Frozen in Time: Exploring the Options for Surplus Embryos

Thousands of unused embryos sit frozen in fertility centres across Canada, their futures uncertain. Three of those belong to Karma Brown, who explores the choices for her surplus embryos and the challenges that come with those decisions

Illustration by Michael Byers

Illustration by Michael Byers

A day after the 2003 blackout hit Toronto, I received a message on my cellphone from our fertility clinic—one I didn’t get for days thanks to spotty cell coverage up north, where we’d headed to escape the blackout’s borders. The clinic left the message to reassure us that while they had lost power, the laboratory generators had kicked in. All of our embryos were safe and sound, chilling in their liquid nitrogen bath.

I remember the (mild) grip of guilt when I realized I hadn’t even thought of the embryos; the way I would feel now if I forgot it was my daughter’s show and tell day at preschool. But that was long before I became a mother. At the time, those embryos were no more than a cluster of cells that had the potential to become something greater. So rather than cry with relief, my boyfriend and I joked about our lack of embryo-parenting skills.

Today, things look different. I am nine years post-cancer (the reason we created the embryos) and considered cured. The boyfriend and I are married, and we have a four-year-old daughter from that lot of frozen embryos. And I no longer see our remaining three embryos simply as cells. One day they could look just like our daughter, who looks just like me. Or perhaps like their dad. Either way, our black and white world of cells versus children has become tinged with shades of grey.

Frozen Embryos in Canada
It’s estimated there are tens of thousands of surplus embryos frozen in fertility centres across Canada. No one knows exactly how many because there’s no national database or tracking system. Many of these embryos will never be used, as storage fee payments lapse and parents can’t be tracked down. These embryos are often termed “orphaned,” which admittedly sounds harsh. But only, I suppose, if you view embryos as babies. Which my husband and I do not.

When someone asked me recently what would happen to our embryos if we were to die, I paused. I had no idea. We currently don’t have a will, although we’re fixing that pronto. But it wouldn’t have even occurred to me to put our embryos in a will (once again, not winning any embryo-parenting awards here). So I asked Sara R. Cohen, fertility lawyer and owner of Fertility Law Canada at D2Law LLP, what rights clinics have regarding unused embryos. My dramatic writer’s brain had cooked up scenarios involving research experiments or another couple getting our embryos, but Cohen quickly put my imagination in its place. “The clinic can only act in accordance with the written instructions provided by the parents before abandonment,” she explained. Having said that, most clinic contracts state they have the right to dispose of excess embryos after a specified period of time of non-payment of storage fees. However, they could never donate the embryos without explicit consent.

So back to our embryos and their future. There are four choices to consider: discard the embryos, use them, donate them to research or donate them to another couple. I remember a comment left on my blog years ago (anonymously, of course) asking why I thought I had any right to choose the fate of our embryos. I’m not sure whose decision she thought it was (although I have some idea), but it highlighted the ethical dilemma. However, Canadian law does not recognize an embryo as having legal rights, so, at least according to the law, we’re the only decision-makers.

Option 1: Discarding Surplus Embryos
Because we aren’t in the life-begins-at-conception camp, the easiest option logistically (perhaps not emotionally) would be to discard the embryos. Essentially, a lab technician would dispose of them in our clinic’s biohazard waste bin. I’m not inclined to sign off on this method since a lot went into creating these embryos—cancer, trust, vision, money, tears and love. And with all that on the table, the waste bin option feels, well, trashy.

For the life-begins-at-conception folks, this is the destruction of human life, akin to murder (seriously, go Google “embryo + destruction”). While I understand this position, both my husband and I believe life begins when a baby takes her first breath. Yet, we have a child who started as one of those embryos; we have seen first-hand what eight cells can become. So I’m nixing the waste bin…at least for now.

Option 2: Using Surplus Embryos
One of the obvious options, and certainly the most warm and fuzzy, is to use the embryos. Find a healthy uterus and cross our fingers for a baby. But we aren’t keen on another surrogacy, both due to the expense (the reimbursement of costs the altruistic surrogate spends on the pregnancy) and the challenges of finding someone. My sister successfully carried our daughter, but she was a one-time deal (we all agreed). So we would need to find a stranger to knock up. And that takes money, trust and, honestly, a bit of a miracle.

Canada only allows altruistic surrogacy, meaning you can’t pay someone to carry a baby for you. Gestational carriers are few and far between in this country compared to the U.S., where surrogacy is fee-for-service in some states (it is, however, illegal in others). We did find a surrogate once before, when our daughter was six months old, but it ended up being an epic failure. So while we haven’t completely closed the surrogacy door, we’ve bought the deadbolt.

But it turns out our clinic offers another option to use the embryos: a vaginal transfer, also known as therapeutic disposal. They place the embryos in the vagina, where no baby would grow. While this is tempting—there’s something poetic about putting the embryos to rest near where they started their journey, and my clinic offers it free of charge—I can’t ignore that no matter how awesome my vagina might be, the embryos are still being discarded. Just in a fancier bin. It’s kind of like preparing for a party when you haven’t invited a single guest.

Option 3: Donating Surplus Embryos for Scientific Research
When I first thought about donating to science, I was partly intrigued and partly freaked out. I knew nothing about stem cell research and have an overactive imagination—a bad combination.

So I met with Andras Nagy, MD, and his wife and research associate, Kristina Nagy, at the Samuel Lunenfeld Research Institute at Mount Sinai Hospital in Toronto. Dr. Nagy is credited with creating Canada’s first-ever embryonic stem cell lines, and the research they’re working on is truly mind-blowing. Embryonic stem cells, also called pluripotent R cells, are unique because they can turn into any other cell in the body. But, unfortunately, the only way to get at these pluripotent cells from an embryo (which come from the inner cell mass) is through the embryo’s destruction pre-implantation. Hence the ethically charged debates that besiege stem cell research.

If we check off “donate to science,” two choices really exist: “One is embryo research, for example, to optimize in vitro fertilization conditions,” Dr. Nagy explains. “But the other is stem cell research.” If we choose embryo research, it’s likely our embryos would never leave our clinic, instead being used for things like training or improving methodologies. But if we choose stem cell research, well, that’s where things get complicated.

“It’s strictly regulated; it’s a legal landscape,” Dr. Nagy says of embryonic stem cell research. And those strict regulations apply to the researchers, the donors and the clinic itself. There are multiple layers of consent and there can be no contact between the donors and researchers, who also can’t pay anything for the embryos. Along with consents and co-ordinating with the Nagys’ lab, our clinic would need to remove all markers linking us to our embryos. They would then be coded with new identities (I like to imagine them sporting 007 codes), and we would never know their fate.

Last year, Dr. Nagy’s lab was approved to receive 15 human embryos for research, a number they chose, he explained, to limit getting more than they actually needed. And while pluripotent-like cells have now been created without embryos, Kristina Nagy says the reality is human embryos will still be needed for research for “a considerable amount of time.”

Option 4: Donating Surplus Embryos to Another Couple
If you can’t fathom destroying your embryos or donating them to science or research, there is another option—as long as you’re okay with the idea of your offspring being raised by someone else.

In Canada, you can donate your embryos to another couple altruistically, either by designating a couple or through an anonymous program. But most of the Canadian fertility centres don’t offer embryo donation (including ours), which means embryo parents may not even be aware it’s an option, or that they can choose the recipients. “A big problem in Canada is that people are generally unaware that embryo donation need not be anonymous,” Cohen says. “There is nothing in the legislation preventing embryo donors from choosing to whom the embryos will be donated.”

Kerry Vandergrift, executive director of Beginnings Family Services—a faith-based organization that provides counselling services through its four Ontario locations (and adoption through one), and the only embryo donation program in Canada not attached to a fertility centre— is the first to acknowledge this choice is not for everyone.

Beginnings’ program (started in 2010) is an open one, which Vandergrift likens to bringing in-laws into your life. “If you think you’re just handing over embryos and that’s the end of it, you’re not,” she says. Instead, like in-laws, the donors and recipients are encouraged to become part of a larger family—one that includes a level of openness Beginnings feels is best suited to the child. Now, of course, “openness” could be as simple as ensuring the parental information is exchanged, or it could mean spending holidays together and melding family events.

The Centre for Fertility and Repro­ductive Health at Toronto’s Mount Sinai Hospital is one of only a handful of clinics offering embryo donation in Canada. Unlike Beginnings, theirs is an anonymous program (although they do offer a contact information disclosure option, commonly referred to as the open identity option) and is open to the clinic’s own patients or those who have asked their doctor for a referral. Samantha Yee, a social worker at the clinic, explains part of the dilemma with the program is how time-consuming it is. “It’s not as simple as matching embryos to a couple,” she says. In fact, it took Mount Sinai nearly two years to get the program up and running (it started in 2011), and Yee says many couples considering donation decide not to proceed once they discover all that’s involved, including psychosocial assessments and counselling.

Embryo donation is far from a trend. Beginnings has made six matches, but none has yet to result in pregnancy. They have about a dozen families on an embryo recipient waiting list, and in the last year they’ve had 10 couples offering to donate embryos. Yee wouldn’t disclose if any babies had been born through the Mount Sinai program. But both Vandergrift and Yee are hopeful the programs will grow as more people learn about and consider embryo donation.

So would we donate our embryos to another couple? It’s a lovely idea, but no. I always imagined having more than one child and the idea of our daughter’s sibling growing up without us knowing him or her is inconceivable. Cross that one off the list.

Option 5: Keeping Your Embryos Frozen
Where does all this leave us? Well, in limbo, much like our frozen embryos. And while I can’t be certain we’ll never use them, or make use of the biohazard waste bin, or donate them to stem cell research, what I do know is that one of our embryos became our daughter. And as such, they matter. We’ll likely add a line in our budget called “Kidsicles” and allocate the annual $250 to keep them frozen indefinitely—which I suppose is choice number five. That decision, at least, is an easy one to make.

2 responses to “Frozen in Time: Exploring the Options for Surplus Embryos”

  1. paulaschuck says:

    Great educational piece here Karma! Thanks for sharing. These are incredibly difficult decisions becoming more relevant as fertility and reproductive science progresses. Thanks for enlightening readers.