Sassica Francis-Bruce
Of those who have undergone IVF successfully, some are fortunate enough to have extra embryos to store for future use. But with that luck, a significant issue can arise. What should people do with these spare embryos when they have decided their family is complete?
The options advertised are straightforward: continued storage, donation (to science, a couple or individual) or disposal. But for those who don’t feel comfortable with any of these choices, is there another option?
Yes, if you dig really hard.
“Compassionate embryo transfer is a procedure where excess embryos are placed in the reproductive tract at a time where implantation is highly unlikely,” says Sydney-based fertility specialist Dr Danielle Robson.
While there are many factors that might influence someone’s desire for a compassionate embryo transfer (CET), it is above all, a highly personal decision. “It’s typically done for personal value or patients who express that they would be really uncomfortable with disposing of embryos by other means,” Robson says. “They see it as nature deciding the outcome for the embryo.”
Dr Kylie Stone, a Ballarat-based clinical psychologist and fertility counsellor, says: “For many patients, embryos represent years of effort, hope and emotional investment. Compassionate embryo transfer offers a way to honour that meaning with intention and care.”
Stone says that for some people, the decision to not use remaining embryos may be out of their control. “In a situation where a woman doesn’t have much autonomy, like if a couple separates or a donor withdraws consent, or the woman gets pregnant naturally, compassionate transfer can offer a more emotionally manageable solution,” she says.
While CET offers a unique solution for many nuanced scenarios, it’s surprisingly uncommon.
“It’s rare,” says Robson. “Single digits each year.”
Dr Russell Dalton, obstetrician, gynaecologist and medical director of Ballarat IVF, approximates the same low uptake.
Dalton’s patient Katherine Hunter, 36, from Hamilton, Victoria, is one of the outliers. After requiring nine embryo transfers to have her two children, and being diagnosed with hyperemesis gravidarum for both pregnancies, Katherine and her husband, Ben, decided not to have any more children. However, they still had two embryos in storage.
“No option [of disposal] really felt comfortable for me,” Katherine says. “I was so mentally attached to them [the embryos].”
When Dalton suggested CET, she became “heart set” on the option.
“It didn’t feel so harsh as disposing of them,” she says. “It felt like a nicer, gentler way to do it.”
For people who have children as a result of previous embryo transfers, like Katherine and Ben, the connection to their “surplus” embryos can’t be discounted, Dalton says. “They know that whilst these embryos may not be babies, they do have potential to generate a child.”
So why, if CET can be so emotionally beneficial, is it rare?
According to Stone, many patients are simply unaware it exists. “CET has unofficially always been around, but it’s certainly not advertised,” she says.
While Robson says it is patients often guiding the conversation towards CET, the procedure is a kind of “secret menu” style option in the fertility world.
An online search of compassionate embryo transfer uncovers very little. Most clinics publicly list donation and destruction as the options for excess embryos, with Genea, for example, also offering patients the ability to collect their embryos once they have “succumbed” (removed from liquid nitrogen storage and left at room temperature for at least 24 hours until perishing naturally).
Another prohibiting factor could be cost. “Compassionate embryo transfer wouldn’t technically be eligible for Medicare because you’re not transferring with the intent of pregnancy,” Robson says.
While some smaller clinics, such as Dalton’s, might not charge for CET, others could charge the same as a frozen embryo transfer. “That’s potentially why it’s not publicised and really rare,” Robson says.
While a lack of awareness of CET and its potential cost can be barriers, Robson cautions that the physical toll of a transfer should not be diminished. “It does involve a procedure,” she says. “That’s not a small thing.”
For Katherine, having a medical procedure wasn’t a deterrent. Neither was the two-hour drive to her clinic where her two remaining embryos were transferred once they “succumbed” and were deemed non-viable. “The experience was really lovely,” says Katherine. “It felt like I was bringing my children home, back to where they started and where they belonged.”
A year on from her CET, Katherine remains “very happy” with the decision. “I would pick a compassionate transfer over and over again,” she says. “It completed our story in a nice touch.”
Dalton believes that the number of people having compassionate embryo transfers is “the tip of the iceberg”.
“There are a lot of people who, if they were offered it, would take it up,” he says.
“Compassionate embryo transfer needs to be part of the conversation for people who have got excess embryos,” he says. “It’s about respecting the rights of the owners of the embryos, the woman who generated them.”
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