Ethical dilemmas posed by surplus frozen embryos in Argentinean fertility centers

Abstract

In Argentina, access to ART treatments has been regulated since 2013, but the law fails to define a number of important issues, including embryo disposition decisions (EDD) and national registries. Disputes regarding the legal status of cryopreserved embryos are a multifactorial problem that, in Latin-American countries, is also associated with the influence of the Catholic tradition on policy makers, and a clear resolution of embryo disposition remains a difficult topic. Also, improvements in IVF laboratory procedures, such as single embryo transfer (eSET), preimplantation genetic testing (PGT), and the freeze-all strategy, have led to an increase in the number of frozen embryos being stored. Yet, little is known of how these enhanced procedures might influence EDD. To collect data on storage content, an online survey was sent to all reproductive facilities, during 2017 and 2020. Based on the survey results, we found a tendency that shows an exponential increase in the number of frozen embryos being stored (by 68.5%). This is a consequence of the improvements in cryopreservation techniques (vitrification) and the development of more efficient ovarian stimulation protocols that have facilitated a rise in elective single embryo transfer (eSET). This paper focuses on three strategies that could be implemented to facilitate EDD under this particular setting. First, counseling sessions at different treatment stages should be encouraged and would be conducted by trained mental health professionals. Second, once storage content is labeled, aneuploid embryos and embryos which were cryopreserved more than 10 years ago, could form part of a national bank for research purposes. Third, promote effective regulation that includes EDD and explicit storage limits.