Donation of surplus frozen pre-embryos to research in Israel: underlying motivations

Kin or Research Material? Exploring IVF Couples' Perceptions about the Human Embryo and Implications for Disposition Decisions in Norway

In vitro fertilization (IVF) involves making embryos outside of the human body, which has spurred debate about the status of the embryo, embryo research and donation. We explore couples' perceptions about embryos and their thoughts and acceptability about various disposition decisions in Norway. Based on an ethnographic study including interviews and observations in an IVF clinic, we show that couples do not perceive their pre-implantation IVF embryos to be human lives; rather, they consider successful implantation the start of life. We suggest that this response indicates a change in the perception of the human embryo or the fertilised egg from incipient life-a viewpoint that was dominant in the discussions of embryo research in the 1980s and 1990s. We also show how this view of the pre-implantation embryo elucidates why donating embryos to research appears acceptable but donating to other infertile couples seems rather difficult. Before transfer to a woman's uterus, the embryo exists in a liminality; it is not yet human life but a living cell with potential for both research and pregnancy. When an embryo is implanted and pregnancy is confirmed, human life activates; the embryo becomes potential kin, influencing couples' struggles with donating embryos to other couples.

Perceptions on using surplus embryos for the treatment of Parkinson's disease among the Swedish population: a qualitative study

BACKGROUND

Human embryonic stem cells are currently used for developing treatment against Parkinson's disease (PD). However, the use of ES cells is surrounded with moral concerns. Research regarding the public's attitudes can form an important basis for policymaking. The aim was to explore the perceptions of the public on using donated human embryos for developing treatment of Parkinson's Disease.

METHODS

Semi-structured individual qualitative interviews were conducted with 11 members of the general population in Sweden. Interviews were analyzed with thematic content analyses.

RESULTS

Four categories and additional sub-categories; Different views on the embryo requires delicacy, Using embryos to treat Parkinson's disease, Doing things in the right way, and Communication, media, and public opinion. In general, respondents were positive towards the usage of embryotic stem cells to treat PD, but the usage were conditioned and specific terms were demanded. Informed consent from both donors were required and delicacy and sensitivity when working with embryos were needed.

CONCLUSIONS

It was perceived better to use surplus embryos to treat PD increase is than to discard them, also among those who perceived the embryo as "a potential life." The participants raised several conditions under usage for treatment should be allowed. Even if the embryos otherwise are going to be discarded, usage requires informed consent from the donating couples.

Unmet communication needs and moral work in the disposition decision concerning surplus frozen embryos: The perspectives of IVF users

The disposition decision is a frequently unresolved issue for many IVF users with surplus frozen embryos (SFEs), and this study draws attention to their experiences and moral work, locating it in the Jewish-Israeli context that legally enables the donation of SFEs to research but prohibits donation to other infertile people. To explore the (mis)understandings and (mis)communication underlying IVF users' decisions concerning the fate of their SFEs, the records of 674 IVF users with SFEs stored for more than 5 years during 1996-2011 were analyzed, and 89 IVF users with different disposition decisions were recruited for semi-structured interviews. With an average of 5.1 SFEs, after an average of 8 years of storage, no response to a written request for a disposition decision came from 60% (n = 404) of IVF users with SFEs. Payment for storage and defrosting were the two most frequent choices (13%, n = 89 and 89, respectively) followed by donation to research and transfer (7%, n = 47 and 45, respectively). Three themes emerged from the interviews: misunderstanding the consequences of not returning the disposition form, communication gaps regarding donation to research, and the unmet wish to donate embryos to infertile people. We conclude by discussing the experiences and views of IVF users as reflecting the implications of the liminality and boundary-work surrounding the frozen embryo as a moral work object, and their consequences for policy recommendations.

The fate of surplus embryos: ethical and emotional impacts on assisted reproduction

Objective:

This paper looked into the findings of a survey on the ethical and emotional aspects encircling the fate of surplus embryos in Assisted Human Reproduction (AHR).

Methods:

Five staff members of a fertility clinic in the Brazilian State of São Paulo answered a semi-structured qualitative interview.

Results:

The answers alluded to the different meanings assigned to embryos by medical staff (genetic material) and couples undergoing fertility treatment (potential child). The meaning couples assigned to their embryos, along with inherent uncertainty and distress, affected the choice of what would be done to surplus embryos.

Conclusion:

Psychological support may be helpful to two key groups present in assisted human reproduction: clinic staff, for support in their interactions with couples; and couples in need of support and awareness on surplus embryo donation.

Parents' malevolent personification of mass vaccination solidifies vaccine hesitancy

Parental hesitancy to vaccinate their children derails the success of mass vaccination campaigns. We examined the effect of parents' personification of the vaccinating agency on vaccine hesitancy (i.e. negative or positive mind change) in 555 parents in a mass wild poliovirus vaccination campaign. Parents were assessed before and after the campaign on attitudes toward vaccination and the vaccinating agency ("The Israeli MoH is caring" vs "hysteric"). Positive mind change was predicted by a gender and malevolent personification. A negative mind change was predicted by parental anxiety. We conclude that parental hesitancy is influenced by parents' attachment to the vaccinating agency.

Embryo donation: Survey of in-vitro fertilization (IVF) patients and randomized trial of complimentary counseling

Design

This study surveyed patients with stored frozen embryos and developed and tested an intervention through a randomized trial to support subjects to consider embryo disposition options (EDOs), especially donation for family building.

Methods

Based on a review of literature on EDOs, the authors developed and mailed a 2-page anonymous survey to 1,053 patients in Massachusetts (USA) to elicit their feelings about their stored embryos. Target patients had embryos cryopreserved for ≥1 year and had not indicated an EDO. Survey respondents were next randomized between usual care (control arm) or an offer of complimentary counseling and educational support regarding EDOs. These counseling sessions were conducted by a licensed mental health professional specializing in infertility treatment.

Results

Despite telephone reminders, only 21.3% of patients responded, likely reflecting most patients’ reluctance to address EDOs. Respondents endorsed an average of 2 of the 5 EDOs, with the following percentages supporting each option: store for future attempts (82%), continue storage (79%), donate to research (29%), discard (14%), and donate for family building (13%). When asked their opinions towards embryo donation to another couple, 78% of patients agreed that donation is a way to help another couple, 48% would consider embryo donation to another family if they had a better understanding of the process, and 38% would be willing to consider donation if they were not going to use the embryos themselves, but 73% expressed discomfort with donation. In the randomized trial, 7.8% of intervention subjects (n = 8) obtained counseling sessions compared to 0.0% (none) of usual care subjects (p = 0.0069). Counseling participants valued not only discussing EDOs, but also assistance in expressing their feelings and differences with their partners.

Conclusion

Improvement in counseling rates over the control arm suggests that free professional counseling is a small, but likely effective, step towards deciding on an EDO.

ClinicalTrials.gov Identifier: NCT01883934 (Frozen embryo donation study).

"I6 passages: on the reproduction of a human embryonic stem cell line from Israel to France"

The first French clinical trial using human embryonic stem cells for regenerative purposes was launched in 2014, using the I6 stem cell line that was imported from Israel. From Israel to France, national reproductive policies and practices inform how basic scientists produce, manage and circulate cells across countries. Building on an interdisciplinary co-production involving two social scientists and a life scientist, this article suggests that biobanks passage cells from in vitro fertilization to stem cell science and from country to country by modifying their reproductive meaning. Four passages are described: the absence of cells in 2005 when the research started in France; the presence of supernumerary embryos available for research in Israeli IVF biobanks; the production of the I6 stem cell bank in Israel; the importation and laboratory biobanking of the cells in France. Human embryonic stem cell lines can never be completely disentangled from reproduction.

A patient-centred approach to embryo donation for research

Most couples enrolled in Assisted Reproductive Technologies' (ART) treatments need to make decisions regarding embryo disposition, as they are asked to sign a consent form about embryo donation for research. Beyond the current assessment of patients' individual experiences and levels of satisfaction with care delivery, we argue that it is crucial to provide stakeholders in health systems with feedback on patients' views about legal and regulatory frameworks. Such knowledge will lend credence and robustness to the consent that the couples give, and will contribute to the implementation of informed relational ethics in clinical practice and to improved patient-centredness in the field of ART.