Discarding Leftover Embryos
This topic is so sensitive for anyone who has been through IVF. The word discard is loaded. It’s final. It insinuates that something thrown away is not wanted or deemed useless. It comes with the weight of the decision to stop treatments, or possible negative outcomes from treatments, or brings back the feelings of what you went through to get samples in storage.
Discarding Leftover Embryos
Discard can mean different things. Embryos that develop in the laboratory are cultured until the time of transfer or freezing. Embryos that are not suitable for either, are by law required to be discarded and documented as such. Culture media is designed to have the right amount of nutrients to support embryo development in the laboratory. Some embryos can make it to day 7 in development but have a high risk of being aneuploid. If not earlier, the embryos start to degenerate after day 8 in culture. This leaves them unsuitable for any type of use. The HFEA is the UK regulatory body that provides IVF clinics with their license but also provides guidance and requirements that we have to uphold. Each embryo has to be documented in terms of development, but also in terms of outcome. This is often T - transfer, F - freeze, D - discard.
We know the word discard is unpleasant.
But it’s important to know that the embryos left in incubators past day 8 - don’t have a chance of continuing to develop into genetically normal embryos that would generate a pregnancy. Discarding dishes with eggs and embryos that aren’t suitable for use at the end of a treatment cycle is a daily task that must be performed in the laboratory. Two embryologists confirm the patient details on lab notes, the dishes, and the number of eggs and/or embryos left in the dish. There is no room for discrepancies.
Embryologists also have the responsibility of discarding frozen eggs, sperm and embryos from storage in liquid nitrogen or gas phase tanks.
In the UK, frozen samples have a maximum storage period of 10 years, unless medically exempt. One would think that requiring IVF to have children is reason enough to be medically exempt and allowed extended storage, but that decision is not up to us. There are instances when the frozen gametes or embryos are consented to be discarded before the 10 years have ended. For example, when PGS/PGD results come back with genetically abnormal embryos, we must acquire consent to discard the abnormal embryos, even if they’re not permitted for use. Or when patients feel they have completed their family, or when they no longer want to proceed with treatment, they sign a consent to discard. While it can bring relief to some, deciding to discard can be one of the hardest decisions to make in IVF. We know what’s gone into creating those embryos, not just from a scientific perspective, but everything our patients have gone through in order to get to that stage.
The process?
Two embryologists have to check latest storage payment, check consents and compare signatures to previously signed consents. Then we need to confirm the number of samples in storage on the consent, in the computer system and in the storage unit. Sometimes there are samples from multiple cycles in multiple storage locations. All samples must be checked with 3 identifiers. Name, date of birth and medical reference number. Once everything adds up, the samples are removed from liquid nitrogen. If samples are being removed for treatment, they need to follow a thaw/warming protocol. For a discard, you don’t follow the protocol. The samples are removed and left in room temperature. In doing so, they will succumb, degenerate and ultimately perish. I wish there was a more deli-cate way to explain this, but it’s the most accurate description in scientific terms.
Do know - it’s not easy for us either. If you have questions, we try to answer them. We try to explain the process as best as we can. We try accommodating any requests you have. Some clinics may even pro-vide you with the freezing device that your embryos have been frozen on. This may help bring some comfort and closure to such a difficult decision. Ultimately, all gametes and embryos will need to have an outcome. If you’re at a crossroads and need help in making a decision, please use your support system. Reach out to your clinic for advice. Speak to a counsellor, therapist or coach. While the tough decision is yours to make, you don’t have to go through it alone.
Sandy Christiansen, Fertility Coach
MSc, HCPC registered clinical embryologist, ESHRE certified embryologist
Medical Disclaimer:
The information provided in this blog is intended for general informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider or qualified medical professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.