IVF News: Insights From an Egg-Freezing Clinic, Custody Battles Over Embryos, and More
Today’s posting offers a close look at timely issues related to in vitro fertilization (IVF) and the infertility field as a whole. From arguments over who gets unused embryos after a couple splits up to debates about whether Jewish law allows for the posthumous use of semen from deceased soldiers, these stories shed light on important questions that don’t always have easy answers. Surprisingly, some of these subjects have been addressed in the media on numerous occasions in the past, showing that even seemingly settled topics can still inspire heated debate or more thorough research. As always, we welcome your comments and your opinions on the best ways to resolve these ongoing issues, especially if they differ from ours.
The CHR’s Editorial Staff
Insights From 8 years of Planned Oocyte Cryopreservation at an “Egg Freezing Clinic”
There are several reasons why a recent paper attracted our attention, with the first being that the clinic that published the paper identified itself – for the first time we ever have seen this – as an “egg-freezing clinic.” We consider this an important definition because clinics that primarily only conduct egg-freezing cycles – only here and there intermingled with a real IVF cycle trying to immediately achieve a pregnancy – must lack ovarian stimulation experience because egg-freezing cycles do not offer immediate cycle outcomes beyond oocyte numbers, maturity, and morphology. For all practical purposes, they often lack experience with the most important IVF cycle outcome parameters, pregnancy and delivery rates.
But, aside from this point, egg-freezing experiences are important to publish. Despite the explosive growth in egg-freezing cycles in the U.S., reported outcome data have remained remarkably sparse and in general have demonstrated surprisingly low efficiency for the concept of egg-freezing to preserve fertility, as later use of frozen eggs in almost all studies was found to be surprisingly low.
The here-discussed study from a NYC-based “egg-freezing clinic,” therefore, added important information over an 8-year span: Between 2016 and 2023, the clinic completed 4,659 cycles for 3,138 patients, with the mean cycle start age actually decreasing from 36.9 ± 2.8 years at the onset to 35.0 ± 3.5 years in the final year of the study.
The mean length of time between freezing and thawing was 3.4 ± 1.9 years. The mean age at first thawing was 39.9 ± 3.5 years, with a median (interquartile range) of 40 (39, 42) years. Among patients who had completed at least one freezing cycle before 2020 (n = 2,163), allowing for a minimum follow-up period of 4 years, only a remarkably low 10.4% (n = 226) returned for warming of their oocytes.
Across 271 such warming cycles, the mean number of MII oocytes warmed was 15, with very good survival and fertilization rates of 90.7% and 77.2%, respectively. Among patients who underwent cryopreservation at ≤40 years of age, warming a higher number of MII oocytes was associated with increased euploid embryo yield. The cumulative ongoing pregnancy/live birth rate for the cohort was 70.3%, ranging from 58.3% for 1–9 MII oocytes warmed to 81.8% for >20 MII oocytes warmed. We here at the CHR would, of course, argue that avoiding the use of PGT-A would likely have resulted in even better pregnancy rates.
So these, then, are the conclusions:
We are not certain that the decline in age of patients in this study is typical. At least, at the CHR, the trend has been going strongly the other way. But we – certainly – are also not primarily an “egg-freezing clinic!”
The main point is clearly that the usage rates of frozen eggs has – overall and especially in young women – indeed remained incredibly low, raising the question of what can – or maybe what should – be done to screen especially younger women in ways to avoid so many, in retrospect, useless cycles of fertility preservation. And recognizing the obvious difficulties in predicting who will or will not need frozen eggs to achieve motherhood, maybe the field should search for alternative solutions. One such alternative could, for example, at a certain age, be an egg-donation option for unused oocytes, including a partial refund of egg-freezing costs and permission for the “egg-freezing clinic” to use those eggs in anonymous donor egg cycles.
Finally, we need more precise outcome data. While the paper-presented cycle outcomes appear quite satisfactory, they – ultimately – cannot be really judged as presented in the paper.
Nevertheless, this was an interesting paper on egg-freezing, especially since it did not come from the NYU group, which so far has been dominating this ongoing discussion.
REFERENCE
Klein et al., Fertil Steril 2026;125(4):671-678
Back Again Under Legal Scrutiny: Who Gets Custody of Unused Embryos When a Couple Splits Up?
We thought that courts all over the country had resolved this issue a long time ago, because who does not remember cases where older women pleaded for the use of embryos they had produced while they were still married? They often argued that these embryos represented their last chance of genetic motherhood, while their ex-husbands often refused their consent with the argument that they no longer wanted to become genetic fathers and couldn’t be forced to agree against their will. And the courts usually held that nobody can be forced into genetic parenthood.
But here we go again, as The New York Times recently reported.1 The case the Times article reported on appears, indeed, still legally surprisingly unsettled since only approximately one-third of states have considered the issue at the appeals court level, where precedent is set.
Moreover, state legislatures are apparently getting interested in the subject: The Michigan Supreme Court in 2025 urged the state’s Legislature to consider the question of such embryo disputes. Arizona already in 2018 became the first state to pass a law requiring that – in case of such a dispute – existing embryos go to whichever party was planning on using them to have children. And in New York, the New York Times article suggested that everybody expects this case to be decisive.
And what is the CHR’s opinion? This is one of those issues where we are happy not to be the judge and happy not to have to make such difficult Solomonian decisions. But if we were forced to make the decision, we, likely, would award the parent who is ready to try to produce a child the right to do so, as long as this would not mean any form of parental responsibility – including financial responsibilities – for the unwilling parent.
But, as we already are making speculative judgment, what would be the decision if both parents want to use a single embryo to have “their own” child? It seems to us that it is only a matter of time until this potential issue will reach the courts. What then?
A modern-day King Solomon would – no doubt – split the embryo. But what could we do?
REFERENCE
Kitchener C. The New York Times, May 24, 2026. https://www.nytimes.com/2026/05/24/us/ivf-embryos-custody.html
Also Back Again: Is Undergoing Assisted Reproduction Procedures Like IVF Increasing Cancer Risks?
This is a question as old as IVF itself and, indeed, even older because it was already raised with the use of the first fertility drugs before IVF became a reality. In those days, they were the oral clomiphene citrate and the injectable Pergonal (the first drug derived from postmenopausal urinary gonadotropins of nuns).
But this study is worth mentioning because of its size: A multi-center cohort study of patients all over the world, it involved 417,984 women exposed to assisted reproduction procedures in Australia between 1991 and 2018, and the findings were once again reassuring: The all-cancer incidence was not different from the age-, jurisdiction-, and calendar year-matched general population of women. Incidence for some hormone-sensitive cancers (uterine, ovarian) and cutaneous melanoma were marginally higher, while incidence for cervical cancer and cancer of the trachea, bronchus, and lungs were marginally but notably reduced.
Specifically, in the total of 417, 984 exposed women, with 274 ,676 (65.7%) having used ART (median age, 34 [31-38] years; median follow-up time, 9.42 [5.08-15.42] years), and 175, 510 (42.0%) having ever used clomiphene citrate (median age, 32 [28-36] years; median follow-up time, 9.42 [5.42-13.58] years), - the overall incidence of invasive cancer was comparable with the general population for the ART (IVF) and IUI (SIR, 0.99; 95% CI, 0.97-1.02) cohorts and slightly elevated for the clomiphene citrate cohort (SIR, 1.04; 95% CI, 1.00-1.07).
For all cohorts, incidence of uterine cancer (SIRs, 1.23-1.83) and in situ and invasive melanoma (SIRs, 1.07-1.15) were elevated, and incidence of cervical cancer (SIRs, 0.52-0.61) and cancer of the trachea, bronchus, and lungs (SIRs, 0.62-0.70) were lower. Ovarian cancer incidence was elevated for the ART (SIR, 1.23; 95% CI, 1.10-1.37) and IUI/OS (SIR, 1.18; 95% CI, 1.01-1.37) cohorts. In situ breast cancer incidence was elevated for the ART cohort only (SIR, 1.24; 95% CI, 1.12-1.38). Incidence of invasive breast cancer was not elevated. Rate differences for invasive cancers with elevated incidence were all small (<1 to 6.51 cases per 100 000 person-years).
The conclusion, therefore, was that the overall incidence of cancer was comparable with that of the general population. The incidence of certain cancers appeared elevated; however, the excess numbers of these cancers were small, and there was a reduced incidence of other cancers. Causation can definitely not be inferred from this descriptive evidence.
REFERENCE
Vajdic et al., JAMA Network Open 2026;9(3):e261332
And Also Back Again: The Question of Whether Time Lapse is Cost Effective in Improving IVF Outcomes?
When time lapse monitoring was first introduced to embryology laboratories, the CHR – rather than purchasing one or more units of what was then called the “embryoscope” (as many clinics did) – decided to first test this new product reaching the market. Securing one of these instruments from a company for several months as a loan, for testing purposes only, we were looking to confirm claims at the time made by proponents of the product (some among them, as later tuned out, with undisclosed financial interests in the company that offered the product) that it would significantly improve pregnancy rates in IVF, shorten the staff time involvement per patient, and would also greatly enhance research on preimplantation-stage embryos. Our short study only was able to confirm the last claim, and even that in only limited ways. Moreover, we found that this new equipment actually increased the time embryologists spent on each patient.1
We, therefore, thanked the company, returned the instrument, and have been practicing without even a single time lapse monitor ever since. And as such, the CHR is likely one of only a very small number of IVF clinics without an abundance of time lapse monitors. Indeed, by now, a large majority of embryos in IVF clinics in the U.S. are routinely monitored in the – granted, steady – environment in such units.
And while steadiness of the environment is, of course, a relatively strong argument, especially in favor of time-lapse equipment for IVF clinics with large embryology staffs, which often diverge in cycle outcomes within a program, this, however, became exactly also the principal reason we chose against converting our embryology from manual morphology to time lapse. While we confirmed that it, of course, allowed for close observations of every embryo (if one wants to do this and spend the time), it forces every embryo into the same protocol. One, of course, theoretically can still individualize, but will one really do this? We didn’t think so, and we, to this day, consider this to have been the right decision for the CHR’s highly unusual patient population. The CHR, therefore, still does not use time lapse monitoring of embryos in routine clinical practice.
As ever-increasing numbers of time lapse systems were purchased by IVF clinics and increasing numbers of manufacturers started to offer such equipment, consensus was, however, reached in parallel through several well-designed studies that – like with so many other “add-ons” to IVF practice since 2010 – time lapse monitoring actually failed to fulfill the many promises its proponents had made in convincing the field to spend millions of dollars on this new equipment (with costs, of course, passed on to patients). Many clinics, even to this day, still charge patients extra “time lapse fees” in every cycle.
And now, as A.I. is trying to secure a foothold in the IVF laboratory, the combination of time lapse monitoring with A.I., of course, looked very enticing and underwent heavy promotion by several start-ups with alleged A.I. programs that could basically “guarantee” IVF pregnancies.
We, of course, are kidding!
At least as of the time of this writing, we are unaware of even a single study having demonstrated outcome benefits for embryo selection via A.I. in IVF cycles. We, however, are aware of at least one company making this claim having gone out of business because, - as we were told by the founder and CEO, “the financial benefit for IVF clinics was not big enough for them to warrant the purchase of the A.I. product.”
And, as with several other useless “add-ons” to IVF, the IVF field once again was lucky in that – what we have come to call the “Dutch Cavalry” – recently took up (as it has done in the past for many different “add-ons,” including, for example, PGT-A) the important research question, whether time lapse monitoring represented a cost-effective service?2 We coined the term “Dutch Cavalry” based on the fact that our Dutch colleagues succeeded in publishing so many important clinical studies, including large patient numbers in a very small country, and because they succeeded in setting up a unique collaborative multi-center research network involving all medical schools in The Netherlands. The study just published reported on the cost-effectiveness of time lapse monitoring with or without the use of embryo selection software compared to routine incubation and selection.2
And here is what they – for us here at the CHR completely unsurprisingly – found: The chance of having a baby within 12 months was similar for time lapse incubators and standard incubators. Time lapse incubators are, however, more expensive. The use of time lapse monitoring, therefore, - even in association with A.I. is, therefore, only unlikely to be cost-effective, - meaning that the higher costs are not balanced by better outcomes.
And for patients, this means that time lapse technology does not increase their chance of having a baby, but it does increase their costs of IVF treatment. The old-fashioned standard method of growing and selecting embryos, therefore, remains the most cost-effective option.
And why were we not surprised by these results? Because, as we just suggested in a very recent paper in Human Reproduction Open, all the evidence in the world now suggests that the concept of embryo selection – one of the earliest dogmas in IVF – simply no longer makes sense.3 Whatever technology we will throw at embryo selection (and how many investments we will make) - for basic biological and statistical reasons, embryo selection within a cycle cohort of embryos will never outbid basic, solid manual embryology in selecting the “best” embryos.
It would exceed the space we have here for this argument to go into further detail, but the absolutely correct logic behind why embryo selection – by whatever means – beyond routine manual embryology does not make sense is in detail explained in our recent publication.3 Thank you to The Netherlands for another important paper!
REFERENCE
1. Wu et al., Reprod Biol Endocrinol 2016;14(1):49
2. Kieslinger et al., Hum Reprod Open 2026;2:hoag034
3. Gleicher et al., Hum Reprod Open 2025;2:hoaf011
Does Jewish Law Allow Making Babies from the DNA (Semen) of Deceased Soldiers?
For obviously tragic reasons, this subject has occupied the Israeli public and media since October 7, 2023, to very significant degrees and has done so with considerable urgency after more than 940 young IDF soldiers in their peak reproductive years and over 210 members of Israel’s security forces lost their lives since that date. Though, of course, a problem of limited relevance to the U.S. public, it is important to recognize that ethical, religious, and legal issues that arose in Israel in obvious association with October 7, 2023, and what has followed since, also can apply to deaths outside of a war zone (for example, in NYC’s subway system, or on Chicago’s South Side).
We are here, therefore, reprinting selected passages of an article posted on Facebook by Hezy Laing, an independent journalist living in Jerusalem, in which he addressed this issue, - obviously from a religious Jewish viewpoint, which, however, as will quickly become apparent, addresses universal ethical, religious, and legal issues.
Among the most poignant stories addressing the issue of posthumous use of semen is that of Dr. Hadas Levy, a pediatrician whose fiancé, Capt. (res.) Netanel Silberg, was killed in Gaza in December 2023. Levy became the first woman in Israel to give birth to a child conceived from the genetic material of a soldier killed in the war.
Her experience, along with the roughly 250 families who have requested retrieval of genetic material from fallen soldiers, has brought unprecedented halachic questions (questions under Jewish law) to the forefront. The issue is especially pressing because sperm retrieval is extremely time‑sensitive. Success is about 75 percent within 24 hours of death and drops sharply after 72 hours.
This urgency intersects with Israeli law, which has evolved since the Attorney General’s 2013 guidelines, which said the following:
Widows or partners may request retrieval without court approval, unless a relative objects.
Parents must normally obtain family court approval, though, due to the narrow time window.
During the early months of the war, the Tel Aviv Family Court temporarily allowed retrieval without prior approval.
Regardless of who requests retrieval, use of the sperm always requires court authorization.
Widows are generally approved based on the presumption that the deceased wished to have children with them; parents must demonstrate evidence of the son’s wishes.
Halachically, the matter is, however, far more complex. Three scenarios must be evaluated separately under Jewish law: A married soldier with children, a married soldier without children (raising issues of so-called yibbum and chalitzah), and a single soldier, where the use of an unmarried woman’s womb introduces additional concerns.
These distinctions shape the positions of three major contemporary poskim (religious judges): Rav Mordechai Halperin argued that, although the deceased cannot fulfill the mitzvah of Peru U’revu after death, enabling his wish to leave a legacy may constitute chesed shel emes, similar to saying Kaddish or performing other acts on behalf of the dead. He later refined his view, but maintained that fulfilling the deceased’s will can be permissible, especially when the desire to leave a “name and remnant” is clear.
Rav Asher Weiss strongly opposed this. He maintains that there is no mitzvah after death, that “mitzvah l’kayem divrei ha‑meis” applies only to monetary matters, and that creating a child for a deceased bachelor inevitably leads to single motherhood, which he considered outside of Torah norms. He further warned that permitting such procedures could normalize parenthood outside of marriage and concluded that such requests should not be fulfilled.
Rav Zalman Nechemiah Goldberg offered a middle position: Without explicit consent, the procedure is forbidden; with clear consent or a strong umdana that this was the soldier’s wish, it is permitted. He bases this on the Torah’s valuation of preserving a person’s “name and remnant,” drawing an analogy from the rationale behind yibbum.
He further argued that the human desire for continuity is deeply rooted in Torah values and can justify posthumous reproduction when the deceased’s intent is known.
Together, these halachic, legal, and emotional dimensions have made posthumous reproduction one of the most sensitive and urgent questions facing Israel today.
REFERENCE
Laing H.Facebook. May 6, 2026. https://www.facebook.com/gershon.shapiro.9/posts/it-is-a-tough-call-one-that-would-require-in-my-opinion-a-sanhedrin-type-court-m/2182582522542965/