Many people know about the more “traditional” alternatives to family building. And on the show, we’ve already discussed a few options, surrogacy and egg donation. We all know about adoption and have all heard about sperm donation.
But there’s another path to non-traditional family building that’s not talked about as often – and it’s one that can often ease the mind for families who have surplus embryos and the financial burden for intended parents seeking to complete their family.
Welcome to Fertility Café. Today on the show, we’re talking about embryo donation – one of the many paths to modern family building. Embryo donation may sometimes be referred to embryo adoption. However, the correct term is embryo donation.
There’s a lot to cover on this topic – from the basics like how it works and where the embryos come from, to tough questions like the legal and ethical considerations behind the practice. We’ll examine the reasons why someone may choose to donate their surplus embryos as opposed to choosing another disposition for them. We’ll also look at the recipient side of things – how do you find and qualify to receive donor embryos? Where do you even start looking, and what kind of cost can you expect?
It’s a big topic with many different angles, so let’s dive in and learn about embryo donation together.
First, let’s define it. Embryo donation is one form of third party reproduction. It involves frozen embryos that are donated by one family and given to another family who desires to have a child.
Frequently, intended parents who undergo IVF have surplus embryos that are cryopreserved in a storage facility, either at a fertility clinic or a long-term reproductive storage bank. Once they decide their family is complete or have no intention to use the embryos themselves, donation becomes an option.
With embryo donation, these unused embryos can be donated to help someone achieve their dream of building a family.
Embryo Recipients can be anyone who needs third party reproduction to help them have a child. Married couples, single individuals, or anyone in need of embryos. Donated embryos become an option when perhaps it’s too costly to do IVF and create embryos. Or when it’s not an option to use one’s own genetic material or that of a partner due to medical reasons. Or sometimes intended parents can’t or don’t want to use donor eggs or sperm.
Where do the donor embryos come from, exactly?
You might be wondering, are there many embryos available to donate? Yes, more than you might think, actually! In the United States, it’s estimated as many as 400,000, or even more, embryos are cryopreserved currently, and it’s becoming problematic.
Just do a quick google search for “frozen embryos” and you’ll find dozens of sensational headlines about the problem. “Extra embryos – too much of a good thing” “The leftover embryo crisis” and “The great frozen embryo debate” are a few examples.
In some ways, this problem of too many embryos seems to have snuck up on the industry, leaving clinics scrambling for a solution, and it’s becoming a significant issue for clinics all over the country. Part of the issue can be traced to lack of regulation – there’s no overarching law in the US, as there is in other countries like the UK, about how many embryos can or should be created and about how long embryos can be stored. It’s one of the reasons embryo donation is getting a lot more traction these days – we need options for all these surplus embryos.
But never mind about the industry or what the clinics must deal with. Truth be told, IPs just don’t know what to do about their remaining embryos. There are no standards for educating patients about their options for leftover embryos. The goal for anyone seeking IVF treatments is to have a child – what happens next is often an afterthought.
When intended parents embark on IVF, it’s hard to know exactly how many quality embryos will be created and viable. It’s very much a numbers game. In last week’s episode, when I took us back to biology class, I talked about blastocyst stage of embryos. The goal during an IVF cycle is to produce several embryos that will grow to blastocyst stage. Embryos that survive to this stage of development have a high implantation potential once transferred into the uterus. But while embryos are being created, nobody can predict the future; Will they grow to viability, and or after transfer, will it produce a pregnancy and ultimately a child? The good thing is embryos, once created, are frozen in time and there when you’re ready.
The creation of embryos isn’t easy for many – from the cost of thousands of dollars, to the emotional and physical toll it takes to go through the whole process. Each one of those embryos represents a potential child. Each embryo is extremely important. They may also represent an enormous amount of struggle, so the decision about how long to keep them stored and ultimately what will become of them is emotionally charged, to say the least.
Because each embryo represents a potential human life, this can present some serious dilemmas for those IPs who have religious or ethical beliefs about when life begins and what role one should have in creating and deciding the fate of embryos. Choosing to create and then not use, or discard, an unknown number of embryos is challenging. In fact, this predicament stops some people from even beginning their IVF process.
Unfortunately, it’s a complex decision. So, the most common decision is the most obvious one, make no decision at all. Keep them stored. At this point in time, unless you’re otherwise told, embryos can be stored indefinitely.
Having the option to have surplus healthy embryos for future use can provide a peace of mind for IPs who want the chance to have a child or want to have more than one child. In some cases, delaying a decision may even be necessary. Maybe you’re putting off the decision because financially it’s not the right time. Or you want to hang on to the embryos as a sort of insurance – maybe in the future, we’ll want another child, so it’s comforting to know the embryos are there, waiting. And that’s totally fine – we all know that family and life situations change, and perhaps the time will be right to try for another child in a few years.
For others, there are legal battles being waged, leaving frozen embryos in limbo. Several cases have hit the news regarding the “custody” of frozen embryos. For example, if a couple divorces or separates but has previously stored frozen embryos, can one of the parties still use them? This is important to note because typically you may have more than one embryo and you and your partner, if you have one, have equal rights to those embryos.
One high-profile case in particular involved Modern Family star Sofia Vergara. She found herself in a multi-year legal battle with her ex over the custody of their embryos. The embryos were created with both of their genetic material, and they had intended to have a child via surrogacy.
When their relationship ended, the question of who could use the embryos became contentious. He wanted custody of them; she didn’t want them used. According to the agreement signed with the fertility clinic, which is typical in the industry, neither person could use the embryos without the other’s consent. The couple found themselves in and out of court for years.
Ultimately, the court ruled in favor of Vergara, stating that custody laws apply to living children, not embryos. It was a messy, multi-year battle. And cases like this happen more often than you might think. You can see how the legal and ethical waters can quickly get muddied here.
And for some it has nothing to do with any legal issues or religious or ethical beliefs. For many, the choice to discard embryos is an impossible one, but leaving embryos frozen indefinitely, stuck in a sort of limbo doesn’t feel right either. And so, the decision keeps getting delayed.
So, what do you do regarding embryo disposition when you’re confident that your family is complete? There are currently 3 options. You can have the embryos thawed and discarded. You can donate to science for approved medical research projects such as stem cell research or you can donate them to another hopeful intended parent. Let’s touch on each of these options.
Even saying it sounds harsh. Destroying embryos. A lot of people won’t even consider this option. But the reality of it is, some IPs would rather have the embryos thawed and discarded than to know that it’s used in research or that a potential child related to their own children is out there in the world.
There is also a less invasive process, in which the embryo is thawed and implanted in the intended mother’s uterus. However it’s purposely done during a period in which the likelihood of implantation is slim to none. So, there won’t ever be an actual pregnancy but the issue on what to do with the embryo is resolved in the gentlest way possible.
Although not a common practice, there are Intended Parents who instead of discarding or donating their embryos to another family, decide to donate them for embryonic stem cell research or studying human development. IPs often choose to donate their embryos for research because they don’t want a child related to their children with someone else and they don’t want the burden of keeping the embryos cryopreserved indefinitely.
The research can help reproductive scientists work toward more accurate and successful technologies, allowing modern medicine to help more people achieve their dreams of becoming parents. Some feel with this type of donation, they can still contribute to easing the infertility struggle for others.
Lastly, there is the option for embryo donation. Rather than put off the decision indefinitely, embryo donation is becoming an attractive and viable option for more and more people. Fortunately, modern science has given us alternatives to simply storing embryos forever or discarding them. Knowing that this option exists may also ease the mind of some who hesitate to start treatments, assuring them that they have a compassionate choice for their leftover embryos.
Now just to be clear, it’s not quite as simple as signing over the title of your car, but it’s also more accessible than you might think. In the year 2000, there were only 334 transfers using donor embryos. In 2016, there were 1,940, and it increases each year as awareness grows.
So, when does this decision of what to do with extra embryos come into play? Ideally, you should have an idea of options before you even begin IVF. It’s best to discuss, prior to creating your embryos, what your wishes will be if you have completed your family and still have remaining embryos. Even if your embryos are already created, and you haven’t had this discussion with your spouse/partner, it would be a good time to discuss your thoughts.
So how does one go about donating frozen embryos?
First, it’s important to understand that, at least in the U.S, frozen embryos are legally treated as property. In almost every state, courts consider contract law when determining what happens to them. This means you have complete control over where your embryos end up.
In some ways, the ease of your choice can depend on the fertility clinic you work with. If this issue is important to you, and you know you’d like to donate unused embryos, discuss their policy up front. Some clinics have their own in-house programs where they’ll work to match your embryos with their own patients. Clinics can vary wildly in how much control they give you over the process and what their requirements are for both donors and recipients.
You also have the option to use an independent matching or embryo donation agencies, or to find a match on your own.
Once you decide that embryo donation is the way to go, the next question is the type of donation you want to have. In the US, you typically have the choice between a known, or directed donation, or an anonymous donation.
With a directed donation, you get the option to select the embryo recipients. Much like child adoption or egg/sperm donation, you’ll be able to review information about the potential recipients – their demographics, careers, family situation, geographical location, etc.
One important point to keep in mind: any children born from these embryos will be genetic siblings to your own children. Be sure to consider this as you weigh questions like known vs. anonymous donation and potential future contact.
Directed donations give you more control over the ultimate disposition of your embryos, and it opens up the possibility to keep in touch with the recipient family for potential connections down the road. For some, the idea of a directed donation eases the worry about having a genetically-related child out there “somewhere” in the world. You can choose if and how often to keep in contact with the recipient family.
Other people don’t like the idea of knowing if or where genetically related children exist. They find comfort in not knowing, perhaps preferring to leave the outcome to fate.
With anonymous embryo donation, you won’t know who receives the embryo or whether it results in a live birth. You won’t have the option for future contact, other than perhaps the exchange of medical information.
In the case of an anonymous donation, your embryos are matched with an intended parent or couple who has typically been on a waiting list for a certain clinic or agency. Some clinics in the US, and some countries as a whole, only allow for anonymous donations, so be sure to find out your clinic’s policy ahead of time.
No matter which type of donation you choose, you can find a lot of joy in helping make someone else’s family building dream come true.
Ethical Guidelines According to the ASRM
While it’s true that the United States doesn’t have much, if any regulation on the federal level, most reputable fertility clinics refer to ethical guidelines established by ASRM, the American Society for Reproductive Medicine.
These standards give us a framework for the fair, ethical, and respectful handling of embryo donation.
Here are a few of the guidelines, to give you an idea. The ASRM states that:
1. “Selling” embryos is unethical, and donors shouldn’t be compensated. Just like you can’t and shouldn’t be paid to donate your kidney to someone in need, neither should you be paid for offering a human embryo to a hopeful parent.
2. Embryos should be screened for possible diseases, and relevant medical or genetic history should be shared with the recipient. If screening or medical history isn’t available for whatever reason, the recipient needs to be fully informed about the risks.
3. Psychological counseling is highly recommended for anyone considering embryo donation – both on the donor and the recipient side. It’s a highly complex and emotional decision best processed with a mental health professional. The mental help professional will discuss things like Family history, Current life stressors and ability to cope, The motivation to donate or to use a donated embryo, Reproductive history, History of abuse or neglect and Interpersonal relationships
There are other recommendations, but you get the idea. The ASRM gives fertility clinics an evidence-based framework for handling embryo donation ethically and appropriately.
While there’s no legal requirement for clinics to follow these guidelines, I think it’s a good idea to ask your clinic where they stand and how they determine their own policies and procedures for embryo donation.
But what happens if your fertility clinic doesn’t offer embryo donation, or you don’t like the options they give you?
Remember what I said earlier about the legal status of embryos in the US? They are legally your property, so you have the right to go elsewhere to donate your embryos.
There are many private, independent organizations that assist in matching embryo donors with hopeful recipients. You will likely have to pay a transfer fee to safely move the embryos from one facility to another. Ultimately, you have the right to donate your embryos apart from the clinic where they are stored.
If you decide you’d like to have a directed donation but your clinic only allows anonymous donations, for example, you’ll need to go elsewhere.
In the United States, you generally have three options at this point.
1. You could go to a different fertility clinic,
2. You can use an independent embryo matching or “embryo donation” agency,
3. Or, you could find a private match between individuals
Because there’s no federal standard for fertility clinics regarding donation, another clinic may end up being the right fit for you. As mentioned before, each one sets its own standards and guidelines for how you can donate.
What about the other two options, though? Independent agencies or private matching? Each option has its own pros and cons, so let’s look at these in more detail.
If you want more control over the process, an independent matching or “embryo donation” agency may be the right choice. The term “adoption” gets used often and can get a bit confusing when used to refer to embryo donation. We’ll talk about this more later, but for now, just know that this term is used by some organizations.
If you are searching for an agency to help you donate your embryos, be sure to do your homework and choose one that has a mission that aligns with your values.
Check with each group about how they qualify recipients. Some are more inclusive than others, allowing recipients of various marital statuses and sexual orientations. Some are very restrictive, allowing only married couples or preferring people of a certain faith. Potential recipients may have to submit to interviews or even home studies.
The third option, finding a private match, also gives you a lot of control over the process. Perhaps you know someone who has had a difficult path to parenthood, and you feel called to donate your embryos to them. Maybe you see a plea for donations on an online message board or in a Facebook group, and you feel like this may be the right recipient for you.
There are several online matching services out there to help you find the right one. Kind of like online dating – potential donors and recipients post profiles, hoping for the right fit. You, as a donor, can sort through profiles on your own, or sometimes, you can ask the service to help you with the selection process. While you have more control and potentially unlimited preferences you can specify, this option requires you to navigate the legal waters of embryo donation on your own.
Agencies and clinics usually have contracts and standards in place already. Going the private route means you’ll need to seek this out on your own. A lot of clinics won’t even move forward with transferring your embryos without clearance from attorneys on all sides.
With a private match, you’ll need to consider details like the type and amount of future contact you’ll have with the recipient; whether you want to be informed if there is a live birth as a result of your donated embryo; if you’ll be required to update your recipient about any future medical or genetic issues, and more.
You and your partner, if you have one, have a lot riding on this decision. Will your own children have genetically-related siblings out there somewhere, and if so – do you want to know? Do you want them to have the possibility of a relationship in the future? Do you agree to be contacted in case of future medical complications? Are you emotionally prepared for meeting a child that is genetically related to you but is not your child?
These are all questions that weigh heavily on the minds of potential donors. As you can see, it’s not an easy decision to make, and I’ll emphasize once again that it’s very important to meet with a mental health professional to help you and your partner process through the emotions involved.
So far we’ve discussed how and why someone might choose to donate their embryos. Now let’s examine how and why you might want to seek a donated embryo.
As I’m sure you know, making a baby isn’t always easy, and the choices for how to get there are numerous. Perhaps you’ve struggled with infertility, multiple pregnancy loss, or other underlying medical conditions. Maybe you’re pursuing parenthood as a single person, or you’re in a same-sex relationship, so the traditional means of having a baby aren’t options for you. Embryo donation may be an option for hopeful parents in all sorts of situations.
Once a donor family and a recipient are matched and all the legal and medical details are worked out, the rights to the embryos are transferred to the recipients. The recipients then have the option to transfer the embryo into the uterus of the intended mother, or it could be that of a gestational carrier. For more information about surrogacy, check out episode 2 of Fertility Cafe.
Using a donated embryo cuts out the first steps of IVF, which can not only improve your odds (depending on your unique fertility situation), but it can also save you money. While we’d all like to say that money is no object when pursuing parenthood, the fact is: IVF is very expensive. If cost is keeping you from this type of treatment, perhaps using donated embryos could help.
Once you’ve been cleared by your doctor to purse pregnancy via donor embryo, your search for a match begins.
So, what are your options for finding donated embryos?
Depending on the clinic you work with and your own personal preferences, you may have a lot of support in this, or you may choose to search on your own. We talked earlier about the three options for donors. Now let’s look at it from the perspective of someone seeking donor embryos.
First up: fertility clinic programs
Many fertility clinics offer in-house programs where they match donors and recipients. This can be a win-win for all parties. As I mentioned earlier, clinics across the country are overflowing with unused frozen embryos, which causes serious space and storage issues.
Former IVF patients find themselves in moral quandaries over what to do with the remaining embryos. And hopeful patients are desperate for cost-effective, successful paths to pregnancy. If a clinic has an in-house donation program, it can be mutually beneficial for all involved.
The disadvantage could be limited supply. If you’re looking for embryos with a particular ethnic makeup, for example, you may have to expand your search. If the clinic requires donors to be anonymous but you prefer to have open communication with your donor family, you’ll need to look elsewhere.
Ask your clinic about their process for matching donors and recipients. How specific are donors able to get with their preferences, for example? Most will allow donors to specify their preferences for recipients of their embryos – for example, the age, ethnicity, religion, or geographical location. Some, although not many, will allow donating families to interview and select recipients personally.
Does the clinic have an upper age limit for the age of the donor and/or the recipient? Do they give preference to recipients who have no previous children? Do they have a standard for how old is too old when it comes to the age of the embryos? These are just a few of the questions you’ll want to ask.
In general, it can be a relief to have one clinic coordinating all the pieces of your embryo donation journey. It can also be more cost-effective, saving you money on things like travel or transport of the embryos.
What if your preferred clinic doesn’t offer a donation program? Or perhaps you’d like more control over the process than your clinic offers? What if the waitlist is way too long?
There are several organizations in the U.S and abroad that help match donors and recipients. These independent groups vary wildly in mission, process, pricing, and wait time.
Just do a quick Google search for “embryo donation agency” and you’ll see a number of options. It can certainly seem overwhelming at first. So let’s look at some key points to consider.
My first suggestion is to look at the organization’s “About” page. Do they have a religious affiliation? What is their mission statement? Do their values align with yours? How long have they been in existence, and where are they located?
Next, check out their requirements for both donors and recipients.
How do they qualify recipients? Some treat embryo donation more like adoption, where the potential recipients complete home studies, counseling, and meet a list of requirements. In fact, there are even some agencies that coordinate both infant adoption and embryo adoption.
For me and for many within the reproductive technology community, the term adoption is problematic when applied to embryos. Still, it’s worth mentioning because you will definitely come across this term as you research your options. We’ll dive into the debate about using the term “adoption” in a little bit.
For now let’s keep talking about the pros and cons of using a private organization to find donor embryos.
For donors, private agencies can be attractive because they offer more control over who receives their embryos. The flip side for you as a recipient is that these tend to be very restrictive about who can qualify.
If the group is religiously affiliated, some, but not all, may require that the recipients be a married man and woman. Clearly, if you are a single person or a same-sex couple seeking a donor embryo, that wouldn’t be a good match for you.
As I’ve mentioned, there is no overarching regulation or law that dictates how embryo donors and recipients should be matched, so it can vary wildly from group to group.
You should also take some time to research the organization’s reputation. Check online reviews, look for testimonials, ask for references, and cross-check the credentials of board members or founders. It doesn’t happen often, but there have been cases of fraudulent agencies taking advantage of hopeful parents.
In general, just be sure to do your homework. Learn as much about the organization as possible, and educate yourself about their processes. There are several reputable agencies out there that have helped match hundreds of donor families with recipients.
On average, the cost for using a service like this will be a bit higher than going through a fertility clinic, but you may be able to find a match more quickly. We’ll talk more about costs for all these options a little bit later.
A third option exists as well – finding a private match. With the prevalence of technology today, it’s becoming easier to find and connect with likeminded people everywhere. I’ve heard multiple stories of intended parents finding matches via social media.
While not the most common scenario, it does happen. A more likely alternative, though, is to use an online matching service. There are several that are either low or no cost, and they allow both donors and recipients to post profiles.
Donating families can specify any criteria or preference they wish, and they have complete control over the selection process. As a potential recipient, you can also search for and reach out to possible matches.
There’s often a cost advantage to finding a private match. You won’t be paying agency fees, and the cost to join an online matching service is either free or very inexpensive.
As you start looking into various groups, websites, and blogs for your embryo donation journey, you’ll surely come across the term “embryo adoption” – a lot of people are confused by this and aren’t sure if it’s the same thing.
I’ve alluded to the problematic nature of this term a few times, so let’s dive into that now. First of all, the ASRM’s stance is that “adoption” is not an appropriate term to use when talking about embryo donation. Why, exactly?
Well, the term “Adoption” implies certain legal rights and responsibilities. The adoption of a child is strictly regulated by state and federal governments, and it carries with it all sorts of legal obligations – as it should! But to apply these legal rules and procedures to human embryos, who have the potential for life but are not yet living, would be placing too much of a burden on potential recipients.
Imagine if every person who attempts pregnancy via donated embryo were required to go to court for parental rights. If they were forced to undergo home visits prior to attempting the embryo transfer. If they were required to complete parent education classes…And then they go through the transfer process, and the embryos never result in a live birth.
Ethically speaking, the ASRM and many other professionals in the field, believe this is too great a burden to place at this point in the fertility process. In reality, the success rate for frozen embryo transfers hovers between 25-35%.
When someone receives a donated embryo and gives birth to a child, there is no question about who is owed parental rights. There is no need for a court order declaring who is the legal parent.
When someone refers to this process as embryo adoption, they’re making the assumption that the embryo is the same as a living child. This simply isn’t the case – yes, it has the potential to become a human life, but the scientific and legal community can’t bestow rights of personhood on an embryo. Courts have consistently sided with the argument that adoption laws only apply to living children.
The phrase “embryo donation” is the preferred terminology within the industry.
As you weigh all this information and start to consider if embryo donation may be the right path for you, I’m sure you have a thousand questions swirling around. I’ll do my best to answer some of the ones that come up most frequently with the parents I’ve worked with.
First, how can you know you’re getting a “healthy” embryo?
In the United States, the FDA requires that both the male and female donors be tested for certain diseases before their embryos can be donated. These screening tests check for HIV, Hepatitis B and C, gonorrhea, chlamydia, and a few other diseases. The donors also undergo blood typing and RH factor tests.
Similar to the information you receive when selecting a sperm or egg donor, you should have access to the medical history of the embryo donors. The more information you have about medical and genetic history, the better you’re able to anticipate or identify potential medical issues down the line.
Even if you receive an anonymous donation, it’s wise to request access to the donors’ medical history report. The fertility clinic or agency should be able to help you get this. If you’re using a private donation, make sure your attorney includes access to medical history in your contract.
Sometimes, it’s possible for embryos to be genetically tested prior to implantation. They can be checked for genetic anomalies or other problems, which can greatly increase the chance of success. Be sure to find out if the clinic you use has this option.
Another worry a lot of people have is about the parental rights of the genetic parents. Will they have any claim to the embryos or any children that are born as a result of their donation?
In short, no. If the genetic parents have signed an agreement to donate their embryos, then they are obligated to transfer the embryos per their contract. They have no claim to parental rights at all.
Perhaps one of the biggest worries I hear expressed is also the most important one: will it work? Will this help me have the child I’ve hoped for all this time?
As with other alternative paths to parenthood, it depends. There are many families out there who have successfully had a child thanks to embryo donation, but of course every situation is unique. Success rates vary based on a few important factors, including the quality and age of the embryo, the age of the recipient and the donor, and the embryo’s developmental stage when frozen.
According to a 2016 report by the CDC, the live birth rate from donated embryos was between 43-45%. Other sources cite a rate closer to 35%. Again, it can vary based on a lot of different factors, so be sure to discuss this with your doctor.
As with any form of third party reproduction, cost is a major factor intended parents have to consider. The good news about embryo donation is that, for many, this option is more affordable than others.
Obviously, the actual cost can vary, but in general, it’s less expensive to use a donated embryo than to complete a full cycle of IVF. The average cost for one cycle of IVF is somewhere around $12,000.
But with embryo donation, you’re skipping the first portion of the IVF process. Rather than go through the egg retrieval and embryo creation process, you skip forward to the transfer step. Because you’re bypassing these first stages, you can expect to pay less. On average, the cost to attempt pregnancy via embryo donation can range from $2000 to $10,000 or more.
As I mentioned before, it’s considered highly unethical to purchase or sell a human embryo, so the cost doesn’t come from that. You’ll be on the hook for other expenses relating to the process. Some of these may include:
● The clinic’s frozen embryo transfer fee
● Psychological or medical evaluation for yourself and the donors
● Legal representation
● Your own medications, ultrasounds, and other treatments
● Travel expenses for you, if applicable
● And sometimes you’ll also be asked to reimburse the donor for their embryo storage fees.
In general, though, this option is more affordable than other alternatives.
After all this, you may be left wondering: is embryo donation right for you?
Whether you’re weighing the difficult decision of what to do with your frozen embryos, or you’re seeking a viable path to parenthood, embryo donation could be the answer you’ve been looking for.
I hope the information I’ve presented here has helped shine a light on the possibility that exists with embryo donation, and that I’ve been able to clear up some questions you had. For more information, check out our resources page at TheFertilityCafe.com.
Thank you so much for joining me today on Fertility Cafe. I’m Eloise Drane, remember “Love has no limits, neither should parenthood.”
