How Does Embryo Donation International Rank Embryo Recipients?

Unfortunately, there are far more potential embryo recipients than donated embryos. While in this country alone, hundred of thousands of embryos are stored in liquid nitrogen, (Hoffman DI, et. al, 2003), less than ten percent and frequently less than five percent are donated to patients in need (Klock SC, et al., 2003). As a result, we often have a waiting list of recipients asking for donated embryos.

First, EDI doesn’t discriminate with respect to race, religion, ancestry, sexual preference or marital status. We also try to be fair to existing EDI patients and to those who have yet to become established patients. We basically are looking for potential embryo recipients who have few other reproductive options available. If one views donated embryos as an essentially rationed commodity, we want to make certain that patients in greatest need are ranked the highest. We try to do this in an ethical and fair fashion but ranking them can be a challenge.

While not absolute, below is a general ranking from high priority to lower priority in our general waiting lists:

  1. The intended parents have no delivered children and limited financial means with few options available.
  2. Their only child died and no other siblings exist.
  3. One of the partners raised a child with a different partner.
  4. Both of the partners raised children with different partners.
  5. Both partners raised one adopted child together.
  6. Both partners raised one (genetic) child together.
  7. Both partners raised children with other partners and one (genetic) child together.
  8. Both partners raised multiple (genetic) children together.

We define a “genetic child” as a child whose genes came from the parents themselves without the use of donated material and also not an adopted child.

Here are some of the questions we also commonly ask in trying to decide where the patients should rank on our waiting lists:

  1. How long have they been on the waiting list?
  2. Are they established patients with EDI or have never been seen before?
  3. Are there other less expensive and viable options such as donor sperm?
  4. What have the patients gone through during their infertility journey?
  5. Is adoption of a live child a possibility?
  6. Are there financial constraints that makes embryo donation far more feasible over other more expensive options?

Also, we actually have multiple lists broken down by the following major categories:

  • Type of embryo donation: Anonymous, Approved and Open Embryo Donation
  • Marital status/sexual orientation: Single woman, single man (very rare), heterosexual couple (married/unmarried), lesbian couple and gay couple (married/unmarried).

As you can see, the process of ranking can get a bit complicated. Our highest priority is healthy embryo recipients who have never had children of their own and have very few fertility options with limited financial means. For example, this group may include cancer survivors who have been left infertile due to the disease or treatment. In many states, cancer survivors find adoption of a child extraordinarily difficult, so embryo donation may be their only option for building a family. We also tend to rank patients higher who have undergone extensive unsuccessful IVF treatments and egg donation is their only remaining option, but due to financial constraints, are unable to afford the procedure.

While we do not exclude patients who have raised children, some requests come from parents with numerous children in their current family. We are actually not looking for potential embryo recipients who are trying to “save” donated embryos. We wish we had enough embryos for everyone, but until we have more embryos than applicants, we will continue to prioritize patients who have never raised children higher than those who have previously experienced the joys of parenthood. We will not exclude such patients, they will be ranked far lower than others on the priority scale.

While some patients who approach EDI have no children, they may have several other fertility options. For example, a young couple that is infertile due to severe male factor infertility, may best be served with sperm donation. Donor sperm generally is less expensive and faster than embryo donation and they can have more than one child using the same donor. We would prefer to save the donated embryos for patients with few available options.

We hope that our readers will understand our basic goals. For any rationed commodity, we want to save it for those in greatest need. If one pictures the embryos as rare, precious and hard to come by, one can imagine why a fair ranking system must be developed.

Ranking systems are never perfect and often seem unfair to those who receive lower rankings. It is difficult to explain a lower ranking to a patient who is desperately seeking to build or expand their family, however, once separated from the emotional aspect, it is usually agreed that a ranking system is needed to fairly as many patients that we can who are seeking donated embryos.

In summary, we feel that a ranking system is necessary to achieve our goal of matching donated embryos to patients in need in an ethical and fair fashion. In a perfect world, infertility wouldn’t even exist and there would be enough donated embryos to meet the demands of those asking for donated embryos. In today’s realistic world, however, the precious gift of donated embryos is simply not given often enough to meet the demands of those seeking donated embryos. Perhaps someday ,though education and research, the number of patients offering their embryos for donation will increase to such a level that we may be able to eliminate or at least trim back segments of our ranking system. Until that day comes, we will have to do our best to assist in matching patients in need to donated embryos in the most ethical and fair fashion we can.

Shelley Osking, L.P.N.
Embryo Donation Coordinator

Corey Burke, B.S., C.L.S.
Laboratory Supervisor

Craig R. Sweet, M.D.
Reproductive Endocrinologist
Founder, Medical and Practice Director

Hoffman DI, et al. Cryopreserved embryos in the United States and their availability for research. Fertil Steril 2003;79:1063-9.

Klock SC, et al. The disposition of unused frozen embryos [letter]. N Engl J Med 2001;345(1):69-70.

4 Responses to “How Does Embryo Donation International Rank Embryo Recipients?”

  • Wow, this is a really interesting article, offering people insight into the world of embryo donation. Choosing which parents receive donated embryos is a heavy burden, but it sounds to me like your team has put a lot of thought and consideration into this ranking system.

    Does EDI ever allow the genetic parents to choose the intended parents?

    Sara R. Cohen
    twitter @fertilitylaw

    • Thank you for the comments. We have indeed tried to put a bit of thought into how we decide who should receive the donated embryos trying to be fair to all involved. I will admit, however, it is an imperfect process and would far prefer such decisions be made by an unbiased committee (removing the burden from our shoulders) or in the same way that donated organs are allocated by need and by mathematical formula. Perhaps someday there will be a universally accepted method to rank the patients. Better yet, if there were enough embryos, a ranking process wouldn’t even be necessary.

      We have three forms of embryo donation. The first is Anonymous where the donors and recipients do not meet. The second is Approved where the embryo donors review a summary provided by a mental health professional who interviewed the potential embryo recipients scrubbed of identifying information giving a “thumbs up” or a “thumbs down” to the recipients. This allows the donors to know more about the recipients and yet still protects all parties with desired anonymity. The third option is Open wherein both embryo donors and embryo recipients eventually break the confidentiality barriers learning more about each other. In this case, both parties need legal counsel and mental health professionals to guide the way. You can learn more about these options by visiting our General Information section of the website.

      Please let us know if we can help you or your clients in anyway possible and thanks again to taking the time to post your comment.

      Craig R. Sweet, M.D.
      Reproductive Endocrinologist
      Embryo Donation International

  • Margo:

    As a single woman, finding a donated embryo can be much more difficult than for a two parent family and I wonder if a single parent plays any role in the ranking?

    • Great question! Please understand that it is the donor that drives this entire process. They are able to provide stipulations regarding the recipients. The most common stipulations are:
      • Geographic location (they don’t want recipients that are located nearby)
      • Marital/Partner Status
      • Sexual Preference
      • Race
      • Religion

      The reality is that few embryo donors currently allow for single women to receive their embryos. As a result, we have a longer waiting list for single women than for couples.

      When we have embryos destined for single women, we then examine that particular waiting list. We use the same criteria to rank the single women with regards to priority as we have listed in the blog above. This process is true for all of the stipulations.

      Excellent question. We should have explained it in the body of the blog, so I thank you for giving me a chance to clarify.

      Craig R. Sweet, M.D
      Reproductive Endocrinologist
      Embryo Donation International

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