They are from couples who cannot be located or who have stopped paying for their maintenance and that the clinics cannot donate to other women or to research, but they do not eliminate them due to legal loopholes and ethical doubts
60,005. This is the almost insignificant number of frozen embryos with no destination in Spain and that assisted reproduction centers cannot destroy.
60,005. It is the number of eggs fertilized by sperm that do not meet the donation requirements for which they were created or whose owners have stopped paying for their maintenance or are untraceable by clinics.
60,005. It is the number of embryos that rest in liquid nitrogen cylinders at -179 degrees and that cannot be used either by the couples themselves or women alone, nor to donate to others, nor for research, nor for a programmed and consented elimination by donors and centers before the start of an in vitro fertilization process.
There are 60,005 abandoned frozen embryos. The number is a finding because it is the first time it is known. In the universe of assisted human reproduction, it is known that there are surplus frozen embryos, but how many have never been calculated. Now, an investigation by the Ethics and Good Clinical Practice Group of the Spanish Fertility Society (SEF) has managed to identify not only where they are, but how many there are.
And the result is disturbing due to the number it adds up to and the ethical dilemma it poses: at least 16% of the frozen embryos in banks have no destination, but they cannot be eliminated. What to do with tens of thousands of groups of cells that legally deserve respect but are not considered life and that are not there for the purpose for which they were generated?
The idea came from Rocío Núñez Calonge, doctor in Biology and member of the SEF Ethics Group. “If we wanted to propose a solution to the authorities, it was better to do it on concrete data than on ethereal realities.” So this Master in Bioethics developed a survey for all public and private assisted reproduction centers in Spain. There were 10 questions to find out the number of frozen embryos each center had for the patients’ own use, donation to other couples or women, research, actual destruction or the most controversial: abandoned. During 2021 it repeatedly sent the survey to 244 banks. Only 71 (29%) answered, but among them were the main and largest, those that keep the largest number of frozen embryos. “Probably, those who did not answer is because they do not have all the data we asked for recorded.” In 2022, the Ethics Group received the results obtained by Núñez Calonge, validated the data and decided that they could be extrapolated to the Spanish reality by the entity of the centers that did respond. The only figure that was known (the centers are obliged to notify their results to the National Registry) is generic, is not specified in uses and dates back to December 31, 2019: in Spain there are 668,082 stored embryos. But until now no one knew what they are intended for or how many are abandoned. With this accredited 29% of responses, the SEF has obtained concrete and extrapolable results: 376,445 embryos have been located (more than half of the total declared in 2019) with the destination of each one. Almost half, 46%, are for “own use”, that is, for couples or women to use in a future fertilization process. They are 173,010.
Almost 18% are on loan for “research”. There are 65,457, although the vast majority (61,990) have not been assigned any project because there are no research plans.
Almost another 18% will be destroyed because the patients explicitly accepted that the embryos that were left over once their reproductive project had been fulfilled would be eliminated. They are 66,968.
5% exist to be donated to other couples or other single women. There are 19,303, but the vast majority (14,009) do not meet the necessary requirements: the woman’s age is over 35 years or the tests have not been completed.
LACK OF REQUIREMENTS
And among the thousands of accumulated embryos there remains a pocket that is a problem: 12% have no destination, not even destruction. It belongs to couples or women who have stopped paying their maintenance or who are unreachable for the centers. They never expressed that the leftovers were destroyed and, therefore, the clinics do not dare to eliminate them. They are 46,046.
Núñez Calonge: “The total of the figures indicates that there is very little donation to other couples and that, in addition, the majority do not meet the requirements. Also that there is a lot of donation for research, but there are no assigned projects, with which these embryos can remain that way indefinitely. There are as many embryos destined for research as for destruction. And there are thousands and thousands of abandoned embryos that the centers continue to accumulate and do not know what to do with.” For this reason, the sum of the 46,046 without a destination and the 14,009 without the possibility of donation places the number of frozen embryos abandoned in Spain: the almost capicúa 60,005.
Why can’t they be destroyed? Current legislation (Law 14/2006 on Assisted Human Reproduction Techniques) says that if after contacting patients for two years, the centers do not receive a response, “the pre-embryos will be made available to the centers where they are cryopreserved, which may allocate them according to its criteria to any of the aforementioned purposes, maintaining the confidentiality and anonymity requirements established and free of charge and non-profit”. However, neither to the SEF nor to those responsible for the centers the expression “they may allocate them according to their criteria” seems sufficient guarantee to destroy them.
Alfonso de la Fuente is the director of the European Fertility Institute, a powerful complex in the center of Madrid. In his laboratory, he stores 250 embryos without a destination or abandoned. “There are not many because we talk a lot with patients to avoid freezing more than is strictly necessary.”
CONFLICT OF TWO KINDS
This specialist in Gynecology and Obstetrics puts the matter in a single paragraph: “It is an uncomfortable situation: you have frozen embryos and people who do not decide about their future because they have disregarded them and you cannot contact them to ask them what to do. That creates a two-way conflict: One is economic, because we have to continue paying for very delicate maintenance, which amounts to around 200 euros a year per frozen embryo sample, and the other is conscientious, because even though they are ours, we do not allocate those embryos to other couples. , nor to investigation, nor did we destroy them because their owners have not expressed it that way.
-And then what happens?
-That we keep them in liquid nitrogen indefinitely. We are afraid to destroy them. There are patients who moved house and forgot to notify the clinic and after three years they ask about their embryos. Or others who stop paying… There are many circumstances.
What do you do if the owner of some embryos appears, claims them, finds that you have destroyed them and reports you? On the one hand, the autonomy of the patient. On the other, clinics doomed to be responsible in perpetuity for embryos with no destination…
… And that dichotomy leads to the enormous ethical challenge of this story. Are frozen embryos life?
For the Constitutional Court, the embryo “is a legally protected asset by indirect effect of the fundamental right to life recognized only in favor of the person born.” However, although the TC maintains that the embryo is a legal asset and is subject to certain protections, it does not consider it a person and, therefore, is not the holder of rights, such as life.
The discussion is eternal and can be summed up in three positions: The embryo is a human being since fertilization, it has the same rights as a person and, therefore, cannot be frozen or used for research.
The embryo is a simple set of cells and, therefore, does not generate ethical obligations.
The embryo is not a person, but it must be treated with special respect, since it is the only one that can become human, which entails certain moral behaviors.
Núñez Calonge: “The embryo is not just a set of cells, but neither is it a human being. It is a potential human being, just like a seed is for a plant. It is an intermediate entity. It deserves respect, but it is not a person”.
Núñez Calonge’s research will be presented this week at the 33rd National Congress of the SEF and calls for a legislative change: “That after a while the remaining embryos of untraceable couples can be destroyed. And that they can be destroyed without prior authorization if the patients They decide. An example: a 35-year-old couple gets a child, they have leftover embryos but they will never want them because they have already fulfilled their reproductive project. With the current law, the center cannot destroy the leftovers until the woman turns 50 , when age is considered no longer reproductive”.
At the European Fertility Institute, Alfonso de la Fuente accepts the place suggested by the photographer and pushes the bottles where frozen embryos are stored. The wheels alleviate the enormous weight of those refrigerators connected to a sensor that would be triggered if the second lid was opened far from the sterility of the laboratory.
-What can you do with these leftover embryos?
-Nothing for the moment. In England there was a consensus and they burned them, but here we don’t know what to do. Without questioning the abortion law, in Spain an ‘in vitro’ embryo is more protected than an ‘in utero’ embryo because you can abort up to 14 weeks and you cannot destroy a five-day embryo. It is no more ethical to keep them indefinitely than to destroy them. Removing them is less bad than having them there forever.
Rocío Núñez Calonge: “If the objective of the remaining embryos is not life, the ethical thing is to give them an end” R.J.Á. She is the author of the research that has detected how many frozen embryos there are for each destination, including those that do not even have it: the abandoned ones. After 37 years in the world of Assisted Reproduction, Rocío Núñez Calonge is a doctor in Biology, professor in the Complutense Master’s Degree in Reproduction, Master’s in Bioethics, member of the Spanish Fertility Society and one of the pioneers in the Biology of Fertility. Reproduction.
Question.- Is there a similar study in the world?
Answer.- No. There is an exaggerated bag of abandoned embryos throughout the world and not a disaggregated data of how many embryos there are for each destination and how many abandoned. This is the first worldwide and Spanish study.
Q.- How many years would have to pass before the centers could destroy the leftovers?
A.- If in five years a couple does not respond, it means that they do not want to know anything and the center should be able to eliminate them. Today, if a couple separates and each has an opinion, the embryos are frozen indefinitely. There should be a deadline to be able to destroy them.
Q.- What is done in other countries?
A.- I like the proposal of the US Ethics Committee, which says that undestined embryos should not be used for other couples and should be destroyed or used for research after some time.
Q.- Is abandoning an embryo irresponsible, negligent or ignorant?
A.- It cannot be generalized. It is human for a couple to forget about the remaining embryos once they have a child. Most couples don’t consider that leftovers can be destroyed. That is why it is important to give good information.
Q.- Is the spirit of your work economistic?
A.- Not at all. It is true that liquid nitrogen is very expensive and needs care. But the key is to sound the alarm based on figures so that the law is modified on an issue with ethical implications.
Q.- What does ethics tell you?
A.- There is no universal ethics. What mine tells me is that embryos should be treated with respect, but they are not a person. When we know that they are not going to have the purpose for which they were created, that they are not going to be implanted and that they are not going to be useful for science, I see no danger in their destruction. We are not destroying human lives. If your goal is not life or research, the ethical thing is to give them an end.
Q.- In your study there are another 62,000 embryos dedicated to research for which there are no projects. Should they be able to be destroyed too?
A.- Yes. Projects with non-germ stem cells, those that do not use embryos, have been promoted more. For this reason, there are many embryos left over that were destined for research, but that will never be used because the lines of research follow other paths.
Q.- What does your study propose?
A.- In terms of prevention, that the legal equality between oocytes and embryos be changed. It is less of a problem to destroy an egg than an embryo. If eggs were frozen instead of embryos, this problem would be avoided in the long run. And as for the present, the centers should be able to destroy the surplus after a period of time.
Q.- Will your research create moral conflicts?
A.- They already exist. The Bioethics Committee of Spain is against assisted reproduction techniques or the freezing of embryos. But there is no universal moral here.