Embryo/sample abandonment has become a growing problem in fertility clinics all over the world. It is a difficult situation for clinics to deal with. Clinics may have different ways of defining abandonment but the most commonly used definition is when a patient has not paid storage fees for a frozen specimen (egg/sperm/embryo) for a minimum of 5 years and fails to respond to any form of communication from the clinic (ex. letters, phone calls, emails). In these cases, the clinic has not received any communication from the patient as to whether the specimen can be discarded or donated which means that they have to keep storing the specimen. As a result, the sample may be stored in clinics for prolonged periods of time without any contact from the patients. The storage is costly for the clinic and sample abandonment has created a big problem for fertility clinics around the world
Many patients think that once embryos are frozen, there isn't much work for the lab members in keeping them safe. Of course when compared to other jobs in the lab (such as ICSI and embryo biopsy), this may seem like an easy task but there are costs for the clinic and lots of responsibility for lab members. The liquid nitrogen levels in each tank drop considerably every week as the liquid nitrogen evaporates which means that every few days, the liquid nitrogen has to be topped up. Clinics also use expensive alarm systems for the tanks to ensure the samples are safe. At the end of the day, one person is responsible to check the tanks and ensure they are functioning properly. Also, a person is assigned as the on-call individual who will be contacted if there is an issue with the tanks. This person has to be able to reach the clinic quickly and deal with the situation. Specimens that are frozen also take up space in the tanks that could be allocated to other patients. It is therefore, not easy to ensure the safety of samples.
Ethically/morally speaking, abandoning your specimens is wrong. These specimens, whether frozen eggs, sperm or embryos have the potential of becoming a human being. Now, you have every right to decide what you want to do with your specimens but you are obligated to making a decision. There is no right or wrong decision on whether you choose to discard, donate or keep storing your specimens but it is wrong to abandon them. It is not easy to decide what you would like to do but there are resources that can help with the decision. First of all, your specialists are there to provide you with all of the necessary information to make an informed decision. There are also psychologists that work closely with fertility clinics who can help with the emotional aspects. Overall, we know the decision is not easy and we are all here to help but it is a decision that needs to be made.
One way that has been proposed to dealing with this issue is putting a time limit on the amount of years a clinic is obligated to keep specimens if the patient has not been paying for storage or keeping in touch with the clinic. Of course if the patient has been keeping up to date with the payments, the clinic will keep their specimen for as long as the patient wishes. This could be a good resolution as long as the amount of time is appropriate. For example, I believe that 5-10 years is an appropriate amount of time to keep the specimens safe after which they can be discarded if the patient does not get in touch. However, keeping the specimen for only 1 year for example would not be appropriate. It is understandable that life can get hectic at times and we may forget to get in touch with the clinic with our decision, but anything more than 5 years is unacceptable.
As for clinics, I think its very important to try and reach patients in a variety of different ways. Even though, patients are required to inform clinics when they change any of their personal information including address and phone number, they may have forgotten to do so. Therefore, clinics should try to contact patients via telephone, email, mail and any other form of communication at different times during the day. This ensures that the patient receives the information and it is the patient's responsibility to contact the clinic. Another options would be to have the patients sign a contract at the beginning of the treatment as to what should happen to the specimen if the clinic is unable to reach the patient regarding the storage of their sample after a minimum of 5 years. I think with this being a growing problem, laws and legislation will soon come into play that allow clinics to discard samples after a certain number of years with no contact from the patient.
Some countries have set a time limit on the storage of specimens. For example, in some places a women's eggs may be stored for only up to 10 years after which it will be discarded. I personally, do not agree with this method. Let's say for example, a young woman in her 20's decides to freeze her eggs for future use. If the eggs were only allowed to be frozen for 10 years, that could mean in her 30's (prime time for seeking out treatment) she would have her eggs discarded and no longer available. This is not right, patients should have the right to store their specimens for as long as they wish. This being said, they are solely responsible for not abandoning their specimens. If the patient is not able to pay the annual fee for the storage, clinics are usually flexible on the payment options and may offer some discounts as long as the patient keeps in touch and maintains their relationship with the clinic. Abandonment of samples is not usually discussed until it is too late and so I believe that specialists have an obligation to explain this issue to patients before they begin any sort of treatment. The patient may not be aware of the costs associated with storing samples and so it is necessary to ensure they understand and take responsibility for keeping their payments up to date. If there are any issues, they can be brought up at the beginning of the treatment and dealt with in a manner that is beneficial for both the patient and the clinic. It can be daunting to reach out to clinics if some time has gone by but it is best to reach out as soon as possible. Clinics are more than willing to listen and will try to help patients make a decision best for themselves and their partners.
If you have any questions/concerns please contact me.
