Embryo donation
If an individual decides to donate their unused embryo(s), they have two main options:
- Donating to other couples or individuals who are experiencing infertility
- Donating for medical research purposes.vii,viii
Evidence shows that many individuals worldwide support the donation of unused embryos to others and/or to research. For example, a survey of over 471 Swedish couples that had surplus cryopreserved embryos found that 73 percent of respondents were in favor of embryo donation being permitted in Sweden, and 77 percent supported donating surplus embryos to other infertile couples.ix Furthermore, approximately 57 percent believed embryo donation for research should be permitted.x It is worth noting that these percentages represent patients from clinics in Sweden and peoples’ views on donation will vary by region.xi,xii,xiii,xiv
Donating embryos to others or to research both contain their own emotional, financial, and ethical considerations. In addition, as will other choices surrounding embryo disposition, the ability to make this decision may be subject to federal or state/ provincial legislation.
Donating embryos to other couples
Donating unused embryos from IVF to other individuals or couples facing infertility can offer hope to others on their own journey toward parenthood. How this can happen may vary - some clinics offer the option to store embryos that could be used by other patients, or it can happen through local or national organizations which match donor embryos to couples.
There is not a large body of research on embryo donation because of the relatively small number of incidents of donation (compared to other procedures) and the difficulty in tracking the process. The most recent data indicates that donating embryos to other families is not the most common choice for those with surplus embryos, however the patients that do choose to donate their embryos feel positive about their decision.xv
Some of the pros and cons of donating embryos are listed below, for both the donors (Table I) and the recipients (Table II).
Table I. Some reported pros and cons of embryo donation, from a DONOR perspective
The option to receive donated embryos provides another option for achieving parenthood in fertility patients that remain childless following other types of assisted reproductive treatment.xxv,xxvi It is worth noting that accepting a donated embryo is not comparable to adopting a child,xxvii and embryos do not always result in live births. Table II outlines some advantages and limitations of receiving embryos that were donated (table II).
Table II. Pros and cons of embryo donation, from a RECIPIENT perspective
Donating embryos for medical research
Some couples opt to donate their surplus embryos for scientific research,xxxv,xxxvi,xxxvii which can contribute to advancements in reproductive medicine, embryology, and regenerative medicine.xxxviii,xxxix,xl
The percentage of IVF patients that support and/or choose to donate surplus embryos to research is highly variable by region. Reported values in published research range from 7 percent in Francexli to 73 percent in Switzerland.xlii However, many of the studies are older and newer research is needed to assess current choices on donation of embryos.xliii One study the US observed embryo donation to research over 50 percent,xliv however values are also variable depending on the clinic and state.
There are a variety of reasons that people may wish to donate their surplus frozen embryos for medical research, such as the “desire not to waste embryos”, “desire to help infertile couples,” and/or “to advance scientific knowledge.”xlv,xlvi,xlvii
Some potential benefits of donating embryos to medical research are:
- Deepening knowledge and understanding of the early stages of human development
- Furthering new techniques and procedures in fertility medicine and training of new embryologists to help build new families
- Contributing to stem cell research and treatments, which can help treat certain medical conditions, such as blood and bone cancers, metabolic disorders, and degenerative diseases.
Please note some jurisdictions prohibit or severely limit donating embryos for medical research.
When surveyed, couples who were asked about their attitudes towards donating unwanted embryos to medical research viewed this option more positively in the following situations:
- Belief in societal benefits of research on human embryos, including benefits to IVF patients and societyxlviii
- Better understanding of science and medical researchxlix
- Desire not to “waste” embryosl,li
- Viewing the embryos as a valuable resourcelii,liii
- Feeling that one’s family was completeliv
For those against donating their unused embryos to research, a recurrent theme in survey answers was the moral or social status of embryos (i.e. as a child or future child), and the lack of control over the type of research for which there would be used.lv,lvi,lvii
The factors discussed above highlight the importance for clear communication and fully informed consent on the part of researchers and clinicians when discussing the options for embryo donation.
Embryo destruction (discarding embryos)
Some couples choose to thaw and discard their surplus embryos, effectively ending their potential for development. This option may be emotionally difficult for some, but it provides closure for those who are not comfortable with other disposition options or who have exhausted all reproductive possibilities. The process involves allowing the embryo(s) to come to room temperature without intending to transfer them or use them for any other purpose. The embryo(s) are then safely handled and disposed of by the clinic.
Personal grief rituals
A person or couple may find the donation or destruction of unused embryos brings grief for many different reasons. Some may grieve that they will no longer have any more babies as they have completed their family, while others may have wanted to have more children but cannot due to financial barriers or other personal reasons. Creating personal grief and memorial rituals can play a crucial role in facilitating healing and can provide a sense of closure.lviii These rituals serve as meaningful expressions of grief,lix allowing individuals and couples to commemorate their embryos’ existence and navigate their emotions. While there is not much research specifically about grief associated with embryo destruction,lx and each person’s experience and emotions will be individual to them, here are a few ideas that may be helpful:
- Planting a memorial tree or garden: Some people choose to place their embryo(s) under a newly planted tree or bush, which they can observe as the seasons change and the years pass while reflecting on their family-building experience.
- Having a ceremony or memorial: Setting a specific date where a person can honor their embryo(s) through lighting a candle, writing a letter or a poem, painting or creating art, or reading a favorite poem to remember their embryo can be a way to acknowledge and process their feelings, and reflect on how their grief changes over the months and years that go by.
- Observing cultural or religious traditions: It may bring comfort to observe cultural or religious practices surrounding grief and loss. This is not well-documented in research, but anecdotally can be helpful for some.lxi
- Some IVF labs may be willing to do a ceremony prior to discarding an embryo.lxii
No two experiences of embryo donation or disposition will be the same, and not everyone who chooses to do so will experience grief. All experiences are valid and normal.
Compassionate embryo transfer
An alternative to donation or destruction of embryos can be what is termed “compassionate embryo transfer,” where an embryo is thawed and transferred at a time in the person’s cycle that is unlikely to result in conception.lxiii This is a relatively new option for embryo disposition and not all REI clinicians offer or perform compassionate transfer,lxiv though in a survey of American REI doctors the main reason for not providing this option was that patients were not requesting it, so it is possible that this will become more widely available in the future.lxv
Choosing compassionate embryo transfer has some important logistical considerations, such as the potential physical discomfort of the transfer process, the financial cost of thawing and transferring the embryo(s) (though this may be seen as a reasonable expense compared to the continued storage of frozen embryos), and the necessity for legal consent to be given by all parties involved. There is also the small possibility that the transfer will result in a pregnancy, so the couple or person must be prepared for this unlikely but not impossible outcome; in a survey of clinicians who had offered compassionate transfer in the United States, 3 out of 75 (4 percent) reported a pregnancy occurring as a result.lxvi
There are also emotional considerations to consider, such as the knowledge that the transfer is not meant to result in a pregnancy, which can lead to feelings of sadness or grief. See above for ideas for dealing with grief around embryo disposition.
Doing nothing
People may opt to continue storing their surplus embryos indefinitely. This allows them to delay the decision-making process while retaining control over the fate of their embryos. People may choose to continue to store embryos to have the option for future pregnancies if circumstances change, such as relationship status, health issues, or financial stability. However, long-term storage raises logistical and legal concerns, including the financial burden of continued storage, and what happens to those embryos once a person or couple have died.lxvii,lxviii Indefinite storage may also cause feelings of grief or a lack of closure, which may be difficult to process. A clinic may have a contract that specifies what should be done with unused embryos after a certain period, and this may be changed or updated according to a patient’s wishes; consider discussing with clinic staff what their regulations and guidelines are.
Conclusion
The decision of what to do with unused embryos is a complex one that requires examining the available options in a person or couple’s local jurisdiction, and with the full informed consent of all persons involved. Individuals or couples should make the decision on embryo disposition with a mind to their values and what is best for their personal, familial, and financial situation. Whatever choice is made, compassionate care and clear communication is essential from clinicians, and informed choice and consent is crucial to ensuring the best option is chosen for the individual.
i Alexander, V. M., et al. (2020). Recent trends in embryo disposition choices made by patients following in vitro fertilization. Journal of assisted reproduction and genetics, 37(11), 2797–2804. https://doi.org/10.1007/s10815-020-01927-y
ii Riggan, K. A., & Allyse, M. (2019). 'Compassionate transfer': an alternative option for surplus embryo disposition. Human reproduction (Oxford, England), 34(5), 791–794. https://doi.org/10.1093/humrep/dez038
iii Lyerly, A. D., et al. (2010). Fertility patients' views about frozen embryo disposition: Results of a multi-institutional U.S. survey. Fertility and Sterility, 93(2), 499-509. https://doi.org/10.1016/j.fertnstert.2008.10.015
iv Simopoulou, M., et al. (2019). Discarding IVF embryos: reporting on global practices. Journal of assisted reproduction and genetics, 36(12), 2447–2457. https://doi.org/10.1007/s10815-019-01592-w
v Bartolacci, A., et al. (2024). Too many embryos: A critical perspective on a global challenge. Journal of Assisted Reproduction and Genetics, 41(7), 1821-1824. https://doi.org/10.1007/s10815-024-03159-w
vi Moutel, G., et al. (2002). Developments in the storage of embryos in France and the limitations of the laws of bioethics. Analysis of procedures in 17 storage centres and the destiny of stored embryos. Medicine and law, 21(3), 587–604.
vii Lee, J. C., et al. (2023). Embryo donation: national trends and outcomes, 2004-2019. American journal of obstetrics and gynecology, 228(3), 318.e1–318.e7. https://doi.org/10.1016/j.ajog.2022.10.045
viii Alexander, V. M., et al. (2020). Recent trends in embryo disposition choices made by patients following in vitro fertilization. Journal of assisted reproduction and genetics, 37(11), 2797–2804. https://doi.org/10.1007/s10815-020-01927-y
ix Wanggren, K., et al. (2013). Attitudes towards embryo donation among infertile couples with frozen embryos. Human Reproduction, 28(9), 2432-2439. https://doi.org/10.1093/humrep/det252
x Wanggren, K., et al. (2013). Attitudes towards embryo donation among infertile couples with frozen embryos. Human Reproduction, 28(9), 2432-2439. https://doi.org/10.1093/humrep/det252
xi Mohler-Kuo, M., et al. (2009). Attitudes of couples towards the destination of surplus embryos: results among couples with cryopreserved embryos in Switzerland. Human reproduction (Oxford, England), 24(8), 1930–1938. https://doi.org/10.1093/humrep/dep103
xii Barishansky, S. J., et al. (2024). One size does not fit all: the personal nature of completed embryo donation. Journal of assisted reproduction and genetics, 41(7), 1793–1806. https://doi.org/10.1007/s10815-024-03156-z
xiii Samorinha, C., et al. (2014). Factors associated with the donation and non-donation of embryos for research: a systematic review. Human reproduction update, 20(5), 641–655. https://doi.org/10.1093/humupd/dmu026
xiv Millbank, J., et al. (2017). Embryo donation and understanding of kinship: the impact of law and policy. Human reproduction (Oxford, England), 32(1), 133–138. https://doi.org/10.1093/humrep/dew297
xv Alexander, V. M., et al. (2020). Recent trends in embryo disposition choices made by patients following in vitro fertilization. Journal of assisted reproduction and genetics, 37(11), 2797–2804. https://doi.org/10.1007/s10815-020-01927-y
xvi Pieters, J. J. P. M., & Van Miltenburg, M. H. A. M. (2022). Altruistic Donation of Surplus Embryos to Known and Unknown Recipients, The Dutch Approach. International journal of fertility & sterility, 16(3), 230–236. https://doi.org/10.22074/ijfs.2022.538120.1183
xvii Barishansky, S. J., et al. (2024). One size does not fit all: the personal nature of completed embryo donation. Journal of assisted reproduction and genetics, 41(7), 1793–1806. https://doi.org/10.1007/s10815-024-03156-z
xviii ESHRE Working Group on Reproductive Donation, et al. (2022). Good practice recommendations for information provision for those involved in reproductive donation†. Human reproduction open, 2022(1), hoac001. https://doi.org/10.1093/hropen/hoac001
xix ESHRE Task Force on Ethics and Law (2002). III. Gamete and embryo donation. Human reproduction (Oxford, England), 17(5), 1407–1408. https://doi.org/10.1093/humrep/17.5.1407
xx Ethics Committee of the American Society for Reproductive Medicine. (2018). Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion. Fertility and sterility, 109(4), 601–605. https://doi.org/10.1016/j.fertnstert.2018.01.001
xxi Ethics Committee of the American Society for Reproductive Medicine (2013). Disposition of abandoned embryos: a committee opinion. Fertility and sterility, 99(7), 1848–1849. https://doi.org/10.1016/j.fertnstert.2013.02.024
xxii Ethics Committee of the American Society for Reproductive Medicine (2013). Disposition of abandoned embryos: a committee opinion. Fertility and sterility, 99(7), 1848–1849. https://doi.org/10.1016/j.fertnstert.2013.02.024
xxiii Government of Canada. (2024). Consent for Use of Human Reproductive Material and In Vitro Embryos Regulations (SOR/2007-137). https://laws-lois.justice.gc.ca/PDF/SOR-2007-137.pdf
xxiv Guidance regarding gamete and embryo donation. (2021). Fertility and Sterility, 115(6), 1395-1410. https://doi.org/10.1016/j.fertnstert.2021.01.045
xxv Ethics Committee of the American Society for Reproductive Medicine. (2016). Defining embryo donation: an Ethics Committee opinion. Fertility and sterility, 106(1), 56–58. https://doi.org/10.1016/j.fertnstert.2016.03.017
xxvi ESHRE Working Group on Reproductive Donation, et al. (2022). Good practice recommendations for information provision for those involved in reproductive donation†. Human Reproduction Open, 2022(1). https://doi.org/10.1093/hropen/hoac001
xxvii Pieters, J. J. P. M., & Van Miltenburg, M. H. A. M. (2022). Altruistic Donation of Surplus Embryos to Known and Unknown Recipients, The Dutch Approach. International journal of fertility & sterility, 16(3), 230–236. https://doi.org/10.22074/ijfs.2022.538120.1183
xxviii ESHRE Working Group on Reproductive Donation, et al. (2022). Good practice recommendations for information provision for those involved in reproductive donation†. Human Reproduction Open, 2022(1). https://doi.org/10.1093/hropen/hoac001
xxix Ethics Committee of the American Society for Reproductive Medicine (2013). Disposition of abandoned embryos: a committee opinion. Fertility and sterility, 99(7), 1848–1849. https://doi.org/10.1016/j.fertnstert.2013.02.024
xxx ESHRE Task Force on Ethics and Law (2002). III. Gamete and embryo donation. Human reproduction (Oxford, England), 17(5), 1407–1408. https://doi.org/10.1093/humrep/17.5.1407
xxxi Ethics Committee of the American Society for Reproductive Medicine. (2018). Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion. Fertility and sterility, 109(4), 601–605. https://doi.org/10.1016/j.fertnstert.2018.01.001
xxxii Jadva, V., & Imrie, S. (2023). Embryo donation: motivations, experiences, parenting, and child adjustment. Fertility and sterility, 119(1), 11–14. https://doi.org/10.1016/j.fertnstert.2022.09.012
xxxiii Government of Canada. (2024). Consent for Use of Human Reproductive Material and In Vitro Embryos Regulations (SOR/2007-137). https://laws-lois.justice.gc.ca/PDF/SOR-2007-137.pdf
xxxiv Guidance regarding gamete and embryo donation. (2021). Fertility and Sterility, 115(6), 1395-1410. https://doi.org/10.1016/j.fertnstert.2021.01.045
xxxv Mohler-Kuo, M., et al. (2009). Attitudes of couples towards the destination of surplus embryos: results among couples with cryopreserved embryos in Switzerland. Human reproduction (Oxford, England), 24(8), 1930–1938. https://doi.org/10.1093/humrep/dep103
xxxvi Bangsbøll, S., et al. (2004). Patients' attitudes towards donation of surplus cryopreserved embryos for treatment or research. Human reproduction (Oxford, England), 19(10), 2415–2419. https://doi.org/10.1093/humrep/deh441
xxxvii Raz, A., et al. (2016). Donation of surplus frozen pre-embryos to research in Israel: underlying motivations. Israel journal of health policy research, 5, 25. https://doi.org/10.1186/s13584-016-0085-4
xxxviii Ye, J., et al. (2017). High quality clinical grade human embryonic stem cell lines derived from fresh discarded embryos. Stem cell research & therapy, 8(1), 128. https://doi.org/10.1186/s13287-017-0561-y
xxxix ACOG Committee on Ethics (2006). ACOG Committee Opinion No. 347, November 2006: Using preimplantation embryos for research. Obstetrics and gynecology, 108(5), 1305–1317. https://doi.org/10.1097/00006250-200611000-00057
xl Donating embryos for human embryonic stem cell (hESC) research: A committee opinion. (2013). Fertility and Sterility, 100(4), 935-939. https://doi.org/10.1016/j.fertnstert.2013.08.038
xli Lornage, J., et al. (1995). Six year follow-up of cryopreserved human embryos. Human reproduction (Oxford, England), 10(10), 2610–2616. https://doi.org/10.1093/oxfordjournals.humrep.a135755
xlii Mohler-Kuo, M., et al. (2009). Attitudes of couples towards the destination of surplus embryos: results among couples with cryopreserved embryos in Switzerland. Human reproduction (Oxford, England), 24(8), 1930–1938. https://doi.org/10.1093/humrep/dep103
xliii Samorinha, C., et al. (2014). Factors associated with the donation and non-donation of embryos for research: a systematic review. Human reproduction update, 20(5), 641–655. https://doi.org/10.1093/humupd/dmu026
xliv Lanzendorf, S., et al. (2010). Disposition of cryopreserved embryos by infertility patients desiring to discontinue storage. Fertility and sterility, 93(2), 486–489. https://doi.org/10.1016/j.fertnstert.2009.02.001
xlv McMahon, C. A., et al. (2003). Embryo donation for medical research: attitudes and concerns of potential donors. Human reproduction (Oxford, England), 18(4), 871–877. https://doi.org/10.1093/humrep/deg167
xlvi Donating embryos for human embryonic stem cell (hESC) research: A committee opinion. (2013). Fertility and Sterility, 100(4), 935-939. https://doi.org/10.1016/j.fertnstert.2013.08.038
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xlviii Samorinha, C., et al. (2016). Couples' willingness to donate embryos for research: a longitudinal study. Acta obstetricia et gynecologica Scandinavica, 95(8), 912–919. https://doi.org/10.1111/aogs.12900
xlix Samorinha, C., et al. (2014). Factors associated with the donation and non-donation of embryos for research: a systematic review. Human reproduction update, 20(5), 641–655. https://doi.org/10.1093/humupd/dmu026
l McMahon, C. A., et al. (2003). Embryo donation for medical research: attitudes and concerns of potential donors. Human reproduction (Oxford, England), 18(4), 871–877. https://doi.org/10.1093/humrep/deg167
li Barishansky, S. J., et al. (2022). Differences in beliefs and experiences of embryo donation (Ed) with or without use of donor gametes: A survey study. Fertility and Sterility, 118(4), e379. https://doi.org/10.1016/j.fertnstert.2022.09.364
lii Raz, A., et al. (2016). Donation of surplus frozen pre-embryos to research in Israel: underlying motivations. Israel journal of health policy research, 5, 25. https://doi.org/10.1186/s13584-016-0085-4
liii De Lacey, S. (2009). Why some patients donate frozen embryos to research and why their reasons are important. Fertility and Sterility, 92(3), S34. https://doi.org/10.1016/j.fertnstert.2009.07.131
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lv McMahon, C. A., et al. (2003). Embryo donation for medical research: Attitudes and concerns of potential donors. Human Reproduction, 18(4), 871-877. https://doi.org/10.1093/humrep/deg167
lvi Samorinha, C., et al. (2014). Factors associated with the donation and non-donation of embryos for research: A systematic review. Human Reproduction Update, 20(5), 641-655. https://doi.org/10.1093/humupd/dmu026
lvii Nachtigall, R. D., et al. (2005). Parents’ conceptualization of their frozen embryos complicates the disposition decision. Fertility and Sterility, 84(2), 431-434. https://doi.org/10.1016/j.fertnstert.2005.01.134
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lx de Castro, M. H. M., et al. (2021). Psychosocial Aspects of Gestational Grief in Women Undergoing Infertility Treatment: A Systematic Review of Qualitative and Quantitative Evidence. International journal of environmental research and public health, 18(24), 13143. https://doi.org/10.3390/ijerph182413143
lxi Becker, G., et al. (2007). Do religious or spiritual beliefs influence bereavement? A systematic review. Palliative medicine, 21(3), 207–217. https://doi.org/10.1177/0269216307077327
lxii Simopoulou, M., et al. (2019). Discarding IVF embryos: reporting on global practices. Journal of assisted reproduction and genetics, 36(12), 2447–2457. https://doi.org/10.1007/s10815-019-01592-w
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