Abandoned embryos: Clinics ethically free to dispose of thousands of embryos frozen in time, doctors’ group says

By Sharon Kirkey, Postmedia News September 8, 2013 June 15, 2006 -Seattle Reproductive Medicine clinic - when embryos are made (sperm and egg together in a petri            dish) manytimes there are more than can/should be put back in the uterus so they get frozen. also, sperm gets                    frozen. so these are pictures of our "freezers" the cryopreservation tanks where these are stored. . Photo by Photo            courtesy Seattle Reproductive Medicine, Handout                 It is the most emotionally charged issue in assisted baby-making: how to “dispose” of the thousands of human embryos that sit frozen in time in fertility clinics across Canada, believed abandoned by the couples that created them. Now, one of the world’s leading organizations of reproductive medicine says fertility clinics are ethically within bounds to discard these forgotten embryos  by removing them from their liquid nitrogen freezers and allowing them to thaw, destroying them in the process. There are an estimated 20,000 abandoned human embryos in the U.S. No one knows how many exist in Canada. One Toronto clinic alone has 1,000 unclaimed embryos in storage. In an updated position statement published in the journal Fertility and Sterility, the American Society for Reproductive Medicine (ASRM) ethics committee says it is “ethically acceptable” for clinics to deem embryos abandoned if at least five years have passed since contact with the couple, reasonable attempts has been made to reach them and no written instructions from the couple exist concerning how to dispose of their leftover embryos. The latest statement strengthens the group’s 2004 opinion on the “disposition of abandoned embryos.” Canadian fertility specialists say the problem has been growing since the first babies conceived in petri dishes were born more than 30 years ago. Since then, an estimated five million children have been born worldwide using in vitro fertilization, and the number of “excess” embryos left over after IVF continues to grow. “I know here at Lifequest we’ve got 1,000 abandoned embryos,” said Dr. Carl Laskin, a past president of the Canadian Fertility and Andrology Society and founding partner of Lifequest Centre for Reproductive Medicine in Toronto. The problem is creating “tremendous amounts of anxiety and stress” for IVF clinics, he said. However, a lawyer who specializes in reproductive law warns clinics could be liable for millions of dollars in damages if embryos are destroyed without the explicit consent of the individual or couple. “The clinic would need to prove how they tried to contact the couple,” Sherry Levitan said. “What if the clients moved? What if they left a voice mail, what if they sent a letter? What if, in some way, they did advise the clinic that they had moved and that piece of paper got lost? “I don’t care that the ASRM thought that disposal was ethical,” Levitan said. “The clinic either had the right to do it or they didn’t, in law. It has nothing do with ethics,” she said.  “That’s just making everybody feel good about it.” Even the committee says the law is unclear. There are an estimated 400,000 frozen human embryos in the U.S. Of those, fewer than five per cent are considered abandoned, “which is still a lot of embryos,” said Dr. Paula Amato, chair of the ASRM’s ethics committee and a Toronto native. The last official count of frozen embryos in Canada was conducted in 2003, when Dalhousie University researchers in Halifax reported a total of 15,615 embryos in storage in 13 clinics. However, there are nearly three times as many IVF clinics in the country today, meaning the number of embryos could be triple the 2003 count. “None of us like dealing with the abandoned embryo issue — it’s difficult for us, it’s not an easy decision,” said Dr. Matt Gysler, president of the Canadian Fertility and Andrology Society. “The important thing is to define, right up front, what to do if the couple no longer wants to take care of the embryos,” he said. “There has to be absolute clarity with the couple from the beginning — ‘if you walk away from this and nobody can reach you, here is what we are forced into doing down the road,’” he said. With in vitro fertilization, eggs are retrieved from the woman (or from a donor), mixed with sperm and the resulting embryos transferred to her uterus. But IVF usually produces more embryos than can be safely used at once (and clinics are increasingly moving to single embryo transfers to reduce multiple pregnancy rates). The best embryos are selected for a fresh transfer. The remainder are frozen. Unlike other countries, there is no time limit on freezing in Canada. There is also no known “shelf life” for frozen embryos. Babies have been born from embryos that had been cryopreserved for 20 years. Most IVF clinics have patients state in writing their wishes regarding “future disposition” of leftover embryos in the case of death, divorce, separation, failure to pay storage fees and other scenarios. But in some cases the couple moves away, drops out of treatment or can’t be contacted. Some have the children they wanted through IVF and can’t bring themselves to discard embryos they no longer want or need. ”There are religious issues that come into play, and moral issues,” said Amato, an associate professor of obstetrics and gynecology at Oregon Health & Science  University. But Amato’s group says clinics are under no ethical obligation to store embryos indefinitely, and that if a clinic “reasonably determines” embryos have been abandoned, they should be ethically free to dispose of them, although “in no case should embryos deemed abandoned be donated to other couples or be used in research,” the committee states. But even the determination of “abandonment” is legally murky. “At present, the law does not give clear guidance on when it is lawful to discard abandoned embryos,” the committee acknowledges. Given that, some programs might prefer to continue storing the embryos indefinitely, the committee says; others “will find the risk of liability to be acceptable.” Every clinic should have clear embryo abandonment policies, the group says. But the issue is fraught with emotion. “We can say, ‘OK, it’s been five years out. We didn’t hear from (the couple), we made every effort to get them and therefore we had to dispose of the embryos,” Laskin said. “And that’s the person that arrives on your doorstep and says, ‘we know it’s been some time, but we would like to go ahead and try this again.’ You’re then faced with that incredibly difficult scenario (of having to tell them) ‘we didn’t hear from you for five years, we couldn’t find you and we disposed of them.’ “Yes, you were ethically in the right to dispose of them,” Laskin said. “And so how does that make you feel when you’re facing this scenario?” “You can get those heartbreak case where the child has died and they want to try it again …. Yes, you’ve done your due diligence (to find the couple). But at the end of the day, what do you do?”            

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