Is It Possible to Expand Oocyte Donors by Decreasing Number of Oocytes for Own Use? Insights From a Large Single-Center Study.

Background: Currently, in China, only women undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles can donate oocytes to others, but at least 15 oocytes must be kept for their own treatment. Thus, the aim of this study was to determine whether oocyte donation compromises the cumulative live birth rate (CLBR) of donors and whether it is possible to expand oocyte donors' crowd. Methods: This was a retrospective cohort study from August 2015 to July 2017 including a total of 2,144 patients, in which 830 IVF-embryo transfer (IVF-ET) patients were eligible for oocyte donation and 1,314 patients met all other oocyte donation criteria but had fewer oocytes retrieved (10-17 oocytes). All 830 patients were advised to donate approximately three to five oocytes to others and were eventually divided into two groups: the oocyte donation group (those who donated) and the control group (those who declined). The basic patient parameters and CLBR, as well as the number of supernumerary embryos after achieving live birth, were compared. These two factors were also compared in all patients (2,144) with oocyte ≥10. Results: In 830 IVF-ET patients who were eligible for oocyte donation, only the oocyte number was significantly different between two groups, and the donation group had more than the control group (25.49 ± 5.76 vs. 22.88 ± 5.11, respectively; p = 0.09). No significant differences were found between the two groups in other factors. The results indicate that the live birth rate in the donation group was higher than that in the control group (81.31% vs. 82.95%, p = 0.371), without significance. In addition, CLBR can still reach as high as 73% when the oocyte number for own use was 10. Supernumerary embryos also increased as the oocyte number increased in all patients (oocyte ≥10). Conclusions: Currently, oocyte donation did not compromise CLBR, and oocyte donation can decrease the waste of embryos. In addition, in patients with 10 oocytes retrieved, the CLBR was still good (73%). Thus, it is possible to expand oocyte donors if the number of oocyte kept for own use was decreased from 15 to 10 after enough communication with patients.

The Impact of Embryo Storage Time on Pregnancy and Perinatal Outcomes and the Time Limit of Vitrification: A Retrospective Cohort Study.

Background: The technique of embryo cryopreservation has been increasingly applied in clinical settings. However, there has been a concern about the safety and efficacy of long-term freezing of embryos. Therefore, the aim of this study was to evaluate whether storage time of vitrification had any effects on pregnancy as well as perinatal outcomes, further, to explore the appropriate time limit of vitrification. Methods: The study included women who underwent at least one frozen-thawed cycle with single embryo transfer between January 1st, 2016 and September 30th, 2019. Patients were assigned into 3 groups according to the storage time (<3 months, 3-12 months and >12 months) to evaluate the impact of embryo storage time on pregnancy and perinatal outcomes. To further investigate the time limit of vitrification, propensity score matching was used to compare the primary outcomes of patients with storage time of 1-3 years, 3-5 years, and >5 years to those stored for ≤1 year. Results: A total of 9806 frozen-thawed embryo transfer cycles were included in our study. After adjustment for confounding variables, no significant differences were found in pregnancy outcomes among groups. However, postponement of transfer increased the risks of large for gestational age and placenta previa. In addition, after propensity score matching, 171 cycles with storage time >5 years were matched with those ≤1 year, both the clinical pregnancy rate and live birth rate decreased significantly when the storage time exceeded 5 years. Conclusions: The duration of vitrification did not significantly affect the pregnancy outcomes within 5 years period. However, the clinical pregnancy rate and live birth rate both decreased significantly when the duration of vitrification exceeded 5 years. It is worth noting that the conclusion was drawn from a small sample study after propensity score matching and should be treated with caution. In addition, the cycles were from different time periods, which could have an impact on the results.

Current perceptions and decisions of patients about cryopreserved embryos in Argentina. / [Percepciones actuales y decisiones de pacientes acerca de embriones criopreservados en Argentina.]

Introduction: Worldwide there is an increase in the number of assisted reproduction treatments. The developments in culture media and drugs, associated with the occurrence of rapid freezing or vitrification techniques has improved the procedures encouraging transfers of a single embryo per cycle. This generates a greater number of viable surplus embryos. An embryo disposition decision making is a complex phenomenon. Method: Method: This descriptive exploratory study investigates the perceptions and opinions of a sample of 60 participants who have started an assisted reproduction treatment in a specialized Fertility Center of the City of Buenos Aires. Results: The absence of children in the majority of the sample (70.6% still have no children) makes the prevailing option to "continue cryopreservation" (36.67%). The majority, 38.4% (23 people), considers that the option that best represents the embryo is "a child". Although there are relatively few people who have decided to donate their embryos (5 participants), several study participants report having reflected on it (35%). The vast majority (86.6%) of respondents would not be willing to face the costs of maintaining a long-term cryopreservation. Conclusion: After more than three decades of assisted reproduction, Argentinean patients still face a high degree of uncertainty regarding what to do with the surplus embryos. Gaining more in-depth knowledge regarding the decision-making process can help to improve the communication strategies. The normative absences generate that the ARTs users are "disengaged" from their embryos; this hinders the decision making, increasing the risk of accumulating more "abandoned" embryos

Introducción: A nivel mundial se registra un aumento en la cantidad de tratamientos de reproducción asistida. La optimización en medios de cultivo y fármacos, asociado al advenimiento de técnicas de congelamiento rápido o vitrificación han logrado mejorar los procedimientos alentando las transferencias de un único embrión por ciclo, generando un mayor número de embriones excedentes viables. La toma de las decisiones sobre la disposición de los embriones supernumerarios es un fenómeno complejo. Método: Este estudio exploratorio descriptivo indaga las percepciones y opiniones de una muestra de 59 participantes que han comenzado un tratamiento de reproducción asistida en un Centro de Fertilidad especializado de la Ciudad de Buenos Aires. Resultados: La ausencia de hijos en la mayoría de la muestra (70.6% aún no tiene hijos) hace que la opción prevalente sea continuar la criopreservación (35,6%). La mayoría, 40.7% (24 personas) considera que la opción que mejor representa al embrión es "un hijo/a". Si bien son relativamente pocas las personas que han decidido donar sus embriones (5 personas) varios participantes del estudio refieren haber reflexionado sobre ello (43%). La gran mayoría (86,5%) de los encuestados no estaría dispuesta a enfrentar los gastos del mantenimiento de la criopreservación a largo plazo. Conclusión: Se constata que, luego de más de tres décadas de desarrollo de las tecnologías reproductivas, aún existe en Argentina un alto grado de incertidumbre en los pacientes respecto de qué hacer con sus embriones excedentes. Conocer más en profundidad el proceso de toma de decisiones puede contribuir a implementar estrategias comunicacionales.

Italian law on medically assisted reproduction: do women's autonomy and health matter?

BACKGROUND: In Italy in 2004, a very restrictive law was passed on medically assisted reproduction (MAR) (Law 40/2004) that placed Italy at the most conservative end of the European spectrum. The law was widely criticized and many couples seeking MAR brought their cases before the Italian Civil Courts with regard to pre-implantation genetic diagnosis (PGD), donor insemination and the issue of consent. Ten years on, having suffered the blows of the Italian Constitutional Court, little remains of law 40/2004. DISCUSSION: In 2009, the Constitutional Court declared the maximum limit of the number of embryos to be produced and transferred for each cycle (i.e. three), as stated in the original version of the law, to be constitutionally illegitimate. In 2014, the same Court declared as unconstitutional the ban on donor insemination, thus opening the way to heterologous assisted reproduction. Heterologous MAR is therefore perfectly legitimate in Italy. Finally, in 2015 a further ruling by the Constitutional Court granted the right to access MAR to couples who are fertile but carriers of genetic diseases. However, there is still much room for criticism. Many couples and groups are still, in fact, excluded from MAR. Same-sex couples, single women and those of advanced reproductive age are, at the present time, discriminated against in that Italian law denies these subjects access to MAR. The history of Law 40/2004 has been a particularly troubled one. Numerous rulings have, over the years, dismantled much of a law constructed in violation of the rights and autonomy of women and couples. However, a number of troubling issues still exist from what is left of the law and the debate is still open at national and transnational level regarding some of the contradictions and gaps in the law highlighted in this article. Only by abolishing the final prohibitions and adopting more liberal views on these controversial yet crucial issues will Law 40/2004 become what it should have been from the start, i.e. a law which outlines the 'rules of use' of MAR and not, as it has been until now, a law of bans which sets limits to the freedom to reproduce.

Survey of 243 ART patients having made a final disposition decision about their surplus cryopreserved embryos: the crucial role of symbolic embryo representation.

STUDY QUESTION: In couples who have chosen and confirmed the fate of surplus frozen embryos, which factors influence their decision, with a special emphasis on their symbolic representation of the embryo(s)? SUMMARY ANSWER: Embryo representation and gamete donation use significantly influence the fate of surplus cryopreserved embryos. WHAT IS KNOWN ALREADY: Previous studies report difficulties for couples to decide whether or not to continue storing their frozen embryo(s) and different factors have been already highlighted which influence their decision, including embryo conceptualization, information and support provided by the medical institution, quality of embryo(s) and life events. Little is known, however, about couples who definitely decided to stop their parental project and finalized the process of decision-making about the fate of their cryopreserved embryo(s). STUDY DESIGN, SIZE, DURATION: This prospective study was conducted over a period of 3 years (2007-2010) and included IVF/ICSI patients with surplus frozen embryos, who made a final embryo disposition decision. Among the 280 eligible IVF/ICSI patients, 247 agreed to participate in the study. According to the available options, 91 persons chose to 'stop cryopreservation', 77 chose donation to 'research' and 48 'embryo donation' to infertile couples. Furthermore, 31 participants who chose embryo donation for a parental project were refused by the center as not compatible with their mandatory medical conditions. Among them, 27 participants then selected donation to research as a new option and were included in a fourth group: 'donation to research after Refusal of Embryo Donation for parental project' or 'research-RED' (n = 27). Four participants chose 'stop cryopreservation', however, given the small number of subjects this latter group was not included in the analysis. In all, 243 participants who made a final choice concerning the fate of their cryopreserved embryos were included in this study. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were sent a letter of invitation to a semi-structured interview of 30 min with a psychologist. Interviews were conducted separately for each partner, including a questionnaire with a common part and a specific part, according to the chosen option, and allowing a quantitative evaluation. A multivariate logistic regression model was used to assess the link between their embryo representation and their decision about their embryos' fate. MAIN RESULTS AND THE ROLE OF CHANCE: After adjustment for age, gender, gamete donation, number of children and the different embryo representations, a choice to 'stop cryopreservation' is more frequent if the embryo is represented as a child [odds ratio (OR) adjusted = 3.29, 95% confidence interval (CI) = 1.62-6.66], P = 0.0009. Representing the embryo as a project prompts patients to choose 'donation to research' [OR adjusted = 3.76, 95% CI = 1.56-9.06], P = 0.0032. Respondents are more likely to choose 'embryo donation' if they represent the embryo as a potential person [OR adjusted = 3.77, 95% CI = 1.45-9.80], P = 0.0064. Furthermore, patients who benefited from gamete donation are ∼10 times more likely to donate their embryos to another couple [OR adjusted = 10.62, 95% CI = 3.99-28.30], P < 0.0001. For more than half the participants (57%) the decision-making was easy, however, deciding to stop cryopreservation was significantly more difficult than choosing research or embryo donation (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION: Socio-economic status, moral and religious affiliations are known to influence the choice of couples but analyzing these factors was not an aim of the present study. WIDER IMPLICATIONS OF THE FINDINGS: When couples definitely decide to stop their parental project, the embryo symbolic representation remains the main factor that influences the fate of their frozen embryo(s). Moreover, this representation can evolve when influenced by external events and information provided. In order to support patients who are making this difficult decision, it could be helpful to explore this symbolic representation early in the IVF/ICSI procedure, before surplus embryo freezing, as a new tool enhancing the accuracy of counseling. STUDY FUNDING/COMPETING INTERESTS: this study was supported by a grant from the 'Agence de la biomedicine (ABM)', the national regulatory ART agency, under the authority of the French Ministry of Health. The authors have no conflict of interest to declare.

Patient Decision-Making About the Disposition of Surplus Cryopreserved Embryos in Canada.

OBJECTIVE: The objective of this study was to identify factors that contribute to patient decision-making for disposition of surplus cryopreserved embryos in Canada. METHODS: In 2013, interviews were conducted with 45 IVF patients from three clinic sites, representing a total of 33 households. Patients interviewed all had unused cryopreserved embryos in storage in 2010. Initial demographic data collection was followed by one in-depth semi-structured interview conducted in 2013. Data were managed and coded thematically. RESULTS: Most patients (21 patients, representing 16 households) renewed storage agreements to keep embryos in storage at the time of the interview. Among patients who did not renew their storage agreements at some point between 2010 and 2013, six patients (representing 5 households) had since used all their embryos, two patients (representing one household) had decided to keep their embryos in storage in perpetuity, three patients (representing 3 households) discarded their embryos outright, and 13 patients (representing 9 households) donated their embryos to research or clinical training. Among patients who donated to research or clinical training, three key themes emerged: a desire to "give back," to contribute to scientific progress, and to avoid "wasting" embryos. These patients were not always certain about whether they had chosen research or clinical training. CONCLUSION: This study demonstrates the applicability of international findings about embryo disposition decision-making to the Canadian setting. Moreover, it identifies that while patients making disposition decisions often choose to donate embryos to research and/or clinical training, they are not always certain about what these options entail. Clinicians, counsellors, and others must ensure that patients are not only aware of their embryo disposition options, but that they understand the nature of these options as well.

Disclosure patterns of embryo donation mothers compared with adoption and IVF.

Attitudes towards information sharing in donor conception have changed in recent years in some parts of the world, with a move towards openness. This study follows up a sample of embryo donation mothers, examining their current disclosure patterns and comparing them with adoptive and IVF mothers to investigate any influence of the method of family creation. This study compared 17 mothers with an embryo donation child aged 5-9 years with 24 mothers with an adopted child and 28 mothers with a genetically related IVF child. Embryo donation mothers were far less likely to share information with the child; 43% were inclined towards disclosing, compared with all adoptive mothers and nearly 90% of IVF mothers. Furthermore, embryo donation and IVF mothers who had disclosed had often only given partial explanations of the child's conception. Differences between embryo donation and adoption in particular should be taken into account when advising embryo recipients.

Perceptions of embryo status and embryo use in an Australian community.

Increasingly, important areas of medical therapy and research rely on the donation and use of human embryos. Yet their use is commonly determined by community tolerance and ethico-legal regulation. The aim of this study was to explore the views of an Australian community about what an embryo is, how it should be used and who should make disposition decisions. The findings of a large representative population survey showed that most participants thought of an embryo as human or potentially human but that this did not affect a majority community view that embryos should be used rather than discarded. This study also found divergent views about what the community perceived to be acceptable uses of embryos. The majority perceived the couple as having the authority to make a disposition decision. Women held different views to men across all three questions. The way an embryo was perceived related significantly to how it should be used and who should decide its disposition. These differences and relationships should be considered when developing clinic practices and ethico-legal frameworks to regulate embryo use in science or treatment.

Asian immigrants to the United States are less likely to donate cryopreserved embryos for research use.

OBJECTIVE: To determine whether there are ethnic differences in the proportion of IVF patients donating excess cryopreserved embryos for use in research. DESIGN: Retrospective. SETTING: University clinic. PATIENT(S): Four hundred consecutive patients undergoing IVF. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Embryo disposition plan reported on the cryopreservation consent form (disposal, donation for research, or donation for therapeutic use). RESULT(S): Compared with Europeans or Asians born in the U.S., Asians born outside the U.S. were less likely to opt to donate excess embryos. Research donation was highly associated with interest in participation in clinical research. CONCLUSION(S): Decreased donation of excess embryos for research among Asians born outside the U.S. may relate to religious, sociocultural, language, or other undescribed factors. Targeted educational strategies may be critical to the development of a diverse pool of embryos available for research.

Embryo disposition: choices made by patients and donor oocyte recipients.

OBJECTIVE: To compare final embryo disposition between patients and donor oocyte recipients. DESIGN: Retrospective study. SETTING: Private infertility practice. PATIENT(S): Patients undergoing IVF with embryo cryopreservation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Final cryopreserved embryo disposition. RESULT(S): A total of 1,262 patients using autologous oocytes had 5,417 embryos cryopreserved. A majority either used their embryos (39%) or continued storage (35%). Of 364 patients, who did not use their remaining 1,406 embryos, 77 (21%) donated 290 embryos to other infertile couples, 41 (11%) donated 160 embryos for research, and 246 (68%) discarded 956 embryos. Concurrently, 272 donor oocyte recipients had 1,233 embryos cryopreserved. A majority either used their embryos (40%) or continued storage (23%). Of 110 recipients that did not use their remaining 455 embryos, 62 (56%) donated 280 embryos to other infertile couples, 6 (6%) donated 31 embryos for research, and 42 (38%) discarded 144 embryos. CONCLUSION(S): In our patient population, a higher proportion of patients with infertility ultimately used or stored their cryopreserved embryos for future reproduction compared with donor oocyte recipients. However, recipients were much more likely to donate to other infertile couples and less likely to discard their remaining embryos compared with patients.

Who abandons embryos after IVF?

This investigation describes features of in vitro fertilisation (IVF) patients who never returned to claim their embryos following cryopreservation. Frozen embryo data were reviewed to establish communication patterns between patient and clinic; embryos were considered abandoned when 1) an IVF patient with frozen embryo/s stored at our facility failed to make contact with our clinic for > 2 yrs and 2) the patient could not be located after a multi-modal outreach effort was undertaken. For these patients, telephone numbers had been disconnected and no forwarding address was available. Patient, spouse and emergency family contact/s all escaped detection efforts despite an exhaustive public database search including death records and Internet directory portals. From 3244 IVF cycles completed from 2000 to 2008, > or = 1 embryo was frozen in 1159 cases (35.7%). Those without correspondence for > 2 yrs accounted for 292 (25.2%) patients with frozen embryos; 281 were contacted by methods including registered (signature involving abandoned embryos did not differ substantially from other patients. The goal of having a baby was achieved by 10/11 patients either by spontaneous conception, adoption or IVF. One patient moved away with conception status unconfirmed. The overall rate of embryo abandonment was 11/1159 (< 1%) in this IVF population. Pre-IVF counselling minimises, but does not totally eliminate, the problem of abandoned embryos. As the number of abandoned embryos from IVF accumulates, their fate urgently requires clarification. We propose that clinicians develop a policy consistent with relevant Irish Constitutional provisions to address this medical dilemma.

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

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.

Assisted reproductive technologies (ART) in Canada: 2006 results from the Canadian ART Register.

OBJECTIVE: To present a report on assisted reproductive technologies (ART) cycles performed in 2006 in Canada and show trends in outcomes over time. This is the sixth annual report from the Canadian ART Register (CARTR). DESIGN: Prospective cohort study. SETTING: Twenty-five of 25 ART centers in Canada. PATIENT(S): Couples undergoing ART treatment in Canada during 2006. INTERVENTION(S): ART treatments, including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and frozen embryo transfer (FET). MAIN OUTCOME MEASURE(S): Clinical pregnancy, live birth, and multiple birth rates. RESULT(S): A total of 12,052 ART cycles was reported to CARTR. In 8278 IVF/ICSI cycles using the woman's own oocytes, the clinical pregnancy rate per cycle started was 33.7% (38.6% per ET), and the live birth rate was 27.1%; the multiple birth rate per delivery was 30.3%, with a high-order multiple birth rate of 1.5%. In 64% of cycles, ICSI was performed. One or two embryos were transferred in 67% of cycles. In 350 IVF/ICSI cycles using donor oocytes, the clinical pregnancy rate was 42.3%, and the live birth rate was 33.6%; the multiple birth rate was 37.3%, with no triplet birth. In 2838 FET cycles using the woman's own oocytes, the clinical pregnancy rate was 24.3%, and the live birth rate was 18.6%; the multiple birth rate was 22.5%, with a triplet birth rate of 0.6%. Birth outcomes were unknown for 3.6% of ongoing pregnancies. CONCLUSION(S): For 2006, CARTR achieved 100% voluntary participation from Canadian ART centers for the fourth consecutive year. Clinical pregnancy and live birth rates continued to increase in 2006 compared with previous years, but multiple birth rates decreased only slightly.

From oocyte to baby: a clinical evaluation of the biological efficiency of in vitro fertilization.

OBJECTIVE: To assess the real biological efficiency of assisted reproduction technology (ART) cycles by using a new metric called oocyte to baby rate, where live babies born (LBB) are reported in relation to the number of oocytes retrieved and used. DESIGN: Retrospective analysis of clinical and embryological database. SETTING: University center. PATIENT(S): Patient's cycles (n = 572) divided by age (<35, 35 to 37, 38 to 40, 41 to 42, >42 years) and by oocyte donors. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Total number of oocytes collected, the number of embryos transferable (fresh and frozen) and corresponding oocyte to LBB rates. In patients with remaining frozen embryos, the final LBB was estimated according to our reported rates. RESULT(S): A total of 572 oocyte retrievals yielded 7213 oocytes. The total number of transferred and frozen embryos was 2252 (a utilization rate of 31.2%). The LBB from fresh embryo transfers was 262 with an additional 64 LBB expected from frozen embryos. The overall oocyte to LBB rate was 4.6% (326 babies born). When analyzed by groups, the oocyte to baby rate was best in donor oocyte cycles (6.8%), and declined to 1% for patients >40. There was no increase in oocyte to LBB if >15 oocytes were obtained. CONCLUSION(S): During ART cycles, only approximately 5% of fresh oocytes produce a baby. The time has come to investigate new methods of oocyte viability assessment and consider changing current ART practice to recruit fewer oocytes.

Support for selling embryos among infertility patients.

OBJECTIVE: To determine the opinions of infertility patients regarding selling extra embryos, and to investigate the relation between patient choice and demographic and socioeconomic characteristics. DESIGN: Cross-sectional, self-administered survey. SETTING: University hospital-based fertility center. PATIENT(S): 1350 consecutive women who presented for infertility care. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Patient opinion regarding selling extra embryos to other couples, and correlations with their demographic and socioeconomic background. RESULT(S): Of respondents with a definitive opinion, 56% felt that selling extra embryos to other couples should be allowed. After adjustment for observed predictors favoring selling extra embryos, we found statistically significantly lower support for selling embryos among patients who were Hispanic (relative to Caucasians) or had never been pregnant, whereas significantly greater support was observed among Hindu and secular women, patients being treated for male factor infertility, and those who in the past had or were currently undergoing intrauterine insemination. Age, education, marital status, and parity were not statistically significantly associated with the opinions about selling extra embryos to other couples. CONCLUSION(S): A large proportion of infertility patient participants approved of selling leftover embryos to other couples. However, some demographic and reproductive factors are significantly associated with patient opinion.

Pregnancy outcome and live birth after IVF and ICSI according to embryo quality.

PURPOSE: The pregnancy outcome and the chances of birth were assessed according to embryo quality after IVF or ICSI. METHODS: The implantation rate (IR), the loss of gestational sacs rate (LGSR), and birth rate (BR) were determined according to the cleavage stage and the integrity of blastomeres after day-2 homogeneous embryo transfers (n = 1812). RESULTS: The LGSR was higher after transfers of 2-3-cell or 5-6-cell embryos and was significantly increased when more than 20% of the embryo volume was fragmented in 4-cell embryos. After transfers of 4-cell embryos without fragmentation, the BR was significantly higher than the BR after transfers of 4-cell embryos with 1-20% fragmentation (16.6% vs 13.1%). The difference was the consequence of a higher IR (20.4% vs 17.3%) but also of a lower LGSR (18.9% vs 24.2%). CONCLUSIONS: Not only implantation and the ability to give a pregnancy, but also the capacity to give a live birth are dependent on the embryo quality.

Factors that affect infertility patients' decisions about disposition of frozen embryos.

OBJECTIVE: To describe factors that affect infertility patients' decision making regarding their cryopreserved embryos. DESIGN: Forty-six semistructured in-depth interviews of individuals and couples participating in IVF programs. SETTING: Two major southeastern academic medical centers. PATIENT(S): Fifty-three individuals, including 31 women, 8 men, and 7 couples. MAIN OUTCOME MEASURE(S): Qualitative analysis of interview transcripts. INTERVENTION (S): None. RESULT(S): Seven broad themes informed participants' decisions about embryo disposition: family and personal issues, trust, definition of the embryo, prospective responsibility to the embryo, responsibility to society, adequacy of information, and lack of acceptable disposition options. Many wished for alternative options, such as a ceremony at the time of disposal or placement of embryos in the woman's body when pregnancy was unlikely. CONCLUSION(S): Recent debates regarding embryo disposition do not reflect the range of values that infertility patients consider when deciding about frozen embryos. In addition to questions about the embryo's moral status, decision making about embryos is informed by a range of factors in the lives of individuals who created them. These perspectives may have important implications for the content and timing of informed consent, facilitating embryo disposition, and advancing policy debates about the ethics of frozen embryo use.

Parents' conceptualization of their frozen embryos complicates the disposition decision.

OBJECTIVE: To ascertain what couples think about their embryos and how they approach making a decision about disposition in light of the fact that the disposition of unused frozen embryos has significant implications for medical research and embryo donation. DESIGN: Ethnographic qualitative interview study. SETTING: Academic research environment. PATIENT(S): Fifty-eight couples who had conceived using a donor oocyte and had at least one frozen embryo in storage. MAIN OUTCOME MEASURE(S): Tape-recorded interviews with 58 wives and 37 husbands were transcribed and analyzed for emergent themes. RESULT(S): With an average of 7.1 embryos per couple, after an average of 4.2 years of storage, 72% of couples with frozen embryos had not reached a disposition decision. Most couples had not anticipated or appreciated the consequences of having surplus embryos. Parents variously conceptualized frozen embryos as biologic tissue, living entities, "virtual" children having interests that must be considered and protected, siblings of their living children, genetic or psychological "insurance policies," and symbolic reminders of their past infertility. CONCLUSION(S): The disposition decision is not only a significant and frequently unresolved issue for couples with stored frozen embryos, but their deeply personal conceptualizations of their embryos contributes to their ambivalence, uncertainty, and difficulty in reaching a decision.