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Limited choices and difficult decisions for patients with frozen embryos
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In the largest, multisite study of fertility patients’ preferences for the future fate of their frozen embryos, researchers found that patients often prefer options that are not available to them and find existing options less than acceptable. 

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Anne Drapkin Lyerly, MD of Duke University Medical Center led a group of professionals surveying patients from nine geographically diverse fertility centers in the United States. One thousand and twenty individuals, women and men who had cryopreserved embryos in storage, answered a questionnaire addressing the likelihood of their choosing among seven options for their unneeded embryos. Five of the embryo disposition options were conventional: store for future reproduction; thaw and discard; donate to another couple; keep frozen indefinitely; and donate for research. Two options characterized as alternative were not actually offered at any of the clinics whose patients were surveyed: transfer to the woman’s body at an infertile time and a disposal ceremony. The patients also answered questions about their desire to have more children or not and considerations and concerns informing their choice of embryo disposition options.

Most of the respondents (54%) said that they were very likely to use their embryos for future reproduction and 21% were very likely to donate them for research. Seven percent or fewer were very likely to choose any other option.

Of the respondents who were certain that they did not want another baby (193 individuals), 41% considered research donation a very likely option, while only 16% considered reproductive donation a very likely option and 12% saw thaw and discard as a very likely option.

The considerations that most influenced patients’ preferences included: wanting to help find cures for diseases; not wanting someone else to raise one’s genetic child; the feeling that thawing and discarding embryos is wasteful; and one’s partner’s opinion about what to do with the embryos.

In analyzing the data, the researchers found that nearly half of the stored embryos were not, at the time of the survey, intended to be used for reproduction, but that the alternatives were not especially appealing to patients, who tended to prefer options not generally available- like research donation- and reject options that are available- such as reproductive donation and thawing and discarding embryos.

Certain demographic factors were predictive of patients’ plans for their embryos. Childless patients were highly likely to intend to use their embryos for a future pregnancy. Patients who had stored their embryos for five years or more were more likely to express the intention to thaw and discard them or to keep them frozen indefinitely than those who had embryos in storage for a shorter period of time.

“Patients preparing for an IVF cycle are completely focused on the immediate goal of achieving pregnancy,” noted Elizabeth Ginsburg, MD, President of the Society for Assisted Reproductive Technology. “As clinicians, we need to give patients more information and more real choices concerning what they can do with the embryos that may remain after they complete their families. It’s a difficult decision that patients have to make but we can help them by discussing with new patients the ramifications of embryo freezing and by regularly reminding patients who have stored embryos of the choices available to them.”

Lyerly et al, Fertility patients’ views about frozen embryo disposition: results of a multi-institutional U.S. survey, Fertility and Sterility, in press December 4, 2008.

The American Society for Reproductive Medicine, founded in 1944, is an organization of over 8000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology. Affiliated societies include the Society for Assisted Reproductive Technology, the Society for Male Reproduction and Urology, the Society for Reproductive Endocrinology and Infertility, and the Society of Reproductive Surgeons.

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