When Scott Gatz and his husband decided to become fathers several years ago, pursuing parenthood meant finding both an egg donor and a surrogate to help them conceive a baby. Their first round of in vitro fertilization produced seven healthy embryos. One of those embryos was successfully transferred to their surrogate's womb, resulting in their son Matthew, who is now 6-years-old.
While the San Francisco couple feels their family is now complete, they are still in a quandary over what to do with their six remaining embryos — what they call their "maybe babies."
Every year they're forced to weigh their options again, Gatz tells Shots, when a letter arrives from the fertility clinic. It asks whether they want to destroy the embryos, donate them for medical research, give them to another infertile couple or continue paying $800 annually to keep the embryos frozen.
"Every time we read the 'destroy' option on the form, my stomach does a somersault," Gatz says. "It feels as if our future children are showing up once a year to confront us."
The men are not alone in their ambivalence. It's estimated that, in the United States, there are almost one million frozen embryos now in storage, a number that includes embryos reserved for research, as well as those reserved to expand families.
In a 2005 study that interviewed 58 couples who conceived through IVF and had at least one frozen embryo in storage, more than 70 percent had not yet decided — even several years after the procedure — how they would dispose of a surplus embryo. Some said they considered the embryos to be biologic tissue or a genetic or psychological "insurance policy." Others told the researchers they thought of the embryos as living entities — "virtual children" that have interests that needed to be considered and protected.
"With the astonishing advancements in reproductive science, IVF now produces far more embryos than it did in the past," says Dr. Anna Glezer, a psychiatrist at the University of California, San Francisco. The choices that abundance poses are very difficult for some couples, she says, "which raises the need for psychological resources, such as peer support groups for these families.'
After conceiving their daughter via IVF, Megan and Jay Khmelev had eight remaining embryos. For two years, says Megan, she was overcome by guilt, anxiety, and sadness as she struggled with what to do with them. At the beginning of her fertility journey, she had imagined one day donating the embryos to science or to another infertile couple.
But after her daughter arrived, she says, she couldn't imagine parting with the surplus embryos in this way. The Khmelevs didn't want eight more children, but discarding the embryos didn't feel like the right choice, either.
"I wish someone had told me that I'd be haunted by the grief of my infertility struggle all over again as I wrestled with my decision," Megan says.
Dr. Aimee Eyvazzadeh, a reproductive endocrinologist in the San Francisco Bay area, says many families she counsels struggle with these choices.
"It's a complicated process," Eyvazzadeh says. "At the beginning of IVF, patients hope for many embryos, because they long to have a baby. They don't realize how their feelings might change once their children are born."
In the 1980s, when fertility clinics began freezing embryos, there wasn't any available research about how patients would feel regarding their frozen embryos after they became parents. More than 30 years later, though the number of IVF babies has steadily climbed, many fertility doctors are still unsure how to handle some patients' ambivalence.
"Our clinic told us that we could freeze our embryos and explained the cost associated with yearly storage fees," Gatz says, "but they didn't mention the feelings that might arise as we faced these choices."
A study published in the March issue of the journal Fertility and Sterility found that that after successful IVF treatment, most of the 131 couples responding to a survey were dissatisfied with the education they obtained from their health care providers about disposal decisions. And less than 50 percent were satisfied with the emotional guidance they got.
Yet other research suggests that peer support can help people make these complicated choices, by giving them a place to disclose their struggles in the company of others who have been through the process.
Francine Lederer, a clinical psychologist in private practice in Los Angeles, offers a "disposition support group," specifically aimed at couples and individuals who are deciding what to do with their embryos.
"After successful IVF treatments, many couples come to view their embryos as human life, which makes it even harder for them to find closure," Lederer says. Some even have funeral ceremonies for the embryos.
For other couples, making these decisions ignites emotional conflict between the spouses, or even beyond — to include the extended family, Lederer finds, because religious beliefs and personal preferences play a role in how each person views the stored embryos. One couple she counseled who had decided to destroy the embryos mentioned that to their parents and discovered the in-laws were aghast.
"Too often, these families have never shared their stories aloud," says Lederer. "Support groups can make a difference by allowing them to talk about their personal experiences with others who understand, which can help them to feel less isolated."
Megan and Jay Khmelev finally decided to do additional rounds of IVF, and use the remaining embryos themselves, but none resulted in a viable pregnancy.
"I'm glad I did the transfers anyway," Megan says. "It gave me and my husband closure, knowing that we had given them a chance to become life."