Shipping embryos or gametes to another clinic

This is a guide that covers the process of shipping embryos/gametes from one clinic to another, including the use of dry shippers, the risks of transport, the process involved with the clinic and how you can prepare, three different shipping methods and approximate costs for the shipment.

Occasionally it’s decided that the embryos from one facility need to be moved to another facility. Maybe you’re just not happy with one clinic, or maybe you’re moving, or maybe the Supreme Court overrules abortion rights and you’re worried about the future of your embryos or gametes.

As a former embryologist who used to handle shipments, I am very familiar with what’s involved when transporting embryos (or eggs, or sperm!), so let’s get to it!

Note that this post applies mainly to the US, although in general this information should apply to other countries.

How are embryos or gametes shipped?

Before we start about the process of shipping the embryos, I think it’s helpful to look at what they’re actually being shipped in. A dry shipper! You can see one below (on the left) along with a carrier case (on the right).

They’re typically about the size of a large fire extinguisher, but with the case they’re quite a bit bigger.

To “charge” a dry shipper you need to fill it with liquid nitrogen, which is absorbed by a foam-like material inside that acts like a sponge. Once this foam is saturated, you can dump any remaining liquid nitrogen out and now the shipper is “dry” and safe for transporting without any special license. The liquid nitrogen saturated foam keeps the dry shipper cold (about -196*C) so it’s safe to store the embryos.

Typically the foam will stay saturated, and safe to store embryos, for a few days to a few weeks (it can vary).

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Risks of transporting embryos or gametes

In terms of maximizing thaw success and survival, it’s often best to keep embryos or gametes where they are. They were frozen using specialized techniques and reagents that your clinic will have access to and be trained to use. The receiving clinic may not be familiar with the sending clinic’s protocols, or the device they use to freeze the embryo. The protocol will be shared from the sending clinic so they’ll have time to read about it, but there are sometimes nuances that aren’t well explained in the protocols.

It’s kind of like driving someone else’s car – you know how to drive but things are a bit different, and if something starts to go wrong you might be panicking trying to find the emergency light button. However it’s pretty rare to get a protocol that is so unfamiliar that damage would occur, based on my experience, and thaw survival rates are typically 95%+ with the majority of protocols used.

Knowing this, it’s a good idea to ask the sending clinic to send an empty freezing device in the shipper. This is immensely helpful for the receiving clinic, who may not be familiar with the device used to freeze the embryos, and they won’t be able to see it until the embryos are being thawed (and often in a very time sensitive and stressful moment). By providing an empty freezing device, the receiving clinic can examine it beforehand to better prepare for the thaw.

Overall, embryologists know what they’re doing and know what to expect. So they won’t take a new procedure lightly and will do their best to make sure they’re doing it properly. And often, protocols are very similar to one another and it’s very rare to have a protocol that is so outside of what an embryologist is trained to do.

What to do before you ship embryos

There’s quite a bit of preparation that needs to be done before the embryos or gametes are shipped, and in some cases the process can take months so being prepared and starting early is important! Also be aware that there will be fees and this can cost a few hundred dollars to thousands of dollars depending on the clinic and whether or not you’re using a third party to ship (with insurance).

Contact the clinics and initiate the process

Firstly, you need to figure out where they’re going to go and you need to contact both the sending clinic and the receiving clinic about this. The sending clinic will have consents (and so will the receiving clinic), but the receiving clinic will have questions for you:

• What kind of specimens are being transferred (eggs, sperm, embryos) and how many?
• Were they generated with your own gametes or with donor gametes?
• What facility are they coming from? (PLEASE supply the email/phone for the person who will be handling the shipments – I can’t tell you how many times I would call the clinic’s default phone number and waste time trying to figure out who to talk to).

Clinics communicate with each other to determine eligibility

The receiving clinic (or sometimes the sending clinic) will then request info from the other clinic.

They’ll be looking for gamete sheets (that contains information on the embryos, when they were frozen, what grades, what gametes were used to make the embryos, etc.) and cryopreservation and thawing protocols. There’s a chance the receiving clinic will not accept embryos or gametes if they are unable to perform the thaw; you may also be responsible for paying for the thawing reagents (hundreds of dollars usually).

*Pro tip. When talking with the sending clinic, be sure to ask them to include an empty freezing device in the shipment.

Some clinics will not transfer embryos that are graded poor quality, or embryos that are from day 7, or mosaics/aneuploids. As far as I know, the US is the only country where selecting the embryo’s sex by PGT-A is permitted. You might have trouble shipping to another country if your embryos have been tested and the biological sex is known.

If embryos were created with donor gametes then the paperwork for the donor will need to be provided to show that they had proper testing (ie. for infectious diseases), otherwise the receiving clinic may not accept them. The sending clinic will have this information.

In some cases, gametes or embryos can’t be received by another clinic unless that clinic has the proper credentials. One example is with New York which requires that sending clinics have a New York State tissue bank license before they can be received by a New York facility. So if your receiving clinic is in New York but your sending clinic is from Texas, the Texas facility will need to have a NYS tissue bank license. If they don’t, then the receiving clinic can request an exemption from the FDA and this can take months.

Sign the consents!

Once the receiving clinic is able to accept the embryos/gametes then there’s the matter of the consents. They’ll usually give you these in the initial communication so make sure you get these done early so the process moves quickly. In some cases you might need to have these notarized, which can also take time. Typically you’ll be asked to sign the following:

• Receiving clinic: storage agreement to accept embryos/gametes into new facility
• Receiving clinic: consent to receive embryos or gametes
• Sending clinic: HIPAA authorization
• Sending clinic: Consent to send embryos or gametes

Establishing a shipping method and time

Once the shipment is determined to be eligible, and all the consents are signed, it’s time to decide on when to ship! This depends in part on which method you’ll be using to ship (next section).

If you’ll be using the clinic to ship there might be delays. Not all clinics are free to ship 24/7. Some clinics only ship embryos at certain times, it might be once a week, or once a month. Or maybe the person who’s shipping is on vacation, so it needs to be done at another time. Or maybe they’re booked for months and can’t get to it until November!

Often there isn’t much choice in when to ship and it’s up to the clinics to decide this.

Methods of shipping embryos or gametes

There are 3 basic ways to transport embryos or gametes:

1. You ship them yourself
2. You have one of the clinics ship them
3. You hire a third party to ship them

Method 1: ship the embryos or gametes yourself

Some clinics will let you rent their dry shipper for a price so you can transport the embryos or gametes yourself. This method tends to be the cheapest but really is only practical if the two clinics are close to each other. Or you can go on a road trip!

International shipping of embryos yourself is not something I am familiar with (third parties can do this). One thing I do know is that the tank cannot be X-rayed. X-rays can cause significant DNA damage and destroy embryos or gametes.

But if you’re shipping locally this of course won’t be an issue!

You’ll be asked to come in to the sending clinic at a specific time (don’t be late!) and to bring the tank back by a certain time (don’t be late!). If this is a long journey there will probably be more flexibility in the timing but please make sure you respect the schedule that they give you. Embryologists are constantly shipping embryos to and from clinics and they rely on those tanks to get this done.

The tank will be locked (using a zip tie) so please don’t tamper with it!

When they give you the tank, simply load it into your car (you can use a seat belt if you’d like) and head off to the receiving clinic. Once you’re there they’ll take the tank in the back and open it up and inspect everything. When they’re finished they’ll bring you back the empty shipper and you can bring it back to the sending clinic.

Method 2: The clinic ships the embryos or gametes

This is probably the most common method of the 3 because it requires the least amount of effort.

Embryologists frequently use services like FedEx to transport dry shippers across the country (domestic only!) and it really isn’t terribly expensive (a few hundred dollars I believe).

The embryologists handle everything so you don’t have to worry about anything except the paperwork. The shipper is loaded with the embryos and sent off to the receiving clinic overnight. If it’s a weekend it might take a few days, but dry shippers last awhile so the embryos or gametes will be okay.

Worst case scenario is your shipment gets lost. It’s *very* rare but it does happen. They may find the shipper eventually, but this may take awhile and the shipper might not be cold anymore. With FedEx there is no insurance on this sort of thing (as far as I know), so this is a risk. But a very, very small risk! I worked as an embryologist for 4 years and I saw it happen once, but they found it rather quickly and all was well.

Method 3: A third party ships the embryos or gametes

This is the best way to go, if you can afford it. I’m not sure on the pricing, but I expect it’s in the high hundreds to thousands. This will include insurance (as far as I know) and is like sending a limo to ship your embryos or gametes. There’s a little red carpet that rolls out of the tank when you receive it (just kidding).

This is also the only way to ship internationally, so if you’re going from the US to any other country you’ll need to use this method.

Your clinic can recommend which third party they’re comfortable using. I’m familiar with Cryoport and they worked well!

Cost for shipping embryos or gametes

This is vary depending on the clinic but typical costs include:

• Administration fee to handle shipment (hundreds)
• Fee for special thawing kit if receiving clinic doesn’t have it (hundreds)
• Fee for shipment (renting tank < using FedEx < using third party – hundreds to thousands)

And I think that’s about it! I’ll leave the comments open for this one so feel free to add any additional information, or ask questions about the process below.

 

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About Embryoman

Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.

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