A heartfelt dilemma: what to do with unused embryos after IVF

Each time Rachel Bailie, 36, drives past Fertility Associates, an IVF clinic in Hamilton, she beeps her horn and her two kids wave.

Inside the clinic is a single, viable embryo - a fertilised egg - frozen for more than 10 years. Bailie went through the IVF process in 2014 which was successful in the first round. She later went on to conceive a child without IVF, completing her family with a son and a daughter.

Ballie was somewhat prepared for the challenging rollercoaster of IVF with its invasive procedures and copious medications. What she wasn’t prepared for was the dilemma of what to do with the single remaining embryo that she and her husband decided not to use.

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At one stage, they planned to donate the embryo to either her sister or a friend, but both women conceived without it. Bailie won’t use it or donate it to strangers, but she also doesn’t want to discard it. Instead, she is paying about $600 a year to keep it frozen.

“When we think about it, you know, it’s a twin to our son Hayden and he is such a cool kid.

“While I see it as a cluster of cells and embryo, I can see in front of me every day what that can turn into and it’s such a beautiful child, so I’m like yeah, it’s hard to view it solely as just a cluster of cells.”

It’s unclear how many of the thousands of New Zealanders who do IVF each year have viable embryos they decide not to use. However, it's likely a small minority.

What is clear is that while some are happy for clinics to dispose of embryos or in rare cases, donate them, others find themselves attached to the microscopic cell cluster regardless of their belief about life’s starting point.

Legislation caps cryopreservation storage at ten years unless an ethical exemption is approved for a longer term. Ultimately, embryos must eventually be used, discarded or returned to patients. Those patients can choose to acknowledge and even mourn their “embabies” - a compound term of embryo and baby used by some - in meaningful ways.

Relationship and sex therapist Angela Rennie works with couples navigating the IVF journey. What to do with leftover embryos is often an unexpected hurdle after a long, hard road.

“There's usually a bit of grief anyway around when you decide you've had enough children or you're not going to have any more, but when that's also layered with what do we do with the embryos that are left over, it really compiles that pressure and grief and decision making.

“I've definitely worked with quite a few couples where the people have disagreed on what they wanted to do afterwards with the embryos.

“You're navigating two people's hopes and desires, grief, morals, values, and that's not always easy.”

Increasingly, single people are turning to IVF. This can be helpful when deciding what to do with surplus embryos, but there can also be a sense of isolation when the burden of choice sits on one set of shoulders, says Rennie.

For a mother of two in the Gisborne area, the one remaining embryo after a successful IVF cycle is always her “taonga,” the Māori word for treasure. The mother, who asked that her name not be used so she could openly discuss a personal matter, has one child through IVF and another pregnancy without IVF. By then, she was in her mid-40s, and it didn’t feel fair to her for future children to have older parents.

Storage fees were becoming a burden, so the family of four drove down in the April school holidays to collect their taonga from the Wellington location of Fertility Associates.

“We brought our taonga home, and so it was a real connection for our kids, for our tamariki.”

The family kept their taonga at home the first night in line with the tangihanga process (funeral rites) where the deceased is never left alone. The following day, the family visited the grave of the mother’s parents and returned their taonga to the whenua (earth).

Her first child, who was conceived through IVF, “felt a deep connection to our taonga as they are aware of their IVF journey. They were able to process and express their feelings of aroha [love] for our taonga and of loss and the end of the IVF journey.”

Like most fertility clinics, Repromed offers counselling as part of the IVF package including talking through what to do with unused embryos, says Dr Debbie Blake, the scientific director of the Auckland-based fertility clinic.

“A lot of people will say to us even when they’re coming through for IVF and they have created embryos, they will often say ‘Oh, these are my babies,’ already thinking of them in that kind of format. Not everyone, but certainly a lot do.”

In the early years of IVF, patients typically ended up with numerous viable embryos and way more than they could use, according to Dr Andrew Murray, the chief medical officer at Fertility Associates. Due to advances in technology and testing capabilities, this is becoming less common.

He estimates that about 20 percent of patients with surplus embryos request them back. When they do, Fertility Associates packages them in a small kiti, a woven flax bag, to mark an occasion that is felt differently by every person.

“...Many people, particularly our Māori patients, but others as well for spiritual reasons will still want the embryos returned and they might, you know, have some form of ceremony or way of commemorating those embryos or acknowledging them.”

A business located in Tauranga called Spilt Milk Co. recently began embedding unused IVF embryos into jewellery. The company also specialises in adding DNA, breast milk and cremated ashes into keepsakes.

The majority of patients at Fertility Associates direct the clinic to dispose of the embryos, says Murray. Current legislation prevents embryos from being used for research, but embryos of a quality too low for an IVF transfer can be used in training for genetic testing.

Very few patients decide to donate their embryos to others. It’s an arduous process that involves approval from the Ethics Committee on Assisted Reproductive Technology and mandatory counselling, including joint counselling between donor and potential recipient, says Murray.

Both Fertility Associates and Repromed can have trouble getting in touch with patients when their ten-year embryo storage term comes to an end. The clinics need both parties involved in creating the embryo to approve of disposing of it.

Sarah, a mother of two in Nelson, and her husband decided quickly after a successful IVF round that they were “one and done.” They considered donating their five remaining embryos to another IVF patient.

“We discussed donating them, but my husband was like ‘To me that feels like giving one of our children away,’ which I understood.”

They also agreed that they did not see their embryos as babies or anything more than a cluster of cells. In the end, they left it up to their IVF clinic to dispose of the embryos.

Bailie, who has her embryo frozen in Hamilton, will likely keep it there until the storage extension expires in about four years. Then, the family will have to make a decision.

The family has Māori heritage so her first thought is to bury it under a tree on her dad’s farm near where her children’s placentas are buried. In the Māori world, after a child is born it is customary to bury the placenta in the ground, often in a place with ancestral connections. Leaving the embryo with the clinic to dispose of isn’t an option.

“...I don’t know if that honours enough of the spiritual link for me.”