Are health care providers adequately educating couples for embryo disposition decisions?

OBJECTIVE: To determine the effectiveness of education provided by health care professionals during and after IVF treatment in preparing couples for surplus embryo disposition decisions. DESIGN: Cross-sectional survey. SETTING: University-affiliated fertility center. PATIENT(S): Couples with embryos cryopreserved for more than 2 years. INTERVENTION(S): Self-administered questionnaire. MAIN OUTCOME MEASURE(S): A Likert scale was used to rate the response to questions about patients' preparedness to make decisions regarding their surplus embryos. RESULT(S): The survey response rate was 70% (131 of 187). Education provided by health care professionals before initiating treatment met the needs of the majority of participants (n = 86). After treatment, the education received was not adequate to assist couples in making embryo disposition decisions. Of the 127 respondents who provided feedback on their intention for their cryopreserved embryos, 37% (n = 47) had no intention of using cryopreserved embryos for their own reproduction, 24% (n = 30) intended to use embryos for procreation, and the remaining 39% (n = 50) remained undecided regarding their future use of their embryos. Participants with more than 3 years of infertility (n = 49) were most likely to feel conflicted about the decision after treatment. CONCLUSION(S): The education received after treatment was considered inadequate. Couples with a long duration of infertility and those conflicted about final embryo disposition may be appropriate targets for further intervention. More written information and/or counseling services after treatment may help patients make informed and timely decisions regarding their surplus embryos.

Catastrophic consequences of assisted reproduction: the case of Turner syndrome.

Women with Turner syndrome are generally infertile due to premature ovarian failure. Few may achieve a spontaneous pregnancy, and others may conceive through assisted reproductive technologies including oocyte donation. These pregnancies are high risk due to the medical conditions associated with Turner syndrome. Maternal death from aortic dissection in pregnancies of women with Turner syndrome is estimated at 2%. These pregnancies are also complicated by severe hypertensive disorders and fetal morbidity and mortality. Guidelines for preconception screening and counseling now exist that may mitigate the maternal and fetal risks associated with pregnancy in women with Turner syndrome.