Fertility patients' views about frozen embryo disposition: results of a multi-institutional U.S. survey

Received 24 July 2008; received in revised form 8 October 2008; accepted 15 October 2008. published online 05 December 2008.

Objective

To describe fertility patients' preferences for disposition of cryopreserved embryos and determine factors important to these preferences.

Design

Cross-sectional survey conducted between June 2006 and July 2007.

Setting

Nine geographically diverse U.S. fertility clinics.

Patient(s)

1020 fertility patients with cryopreserved embryos.

Intervention(s)

Self-administered questionnaire.

Main Outcome Measure(s)

Likelihood of selecting each of five conventional embryo disposition options: store for reproduction, thaw and discard, donate to another couple, freeze indefinitely, and donate for research; likelihood of selecting each of two alternative options identified in previous research: placement of embryos in the woman's body at an infertile time, or a disposal ceremony; importance of each of 26 considerations to disposition decisions; and views on the embryo's moral status.

Result(s)

We found that 54% of respondents with cryopreserved embryos were very likely to use them for reproduction, 21% were very likely to donate for research, 7% or fewer were very likely to choose any other option. Respondents who ascribed high importance to concerns about the health or well-being of the embryo, fetus, or future child were more likely to thaw and discard embryos or freeze them indefinitely.

Conclusion(s)

Fertility patients frequently prefer disposition options that are not available to them or find the available options unacceptable. Restructuring and standardizing the informed consent process and ensuring availability of all disposition options may benefit patients, facilitate disposition decisions, and address problems of long-term storage.

Key Words: Cryopreserved embryos, frozen embryos, embryo disposition, informed consent, discarding embryos, embryo donation, embryo research, ethics

a Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina

b Trent Center for Biothics, Humanities, and History of Medicine, Duke University, Durham, North Carolina

c Department of Medicine, Duke University, Durham, North Carolina

d Center for Palliative Care, Duke University, Durham, North Carolina

e Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina

f Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California

g Oregon Reproductive Medicine, Portland, Oregon

h Institute for Genome Sciences and Policy Center for Genome Ethics Law and Policy, Duke University, Durham, North Carolina

i Department of Obstetrics and Gynecology, Penn State Hershey College of Medicine, Hershey, Pennsylvania

j Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California

k Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri

l Department of Obstetrics, Gynecology, and Women's Health, UMDNJ–New Jersey Medical School, Newark, New Jersey

m Shady Grove Fertility Center, Rockville, Maryland

n Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado

o Department of Medicine, Johns Hopkins University, Baltimore, Maryland

p Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland

q Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

r Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland

Reprint requests: Anne Drapkin Lyerly, M.D., M.A., Box 3040, Duke University Medical Center, Durham, NC 27710 (FAX: 919-669-1789).

A.D.L. has nothing to disclose. K.S. has nothing to disclose. C.V. has nothing to disclose. E.N. has nothing to disclose. C.A. has nothing to disclose. B.B. serves on the speakers' bureau for EMD Serono. R.C-D. has nothing to disclose. W.C.D. has nothing to disclose. E.G. has nothing to disclose. E.S.J. has nothing to disclose. P.G.M. has received grant support from Ferring and EMD Serono. E.R.M. is a consultant for Merck and GSK. B.O. has nothing to disclose. W.S. has performed sponsored research for Organon. J.S. is a consultant for Pfizer. J.A.T. has nothing to disclose. D.W. has nothing to disclose. R.R.F. has nothing to disclose. E.W. has nothing to disclose.

Supported by the Greenwall Foundation Presidential Award and Faculty Scholars Program; Duke Institute for Genome Sciences and Policy's Center for Genome Ethics, Law and Policy Research Fellowship Award; National Heart Lung and Blood Institute, the National Institutes of Health (1 K01 HL79517-01) [A.D.L.]; MREP Career Development Award from VA Health Services Research and Development (MRP 02-263 [K.S.], MRP04-216-1 [C.V.]); and NHGRI and U.S. Department of Energy (P50 HG003391) [R.C-D.].

PII: S0015-0282(08)04204-0

doi:10.1016/j.fertnstert.2008.10.015

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