 107 of those couples still had embryos in the freezer, and 16 of those couples were still in treatment," she says. "And of the 91 couples that were left, we tried to contact them over a period of three months, using certified letter, phone, poring through birth announcements, searching every record we could find.

"We could only locate 52 couples, and that's consistent with international studies," Klock adds. "And when we spoke to them, 17 of the couples chose to dispose of the embryos, seven chose to donate them to an infertile couple, five donated them to research, 15 wanted to continue the storage, six wanted to undergo another transfer cycle [try to get pregnant again] and two were undecided."

Klock says the researchers then compared the couples original consent forms with the new choices. "What we found was that only 12 couples kept to the same original disposition choice."

The findings are published in a research letter in the July 5 New England Journal of Medicine.

It's not uncommon for couples to abandon frozen embryos, says Sean Tipton, a spokesman for ASRM in Washington, D.C. "Infertility is an emotionally devastating disease, so it is very common for couples to want to put the disease behind them, and that can include not informing the clinic or physician when or where they move."

Tipton says ASRM has developed ethical guidelines for clinics.

"Basically it says, after five years, if you cannot get in touch with the patient, it's acceptable to consider [the frozen embryos] abandoned and dispose of them. Our committee also suggests if you don't have consent for any other use, that the embryos should be destroyed. You need to have specific consent to have them donated for research or to another couple," he says.

Klock says her findings point to the need for a "national discussion" on the disposition of frozen embryos.

"We have to be cognizant of the fact that people change their minds about what they want to do with these embryos. Given the controversy over the use of these embryos in stem-cell research and the ethical issues surrounding the use of frozen embryos, I think there needs to be a national discussion about the issues these frozen embryos represent," she says.

What to Do: For more on in-vitro fertilization, visit the American Society of Reproductive Medicine. And for more on the ethics surrounding frozen embryos, see this Harvard University Web site.

SOURCES: Interviews with Susan Klock, Ph.D., associate professor of obstetrics, gynecology and psychiatry, Northwestern University School of Medicine, Chicago; Sean Tipton, spokesman, American Society of Reproductive Medicine, Washington, D.C.; July 5, 2001, The New England Journal of Medicine
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