Cryopreserved embryos now number in the hundreds of thousands which means questions about their management, disposition, and potential use have shifted from theoretical discussion to pressing clinical, ethical, and regulatory concerns.
The campus on the fate of supernumerary cryopreserved embryos, jointly organised by the SIGs Ethics and Law, Psychology and Counselling, and Stem Cells, examined the diverse and often contentious issues associated with surplus embryos. Across two days of presentations and discussion, the workshop addressed the fragmented legal landscape, emerging ethical dilemmas, and evolving clinical practices shaping this increasingly complex area of assisted reproduction.
At the core of the meeting was a shared understanding that the growing number of surplus embryos presents not only logistical and legal challenges, but also underscores the need for more coherent clinical guidelines, greater regulatory consistency, and enhanced multidisciplinary cooperation.
Irene Cuevas, from Hospital General Universitario de Valencia, Spain, opened the course with a comprehensive presentation that set the stage for the complexity ahead. She acknowledged the difficulty of preparing a talk that had to span fragmented and often contradictory regulations. Drawing on data from Spain and beyond, she detailed the rapid rise in cryopreserved embryos, many of which remain in storage for years without a clear plan for disposition. The classification of embryos as Substances of Human Origin (SoHO) under European law has introduced new regulatory layers, but not necessarily greater clarity. Her talk also underscored the importance of traceability, proposing digital systems as a safeguard against errors in cryostorage and in transport logistics. It called for harmonised legislation and standardised protocols to match the growing demands of fertility care.
Sara Dalla Costa, from Instituto Bernabeu Venezia, Italy, expanded on the legal dimension with a comparative overview of how European countries regulate embryo storage, usage, and disposition. She highlighted the stark disparities in national laws, ranging from indefinite storage to strict time limits, which ultimately lead to an increasing number of cross-border embryo transfers. The varied definitions of the legal status of embryos further complicate ethical decision-making and regulatory oversight, she said. Dalla Costa made a compelling case for European legal harmonisation, arguing that such alignment is not only necessary for legal certainty and patient safety but also for ensuring that regulations evolve in step with scientific progress and shifting societal values.
Nils Hoppe, from LDMH Partners and Centre for Ethics and Law in the Life Sciences, University of Hannover, a legal scholar practising in Germany and the UK, outlined the philosophical arguments around the management of surplus cryopreserved embryos. He challenged the audience to consider what it means for embryos to occupy a “legal liminal space”, not fully property, not fully persons, yet subject to intense regulatory scrutiny. Hoppe traced how this ambiguity affects both the clinical and research pathways for surplus embryos, particularly as they accumulate in cryostorage. He also addressed the limits of domestic regulation in a context where patients, embryos, and scientific knowledge cross borders with increasing frequency. Advocating for a fresh approach to embryo protection laws, Hoppe argued that advances in biomedical science must be mirrored by a reassessment of how we define and govern the embryo, especially in research settings.
Juliana Pedro, Clinical Psychologist at the Centre for Reproductive Genetics A. Barros, Portugal, emphasised that behind every frozen embryo is a story, and often, an unresolved one. She focused on the psychological and ethical burden of decision-making when patients are asked to choose the fate of their surplus embryos. She said that this is often a deeply emotional and morally complex process, requiring more than a checkbox on a consent form. Pedro proposed a threefold strategy: ensuring that patients are informed early about the possibility and implications of surplus embryos, providing adequate time for reflection and counselling, and tailoring support to the individual values and priorities of each patient. By doing so, clinics can help patients engage in decisions that are ethically grounded and emotionally sustainable, especially when those decisions involve letting go.
Catello Scarica, from New Fertility Group, Italy, highlighted the economic and systemic pressures that come with increasing numbers of stored embryos. He explored how clinical strategies, such as the freeze-all approach, can lead to unintended storage burdens and logistical challenges. Scarica presented emerging data on the cost-effectiveness of embryo management strategies and argued for a model in which patients are made aware of the financial and legal responsibilities associated with long-term storage. His talk emphasised that responsible disposition planning must also factor in institutional sustainability and resource allocation.
In her talk, Kay Elder from Bourn Hall Clinic made a passionate case for embryo donation for research, not as an afterthought, but as a founding value of IVF. A pioneer in the field, she drew from her experience at Bourn Hall, the world’s first IVF clinic founded by Patrick Steptoe, Bob Edwards, and Jean Purdy. She reflected on the enduring vision of Bob Edwards: to uncover the mysteries of early human development. Elder detailed the barriers that prevent meaningful research, from overly complex consent forms to legal ambiguities, despite thousands of embryos being discarded that could have powered scientific progress. She advocated for streamlined, ethically sound consent models, warning that if policy does not change, then knowledge could be wasted.
Next, Vasanti Jadva, from the University of London, UK, reviewed the limited body of research on how embryo donation affects families. Her analysis revealed no significant differences in parental bonding, psychological well-being, or child development outcomes in families resulting from embryo donation compared to those formed via spontaneous conception. However, she also pointed to unresolved questions, particularly around how donor-conceived children make sense of having genetic siblings raised in different families. Jadva’s presentation highlighted the need for longitudinal studies and continued psychosocial support.
In a presentation focused on how surplus embryos can be used in research, Mina Popovic, Group Scientific Director from Eugin, Spain, presented data from extended in vitro embryo cultures that help validate the predictive value of preimplantation genetic testing for aneuploidy (PGT-A). Popovic also shared results from the preclinical validation of a novel ultrafast blastocyst warming protocol, which matched conventional protocols in developmental outcomes while significantly reducing lab time and stress on embryos. Popovic emphasised that the limited use of embryos in research is not due to their availability, but rather to insufficient patient and professional education and persistent funding gaps. She advocated greater investment, education, and regulatory reform, positioning human embryo research not only as a scientific imperative but as a driver of tangible clinical progress in reproductive medicine.
Heidi Mertes, from Ghent University, Belgium, provided an ethical analysis of the status of human embryos and emerging embryo models. She distinguished between surplus embryos, non-viable embryos, and those created for research, each carrying different ethical implications. Mertes questioned the “argument from potential”, particularly as it applies to stem-cell derived embryo-like structures such as blastoids, noting that their ethical advantage erodes as they increasingly resemble natural embryos. Referencing ISSCR and ESHRE guidelines, she called for clear boundaries and review frameworks, concluding that while models offer promise, donated embryos often remain scientifically preferable in many contexts.
Returning to the patient perspective, Giuliana Baccino, Managing Director of New Life Bank, Spain, examined how patients’ attitudes and beliefs influence their decisions regarding cryopreserved embryos. She advocated for early conversations about long-term reproductive goals and emphasised the value of psychological appointments to support emotionally complex choices. Her work highlights the need for greater integration of psychosocial care in fertility treatment.
Mariana Martins, from the University of Porto, Portugal, challenged assumptions about genetic relatedness, presenting data that shows no significant differences in mental health between donor-conceived individuals and those conceived without assistance. She urged healthcare professionals to reflect on how their own beliefs about genetics and family structure may shape the information they offer to patients. In addition, they should ensure that all reproductive options, including third-party reproduction, are presented transparently from the very beginning.
Finally, Mara Simopoulou, from the University of Athens, Greece, delivered a wide-ranging talk that wove together embryology insights with patient communication, in a legislative context. Describing embryo cryopreservation as a clinical and scientific revolution, she explored the factors contributing to the rising number of stored embryos, reviewed recent outcome data, and addressed ongoing debates about how long embryos can and should remain frozen. As an embryologist, she provided insights into embryo quality and viability, while emphasising the importance of interdisciplinary collaboration and clear communication between clinicians, scientists, and patients.
In a field where embryos can be frozen, stored, shipped, studied, and too often forgotten, this campus stressed the urgency of addressing the complex realities of embryo cryopreservation. By drawing together perspectives from law, ethics, psychology, embryology, and clinical care, the course reaffirmed that the management of surplus embryos is not a peripheral issue, but a central concern for the future of assisted reproduction. Ongoing interdisciplinary dialogue and collaboration will be essential to ensure that evolving practices remain patient-centred, evidence-based, and ethically sound across legal and cultural boundaries.
References:
1 Go K, Romanski PA, Bortoletto P, Patel C, Srouji SS, and Ginsburg ES. Meeting the challenge of unclaimed cryopreserved embryos. Fertility and Sterility 2023 119(1); 15-20.
2 ESHRE Working Group on Reproductive Donation, Kirkman-Brown J, Calhaz-Jorge C, Dancet EA, Lundin K, Martins M, and Frith L. Good practice recommendations for information provision for those involved in reproductive donation. Hum Reprod Open 2022(1); hoac001.
3 Writing Group of the ESHRE Ethics Committee, Guido Pennings, Wybo Dondorp, Mina Popovic, Susana Chuva de Sousa Lopes, Heidi Mertes. Ethical considerations on the moral status of the embryo and embryo-like structures; Human Reproduction November 2024 Vol 39 (11); 2387–2391; https://doi.org/10.1093/humrep/deae228
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