Fewer Embryos, Smarter Strategy: How to Avoid the Spare Embryo Dilemma

What happens when IVF success leaves you with more embryos than you ever planned for?
 In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols tackles the emotional and practical side of “extra embryos.” He explains why the U.S. system often pushes patients to create as many embryos as possible — and how cost, culture, and regulation shape that pressure.

You’ll learn the pros and cons of mini-IVF, selective fertilization, and egg-only freezing, and why “more” isn’t always better when it comes to embryo creation. Dr. Amols also breaks down five crucial questions to ask your clinic before you start stimulation, so your IVF plan aligns with your values, not just your clinic’s routine.

Whether you’re planning your first cycle or staring at a freezer inventory you never expected, this episode helps you find the balance between success, cost, and peace of mind.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

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Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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Today we talk about a topic nobody wants to talk about, but everybody in IVF faces eventually. What do you do with your spare embryos? I'm, Dr. Mark Amols, and this is Taco about Fertility Tuesday. In the prior episode, I discussed disposition of embryos after ivf, where we talked about what to do with embryos, such as discarding them, donating them, donating them to research, or even certain types of compassion embryo transfers. But in this episode, we're going to talk a little bit more about strategy. Because for some couples, those embryos represent hope for future kids. For others, they may become an emotional weight, frozen reminders of decisions yet to be made. So today we're asking the big question. Should we be making fewer embryos from the start, I think the first question comes, why do we make so many embryos? I mean, the logic goes, the more eggs we retrieve, the more embryos we'll have. And the more embryos you have, the better odds of success. Right? Sounds pretty reasonable. And this kind of makes sense from the standpoint of attrition rates, where you see multiple eggs being removed and then a few fertilized and few end up becoming embryos. It makes sense to help patients have the best chance by making more embryos. And honestly, with the cost of IVF being so high, most people don't want to just make one or two embryos. They would like to have a whole bunch to make it cost effective. But there's a major problem here. The math doesn't consider your feelings. It doesn't consider the moral and emotional hangover of having a freezer full of embryos you might never use. I mean, let's be honest. When you're going to an IVF cycle, you want as many eggs as possible, and you want to make as many embryos as possible because you have one goal, and that one goal is become a parrot. Everything else goes to the side. The issue is when you finally have success and then you realize you have all these embryos, which gave you confidence in the past because you're like, hey, I got tons of these. I'm, going to have success now. Now you have this question of, but what do I do now? Unfortunately, in the United States, because of the cost going high and because of the expectations, making more embryos has become the norm. But that isn't true everywhere. Across the ocean, many countries legally limit how many embryos can be created or transferred. In places like Italy and Germany, clinics can fertilize only a certain number of eggs at once. The rest stay frozen as eggs, not embryos. Why? To prevent this exact problem. Having embryos indefinitely frozen in storage limbo. But in the United States, we do not have that restriction. So it's up to the patient and the clinic to decide how many embryos we're going to make. So one option could be do a mini ivf. In a mini ivf, you're not going to make as many embryos because you're getting fewer eggs. And it could be a little bit lower cost per cycle. And you can definitely have lower risk ovarian hyperstimulation and obviously far fewer leftover embryos. But there's a problem. There's a trade off. When you get fewer eggs, you make fewer embryos, and your success rate per cycle will go down. There is plenty of data out there that shows many IVF cycles do not have the success rate of regular M IVF cycles. So you may need 2, 3, 4 mini IV cycles to equal one conventional IVF cycle. Now, that doesn't make it wrong. This is the trade off. Now, what about selective fertilization? Well, that's a great option where instead you can still make all the eggs, but now you only fertilize so many eggs, so that way you don't have extra embryos sitting around. And so if you ever choose to stop, you just have to discard eggs. But again, there's a trade off, the cost. When you go and freeze eggs to then thaw those eggs, require xe to fertilize them, you add additional cost and significant cost as well, and you still run to the same problem. Let's say you make 30 eggs and say, I'm only going to fertilize six of them. and let's say from those six, you get three embryos, you have your kids, and now you want to have some more. How many aches do you thaw? You only want one more kid. Well, if you thaw six, you may still get more embryos. So do you thaw one at a time, two at a time? Well, with each one of those thaws, there's an expense. Expense to clank the thawdom, an expense to do ICSI and needing specialized embryologists who can do that. And so it would not be surprising that the cost of just fertilizing one egg at a time could be at minimum somewhere around 4,000 or higher per egg if you're doing it one at a time. That's why most people will just thaw all of them and then fertilize them for the one cost. But that would defeat the purpose. The purpose is to not have extra embryos. And this lies the conundrum. Currently in the United States, where everyone is paying for things out of pocket, you run into this issue of either having to have a lower chance at IVF by making fewer eggs, or choose to make a lot of eggs, but then if you don't make embryos, you have to spend more money to eventually use those eggs. Part I didn't mention is in those other countries, they usually pay for this. That way, there's no incentive for a patient to have to make a lot of embryos. That way, they can sit there and say, yeah, I'll do a small cycle, because they're not paying for it. That's the problem we've created by making the cost so expensive and putting the cost onto the patients. There is an incentive to push harder, make more eggs and freeze more embryos. But it doesn't have to be that way. Now, don't get me wrong, there are times you should do that. We're talking about young people here. But let's say you're 37, and again, you're young. I, don't want anyone getting mad at me, but that is a little mature on the fertility scale. We know at that point, more than half the eggs are going to be abnormal. So a, mini IVF would actually put you at risk if you're wanting a larger family. If you're wanting one kid, yeah, don't make a lot of eggs. But if you're wanting multiple kids, you probably need to freeze your embryos then to be able to have kids in the future. So that's a situation where the case for less is not warranted. The same problem still is going to exist, which is what do you do with extra embryos? But there you don't have the time to make that decision later. Now, you could still do selective fertilization in that situation. Freeze a bunch of eggs and just make only so many embryos. But again, that will add more cost if you're in the United States. Here are the questions you need to ask. Are you comfortable with extra embryos in storage for years? Would you feel okay donating them to research or another family? Or does the idea of discarding them make you uneasy? There is no wrong answer, but there is a wrong time to think about it, and that's after retrieval. By planning earlier, you can prevent that situation from coming up and feeling like you're in a pinch. Now, some patients are choosing to freeze the unfertilized eggs instead of creating the embryos until they're ready to decide. And that's a fair option, but again, it adds cost. If you're someone who's younger and you have time, you can make fewer embryos. But you're going to have to then spend money again in the future to make embryos again. Hopefully at that point will be mandated and everyone will have coverage. But if you don't, hoping for that could be a financial risk. The bottom line is decide what matters most to you now before you start stimulation. Alright, so grab a pen and write these five questions down. That will save you a world of stress later. Number one, what's our target number of eggs and embryos? Each clinic, this is going to be a different number. If you have a clinic that has 100% pregnancy rate, then you only want three kids, you can only make three embryos. But that's not usually how it works. So clinics that have lower pregnancy rates, you might need more embryos to get to that success. This is something you'll need to know when you're trying to come to that target number. Question two, if we get more than planned, what's the strategy for the extras? This is also a point where there is no wrong or right. The strategy could be you're okay with discarding them, and that's okay. You may feel comfortable donating them to research or maybe even donating them to an adoption agency that can donate out your embryos. Maybe you have a family member. All those are fair options. There's even options of doing what are called compassionate transfers. We don't do those at our clinic, but some clinics do. That's where you transfer the embryo in a time that's not really compatible with implantation. And so you're going through the transfer, but without really a chance of success. The third question is, what are your storage policies and how much will it cost you every year? That's important. They charge $1,000 a year. That may change what you do. Number four, would a milder stimulation protocol make sense for you given your age and your ovarian reserve? This goes back to that point. If you're young and you're only one in two kids, you probably don't need to make a bunch of eggs and you can get away with something like 15 or 16 eggs. But if you're someone who is more mature, where you know you're gambling and that this is a numbers game, you do need to make more eggs. And so a milder stimulation wouldn't make sense. Even though you don't want to have extra embryos. The fifth question would be could we freeze some eggs instead of fertilizing them? All right now, each clinic is going to be a little bit different on this. You'd have to figure out the cost for that clinic to do that, and you would also want to make sure your clinic is good at freezing eggs to do that. But these are important questions for you and your clinic when making future plans. So here's the big in ivf, more isn't always better. It's about creating enough embryos to reach your goal, not so many that they become a lifelong question mark. Talk with your doctor, ask these questions and make sure your cycle plan fits your values, not just your clinic's routine. Hopefully this podcast was helpful for you. Maybe you have been worried about this and wanted to come up with a plan and this can help you start that plan and help you know what to talk to the clinic about. If you haven't catched our show Sperm Meets Egg this upcoming Wednesday, we'll be actually talking about this topic and actually having experts m in the field talking about the different options including embryo adoption. If you have questions, make sure you come to that show where you can ask your questions live. As always, I greatly appreciate everyone who listens to this podcast. Without you, there'd be no point to do this. I hope this podcast helped you or maybe a friend of yours who's going through this. If you like it, let them know about our podcast and give us a five star review on your favorite medium. As always, I love doing this. I look forward to talking again next week on Taco Belt Fertility Tuesday.