Use of in-vitro fertilisation embryos cryopreserved for 5 years or more

The Fate of Unused Embryos: Discourses, Action Possibilities, and Subject Positions

Although in vitro fertilization (IVF) has offered hope to those struggling with infertility, it has also had some unintended consequences, including the fate of embryos that may be "surplus" to requirement following IVF treatment. The number of embryos in storage across the world is high, creating a dilemma for patients who need to make disposal decisions, as well as presenting an administrative and practical dilemma for clinics. Research has suggested that patients' views of the status of their embryo/s may affect their disposal decisions, and yet the nature of the links between views of the embryo and decisions to either donate or discard remain unclear. In this article, we engage in a discursive analysis of literature on disposal decisions. We discuss the range of ways in which embryos may be constructed, and demonstrate how these discourses make available or constrain particular action possibilities, and offer particular subject positions for patients. The analysis highlights the complexity of the relationship between embryo status and decision making, and may assist clinicians in supporting and guiding patients' decisions.

The ethical dilemma of embryonic stem cell research

To determine the knowledge, attitude, and ethical concerns of medical students and graduates with regard to Embryonic Stem Cell (ESC) research. This questionnaire based descriptive study was conducted at the Civil Hospital Karachi (CHK), Pakistan from February to July 2008. A well structured questionnaire was administered to medical students and graduate doctors, which included their demographic profile as well as questions in line with the study objective. Informed consent was taken and full confidentiality was assured to the participants. Data were entered in a Statistical Package for Social Sciences (SPSS version.12) and analyzed. A total of 204 male and 216 female medical students and doctors were administered questionnaires out of which 105 males (51.4%) and 108 females (50%) were aware of the embryonic stem cell research and its ethical implications. Forty percent males and 47% of females were of the opinion that life begins at conception. Forty-six percent males and 39% females were in favor of stem cell research while only 31% males and 28% females supported the ESC research. Less than 1/3 of students supported using frozen embryos for research purposes while more than 2/3 indicated that they were unlikely to support abortion for stem cell research purposes. The majority of the students were in favor of stem cell research with some reservations regarding ESC research. A sizeable number of students withheld their views, reflecting their poor understanding of medical ethics. The result of the study indicates a need for incorporating bioethics into the medical curriculum.

Pre-birth characteristics and 5-year follow-up of women with cryopreserved embryos after successful in vitro fertilisation treatment

Many patients do not make a decision about the disposition of their surplus embryos until they are compelled to do so by statutory limits. In the current study, the characteristics of women who had conceived through in vitro fertilisation (IVF) and who still had embryos stored (E-S; n = 26) 5 years after IVF were compared to a cohort comparison group (C-C; n = 40). At time 1 (T1, 28 weeks pregnant) women completed questionnaires on personality traits (anxiety, locus of control and dependency) and participated in an interview on socio-demographic characteristics, family composition and stored embryos. At T2 (5 years later) women were re-interviewed and asked about beliefs about the embryos. Women in the E-S group were significantly younger, had been married or living with their partner for fewer years and had had more children than the C-C group. Further, women in the E-S group were more likely to have an external locus of control and a dependent personality than women in the C-C group. Almost all women in the E-S group (88.5%) thought of their embryos as siblings to existing children, and reported thinking about the embryos occasionally (61.5%) or frequently (34.6%). The personality differences identified may suggest that women who still have embryos after the end of fertility treatment may be in need of decision support.

Embryo donation in New Zealand: a pilot study

BACKGROUND

In New Zealand, embryo donation to others was approved in late 2005 and follows strict guidelines. To date, few donations have proceeded. Given the novelty of embryo donation and New Zealand's guidelines around donation, this study explores how potential recipients in New Zealand made meaning of embryo donation.

METHODS

Thirteen potential recipients were interviewed regarding decision-making around embryo donation. Data were analysed thematically, identifying the major concerns that shaped their perspectives and decision-making regarding embryo donation.

RESULTS

The concept of genetic lineage emerged as the most important consideration. Participants viewed the embryo as a direct and permanent link between the genetic parents and the child resulting from donation. The genetic link implied ongoing responsibility, interest, care and even ownership. Participants were particularly cognizant of the need for children born from embryo donation to have access to information regarding their heritage. Wider concerns around the quality of the embryo's genetic material were expressed. Neither discarding surplus embryos nor embryo donation was seen as easy options. Participants found embryo donation to be a psychologically and morally complex issue and expressed some caution about pursuing this option.

CONCLUSIONS

The emphasis on genetic lineage as a priority in decision-making needs to be recognized especially within contexts where guidelines emphasize donor registration and cultures are shaped by open-adoption practices and the importance of knowing one's lineage.

Patients' attitudes to their embryos and their destiny: social conditioning?

The clinical management of embryo storage and disposal is dynamic and subject to changes in the cultural context such as public debate and the implementation of public policy. Studies of the decisions made by patient couples for their embryos, and trends in decision-making over time and in relation to issues arising in the cultural context are rare. Studies of the attitudes that patient couples have towards their frozen embryos have largely focused on measuring patients' intentions in relation to publicly contentious outcomes. A small but expanding number of interview studies are illuminating the meaning that couples attribute to frozen embryos and how this influences decisions for their destiny. This chapter maps both quantitative and qualitative studies of patients' attitudes and decisions illuminating similarities and contradictions in study findings, and ultimately highlights the range of attitudes in patients, clinics and the community towards what is evidently a difficult and morally challenging decision to end the storage of frozen embryos.

Deciding the fate of supernumerary frozen embryos: a survey of couples’ decisions and the factors influencing their choice

OBJECTIVE

To investigate the decisions that couples make regarding supernumerary frozen embryos, the factors influencing these decisions, and the degree of difficulty involved in reaching a decision; and to canvass attitudes toward donating embryos to stem-cell research.

DESIGN

Anonymous postal survey.

SETTING

A large, private IVF clinic in a major city in Victoria, Australia.

PATIENT(S)

A consecutive cohort of couples who contacted the Monash IVF clinic in relation to embryos in long-term storage.

INTERVENTION(S)

Subjects completed a survey regarding decisions about surplus frozen embryos.

MAIN OUTCOME MEASURE(S)

Couples' decision regarding supernumerary embryos and reasons for the decision, experience of deciding, and attitudes about embryo donation for stem-cell research.

RESULT(S)

Forty percent (123/311) returned completed questionnaires. The most common decision was donation to research (42%). Altruistic motives and desire not to waste embryos were determinants of embryo donation. Determinants of disposal were not wanting a full sibling to existing children and opposition of embryo research. Forty-five percent found deciding distressing. The majority (69%) approved of embryo donation to stem-cell research.

CONCLUSION(S)

Most couples preferred embryos to come to some use rather than being disposed of. Almost half the sample reported finding the decision making distressing. A majority approved of embryo donation for stem-cell research.

Research implications of embryo cryopreservation choices made by patients undergoing in vitro fertilization

In 782 cryopreservation cases over 11 years, 60% of patients personally used their embryos, 26% kept their embryos in storage, 8% discarded their embryos, 5% gave them to research, and 1% anonymously donated them to other couples.

Birth of a healthy baby after transfer of embryos that were cryopreserved for 8.9 years

OBJECTIVE

To report successful pregnancy from embryos that had been cryopreserved for 8.9 years.

DESIGN

Case report.

SETTING

Fertility clinic of the University of Buenos Aires School of Medicine.

PATIENT(S)

A 43-year-old woman with ovarian failure and a 45-year-old man with nonobstructive azoospermia underwent embryo donation.I NTERVENTION(S): Five embryos that had been cryopreserved and stored since 1989 were thawed in 1998 and donated to an infertile couple. Endometrial preparation was performed with 17beta-estradiol and progesterone. The four embryos with better morphologic characteristics were transferred into the uterus.

MAIN OUTCOME MEASURE(S)

Post-thaw embryo survival, pregnancy, and birth.

RESULT(S)

Embryo survival was satisfactory as assessed by morphology. Pregnancy was confirmed by ultrasonography. A healthy baby weighing 2120 g was delivered by cesarean section at 36 weeks.

CONCLUSION(S)

Human 8-cell embryos may be viable after extended storage and can result in successful pregnancy.

Factors influencing the decision to use or discard cryopreserved embryos

BACKGROUND

Couples' reasons for discarding supernumerary fertilized cryopreserved embryos and gender differences in attitudes toward the frozen embryos were investigated among Swedish couples undergoing in vitro fertilization (IVF) at a private clinic. At the time of the study Swedish law stipulated that couples could keep their frozen embryos for a maximum of one year, with the possibility of an extension based on individual requests.

METHODS

A questionnaire with structured and unstructured questions was sent to 124 women and 124 men who had entered the IVF treatment and obtained supernumerary embryos from 1 January 1994 to 1 March 1995. Eighty-two women and 74 men completed the questionnaire.

RESULTS

After a mean storage time of 25.3 (+/-11.0) months 22 (26.8%) of the responding couples had their embryos discarded. The reasons were mainly practical, such as a positive outcome of IVF and a legally too short storage time. Comparisons between women and men showed that fewer women (13;17.6%) than men (20;27%) had been uncertain during the IVF treatment about using the frozen embryos at a later date and that men more often than women expressed anxieties about possible effects of the freezing procedure on the potential child (p=0.009).

CONCLUSION

A positive outcome of the original IVF treatment and a short maximum legal time of cryopreservation were the most common reasons why couples discarded their embryos. The men more often than women expressed anxieties about possible effects on a potential child. The results emphasize the need for giving detailed information to the couples about cryopreserved embryos and children born by this method.