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


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


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


      Nine geographically diverse U.S. fertility clinics.


      1020 fertility patients with cryopreserved embryos.


      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.


      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.


      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

      To read this article in full you will need to make a payment


      Subscribe to Fertility and Sterility
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bankowski B.J.
        • Lyerly A.D.
        • Faden R.R.
        • Wallach E.E.
        The social implications of embryo cryopreservation.
        Fertil Steril. 2005; 84: 823-832
      1. United States Department of Health and Human Services/Centers for Disease Control and Prevention. 2004 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports. Available at:

        • Hoffman D.I.
        • Zellman G.L.
        • Fair C.C.
        • Mayer J.F.
        • Zeitz J.G.
        • Gibbons W.E.
        • et al.
        Cryopreserved embryos in the United States and their availability for research.
        Fertil Steril. 2003; 79: 1063-1069
        • Levin Y.
        A middle ground for stem cells.
        New York Times. January 19, 2007; : A23
        • Hatch O.G.
        Audio interview: expanding federal funding for embryonic stem-cell research.
        N Engl J Med. 2007; 356: e18
        • de Lacey S.
        Parent identity and ‘virtual’ children: why patients discard rather than donate unused embryos.
        Hum Reprod. 2005; 20: 1661-1669
        • Lyerly A.D.
        • Steinhauser K.
        • Namey E.
        • Tulsky J.A.
        • Cook-Deegan R.
        • Sugarman J.
        • Walmer D.
        • Faden R.
        • Wallach E.
        Factors that affect infertility patients' decisions about disposition of frozen embryos.
        Fertil Steril. 2006; 85: 1623-1630
        • McMahon C.
        • Gibson F.
        • Cohen J.
        • Leslie G.
        • Tennant C.
        • Saunders D.
        Mothers conceiving through in vitro fertilization: siblings, setbacks, and embryo dilemmas.
        Reprod Technol. 2000; 10: 131-135
        • Saunders D.M.
        • Bowman M.C.
        • Grierson A.
        • Garner F.
        Frozen embryos: too cold to touch? The dilemma ten years on.
        Hum Reprod. 1995; 10: 3081-3082
        • Brzyski R.G.
        Efficacy of postal communication with patients who have cryopreserved pre-embryos.
        Fertil Steril. 1998; 70: 949-951
        • de Lacey S.
        Decisions for the fate of frozen embryos: fresh insights into patients' thinking and their rationales for donating or discarding embryos.
        Hum Reprod. 2007; 22: 1751-1758
        • Zweifel J.
        • Christianson M.
        • Jaeger A.S.
        • Olive D.
        • Lindheim S.R.
        Needs assessment for those donating to stem cell research.
        Fertil Steril. 2007; 88: 560-564
        • Van Voorhis B.J.
        • Grinstead D.M.
        • Sparks A.E.
        • Gerard J.L.
        • Weir R.F.
        Establishment of a successful donor embryo program: medical, ethical, and policy issues.
        Fertil Steril. 1999; 71: 604-608
        • Kovacs G.T.
        • Breheny S.A.
        • Dear M.J.
        Embryo donation at an Australian university in-vitro fertilisation clinic: issues and outcomes.
        Med J Aust. 2003; 178: 127-129
        • Klock S.C.
        • Sheinin S.
        • Kazer R.R.
        The disposition of unused frozen embryos.
        N Engl J Med. 2001; 345: 69-70
        • McMahon C.A.
        • Gibson F.L.
        • Leslie G.I.
        • Saunders D.M.
        • Porter K.A.
        • Tennant C.C.
        Embryo donation for medical research: attitudes and concerns of potential donors.
        Hum Reprod. 2003; 18: 871-877
      2. McMahon CA, Saunders DM. Attitudes of couples with stored frozen embryos toward conditional embryo donation. Fertil Steril. Published online November 28, 2007.

        • Hammarberg K.
        • Tinney L.
        Deciding the fate of supernumerary frozen embryos: a survey of couples' decisions and the factors influencing their choice.
        Fertil Steril. 2006; 86: 86-91
        • Edwards P.
        • Roberts I.
        • Clarke M.
        • DiGiuseppi C.
        • Pratap S.
        • Wentz R.
        • et al.
        Increasing response rates to postal questionnaires: systematic review.
        BMJ. 2002; 324: 1183
        • Lyerly A.D.
        • Faden R.R.
        Willingness to donate frozen embryos for stem cell research.
        Science. 2007; 317: 46-47
        • Willis G.B.
        Cognitive interviewing: a tool for improving questionnaire design.
        Sage, Thousand Oaks, CA2005
        • Gurmankin A.D.
        • Sisti D.
        • Caplan A.L.
        Embryo disposal practices in IVF clinics in the United States.
        Politics Life Sci. 2003; 22: 4-8
        • Hudson K.L.
        • Scott J.S.
        • Faden R.R.
        Values in conflict: public attitudes on stem cell research.
        Genetics and Public Policy Center, Washington, DC2005
        • Baylis F.
        • Beagan B.
        • Johnston J.
        • Ram N.
        Cryopreserved human embryos in Canada and their availability for research.
        J Obstet Gynaecol Can. 2003; 25: 1026-1031
        • Osmanagaoglu K.
        • Collins J.A.
        • Kolibianakis E.
        • Tournaye H.
        • Camus M.
        • Van Steirteghem
        • et al.
        Spontaneous pregnancies in couples who discontinued intracytoplasmic sperm injection treatment: a 5-year follow-up study.
        Fertil Steril. 2002; 78: 550-556
        • Hug K.
        Motivation to donate or not donate surplus embryos for stem-cell research: literature review.
        Fertil Steril. 2008; 89: 263-277
      3. Elements to be considered in obtaining informed consent for ART.
        Fertil Steril. 2006; 86: S272-S273
        • Elford K.
        • Lawrence C.
        • Leader A.
        Research implications of embryo cryopreservation choices made by patients undergoing in vitro fertilization.
        Fertil Steril. 2004; 81: 1154-1155
        • Burton P.J.
        • Sanders K.
        Patient attitudes to donation of embryos for research in Western Australia.
        Med J Aust. 2004; 180: 559-561
        • Crockin S.
        How do you ‘adopt’ a frozen egg?.
        Boston Globe. December 5, 2005;
        • Committee on Guidelines for Human Embryonic Stem Cell Research
        Guidelines for human embryonic stem cell research.
        National Academies Press, Washington, DC2005 (revised 2007)
        • Daley G.Q.
        • Richter L.A.
        • Auerbach J.M.
        • Benvenisty N.
        • Charo R.A.
        • Chen G.
        • et al.
        ETHICS: The ISSCR guidelines for human embryonic stem cell research.
        Science. 2007; 315: 603-604