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PubMed2001

Precommitment stategies [sic] for disposition of frozen embryos.

The question of whether to enforce agreements to implant frozen embryos after divorce has become a major concern for the 300 clinics and thousands of couples who use infertility services every year. Although courts in New York and Tennessee support enforcement, recent decisions by appellate courts in Massachusetts and New Jersey have refused to enforce such agreements on the ground that courts should not force people to reproduce. This article analyzes conflicts over enforcement of agreements for disposition of frozen embryos in terms of the precommitment strategies that persons use to plan their lives. It shows that refusal to enforce contracts for frozen embryos is unfair to the parties who relied on them in undertaking invasive infertility treatments, and possibly unconstitutional. It also addresses the extent to which precommitments for rearing rights and duties in resulting children should be enforced, if agreements to implant embryos are recognized.

Advance Directives↗
PubMed2001

Gender bias in the disposition of frozen embryos.

OBJECTIVE: To examine the gender differences found among couples when choosing the disposition of their frozen embryos. DESIGN: Retrospective chart review. SETTING: University affiliated in vitro fertilization (IVF) center. PATIENTS: Couples undergoing their first cycle of assisted reproductive technology (ART). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Choice of disposition of gametes and embryos. RESULT(S): Gender bias is found when couples choose the disposition of their frozen embryos, but not when they choose the disposition of their gametes. CONCLUSION(S): Gender bias was found in couples who made decisions regarding the disposition of their frozen embryos.

Adult↗
PubMed2007

Having a child to save a sibling: reassessing risks and benefits of creating stem cell donors.

This manuscript assesses the risks, benefits, and ethical concerns regarding the use of assisted reproductive techniques (ART) to create a new donor for stem cell transplantation. We address ethical literature, the medical and psychosocial impact on patient, donor, family, and medical caregivers, and the appropriate decision-making process. We conclude that the use of ART to create a stem cell donor can be ethically acceptable. The decision to conceive a donor has medical and psychosocial implications. The family is the appropriate decision-maker and must consider risks and benefits to all parties with input from medical caregivers.

Abortion, Eugenic↗
PubMed2003

Reasoning about embryos, cloning and stem cells: let's get more clear and distinct.

Plural democratic societies encourage and require the tolerance of disparate views. However, in relation to contentious areas like assisted reproductive technologies and destructive embryo research, tolerance is strained by the normative force of our fundamental beliefs about the moral status of early human forms. Yet in the continuing debates, spokespersons for different positions often do not concede all the implications of their arguments, may sidestep the real moral issues, and can fail to be clear about the foundations on which their arguments and policy advice ultimately rely. Guidelines and statutes can be rendered incoherent by the desire to balance and satisfy opposing values, rather than honestly reflecting the primary values they espouse. I call for greater clarity and honesty as these issues continue to be debated. An uncritical adherence to pluralism will encourage strategic obfuscation, but citizens of democracies need to be clearly informed about all the premises of opposing positions. Decisions about ethically and legally acceptable reproductive technologies ultimately depend on support for one metaphysical grounding at the expense of another. This should be acknowledged, as should its implications for policy.

Adult↗
PubMed2000

Microscopic assessment of pronuclear embryos is not definitive.

The microscopic classification of embryos, especially unipronuclear embryos, is not very precise. A number of undocumented and unipronuclear embryos were determined to be diploid following karyotyping and fluorescence in situ hybridization (FISH). Accelerated and asynchronous pronuclear dismantling at the time of checking for embryo fertilization accounts for this disparity. Diploid embryos were also observed among tripronuclear embryos. However, not all embryos ascertained as diploid by FISH were karyotypically normal following full karyotype analysis. By taking into account the "background" abnormality rate, the rate of diploid embryo wastage was estimated to be about 40% among undocumented embryos and about 58% in total. A high percentage of misclassification infers an unintended loss of otherwise transferable embryos. Such a discrepancy is particularly important to older women who have fewer embryos. If these are a woman's only embryos, preimplantation genetic diagnosis might be applicable in determining those that are diploid and suitable for transfer. This could potentially reduce the number of wasted embryos and cycles. The present study has also shown that mosaicism is common but it is still unclear whether mosaicism is indicative of embryonic abnormality or is a fairly common phenomenon among healthy embryos. Bipronuclear embryos that present with abnormal or delayed cleavage are often chaotic in their chromosomal constitution. Such embryos should not be transferred.

Adult↗
PubMed2003

[Preimplantation diagnosis--a routine examination?].

The discussion on pre-genetic diagnosis continues. The question is whether it should be allowed in Austria and Germany, too. Pre-geneticdiagnosis aims at examining embryos for possible genetic damage prior to implantation. The method of producing embryos in vitro (IVF) primarily served to enable hitherto childless couples to become parents. Currently, however, application is moving towards helping couples capable of natural fertilisation but at higher risk of producing a handicapped child. Here, embryos are created in vitro, examined and only implanted if in good health. The damaged embryos, however, are destroyed. Some argue that this form of selection is no different to the termination of pregnancy in an abortion, and furthermore the PID is the more gentle method. These arguments are discussed in this article, and in addition whether the principle of preserving human dignity is already valid for the embryo and whether a doctor is authorized to produce, select and kill human life.

Austria↗
PubMed2006

Donation of surplus frozen embryos for stem cell research or fertility treatment-should medical professionals and healthcare institutions be allowed to exercise undue influence on the informed decision of their former patients?

The increasing availability of clinical assisted reproduction has led to an accumulated surplus of frozen embryos within fertility clinics worldwide. Couples that have attained success in clinical assisted reproduction, and have no further desire to reproduce; are often faced with an agonizing dilemma on what to do with their surplus frozen embryos-whether to simply discard them, or donate either for scientific research or to other infertile couples. There is a risk that persons or institutions directly involved in procuring donated embryos will prioritize their own interests over the informed choice of the patient to donate either for scientific research or to other infertile couples. Very often, formerly infertile couples who have attained reproductive success feel an overwhelming sense of gratitude to the fertility doctor handling their treatment. Hence, there is a risk of medical professionals exercising undue influence on their former patients, to sway the final decision to their preferred outcome. In the private practice setting, the preferred outcome would likely be donation for the treatment of other infertile couples; whilst in the case of medical professionals affiliated with research or academic institutions, the preferred outcome would likely be donation for stem cell research.

Decision Making↗
PubMed2006

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.

Attitude↗
PubMed2006

Comparison of pronuclear zygote morphology and early cleavage status of zygotes as additional criteria in the selection of day 3 embryos: a randomized study.

OBJECTIVE: Both pronuclear morphology and early zygote cleavage have been used in combination with day 3 criteria to predict implantation and pregnancy. However, in routine practice, it is impractical to use both these criteria to select embryos on day 3. The objective of the present study was to find which of the two criteria is more predictive in terms of implantation and pregnancy. DESIGN: Randomized study. SETTING: Hospital-based fertility center. PATIENT(S): A total of 330 IVF/ICSI patient cycles. INTERVENTION(S): Patients were randomized to two groups. The embryos of one group were classified into subgroups A, B, and C based on pronuclear morphology (group 1) and the embryos of the second group were classified into subgroups A, B, and C based on early cleavage status (group 2). MAIN OUTCOME MEASURE(S): Comparisons were made of implantation and pregnancy rates between groups 1 and 2, between subgroups within each group, and between the corresponding subgroups of groups 1 and 2. Progression of zygotes from day 1 to day 3 in group 1 was recorded, and retrospective analysis of pronuclear morphology of zygotes in group 2 was performed. RESULT(S): The overall implantation and pregnancy rates tended to be slightly higher for group 1 compared to group 2 patients, but not statistically significant. Further, there was no significant difference between the corresponding subgroups. Implantation and pregnancy rates of subgroup A zygotes from each group were significantly higher (P<.01) than the rates of subgroup C. CONCLUSION(S): There was no significant difference between the two groups in terms of implantation and pregnancy. However, pronuclear morphology is a more satisfactory criterion than early cleavage to assist embryo selection on day 3. This is because zygotes with early cleavage ability can be identified from their pronuclear morphology. Thus, observation for early cleavage on day 1 and assessment of progression of embryos on day 2 in addition to pronuclear morphology scoring is not necessary in the selection of embryos for transfer on day 3.

Adult↗
PubMed2007

[Embryo donation in France: practice and difficulties. Strasbourg's experience].

OBJECTIVE: The aim of this study was to present the situation of embryo donation in France and around the world, to expound the difficulties of its practice and the results obtained in our centre 3 years after the introduction of this procedure. PATIENTS AND METHODS: Embryo donation in France is controlled by implemented decrees published between 1999 and 2004. The couples, who have stored frozen embryos since at least two years, were contacted for a pluridisciplinary medical consultation. The indication of embryo donation was evaluated for the recipients through a pluridisciplinary approach. RESULTS: Among the interviewed couples, 16.7% have chosen embryo donation but only half of them have completed the procedure (6% of the couples with frozen embryos). The main indications for embryo donation were a double sterility, unexplained genetic disease, ART failures (poor fertilization or bad embryo quality) and oocyte donation when the delay was too long for the couples. The pregnancy rate was 28.6% after the 21 first embryo transfers. DISCUSSION AND CONCLUSION: The results of embryo donation confirm the international experience both considering the poor number of donated embryos, medical indications and results. Embryo donation has its place among ART techniques, but one should not ignore the general debate on ethical questions raised by this procedure.

Embryo Disposition↗
PubMed2000

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

Human embryos cryopreserved after in-vitro fertilisation can be stored initially for 5 years, and the storage period may be extended to a maximum of 10 years. Of 1344 embryos cryopreserved between 1988 and 1994 at two centres in Manchester, 67% (904 embryos) have had to be destroyed at the end of the first 5-year interval, even if the couples involved remain childless.

Cryopreservation↗